Current situation and capacity in the South-East Asia Region

Transcription

1 Current situation and capacity in the South-East Asia Region Theme: Diabetes / Obesity Chandrika N Wijeyaratne Sri Lanka Medical Association TWG on Regional Action Plan on NCD Bangkok June 2013

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3 INDICATORS Age-standardized prevalence of overweight and obesity in adults aged 18+ years and adolescents (defined as body mass index greater than 25 kg/m² for overweight or 30 kg/m² for obesity for adolescents according to the WHO Growth Reference) STEP 2 Age-standardized prevalence of raised blood glucose/diabetes among adults aged 18+ years (defined as fasting plasma glucose value 7.0 mmol/l (126 mg/dl) or on medication for raised blood glucose) STEP 3

4 LIFE CIRCLE APPROACH TODAY S GIRL CHILD IS TOMORROW S MOTHER

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7 Is baseline information available for the target?

8 Latest STEPS Survey (Year) Tobacco Alcohol Physical activity Over weight Blood pressure Diabetes Salt Sample size Previous rounds (Year) Country Table: STEPS (or similar) surveys in SEAR countries, Indicators for which data was collected Representat iveness Age group (years ) Banglad esh 2010 National 25+ 9, Bhutan 2007 Capital city ,484 Nil DPRK 2008 India* Capital city + 3 rural areas ,742 7 States 3- South 2-Central 1-North 1-North- East appr ox 5000 per state 2005,

9 Indonesi a Maldive s National Male Capital city , , 2003, 2006, (I, II, III) Myanma r 2009 National , Nepal 2013 National 18+ 4,100 Sri Lanka 2006 National Thailand 2009 National plann Timor- ed in Leste , 2005, , , 1998

10 What is the current capacity of Member countries to collect and report on the target every 5 years?

11 Evidence of country level sub-optimal / concurrent timings? Reliable data collection Sample size? Representative Sampling? Validated tools / methods? Is there reliable baseline data -? Accurate reporting? Potential to study trends over time

12 Global school-based student health survey (GSHS) to capture younger age group E- STEPS (Pocket PCs) lower age limit 18 yrs Country capacity to address and respond to NCDs Has a Unit / Branch / Dept in MOH with responsibility for NCDs Has an integrated or topic-specific policy / programme / action plan which is currently operational

13 Is there a reliable system for data collection in the Member countries?

14 Country Overweight Obesity Diabetes Latest Year Survey method Youth Data Bangladesh Yes Yes 2007 DHS survey 2003 Bhutan Yes Yes 2007 STEPS survey No DPRKorea Yes No 2008 STEPS Survey No DRTimor Leste Yes No 2003 DHS survey No India Yes Yes 2002 Prevalence Study of Diabetes India National Family HS Indonesia Yes Yes 2001 STEPS No Maldives Yes Yes 2001 (BMI) 2004 (DM) Multiple indicator cluster survey No No WHO Global Information data Jun 2013

15 Country Overweight Diabetes Latest Year Survey Youth Myanmar Obesity Yes Yes 2004 STEPS method survey No Data Nepal Yes Yes 2008 (BMI) 2003 (DM) Risk Factor Prevalence Survey No Myanmar Yes Yes (subnational) Sri Lanka Yes Yes (subnational) Thailand Yes Yes (BMI& DM) 2009(BMI) 2007 (BMI) 2000 (DM) STEPS survey No STEPS survey Temporal trends (rural) Population health survey InterAsia study (DM 2000) No No WHO Global Information data Jun 2013

16 What additional data collection mechanisms are needed to enable reporting on the nine global targets?

17 WHO Global Information database 2010 NCD Indicators

18 WHO Global Information database 2010 NCD Indicators

19 WHO Global Information database 2010 NCD Indicators

20 WHO Global Information database 2010 NCD Indicators

21 Sri Lanka

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23 Prevalence Prevalence of obesity* Katulanda, % % % 40% < % 0% All Urban Rural *Based on cut-offs proposed for South Asians

24 Prevalence Prevalence of central obesity Katulanda Male Female All Waist cut offs: Male 90cm Female 80cm (IDF 2006)

25 This report is dynamically generated from the WHO Global Infobase website ( based on the latest available data in a regularly updated database. You can help this project by downloading our data template ( ata_template.xls), and entering details of your survey, for submission to the Infobase team at Infobase@who.int.

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27 current regional situation and capacity - summary Age-standardized prevalence BG/diabetes among adults aged 18+ NCD risk factor surveys FBG cut off? 100 vs 126 SEAR data + in 82% Part of multiple risk factor survey Age-standardized prevalence Overweight & Obesity among adults aged 18+ NCD risk factor surveys SEAR data + in 82% Adolescent surveys 42% Part of multiple risk factor survey

28 Recommendations minimum actions/mechanisms needed for collecting, using and reporting data greater emphasis on the need for coordination of national / sub national country level an essential agenda item of the NATIONAL ACTION PLAN for surveillance (2014, 2019, 2024) multiple risk factor approach common method STEPS aim for blood sampling better integration curative and preventive HS regional maps (through inter-country coordination) reporting of peer reviewed research data (GRIPS) - available data is better than no data

29 Recommendations beyond basics Regional specifics address life circle issues (LBW/Macrosomia, GDM, Childhood /adolescent obesity) encourage evidence based approach (policy to implementation) Capture pre-diabetes / Metabolic syndrome data Gender issues (inter-generational effects) Cut off BMI? 27.5 kg/m 2 ; Waist Circumference Prioritize urban sector (high risk groups) data collection when national level data collection is not feasible

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