Ministry of Health Malaysia National Health & Morbidity Survey 2015; NCD Risk Factors ZALMA ABDUL RAZAK Nutrition Division Ministry of Health Malaysia
2 Introduction The National Health and Morbidity Survey (NHMS) is a nationally representative health survey of population in Malaysia. NHMS was first initiated in 1986. The 2 nd NHMS was conducted ten years later in 1996 than followed by the 3 rd NHMS in 2006. The Minister of Health had suggested a more frequent survey to ensure timely information for policy makers particularly to support the implementation of health care transformation and the 5-yearly Malaysia Plan.
3 Introduction Starting from 2011, the survey was planned to be conducted as 4 yearly cycles with annual data collection (2011-2014). NHMS 2015 was conducted as the first survey in a new cycle of NHMS (2015-2018).
4 Objectives To supplement community-based data on the pattern of common health problems, health needs and expenditure on health in the community to enable the Ministry of Health to review priorities and activities of programmes, plan future allocation of resources.
5 Scopes of NHMS 2015 1. Healthcare Demand 2. Non-Communicable Diseases & NCD risk factors a. Non-Communicable Diseases Diabetes Mellitus Hypertension Hypercholesterolemia b. NCD risk factors Nutritional Status & Obesity Dietary Practice Physical Activity Smoking 3. Family Health 4. Others
A. Non-Communicable Diseases I. Diabetes Mellitus II. Hypertension III. Hypercholesterolemia 6
7 I. DIABETES MELLITUS Prevalence of Diabetes, 18 years Known DM 8.3% Undiagnose d DM 9.2% Total DM 17.5% 3.5 million people affected
8 2 18.0 16.0 Trend of Diabetes, 18 Years NHMS (2006, 2011 & 2015) 15.2 17.5 14.0 12.0 8.0 6.0 4.0 2.0 11.6 8.0 7.0 7.2 4.5 9.2 8.3 NHMS III (2006) NHMS 2011 NHMS 2015 Total diabetes Known Undiagnosed
Trend of Diabetes, 30 Years, NHMS (1996, 2006, 2011 & 2015) 9 25.0 20.8 22.5 2 15.0 5.0 8.3 6.5 14.9 9.5 5.4 10.7 10.1 11.9 10.6 1.8 NHMS 1996 NHMS 2006 NHMS 2011 NHMS 2015 Total Known Undiagnosed
10 Prevalence of Diabetes, 18 Years, By Age Groups (NHMS, 2015) 45.0 4 38.3 38.0 39.1 37.0 35.0 32.9 3 25.0 2 15.0 5.0 5.5 5.5 5.2 5.9 0.7 12.9 10.6 8.9 9.5 7.4 7.2 3.4 3.4 1.4 27.0 26.5 22.0 20.6 17.6 14.8 11.0 11.5 12.2 12.4 11.8 10.5 6.9 24.4 13.6 27.9 11.2 24.4 12.6 Known Undiagnosed Total diabetes
11 Prevalence of Diabetes, 18 Years, by Sex (NHMS, 2015) 2 18.0 16.0 16.7 18.3 14.0 12.0 8.0 6.0 7.6 9.1 9.1 9.2 4.0 2.0 Male Female Total DM Known DM Undiagnosed DM
Prevalence of Diabetes, 18 Years, by Ethnicity (NHMS, 2015) 12 25.0 22.1 2 15.0 14.6 12.0 10.7 7.4 9.0 16.0 9.8 7.7 7.7 6.8 11.9 8.1 8.6 7.7 5.0 2.5 5.2 3.8 3.1 4.3 Total Diabetes Known Diabetes Undiagnosed DM IFG Malay Chinese Indian Other Bumiputras Other
13 Prevalence of Diabetes, 18 Years, By Locality (NHMS 2015) 2 17.7 16.7 15.0 8.7 9.1 7.2 9.5 5.0 4.7 5 Total Diabetes Known DM Undignosed IFG Total Diabetes Known DM Undignosed IFG Urban Rural
14 3 25.0 2 15.0 5.0 13.4 11.1 19.8 22.5 13.6 Prevalence of Diabetes, 18 Years by State NHMS (2006, 2011 & 2015) 25.4 19.7 19.3 18.5 17.1 16.7 15.2 15.3 11.7 22.0 18.1 16.7 14.814.9 15.0 12.1 16.2 12.6 19.4 24.8 13.5 20.6 16.5 15.5 12.0 18.6 11.1 11.6 6.4 14.2 9.0 12.3 14.8 17.4 12.6 11.3 19.2 8.8 NHMS III (2006) NHMS 2011 NHMS 2015
15 II. HYPERTENSION Prevalence of Hypertension, 18 years NHMS 2015 Known Hpt 13.1% Undiagnosed Hpt 17.2% Total Hpt 30.3% 6.1 million people affected!!
