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National NCD Program
           in Oman
      Dr. Ali Jaffer Mohammed
         Advisor Health Affairs MOH




1
                                      Ministry of Health
                                            Oman
Presentation Overview
•   Five Year Plans
•   NCD’s Burden in Oman
•   Diabetes as an example
•   Program Implementation
         -National Level
        -District Hospital level
        -PHC level
        -Community Level
2
                                   Ministry of Health
                                         Oman
The Five year Plans




3   7th Five Year Plan 2006-2010   8th Five year plan 2011-2015
                                                                  Ministry of Health
                                                                        Oman
Five Year Plan -Domain 13:NCD’s
    7th Five Year Plan 2006-2010   8th Five year plan 2011-2015




4
                                                                  Ministry of Health
                                                                        Oman
Scope & Rational
• High Prevalence of NCDs in Oman (Ages
  20+ years): Behavioral/individual Risk
  factors
• Diabetes                     12%
• Hypertension                      35%
• Dyslipidaemia                40%
• Overweight & obesity         48%
• Tobacco use                  23% 14.7%
Source: OWHS-2008          (2008)   (2011)



5
                                             Ministry of Health
                                                   Oman
Insulin Resistance Syndrome
                              (Metabolic Syndrome)

                                 Central/abdominal
                                   obesity 24.6%
High TG 20.7%
                                                              Microalbuminuria
Low HDL 75.4%                         Prevalence of
                                    metabolic syndrome

    HBP 23.1%
                                        Oman
                                         21%                       Endothelial
                                         USA                       dysfunction
High FPG 18.1%
                                         23%


                         Atherosclerosis, cardiovascular disease

6   Source: Nizwa 2001
                                                                            Ministry of Health
                                                                                  Oman
Deaths attributable to diseases and injuries, all ages,
Oman, 2002.




                                                            Total Deaths
                                                            attributable to NCDs
                                                            =62%




 7
                                                                           Ministry of Health
                    Source :WHO Global Burden of Disease 2002.                   Oman
Disability-adjusted life years lost attributable to
     diseases and injuries, all ages, Oman, 2002.




                                                                  Total DALYs lost
                                                                  attributable to
                                                                  NCDs=23%




8
                                                                                 Ministry of Health
                      Source: WHO Global Burden of Disease 2002                        Oman
Rational
In the WHO Global Action Plan for Prevention
  and Control of NCD objective # 3 is
     To promote interventions to reduce the
     main shared modifiable risk factors for
     non-communicable diseases : tobacco
     use, unhealthy diets, physical inactivity
     and harmful use of alcohol.
So the Oman NCD prevention and control program
  is carrying out the activities at different health
  care levels
9
                                                 Ministry of Health
                                                       Oman
The Top 10s (prevalence %)
          Till 2010 Oman was ranked in top 10, but in 2011 when the
     International Diabetes Federation(IDF) recalculated the prevalence
        using different criteria, it has become 43rd Rank with a 10.75%
                                     prevalence
                   8th
                                        (




                   43rd
 43. Oman                       10.75


 IDF Atlas, V5, 2011
10
                                                                      Ministry of Health
                                                                            Oman
Country/territory     Comp. prevalence (%)
                             WHO Standard
     Kuwait                                21.10
                                                   6th
     Lebanon                               20.17
     Qatar                                 20.17
     Saudi Arabia                          20.02
     Bahrain                               19.88
     UAE                                   19.22   To
     Egypt                                 16.94
     Libyan                                14.19
     Jordan                                12.37
     Iran                                  11.34
     Oman                                  10.75   11th
11   IDF Atlas, V5, 2011                                  Ministry of Health
                                                                Oman
Annual and Cummulative Number of People with Diabetes on the Register

               70000
                              New registered diabetic          Total registered diabetic                                         61583
               60000
                                                                                                           57167      56036    =11.50%
                                                                                                54599
               50000                                                                 48972

                                                                       42017
               40000
No. of Cases




                                                           37286

               30000                            31704
                                                                                                               >40 years
                                     27432
                                                                                                               population=
                          23386
               20000                                                                                           535344 (2011
                                                                                                               data )
               10000                                                              4862       5167       5482       5393       5413
                       3590       3487       3548       4177        4372

                  0
                       2000       2001       2002       2003        2004          2005       2006       2007       2008       2009

     Annual Health Reports 2000-2009                                       Year
         12
                                                                                                                                 Ministry of Health
                                                                                                                                       Oman
40-59 Years Old Most Affected
                1800
                1600
                1400
                1200                                                          20-29
 No. of Cases




