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The Magnitude of Non-communicable diseases & their

Risk factors in Malawi

Malawi NCD STEPS SURVEY 2009

BY DR KELIAS MSYAMBOZA

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What are NCDs

• A group diseases used to be regarded as “diseases of the west, affluent, rich, or urban people”

• Include:– Cardiovascular diseases (Hypertension, Heart

diseases, Stroke)– Cancer– Chronic respiratory diseases e.g. asthma– Diabetes– Mental diseases etc

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Importance of NCDs to Malawi

• Because of change in life styles, NCDs are increasingly becoming significant causes of morbidity and mortality in developing countries

• In Malawi, in adults, NCDs are probably the 2nd commonest cause of illness, lost of productive days and death after HIV/AIDS

• NCDs are part of 1st objective of PoW for SWAp 2004-2010:

“To reduce the disease burden due to communicable & Non-communicable diseases thru improving access to quality EHP, essential non-EHP services Emergency and Trauma services mainly targeted at the poor”

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NCD STEPS Survey objectives

1. To determine the magnitude of selected NCDs:– High blood pressure (Hypertension)– Diabetes– People with or at risk of Heart diseases (Raised cholesterol)

2. To determine the magnitude of risk factors:– Tobacco smoking– Excessive alcohol intake– Overweight/obesity– Physical inactivity– Inadequate fruits and vegetable intake

3. To use data to advocate for resources, policies, regulations etc for NCDs

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Materials & Methods

Method Outcome

Participants - 25-64 year olds

Sample size N=z2p(1-p)/e2 5,760

Survey design Population based National sample

EA selection PPS 144 EAs selected

HH selection Systematic 40 per EA

Participant Kish 1 per Household

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STEPS

Component Equipment

STEP 1 Questionnaire PDA

STEP 2 Physical measurements

(BP, HT, WT, waist & hip circ)

Weighing scales, tape measures, rulers, BP machines

STEP 3 Biochem tests

(FBS, total chol

Accutrend plus machines

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Results

Age group (yrs)

Males Females Both sexes

n % n % n %

25-34 719 30.8 1616 69.2 2335 44.9

35-44 459 34.7 862 65.3 1321 25.4

45-54 296 32.8 604 67.1 902 17.3

55-64 216 33.2 434 66.8 650 12.5

25-64 1,690 32.5 3,516 67.5 5,206 100.0

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Magnitude of selected NCDs by Gender

NCD Prevalence(%)

Males Females Both sexes

Hypertension (HT) 38.0* 28.8 31.6

Diabetes 6.6 4.8 5.3

Raised cholesterol 7.0 11.3* 10.0

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Magnitude of selected NCDs by Urban/Rural

NCD Prevalence(%)

Urban Rural Both

High Blood pressure 27.9 32.0 31.6

Diabetes 7.4 9.2 5.3

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NCD risk factors by Gender

Risk factor Prevalence (%)

Males Females Both

Tobacco smoking 26.3* 2.9 10.4

Alcohol 30.3* 4.1 12.6

Heavy drinking 19.2* 2.3 7.8

Physical inactivity 6.4 12.6* 10.6

Overweight 16.1 28.0* 23.9

≥3 risk factors 18.0 15.4 16.2

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NCD risk factors by Urban/Rural

Risk factor Prevalence (%)

Urban Rural Both

Tobacco smoking 6.6 10.9* 10.4

Alcohol 13.4 12.5 12.6

Physical inactivity 24.1* 8.7 10.6

Overweight 38.6* 21.9 23.9

≥3 risk factors 22.6 15.5 16.2

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People with or at risk of NCDs (N=4,561,430; 2008 census)

% No. of people

High BP 31.6 1,459,658

Diabetes 5.3 241,756

High Cholesterol 10.0 456,143

Tobacco smokers 10.4 638,600

Alcohol drinkers 12.6 574,740

Overweight 23.9 1,090,182

≥3 NCD risk factors 16.2 738,951

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Conclusion

• NCDs & their risk factors are major public health problems in Malawi

• Majority (94.4%) of people with high blood pressure and diabetes do not know that they have a problem

• Thus what we are seeing at health facilities is only 6% of people with High blood pressure and or diabetes.

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Proposed way forward

• There is need to establish NCD control programme

• There is need to develop multi-sectoral comprehensive Plan of Action & policies for NCDs

• There is need to allocate resources for NCDs within and or outside SWAp

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Proposed way forward cont…

• There is need to support and or strengthen the existing efforts such as:

– Age limit for alcohol drinking,– Drinking and driving– Opening and closing hours for alcohol selling– Taxation on alcohol

– Age limit for tobacco smoking– Ban on public smoking and workplaces– Taxation on cigarettes & other tobacco products– Consider ban on tobacco advertising, promotion &

sponsorship

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Acknowledgments

• MoH- Clinical Department

• WHO

• Data collectors

• DHOs

• HSAs

• Chiefs

• Participants

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Prevalence of NCDs & their risk factors in some countries in the region

% MW MZ ZWE BTW

Tobacco 10.4 18.7 11.8 19.5

Alcohol 12.6 77.2 24.5 27.4

Obesity 5.5 7.1 14.1 15.7

EBP 31.6 33.1 17.9 32.11

EBS 5.3 1.4 2.4 19.5