Challenges of NCDs in Palestine
***
Heidar Abu Ghosh
Director of
Chronic Diseases Program
***
Palestinian Medical Relief Society
1
H.I. GHOSH
NCDs of Interest..
•
•
•
•
•
•
•
2
Heart
HTN
Diabetes
CVD
Cancer (Breast)
Dyslipidemia
Obesity ?!
H.I. GHOSH
Targeted Diseases
• High prevalence
• An increasing morbidity and mortality
burden
• An increasing economic, social, and
psychological burden
• Early detection improves prognosis
• Public awareness is crucial for prevention
• Comprehensive management is generally
absent
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H.I. GHOSH
How High is the Risk ?
• After the age of 35 years:
– 1 out of six may develop diabetes
– 1 out of 3 may develop hypertension
– 1 out of 2 have dyslipidemia
– 2 out of 3 are overweight
– 2 out of 5 are obese
– 1 adult male out of 3 is a smoker
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H.I. GHOSH
Global Trends
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H.I. GHOSH
Estimated prevalence of diabetes and number of
cases of diabetes in millions. (Adapted from King et
al, 1998).
Year
1995
2000
2025
Prevalence %
4.0
4.2
5.4
Number
(millions)
135.3
154.4
300
Developed
countries
Prevalence %
5.9
6.2
7.6
Number
(millions)
51
54.8
72.2
Developing
countries
Prevalence %
3.3
3.5
4.9
Number
(millions)
H.I. GHOSH
84.3
99.6
227.7
Region
World
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NCDs in LD Countries
• In LD countries –like Palestine- that experience
the double burden of diseases, NCDs
contributed to more than half of total mortality
and 40% of total disease burden
• The large burden of NCDs in these countries is
characterized both by the increased incidence of
diseases and the relatively early age at which
they appear
• NCDs also contribute largely to disability in both
the developed and developing countries.
Source: World health report 2003
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H.I. GHOSH
NCDs in Palestine
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H.I. GHOSH
Current Status
• Demographic and Epidemiological
Transition
• Progressive Urbanization
Caloric Excess
Less Physical Activity
Increased Tobacco Consumption
Predominance of Overweight and Obesity
Qualitatively Poor Diet
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H.I. GHOSH
Demographic & Epidemiological
Transition
•
•
•
•
Better control of communicable diseases
Relative increase ageing of populations
Decrease in IMR
Socio-economic transformation
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H.I. GHOSH
Demographic Characteristics
• Number of people in WBG is 3,117,290
– WB: 1,992,105
– Gaza: 1,125,185
• Children under the age of 15years
comprises 47% of the population
• Those under 30 years old comprise 70%
• The proportion of elderly (65years and
older) is 3.3% (PCBS: 2000)
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H.I. GHOSH
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H.I. GHOSH
Risk Factors
Modifiable:
 Caloric excessobesity
 Diet
 Physical inactivity
 Smoking
Non- modifiable:
 Age
 Gender
 Ethnic group
 Family history
 Personal history
STRESS
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H.I. GHOSH
Nutrition
• Traditional nutrition
• Modern diet”:
– High fibers, whole
grains
– Less animal fat
– More complex
carbohydrate
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– Less fibers ,refined
grains
– More animal fat
– More simple sugar
H.I. GHOSH
Qualitatively Poor Diet
•
•
•
•
•
•
15
High-fat (cholesterol )
Unsaturated fatty acids
Rapidly absorbed carbohydrates
Fiber
Salt
Vitamins
H.I. GHOSH
Urbanization
Caloric Excess
Less Physical Activity
Increased Tobacco Consumption
Predominance of Overweight and Obesity
Qualitatively Poor Diet
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H.I. GHOSH
Duality of Health Problems
• Modern diseases
- Diabetes Mellitus
- Hypertension
- Coronary heart
diseases
- Cancer.
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• Diseases of
underdevelopment
- Infectious diseases
- Malnutrition
- Poor housing
conditions
H.I. GHOSH
Leading Causes of Death
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Disease
Palestine
Israeli
Arabs
Global
Infectious
diseases
CVD
6.6
5
33
30
42
30
Cancer
19
18
12
D.M.
2.3
2.7
2
H.I. GHOSH
Adult mortality in Palestine (2002)
15.3
15.1
16
14
11.6
12
9.42
10
8
MoH:2004
5 .4
5.6
2 .6
3.2
6
4
H.I. GHOSH
Sinility
Accidents
Cancer
D.M.