16 Trend of Hypertension, 18 Years NHMS (2006, 2011 and 2015) 4 35.0 3 32.2 32.7 30.3 25.0 2 15.0 5.0 NHMS III (2006) NHMS 2011 NHMS 2015
17 Trend of Hypertension, 30 Years NHMS (1996, 2006, 2011 and 2015) 5 45.0 4 35.0 3 25.0 2 32.9 47 43.5 39.8 15.0 5.0 NHMS 1996 NHMS 2006 NHMS 2011 NHMS 2015
18 Prevalence of Hypertension, 18 Years by Age Groups, (NHMS, 2015) 8 75.4 73.4 7 65.0 67.8 6 5 4 3 2 0.7 6.06.7 32.2 23.9 23.8 20.3 18.1 15.9 15.0 13.2 12.0 11.9 9.4 10.4 7.5 5.8 1.9 2.8 3.9 55.5 49.3 38.8 39.1 37.1 29.3 26.2 26.2 27.9 28.7 23.1 50.4 25.0 46.1 27.3 Known Undiagnosed Total HPT
19 Prevalence of Hypertension, 18 Years By Sex, (2015) 35.0 3 30.8 29.7 25.0 2 18.6 15.0 14.0 15.6 12.2 5.0 Total Hypertension Known hpt Undignosed hpt Total Hypertension Known hpt Undignosed hpt Male Female
20 Prevalence of Hypertension, 18 Years By Ethnicity, (NHMS, 2015) 4 35.0 3 33.4 32.4 31.1 30.8 Malays 25.0 Chinese 2 15.0 2 18.6 17.0 15.2 15.7 15.6 12.5 15.4 17.6 14.9 Indians Other Bumiputras Others 5.0 5.2 Overall Known Undiagnosed
21 Prevalence of Hypertension, 18 Years By Locality, (NHMS, 2015) 35.0 33.5 3 29.3 25.0 2 15.0 13.2 12.8 16.1 20.7 5.0 Total hypertension Known Undiagnosed Urban Rural
22 Prevalence of Hypertension, 18 Years By State, NHMS(2011 &2015) 45.0 4 35.0 3 25.0 2 15.0 36.4 27.4 38.2 37.5 33.8 27.9 32.8 25.8 34.1 32.5 29.9 28.5 29.8 28.4 42.9 36.4 41.1 35.4 28.7 25.5 26.8 29.1 26.9 26.8 40.5 37.3 33.8 27.1 24.1 22.5 5.0 2011 2015
23 III. HYPERCHOLESTROLEMIA Prevalence of Hypercholesterolemia, 18 years, NHMS 2015 Known hypercholesterolemi a 9.1% Undiagnosed hypercholesterolemia 38.6% Total hypercholesterolemia 47.7% 9.6 million people affected!! 4 out 5 affected people were unknown cases
24 Trend of Hypercholesterolemia, 30 Years, NHMS (1996, 2006, 2011, 2015) 6 56.8 5 4 3 28.2 43.9 2 11.7 NHMS 1996 NHMS 2006 NHMS 2011 NHMS 2015
25 Prevalence of Hypercholesterolemia, 18 Years by Age Groups, (NHMS, 2015) 8 7 6 57.2 60.1 65.5 68.8 65.3 61.6 62.7 58.3 5 4 3 2 49.7 44.0 47.4 47.9 48.1 48.5 44.2 33.7 39.8 26.5 31.4 22.0 25.6 20.2 21.9 17.4 12.2 9.8 5.4 4.2 2.2 0.2 0.8 25.2 4 38.1 38.4 23.5 24.3 22.3 36.0 Known Undiagnosed Total Hchol
26 Prevalence of Hypercholesterolemia, 18 Years By Sex, (NHMS, 2015) 6 5 52.2 4 3 43.5 35.0 42.4 2 8.5 9.8 Total Hypercholesterol Known Undiagnosed Total Hypercholesterol Known Undiagnosed Male Female
27 Prevalence of Hypercholesterolemia, 18 Years By Ethnicity, (2015) 6 5 50.1 50.1 47.5 45.4 41.4 Malay 4 3 2 37.4 37.8 36.5 35.2 34.2 Chinese Indians Other Bumiputras Others 8.7 12.3 11.0 11.2 2.2 Overall Chol Known Undiagnosed
28 Prevalence of Hypercholesterolemia, 18 Years By Locality, (2015) 6 5 47.7 47.7 4 3 2 38.0 40.5 9.7 7.1 Overall Chol Known Undiagnosed Urban Rural
29 Prevalence of Hypercholesterolemia, 18 Years By State, NHMS (2011 &2015) 6 5 4 3 2 37.7 45.8 43.4 53.5 33.8 51.7 35.9 46.6 39.7 49.5 31.7 56.2 32.7 52.2 48.3 47.0 45.0 45.1 31.9 43.5 34.9 52.1 31.1 40.9 33.5 48.6 29.4 52.9 33.3 46.4 NHMS 2011 NHMS 2015
B. NCD RISK FACTORS I. Nutritional Status including Obesity II. Dietary Practices III. Physical Activity IV. Smoking V. Alcohol consumption 30
31 I. NUTRITIONAL STATUS (Aged 18 years old)
