Cindi Health Monitor Survey In The Republic Of Macedonia, 2002-2007

CINDI HEALTH MONITOR SURVEY AN INTEGRATED PART OF CINDI CONCEPTUL MODEL IN MACEDONIA National programme for NCD prevention and control

Prim. d-r

PhD.

spec. of sports medicine – subspec. nutritionist   Lazar Licenovski 13, 1000 Skopje, phone +389-02-3225-402

[email protected]

PUBLIC HEALTH INSITUTE OF SPORTS MEDICINE, NUTRITION UNIT, SKOPJE, MACEDONIA 1

Community and primary care-based demonstration project for health promotion and noncommunicable diseases (NCD) prevention has been prepared as an integrated part of conceptual model for CINDI National Programme. Republic of Macedonia is in the process of joining CINDI and implementing the CINDI concept through the process of health care reform. In focus of the reform in primary health care is the implementation of health promotion and NCD prevention measures in preventive practice of “family” doctors. 2

The purpose of the study:   1. To analize professional reasons that justify realization of the CINDI Programme based on information of health status in the Republic of Macedonia.

2. Assessment of national capacity in primary health care to realize CINDI project on promoting healthy nutrition and physical activity in different age groups. 3. The role of National Health Autority in CINDI team to confirm the Macedonian CINDI-Plan of action in health promotion, heart disease and other chronic disease prevention in related to physical activity and nutrition over the next 5 year. 3

Methods: 1.-Secondary data obtained from mortality/morbidity statistics in the Republic of Macedonia (1990-2001). -The results for family aggregation of common risk factors for chronic diseases obtained from medical research (BMI, Systolic/diastolic BP, T.Chol., TG, HDL, LDL, Glyc., smoking, decreased VO2max, dietary habit, and stress) in randomized simples (Demonstation Projects 1990 and 1998). 2. National capacity in primary health care obtained from WHO questionnaire connected with “Assessment of national capacity for noncomunicable disease prevention & control” in 2001 year. 3. Protocol and quidelines about CINDI principles and strategies for health promotion and disease prevention (WHO CINDI publications). 4

Results and Conclusions: 1. NCD are the main cause of morbidity and mortality during the last 10 years in the Republic of Macedonia. ( figures-1 and figure-2). In the last three decades the cardiovascular disease, esspecialy coronary heart disease, malignant neoplasm's, and diabetes mellitus remains the most common cause of death for the Macedonian population. In 1972 mortality from them accounting for 37% from total mortality, and year by year this percentage has increasing significantly up to 55.6% in 2001 with continuous trend to this days. 5

Figure 1. Mortality rate from noncommunicable diseases in The Republic of Macedonia for the period 19912001 up to 100.000 population   500 450 400 350 300

359.5

464.9

464.9

458.7

468.6

129.5

140.5

142.6

150.3

1995

1997

385.9

250 200 150 100 50

108.3

111.4

1991

1993

KVB Cancer

0

1999

2001 6

Figure 2. Morbidity rate from circulatory diseases in the Republic of Macedonia up to 100.000 population Hypertens ia 25000

Is chemic hard dis eas e Cerebro vas cular

20000

Circulatory dis eas es

15000

10000

5000

0 1972 1978 1984 1990 1991 1992 1993 1994 1995 1997 1998

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The results of common risk factors for NCD include: 1. BMI distribution varies significantly according to the stage of transition of a country. Figure-3 illustrates the tendency for rapidly increase in the proportion of the population with high BMI than the proportion of the population with low BMI in the early stage of transition. The distribution of BMI tends to change again in the later phases of transition with an increase in the prevalence of high BMI among the poor. 8

Figure 3. BMI Distribution in adult population in Skopje in the last 10 years (1990-2000 year) %

80 70

75.8

1990

65.5

1995

58.8

1998 2000

60 41.6

50

41.5

40 30

14.9

20

18.2 15.9

18.6

23 16.8

9.3

10 0

BMI < 25

BMI > 25-29.9

BMI > 30

9

 

Figure 4. Prevalence of systolic and diastolic blood pressure in adult population in Skopje % 100

88.7

1990

80.9 68.3

80

73.8

1998

60 40

23.7

16.6 10

20

11.9 1.2

2.4

7.9

14.3

0 <140

>140

systolic BP

>160

<90

>90

>95

diastolic BP 10

Figure 5. Prevalence of risk factors for NCD in adult population from central region in Skopje 80

  75

%

60

40

35.2

35.9 28.8 23.8

20

28.2

23.4

18.2

14.2

18.2

15.8

12.5

T. C

rs sm ok e

s re s st

OP V
.0 HD

L< 1

5

>6 . Gl y

) 3(

BM

I> 25

) TG >2 .

I> 25 BM

ho l> 6.

5(

T. C

ho l> 6.

5

5

0

3.7

LD L> 4.

