Ministry of Health and Population Ministry of Health and Population Preventive and Primary Health Care SectorPreventive and Primary Health Care Sector
Epidemiology and Disease Surveillance Unit (EDSU)
NON-COMMUNICABLE DISEASE SURVEILLANCE SYSTEM,EGYPT 2006
Presented by: Dr. Eman A. EllabanyMedical Epidemiologist
Supervised by: Dr AbdelSupervised by: Dr Abdel--Nasser M.ANasser M.AExecutiveExecutive director ofdirector of Epidemiology and Disease Surveillance UnitEpidemiology and Disease Surveillance Unit
Geog
raph
yGe
ogra
phy
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.
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
Introduction
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.
Step-wise Surveillance System
Stepwise SurveillanceSTEP 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
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
Sampling frame and designTechnique: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 designWorking 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 designTools: • 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).
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.
Sampling frame and design
Results of Egypt Steps surveyStep 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
Age (year)
55 - 65
45 - 54
35 - 44
25 - 34
15 - 24
perc
ent
40
35
30
25
20
15
10
50
SEX
Male
Female
Prevalence Of Education Achieved By The Survey Participants
Education level
Post Graduate
Bacholer
Tech depolma
High school
Secondary
Primary
Some 1ry schooling
No formal school
Per
cent
40
35
30
25
20
15
10
5
0
SEX
Male
Female
Employment Status Of Participants
Occupation
Can not work
Unemploy. (can work)
Retired
Housewife
Student
Labor
Private work owner
Non Govern employee
Govern. employee
Per
cent
60
50
40
30
20
10
0
SEX
Male
Female
Prevalence of Tobacco smokers34.6
27.4
0.7 0.4
18
14.2
0
5
10
15
20
25
30
35
Perc
ent
Male Female Both
Current daily smokers
Manufactured cigarette
Burden of smoking
17
19.6
9.6
18.216.9
19.6
02468
101214161820
Ave
rage
num
ber
Male Female Both
Average years smoking
Mean No. cigarette/day
Prevalence of Alcohol consumption3.8
0.3
2.1
00.5
11.5
22.5
33.5
4
Perc
ent
Male Female Both
Percentage of current drinkers (who drank alcohol in the Percentage of current drinkers (who drank alcohol in the past 12 monthspast 12 months))
For those who drank alcohol in last 12 monthsthe
17.1
0
6.1
02468
1012141618
Perc
ent
Male (≥5 drinks) Female (≥4drinks)
Both (≥4 drinks)
Drinks / day
Percentage who ate 5 or more combined
servings of fruit & vegetables per day
21.3 20.9 21.1
0
5
10
15
20
25
Perc
ent
Male Female Both
5 serving & more / day
Physical activity
45.1
57.4
50.6
0
10
20
30
40
50
60
Perc
ent
Male Female Both
< 600 METPercentage with low levels of activity (defined as <600
MET-minutes/week)
Results of Egypt Steps survey
Step 2
Physical Measurements(Overweight and obesity)
60
21.8
72.2
39
66
30.3
01020304050607080
Perc
ent
Male Female Both
Overweight /BMI ≥25
Obese / BMI ≥ 30
Prevalence of Hypertension(Percentage with raised BP)
26.3
6.2
27.1
7.6
26.7
6.9
0
5
10
15
20
25
30
Perc
ent
Male Female Both
SBP ≥ 140 and/or DBP ≥ 90 mmHg
SBP ≥ 170 and/or DBP ≥ 100 mmHg
Results of Egypt Steps survey
Step 3Biochemical Measurements
Prevalence of DiabetesPercentage with raised fasting blood glucose
(≥ 7.0 mmol/L)
6.2
8.27.2
0123456789
Perc
ent
Male Female Both
(≥ 7.0 mmol/L)
Prevalence of raised total Cholesterol
15.7
2
23.1
4.4
19.4
3.3
0
5
10
15
20
25
Perc
ent
Male Female Both
(≥ 5.2 mmol/L) (≥ 6.5 mmol/L)
Conclusion and RecommendationStepwise Surveillance System is important to
• Collect data and analyze it on an ongoing basis
• Use data for shaping public health policy• Predict future case load of NCDs• Monitor impact of public health programs• A repeat survey is planned for 2008 if funds
permit
Conclusion & Recommendation • Standardized sheets for each chronic
patients are needed to get more data about the Egyptian character of patients with chronic diseases
• Application of Health Program for Chronic diseases monitoring is important
• Nationwide standardized database using software.
Thank You