Non Communicable Disease Surveillance A Pilot Project in the District of Polonnaruwa

1. Non Communicable Disease Surveillance A Pilot Project in the District of Polonnaruwa Dr Shaluka Jayamanne MD MRCP Consultant Physician GH Polonnaruwa

2. OBJECTIVE OF THE PRESENTATION • To present a newly established surveillance system on priority chronic NCD in Polonnaruwa • To present a community based screening programme for a major health problem in NCP - CRF

3. Epidemiology of non communicable diseases in the district of Polonnaruwa

4. Situation of NCD Increasing trend with an aging population Increasing trend with change in life style Transport Agriculture Diate Alcohol and tobacco Control of infections

6. Epidemiology of NCD • We do not have a district data base • No Outpatient care statistics • Inpatient statistics also have not been audited- Repetition Inadequate documentation • There is no notification system for NCD

7. Epidemiology NCD • The top three causes of mortality are related to NCD • Although NCD are not the leading causes for hospital admissions they take up a larger proportion of bed occupancy • More than 90% of medical clinic attendance are related to NCD

10. Mortality Figures • 2003 1. Slow foetal growth and LBW -75 2. Cerebro-vascular Disease -57 3. Renal Failure -56 • 2004 1. Renal Failure -89 2. Cerebro-vascular Disease -55 3 Slow foetal growth and LBW -43 • 2005 1. Cerebro-vascular Disease -35 2. Renal Failure -28

16. Renal Failure Admissions and Deaths

17. Cerebroavascular Disease Admissions and Deaths

18. NCD Epidemiology • Overall we see an increasing trend in NCDs • Proportionately death rates have come down marginally • Mortality data has not been assessed comprehensively

19. Disease burden has changed towards chronic conditions in Polonnarwa world wide. Majority of Health systems haven’t

20. Prioritizing Prevention & Control Efforts • Leading Causes of Death • Years of Potential Life Lost • Economic Cost to Society

21. Noncommunicable Disease Model Personality Beliefs Your genetic endowment Behavioral choices

22. Noncommunicable Disease Model Environment Health Care System Personality Beliefs Economics Your genetic endowment Water Quality Behavioral choices Air Pollution

23. Importance of a Surveillance System for Chronic NCD • Surveillance provides health information in a timely manner to fight epidemics now or plan for the future. • A SURVEILLANCE SYSTEM: NOT ENTIRELY A NEW FIELD • Notification of Communicable Diseases • Pilot of a Surveillance System in Colombo District (XXX) • The present information system • Xxxxx (status… strengths and weaknesses vis-à-vis chronic NCD)

24. Transforming the District Information System • POLONNARUWA - AN IDEAL PARTNER • The success of earlier pilot testing of information systems • Hospital Information system • Drugs management Information • Public Health Information System • Positive Previous experiences • Cooperation of the staff in innovative projects – Easy to work with • Good motivated team with positive attitudes

26. Phase 1: CVD Hypertension Ischaemic Heart Diseases Cerebrovascular Diseases Congenital Heart Diseases Diabetes Phase 2: Renal diseases Cancer Mental health Others Phase 1 GH Polonnaruwa BH Medirigiriya DH Hingurakgoda MOH (all 7) Areas Phase 2 All Hospitals in Polonnaruwa All MOH areas The Surveillance System

27. PROPOSED CHRONIC NCD SURVEILLANCE SYSTEM House- hold - Facilitate continuity of care (e.g. follow up, treatment) - Health promotion Patient - Risks analysis - Health promotion PHI RE Ward Doctor Generates NCD Notification Card (NCD NC) MOH MO/PH Using the NCD NC, enters information in the MOH NCD register Generates NCD Basic Surveillance Form Generates NCD Special Surveillance Form Using the NCD NC, enters information in the Hospital NCD Register

32. CHRONIC NCD SURVEILLANCE SYSTEM:FORMS & REGISTERS • NCD Notification Card • Hospital NCD Register • MOH NCD Register • NCD Basic Investigation Form • PHI NCD Register • NCD Monthly Return

33. Programme Today

34. CRF- Extent of the Problem Leading cause of death at GH Polonnaruwa in year 2004 Among three leading causes for hospital medical admissions 10% of clinic attendance is due to CRF Until recently there was no established community screening programme Therefore this is the tip of the ice berg

35. CRF • Main Characteristics • Male to Female ratio 5:2 • Average age of Diagnosis 30-50 years • More than 95% are farmers • Poor socio-economic class

36. CRF • Overall analysis shows that 8-10 deaths per month is due to CRF or related causes • Average in hospital mortality with CRF is about 120/per year • Considering the fact that a substantial number of deaths occur outside the hospital we can assume a figure around 180

37. CRF • It is difficult to give a general figure of prevalence with these results but we can assume a 2%-3% prevalence • Protienurea seems to be a useful cheap marker • We need a screening programme using the available infrastructure

38. Renal Screening and Management Established Renal Clinics led by a VP and trained medical officers in renal medicine in regional hospitals Medirigiriya Bakamuna Welikanda Aralaganwila

39. Renal Screening • Established a continues screening programme in MOH divisions led by community health staff and health volunteers • Detection of protienurea and high BP are the main determinants • Screened patients are referred to clinics for further evaluation

40. CRF Notification • CRF patients are notified to the regional epidemeologist • The notification will be forwarded to the PHI • We have submited a data collection form to the PHI

43. CRF Screening programme – Polonnaruwa

44. Establishing Epidemiological Data • The collected data will be analysed • We hope to screen about 50% of the population by the middle of next year

45. Issues for discussion • Whose responsibility to establish a notification system for Chronic NCDs. • If so when to start national system? Funds and human resources ? • Are we going to incorporate it into existing system. • Can PHI measure BP (Using Electronic Device)

47. Thank you