                1000                                                          30-39
                 800
                                                                              40-49
                 600
                 400                                                          50-59

                 200                                                          60-69

                   0
                                                                              70+
                       2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Annual Health Reports 2000-2009               Year
  13
                                                                           Ministry of Health
                                                                                 Oman
Action by in MOH

• High Political Commitment
• Established NCD Department 2003
     – Priority Diseases section (DM, CVD, Cancer,
       Renal)
     – Specific Diseases (eye, ear)
     – Mental Health
     – Tobacco Control
• Formation of National Diabetes
  Committee
14
                                                Ministry of Health
                                                      Oman
Surveillance of NCDs
• Oman-pioneered applying the WHO
  protocol for the Diabetes Survey in 1991,
• Then Surveys were carried out 10 yearly-
  in 2000, and 2008(as part of Oman WHS

• National Diabetes Register



15
                                          Ministry of Health
                                                Oman
•Risk Factors(enter the number)
      Baseline          •Weight( Kg )
     First Year         • Height (cm)
                        • Duration of Diabetes
                        •Clinical findings -
                           Blood Pressure
                           Peripheral Pulses
                           Neuropathy
                           Fundus Retinopathy
                           Foot Ulcer
         Five years     •Laboratory Investigations
                           -Blood Glucose-(Fasting &2 hrs pp)
                           -OGTT –(fasting & 2 hr pp)
                           -Fasting Lipids-(cholesterol,
                                             LDL, HDL,TG)
                           -Renal Function ( Blood urea,
                                    creatinine, Urine-protein,
                                     sugar, ketones)
                            -HbAIC
                            -ECG
                        •Type of Diabetes
                        •Treatment
                        • Remarks
         Twelve years

                                                                 16
                                                                 Ministry of Health
16                                                                     Oman
Actions: At District Hospital
     – Distinct clinic for diabetes
       • Specialist physician
       • Nurse
       • “Educator”              •Insulin
                                 •Oral hypoglycemics

     – Medication for Rx of DM-  •Antihypertensives
                                 •Statins
                                 are available at all
     – Glycated HbA1c            Care levels.
                                 The Higher PHC
                                 Committee and
                                 Diabetes Committee
                                 will approve new
                                 medicines as per
17                               requirement          Ministry of Health
                                                               Oman
Diabetic clinics in Poly Clinics

          20


          18


          16
Clinics




          14


          12
                                               diabetic clinics in PC
                                               Target by 2010
          10


          8
               2005            2006            2007                     2008   2009
Department of NCD, MOH, Oman
                                               Year
     18
                                                                                      Ministry of Health
                                                                                            Oman
Combined Clinics
                 25
                             DM & Obgyn
                 20          Target

                 15
       Clinics




                 10

                 5

                 0
                      2005        2006    2007   2008   2009
Department of NCD, MOH, Oman              Year

  19
                                                               Ministry of Health
                                                                     Oman
At PHC level

        Increase in Mini-Diabetes Clinic
     120

     100                                                           100
                                          88       90
      80

      60                          61
                   50             50      50       50              50
      40
                   30
      20                                       Mini Diab & HTN Clinics
                                               Target
        0
               2005            2006    2007    2008            2009
Department of NCD, MOH, Oman
  20
                                                                         Ministry of Health
                                                                               Oman
… At PHC
 • Training of GPs
 and Nurses




21
                     Ministry of Health
                           Oman
22
     Ministry of Health
           Oman
Diabetic Foot
     Training Omanis on Podiatry
     (Outside Oman) + (in Oman)
                   • In 2008 , 5 Omanis
                     were sent to Australia
                     for doing their BSc IN
                     Podiatry at La Trobe
                     University
                   • They then carried out
                     Training for Nurses in
                     Podiatry in Oman.


23
                                        Ministry of Health
                                              Oman
Training for Nurses in Podiatry carried out
          by Glasgow Caledonia University




24
                                               Ministry of Health
                                                     Oman
Nurse-Run in Foot Clinics

                      25
                            Diabetic Foot Clinics                     23
                      20
     No. of Clinics




                      15                                      15

                      10

                       5

                               1           1           1
                       0
                            2005       2006         2007   2008    2009
Department of NCD, MOH, Oman                        Year

    25
                                                                           Ministry of Health
                                                                                 Oman
1
                                                        Oman Sea
                              UAE
                                                  5

Distribution of                           1
                                                           3
                                                                   2


Diabetes Foot                             1

                                                       4       2
                                                                       3
   Clinics             Kingdom of
                       Saudi Arabia