2.5

1990 1998 11

2. There are great potencial within primary health care to realize CINDI project for health promotion and the primary prevention of major chronic diseases through changes of lifestyle of the population such as increased physical activity and balanced diet (average 1488 population per one MD). The territory of Republic of Macedonia is divided into five regions with distrinct centres for the implementation of all NCD related preventive activities ( figure 6).

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Figure 6. Organizational structure – CINDI HEALTH MONITOR SURVEY CENTRES in the Republic of Macedonia

167

167

1877

1877 149

 

149 150

150 384

222 389

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3. The role of the Macedonian Health Authority in CINDI - team is to accept an alternative classification system for prevention strategies aimed at chronic multifactorial conditions. This is based on three levels of preventivntion directed at everyone in the population (public health promotion), an above/average risk groups (selective prevention) and at high-risk individuals (targeted prevention). In this new scheme promotion and prevention are used to describe those action that occur before the full development of the condition. 14

This project form a link between precede medical research and the application of new index as mathematical model for predicting the effects of non-pharmacological interventions in the population at above/ average and high risk for NCD such as truncal obese individuals with atherogenic risk factors. Logistic model in form of equation is: ln “RR” =108.2588–1.7689  DKN-B in +1.7087 BMI in+0.3993- Hb 2.9423-VO2max OPV – 10.5402 WHO in + 0.0770-50% kcal/h 15

Exponent B can be interpreted in terms of relative risk (“RR”) in cohort studies. The proposed non-pharmacological intervention is hypocaloric, hiperprotein diets of 1200kcal/d and 1400kcal/d (second phase) since the relative risk is less than 1 (ln“RR”<1). Increased physical activity by the recommendations of ACSM (1993) and CDC (2001) statistically significant promotes development of VO2max. Change in level of VO2max at 17.16% from baseline promotes significant greater reduction in level of WHR, OS sm, %fat (%M), body weight (TTkg), LBM kg, BMR kcal/d and LDL/HDL in PAD(physical activity and diet) than those in D (diet) group obese subjects (figure 7).  

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Figure 7. Change in level of VO2max and “major” risk factors for NCD in FAD (physical activity and diet) and D (diet) group of truncal obese subjects  

HDL 10,4

TT

%M

LBM

WHR

-1.8

-7,9

-5.3

-6.3

-10,3

-3,3

-4,5

-3.3

OS

VO2max 17,1

25 % 14,8 15

LDL/HDL

BMR

%FAI VO2-OPV

-5.6

-9,5

-5,2 -7.7

-9.3

5

-3.1 -5

-10,2

-15 -25

-28,6

FAD D

-35

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C I NDI PR OG R AM M E I N M AC E DONI A - C ONC E PTUAL M ODE L

 

M inistry of Health Coordination CINDI Centre Adm Administrative inistrativen delSector I NTERVENTNI PROCESI INTERVENTION PROCESSES

demonstaciono Demonstartion podra~je area

Used from health services

randomizirani randomized groups grupi

-knowledge -znaewe -behaviour -na~. na odnes. -family -semejstvo -cultural level -kultur. nivo -social support -socij.podr{   

grupi Groups (pol, (gender vozrast) and age) Location (schools, lokacija(u~il,kolekt) work) inic. indikatori: Inicial indicators: 1. Morpho-phisiological 1.morfo-fiziolo{. risk-factors : rizik-faktori WHR BMI;BMI; WHR, HTA mmHg; HTAmmHg; fc-mir/max, Fc in rest/max

Tot.Tot. holest; TG cholest; TG HDLHDL -holest, 2 2-holest max ./ METs. VO2 VO max, METTs. 2 2. Behavioural 2.rizikfaktori risk factors: na odnesuvuvawe : Nutrition, Smoking and ishrana; pu{ewe, Physical inactivity

hipokinezija.

Community level

primeneti Used from od SINDI CINDI programata programme

Final indikatori: fin. indicators: 1. rizik-faktori risk factors

2. m morbidity orbiditet na of “major” HNB NCD 3. m mortality ortalitet

population

First nezavisni variables varijabli

-community -aktiviranost -organized na zaednica groups and -m asovno vklu~ individuals organiz. grupi -screening i individuiof risk factors -skrining na:: education/ rizik-faktiri promotion oc edukac./prom

MONITORING M ONI TOR I NG I AND EVALUACIJ EV AL UAC A I ON

Second variables

1. individual health 1.li~ ni zdravst. status, karakteristiki 2. socio-demographic 2.socio-demogr. characteristics karakteristiki 3. social enviroment 3.socij.okolina.  

      CINDI-Conceptual model Macedonia, 2002 - 2007 National coodinator: Simovska Vera MD., PhD.

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Monitoring of health behaviours and related factors on a national level is an important vehicle for health promotion and disease prevention. The overall puepose of the CINDI Health Monitor is: - to evaluate and to promote favourable health behaviours in population - to evaluate the effectiveness of national health policy. The proposal-project to establish a CINDI national health behaviour monitoring system in the Republic of Macedonia was created in 2002 year as part of CINDI conceptual model for development and implementation of National programme for chronic diseases prevention and health promotion (WHO CINDI Programme). 19