Ministry of Health and Population Preventive and Primary Health Care Sector
Epidemiology and Disease Surveillance Unit (EDSU) NON-COMMUNICABLE DISEAS...
Ministry of Health and Population Preventive and Primary Health Care Sector
Epidemiology and Disease Surveillance Unit (EDSU) NON-COMMUNICABLE DISEASE SURVEILLANCE SYSTEM, EGYPT 2006 Presented by: Dr. Eman A. Ellabany Medical Epidemiologist
Supervised by: Dr Abdel-Nasser M.A Executive director of Epidemiology and Disease Surveillance Unit
Geography
Introduction Chronic diseases represent a major problem and public health burden in developing countries. It represents 73% of deaths and 60% of global disease burden.
Introduction In Egypt, there is emerging evidence that diabetes mellitus, obesity, hypertension and hyperlipidemia contribute to national morbidity and mortality as it represents about 26% of all deaths related to chronic diseases. So, Egypt is in need of conducting national survey to measure the burden and the actual prevalence of chronic diseases
Step-wise Surveillance System Stepwise is a frequent community based survey dealing with prevalence of chronic diseases (diabetes mellitus, hypertension , cardiovascular diseases…etc) and their behavioral risk factors; obesity, hyperlipidemia, smoking, drinking alcohol, feeding habits, oil consumption, and physical activities. Also physical and biochemical measurements.
Sampling frame and design The Egyptian population in last census was estimated to be around 70 millions. Population: 10000 randomly selected proportioning to the total population considering the selected age group (≥ 15: ≤ 65 years) and gender Sites: random selection of 10 Governorates of 27 to represent the whole geographical area
Sampling frame and design Technique: Multistage and Stratified Cluster Random sampling • PSU included Egyptian Governorates as clusters . They were stratified into Urban / Frontier / Delta / Upper Egypt . 10 of 27 Governorates were randomly selected to represent total population in a proportionate way.
• SSU were districts in each governorate • TSU were streets and buildings • Houses were the end sampling units.
Sampling frame and design Working team: Consists of Epidemiologist to fill the questionnaire and supervise other steps during the interview. Nurse to take blood sample, physical measurements (wt, ht, waist circumference), and measure blood pressure. Sanitarian from the related health district guides the team towards the selected streets and building
Sampling frame and design Tools: • Questionnaire: we use the international Stepwise questionnaire after translating it in Arabic using the public traditional Egyptian language to facilitate the mission for the interviewer. • WHO scales & measures for height and weights were standardized. • WHO supplied the REFLETRON machines and kits for biochemical measurements (Fasting blood sugar, cholesterol, triglyceride, and HDL).
Sampling frame and design The three steps of the Step-wise survey were done together The field work of the survey conducted through the year 2005 starting the field work from January to December 2005 Data entry on Access software taking 6 months ( from January to June 2006) Preliminary descriptive analysis done using SPSS program.
Results of Egypt Steps survey
Step 1
Sample size
• Out of 10,000 a total of 9780 adults participated in the Egyptian Steps survey. • The overall response rate was 97.8%
Population Pyramid of Egypt
Age distribution by Gender of 9870 Egyptian participants 40 35
percent
30 25 20 15
SEX
10 Male 5 0
Female 55
45
35
25
15
-6
4
4
4
4
5
-5
-4
-3
-2
Age (year)
Prevalence Of Education Achieved By The Survey Participants 40 35 30
Percent
25 20 15
SEX
10 5
Male
0
Female Po st
ch Ba
ch Te
h ig H
co Se
e at du ra G
er ol
l oo
a lm po de
y
ol ho sc
ar nd
y
ar im Pr
ch
g in ol ho sc
s al
y 1r
rm fo
e m So
o N
Education level
30
Percent
Employment Status Of Participants 60
50
40
SEX 20
Male 10
Female 0
an C ( y.
n ca
k or tw no
o pl m ne U d ire et R ife w se ou H t en ud St
k) or w
r r bo ne La ow k or w ee e oy at pl iv Pr em n er ov G ee on oy N pl em n. er ov G
Occupation
Prevalence of Tobacco smokers 35
34.6
Current daily smokers
30 27.4
Manufactured cigarette
Percent
25 20
18
15
14.2
10 5 0
0.7
Male
0.4
Female
Both
Average number
Burden of smoking 20 18 16 14 12 10 8 6 4 2 0
19.6
19.6 18.2
17
16.9
9.6
Average years smoking Mean No. cigarette/day
Male
Female
Both
Prevalence of Alcohol consumption 4
3.8
3.5
Percent
3 2.5 2.1
2 1.5 1 0.5 0
0.3
Male
Female
Both
Percentage of current drinkers (who drank alcohol in the past 12 months)
Percent
For those who drank alcohol in the last 12 months 18 16 14 12 10 8 6 4 2 0
17.1
6.1
Male (≥5 drinks)
0 Female (≥4 drinks)
Both (≥4 drinks)
Drinks / day
Percentage who ate 5 or more combined servings of fruit & vegetables per day 25
Percent
20
21.3
20.9
21.1
Male
Female
Both
15 10 5 0
5 serving & more / day
Physical activity 60
Percent
50
57.4 50.6 45.1
40 30 20 10 0
Male
Female
Both
< 600 MET
Percentage with low levels of activity (defined as