     (April 2009)                             0




                                      1
               Yemen                                  Arabian Sea


26
                                                                   Ministry of Health
                                                                         Oman
Reduction in Amputation
    Amputations/10,000 Patients/yr




                                     50
                                                                                      Foot amputation
                                     45
                                     40
                                     35
                                     30
                                     25
                                     20
                                     15
                                     10
                                      5
                                      0
                                          2001   2002   2003   2004   2005   2006   2007   2008   2009
                                                                      Year
Department of NCD, MOH, Oman

     27
                                                                                                   Ministry of Health
                                                                                                         Oman
Secondary Prevention
        SCREENING TOOLS




28
                          Ministry of Health
                                Oman
Non-Invasive Tool
 Diabetes Risk Score
(Has Not been implemented in Oman
  as Screening for Common NCDs
          for >40 years old
           is implemented




 29
                                    Ministry of Health
                                          Oman
2.4.1 The National NCD Screening
               Program 2006




30
                                    Ministry of Health
                                          Oman
31   Ministry of Health
           Oman
In PHC
 • Screening for common NCD
   conditions:
    (only for 40+ years)
     – Diabetes (FBS)
     – Hypertension (BP measurement)
     – Chronic Renal disease (GFR)
     – Dyslipidaemia (TC, HDL, LDL, TG)
     – Obesity (BMI, WC)

32
                                          Ministry of Health
                                                Oman
NCD Screening Results (2008)

               Males   Females   Both
    No.
 Screened      6,785    10,894   17,679
               (38%)    (62%)

BMI>30          23%      36%      31%
Abnormal        54%      76%      68%
WC
Pre-HTN         15%      14%      14%
HTN             21%      19%      19%
Pre-DM          36%      35%      35%
DM              8%       6%       7%
High Choles.    43%      47%      46%
eGFR < 90
 33             32%      26%      28%     Ministry of Health
                                                Oman
At Community Level




34
                          Ministry of Health
                                Oman
Community Based Initiatives
• The Nizwa Healthy Lifestyle project – WHO
  Community Based Program supported by MOH.
      -1st baseline risk factor survey.
      - In 2010 Evaluation of project was done by
        WHO Consultant.
      -It has been extended to other areas like Sur etc.
• School Health Program
      -The Health Promoting Schools program
      -Facts of Life

 35
                                                           Ministry of Health
                                                                 Oman
Tobacco Control Oman

•    Oman Ratified FCTC 2005
•    Smoking ban in all public places
•    Pictorial Health Warning ( all GCC)
•    Maintaining the status quo is a big
     challenge
         -due to tobacco lobbyists
         -Increased Shisha useage in
          older age group in both men and women
36
                                                  Ministry of Health
                                                        Oman
Challenges (1)
 • PHC structure needs further changes
 • Inadequate number trained staff to deal
   with complex NCD conditions
 • Unavailability of latest medications
   (e.g.insulin Analogue) due to cost
   constraints
 • Limited lab services for tests in PHC –No
   electronic linkages for test results from
   Hospitals
37
                                           Ministry of Health
                                                 Oman
Challenges (2)
 • Need for electronic record system for
   defaulters follow-up, monitoring &
   evaluation
 • Shortage of health educators




38
                                           Ministry of Health
                                                 Oman
Thank You

39
                 Ministry of Health
                       Oman

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National NCD Program in Oman

