Epidemiology and Disease Surveillance Unit (EDSU)

Ministry of Health and Population Preventive and Primary Health Care Sector Epidemiology and Disease Surveillance Unit (EDSU) NON-COMMUNICABLE DISEAS...
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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.

Stepwise Surveillance STEP 1 • Self Report – Demographics – Physical activity – Diet – Smoking – Alcohol – NCD’s

STEP 2 • Physical – – – –

Height Weight BP Waist circumference

STEP 3 • Biochemical – Fasting glucose – Cholesterol – Triglycerides – HDL

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

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