32 Trend of Overweight and Obesity, 18 Years NHMS (1996, 2006, 2011 & 2015 35.0 3 29.1 29.4 30 25.0 2 15.0 5.0 16.6 4.5 14 15.1 17.7 1996 2006 2011 2015 obesity overweight
33 Prevalence of Overweight and Obesity, 18 Years by Sex (NHMS, 2015) 35.0 3 31.6 28.3 25.0 2 15.0 15.0 20.6 Male Female 5.0 Overweight Obesity
34 Prevalence of Overweight and Obesity, 18 Years by Ethnicity (NHMS, 2015) 4 35.0 3 25.0 2 15.0 31.0 28.1 35.0 31.2 25.3 21.1 11.7 27.1 18.0 Malays Chinese Indians Other Bumiputras Others 7.7 5.0 Overweight Obesity
35 Prevalence of Overweight and Obesity, 18 Years by Locality (NHMS, 2015) 35.0 3 30.7 28.1 25.0 2 15.0 17.7 17.5 Urban Rural 5.0 Overweight Obesity
36 Prevalence of Obesity, 18 years By State, NHMS (2011 &2015) 3 25.0 2 15.0 18.1 15.9 15.2 20.5 16.2 16.2 17.7 21.9 16.0 23.9 19.4 15.3 13.8 12.8 17.5 16.2 21.7 22.3 18.7 18.6 17.1 14.0 10.6 13.4 18.4 14.9 14.0 13.5 14.9 25.8 5.0 NHMS 2011 NHMS 2015
37 NUTRITIONAL STATUS (Aged < 18 years old)
38 Trend of BMI-For-Age, (Aged < 18 years old) NHMS (2006*, 2011* & 2015**) *CDC 2000 Reference ** WHO 2006 Standard & WHO 2007 Reference
Prevalence of Body Mass Index for age * by Sex, (NHMS, 2015) 39 90 80 70 77.7 83.1 60 50 40 30 20 0 8.7 6.9 13.6 0 Thinness (BMI for age <-2SD) Normal (BMI for age -2SD - < +2SD) Obesity (BMI for age > +2SD) Male Female
Prevalence of Body Mass Index for age * by Locality, (NHMS, 2015) 9 8 79.8 81.6 40 7 6 5 4 3 2 8.0 7.2 12.1 11.2 Thinness (BMI) for age <- 2SD) Normal (BMI for age - 2SD - < + 2SD) Obesity (BMI for age >+ 2SD) Urban Rural * WHO 2006 & WHO 2007 Reference
II. DIETARY PRACTICES 41
42 Prevalence of Adequate Intake of Fruits or Vegetables ( 5 Servings) by Sex (NHMS, 2015) 7.0 6.4 6.0 5.6 5.0 4.0 3.0 2.0 1.0 Male Female
43 Prevalence of Adequate Intake of Fruits or Vegetables ( 5 Servings) by Ethnicity (NHMS, 2015) 12.0% 10.7 % 8.0% 8.3 6.0% 4.0% 4.3 5.1 4.2 2.0% % Malays Chinese Indians Other Bumiputras Others
III. PHYSICAL ACTIVITY 44
Trends of Physical Activity, NHMS (2006, 2011 & 2015) 45 8 7 6 64.7 56.3 69.5 64.3 59.0 71.1 66.5 61.7 5 4 3 2 49.5 NHMS 2006 NHMS 2011 NHMS 2015 Overall Male Female NHMS 2006 respondents aged 18 years and above NHMS 2011 & 2015 respondents aged 16 years and above
46 Prevalence Of Physically Active Adults bylocality, (NHMS, 2015) 8 7 65.0 71.3 6 5 4 3 2 Urban Rural
47 Prevalence of Physically Active Adults byage Groups, (NHMS, 2015) 8 7 6 61.0 67.9 68.1 69.3 70.8 73.4 72.4 72.3 63.3 60.9 57.4 48.1 5 4 3 2 3
48
49 Prevalence of Current Tobacco Smoker by Sex, > 18 Years (NHMS 2015) Prevalence %
50 Prevalence of Current Tobacco Smoker by Age Groups, 15 years, (NHMS, 2015) 35.0 3 25.0 25.3 27.7 29.3 29.7 26.3 23.8 22.1 Prevalence % 2 15.0 13.2 17.4 14.2 13.5 11.2 9.2 5.0 18-19 20-24 25-29 30-34 36-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75+
Prevalence of Current Tobacco Smoker by Ethnicity, 15 years, (NHMS, 2015) 51 4 35.0 35.0 3 25.0 2 15.0 24.7 14.2 16.5 25.8 Malay Chinese Indian Other Bumiputras Others 5.0
52 Prevalence of Current Tobacco Smoker by States, 15 years (NHMS 2015) Prevalence % 3 25.0 2 15.0 22.2 26.5 24.6 16.9 20.9 25.5 19.2 21 22.2 28.4 25.4 20.9 22.2 19.1 12.4 5.0
53 Thank You Acknowledgement: Institute for Public Health, Ministry of Health Malaysia