  • 1. National NCD Program in Oman Dr. Ali Jaffer Mohammed Advisor Health Affairs MOH 1 Ministry of Health Oman
  • 2. Presentation Overview • Five Year Plans • NCD’s Burden in Oman • Diabetes as an example • Program Implementation -National Level -District Hospital level -PHC level -Community Level 2 Ministry of Health Oman
  • 3. The Five year Plans 3 7th Five Year Plan 2006-2010 8th Five year plan 2011-2015 Ministry of Health Oman
  • 4. Five Year Plan -Domain 13:NCD’s 7th Five Year Plan 2006-2010 8th Five year plan 2011-2015 4 Ministry of Health Oman
  • 5. Scope & Rational • High Prevalence of NCDs in Oman (Ages 20+ years): Behavioral/individual Risk factors • Diabetes 12% • Hypertension 35% • Dyslipidaemia 40% • Overweight & obesity 48% • Tobacco use 23% 14.7% Source: OWHS-2008 (2008) (2011) 5 Ministry of Health Oman
  • 6. Insulin Resistance Syndrome (Metabolic Syndrome) Central/abdominal obesity 24.6% High TG 20.7% Microalbuminuria Low HDL 75.4% Prevalence of metabolic syndrome HBP 23.1% Oman 21% Endothelial USA dysfunction High FPG 18.1% 23% Atherosclerosis, cardiovascular disease 6 Source: Nizwa 2001 Ministry of Health Oman
  • 7. Deaths attributable to diseases and injuries, all ages, Oman, 2002. Total Deaths attributable to NCDs =62% 7 Ministry of Health Source :WHO Global Burden of Disease 2002. Oman
  • 8. Disability-adjusted life years lost attributable to diseases and injuries, all ages, Oman, 2002. Total DALYs lost attributable to NCDs=23% 8 Ministry of Health Source: WHO Global Burden of Disease 2002 Oman
  • 9. Rational In the WHO Global Action Plan for Prevention and Control of NCD objective # 3 is To promote interventions to reduce the main shared modifiable risk factors for non-communicable diseases : tobacco use, unhealthy diets, physical inactivity and harmful use of alcohol. So the Oman NCD prevention and control program is carrying out the activities at different health care levels 9 Ministry of Health Oman
  • 10. The Top 10s (prevalence %) Till 2010 Oman was ranked in top 10, but in 2011 when the International Diabetes Federation(IDF) recalculated the prevalence using different criteria, it has become 43rd Rank with a 10.75% prevalence 8th ( 43rd 43. Oman 10.75 IDF Atlas, V5, 2011 10 Ministry of Health Oman
  • 11. Country/territory Comp. prevalence (%) WHO Standard Kuwait 21.10 6th Lebanon 20.17 Qatar 20.17 Saudi Arabia 20.02 Bahrain 19.88 UAE 19.22 To Egypt 16.94 Libyan 14.19 Jordan 12.37 Iran 11.34 Oman 10.75 11th 11 IDF Atlas, V5, 2011 Ministry of Health Oman
  • 12. Annual and Cummulative Number of People with Diabetes on the Register 70000 New registered diabetic Total registered diabetic 61583 60000 57167 56036 =11.50% 54599 50000 48972 42017 40000 No. of Cases 37286 30000 31704 >40 years 27432 population= 23386 20000 535344 (2011 data ) 10000 4862 5167 5482 5393 5413 3590 3487 3548 4177 4372 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Annual Health Reports 2000-2009 Year 12 Ministry of Health Oman
  • 13. 40-59 Years Old Most Affected 1800 1600 1400 1200 20-29 No. of Cases 1000 30-39 800 40-49 600 400 50-59 200 60-69 0 70+ 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Annual Health Reports 2000-2009 Year 13 Ministry of Health Oman
  • 14. Action by in MOH • High Political Commitment • Established NCD Department 2003 – Priority Diseases section (DM, CVD, Cancer, Renal) – Specific Diseases (eye, ear) – Mental Health – Tobacco Control • Formation of National Diabetes Committee 14 Ministry of Health Oman
  • 15. Surveillance of NCDs • Oman-pioneered applying the WHO protocol for the Diabetes Survey in 1991, • Then Surveys were carried out 10 yearly- in 2000, and 2008(as part of Oman WHS • National Diabetes Register 15 Ministry of Health Oman
  • 16. •Risk Factors(enter the number) Baseline •Weight( Kg ) First Year • Height (cm) • Duration of Diabetes •Clinical findings - Blood Pressure Peripheral Pulses Neuropathy Fundus Retinopathy Foot Ulcer Five years •Laboratory Investigations -Blood Glucose-(Fasting &2 hrs pp) -OGTT –(fasting & 2 hr pp) -Fasting Lipids-(cholesterol, LDL, HDL,TG) -Renal Function ( Blood urea, creatinine, Urine-protein, sugar, ketones) -HbAIC -ECG •Type of Diabetes •Treatment • Remarks Twelve years 16 Ministry of Health 16 Oman
  • 17. Actions: At District Hospital – Distinct clinic for diabetes • Specialist physician • Nurse • “Educator” •Insulin •Oral hypoglycemics – Medication for Rx of DM- •Antihypertensives •Statins are available at all – Glycated HbA1c Care levels. The Higher PHC Committee and Diabetes Committee will approve new medicines as per 17 requirement Ministry of Health Oman