HTN
Respiratoy
19
CHD
0
CVD
2
Diabetes Mellitus
• Diabetes is more prevalent than in Europe
and North America
• It is estimated that the prevalence in the
population aged 20years and above is
more than 10%
• Our data showed a prevalence of 19% for
people of 35years and above
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H.I. GHOSH
Cancer
• Rare published reports
• It is becoming a major public health
concern
• The second reported cause of death after
CVDs
– The most common: Breast in females and
lung in smoking males
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H.I. GHOSH
Leading cause of cancer mortality
in Palestine
pancereas
non Hodgekin lumphoma
prostate
stomach
liver
brain & other part of NS
colorectal
leukaemia
breast
bronchus & lung
0
22
2
4
6
H.I. GHOSH
8
10
12
14
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PMRS
CHRONIC DISEASES
PROGRAMME
“ A CALL FOR ACTION”
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H.I. GHOSH
A Different Approach
• A comprehensive approach in the
management of diseases:
• Prevention
– Life style modification
– Health promotion
• Early detection
• Proper treatment
• Train and support management at PHC
level
• Establish a good referral system
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H.I. GHOSH
Implementation
• The goals are to be met through different
activities at:
– The Chronic Disease Center
– The Mobile Clinic
– PMRS health centers
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H.I. GHOSH
Components
Prevention, Early Detection
And
Health Promotion
Surveillance,
Data Collection,
And
Research
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Proper Management
H.I. GHOSH
Activities
• Activities include:
– Training
– Screening
– Health Education
– Early diagnosis
– Proper Management
– Data collection & Research
– Coordination and cooperation
– Advocacy & Lobbying
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H.I. GHOSH
Screening
• Every male and female over 35 years:
– Glucose level in blood
– Lipid profile
– Blood pressure
– Body Mass Index
• Every female over 25 years:
– Breast examination
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H.I. GHOSH
Mobile Clinic
• More than 11,000
people screened fpr
NCDs
• 68% were women
• 7800 women were
screened for breast
abnormalities
• All of them know how
to do self breast
examination
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H.I. GHOSH
The Chronic Diseases Center
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H.I. GHOSH
The Chronic Diseases Center
• A unique center in Palestine with a holistic
approach for management of NCDs
• Management of heart diseases, diabetes,
hypertension, and dyslipidemia
• Risk assessment
• Early detection of NCD through diagnostic
procedures
• Counseling
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H.I. GHOSH
Diagnostic Procedures
•
•
•
•
•
Patient’s and family history
Blood pressure
Weight and height
Dr’s examination
Upon need:
–
–
–
–
ECG
Echocardiography
Treadmill
Holter
• Counseling
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H.I. GHOSH
Some Results From
PMRS Screening Services
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H.I. GHOSH
Characteristics of Population
Characteristic
Mean age (years)
Males
Females
Both
49.62
46.33
47.2
Mean weight (Kg)
79.63
73.67
75.25
Mean height (cm)
170
157
160
Mean BMI
Smoking (%)
High fat nutrition
(%)
Low physical
activity
27.63
34.8
92.8
29.85
1.4
96.9
29.26
10.2
95.8
64.3
67.2
66.4
88.9
74.6
78.4
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Stress
(%)
H.I. GHOSH
Selected factors associated with diabetic status
DM
Triglycerides
(mg/dl)
T. cholesterol
(mg/dl)
LDL (mg/dl)
HDL (mg/dl)
35
Males
Females
Males
Females
Males
Females
Males
Females
H.I. GHOSH
155
135.5
194.7
191.3
126.9
114.7
38.6
50.1
207.5
191
210
212.9
129.2
130.8
37
46
Cost of chronic diseases
• Economic
• Impact of the quality of life
• Decrease the productivity of
individuals
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H.I. GHOSH
A CHALLENGE AND AN
OPPORTUNITY
• The rapid rise of noncommunicable
diseases represents one of the major
health challenges to global development in
this century. This growing challenge
threatens economic and social
development as well as the lives and
health of millions of people
Source: World health report 2003
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H.I. GHOSH
A CHALLENGE AND AN
OPPORTUNITY
• Noncommunicable diseases are estimated
to have contributed to almost 60% (31.7
million) of deaths in the world and 43% of
the global burden of disease.
• Based on current trends, by the year 2020
these diseases are expected to account
for 73% of deaths and 60% of the disease
burden.
Source: World health report 2003
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H.I. GHOSH
A CHALLENGE AND AN
OPPORTUNITY
• Developing Countries suffer the greatest
impact of noncommunicable diseases.
• The total number of deaths attributable to
noncommunicable diseases, 77%
occurred in developing countries,
• The disease burden represents, 85% in
these countries.
Source: World health report 2003
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H.I. GHOSH
LESSONS LEARNED
• Noncommunicable diseases are to a great
extent preventable through interventions
against the major risk factors and their
environmental, economic, social and
behavioural determinants in the population.
• A comprehensive long-term strategy for
control of noncommunicable diseases must
necessarily include prevention of the
emergence of risk factors in the first place.
Source: World health report 2003
40
H.I. GHOSH
Chronic Disease Management
• All treatment plans and education
programs must be adapted to the cultural
and social environment for the patients.
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H.I. GHOSH