  • 18. Diabetic clinics in Poly Clinics 20 18 16 Clinics 14 12 diabetic clinics in PC Target by 2010 10 8 2005 2006 2007 2008 2009 Department of NCD, MOH, Oman Year 18 Ministry of Health Oman
  • 19. Combined Clinics 25 DM & Obgyn 20 Target 15 Clinics 10 5 0 2005 2006 2007 2008 2009 Department of NCD, MOH, Oman Year 19 Ministry of Health Oman
  • 20. At PHC level Increase in Mini-Diabetes Clinic 120 100 100 88 90 80 60 61 50 50 50 50 50 40 30 20 Mini Diab & HTN Clinics Target 0 2005 2006 2007 2008 2009 Department of NCD, MOH, Oman 20 Ministry of Health Oman
  • 21. … At PHC • Training of GPs and Nurses 21 Ministry of Health Oman
  • 22. 22 Ministry of Health Oman
  • 23. Diabetic Foot Training Omanis on Podiatry (Outside Oman) + (in Oman) • In 2008 , 5 Omanis were sent to Australia for doing their BSc IN Podiatry at La Trobe University • They then carried out Training for Nurses in Podiatry in Oman. 23 Ministry of Health Oman
  • 24. Training for Nurses in Podiatry carried out by Glasgow Caledonia University 24 Ministry of Health Oman
  • 25. Nurse-Run in Foot Clinics 25 Diabetic Foot Clinics 23 20 No. of Clinics 15 15 10 5 1 1 1 0 2005 2006 2007 2008 2009 Department of NCD, MOH, Oman Year 25 Ministry of Health Oman
  • 26. 1 Oman Sea UAE 5 Distribution of 1 3 2 Diabetes Foot 1 4 2 3 Clinics Kingdom of Saudi Arabia (April 2009) 0 1 Yemen Arabian Sea 26 Ministry of Health Oman
  • 27. Reduction in Amputation Amputations/10,000 Patients/yr 50 Foot amputation 45 40 35 30 25 20 15 10 5 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 Year Department of NCD, MOH, Oman 27 Ministry of Health Oman
  • 28. Secondary Prevention SCREENING TOOLS 28 Ministry of Health Oman
  • 29. Non-Invasive Tool Diabetes Risk Score (Has Not been implemented in Oman as Screening for Common NCDs for >40 years old is implemented 29 Ministry of Health Oman
  • 30. 2.4.1 The National NCD Screening Program 2006 30 Ministry of Health Oman
  • 31. 31 Ministry of Health Oman
  • 32. In PHC • Screening for common NCD conditions: (only for 40+ years) – Diabetes (FBS) – Hypertension (BP measurement) – Chronic Renal disease (GFR) – Dyslipidaemia (TC, HDL, LDL, TG) – Obesity (BMI, WC) 32 Ministry of Health Oman
  • 33. NCD Screening Results (2008) Males Females Both No. Screened 6,785 10,894 17,679 (38%) (62%) BMI>30 23% 36% 31% Abnormal 54% 76% 68% WC Pre-HTN 15% 14% 14% HTN 21% 19% 19% Pre-DM 36% 35% 35% DM 8% 6% 7% High Choles. 43% 47% 46% eGFR < 90 33 32% 26% 28% Ministry of Health Oman
  • 34. At Community Level 34 Ministry of Health Oman
  • 35. Community Based Initiatives • The Nizwa Healthy Lifestyle project – WHO Community Based Program supported by MOH. -1st baseline risk factor survey. - In 2010 Evaluation of project was done by WHO Consultant. -It has been extended to other areas like Sur etc. • School Health Program -The Health Promoting Schools program -Facts of Life 35 Ministry of Health Oman
  • 36. Tobacco Control Oman • Oman Ratified FCTC 2005 • Smoking ban in all public places • Pictorial Health Warning ( all GCC) • Maintaining the status quo is a big challenge -due to tobacco lobbyists -Increased Shisha useage in older age group in both men and women 36 Ministry of Health Oman
  • 37. Challenges (1) • PHC structure needs further changes • Inadequate number trained staff to deal with complex NCD conditions • Unavailability of latest medications (e.g.insulin Analogue) due to cost constraints • Limited lab services for tests in PHC –No electronic linkages for test results from Hospitals 37 Ministry of Health Oman
  • 38. Challenges (2) • Need for electronic record system for defaulters follow-up, monitoring & evaluation • Shortage of health educators 38 Ministry of Health Oman
  • 39. Thank You 39 Ministry of Health Oman

Hinweis der Redaktion

  1. The Pacific Islands and MENA dominate this category. The rates are more than twice the global average. Changes again only take into account changes in the population structure and urbanisation. For Pacific Islands, urbanisation is 100% so it is just age changes that can be expected. New for this edition: IMPORTANT: Nauru is no longer number 1 This is due not only to new data from the region, but may also reflect the effects of mortality due to diabetes. The emergence of MENA – 6 out of the 10 countries are in MENA