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Prim. d-r PhD. spec. of sports medicine - nutritionist

 Lazar Licenovski 13 1000 Skopje phone ++389-02-225-402

mfh.cindi@makedonija.com

CINDI HEALTH MONITOR SURVEY - CINDI HEALTH MONITOR SURVEY - AN INTEGRATED PART OF CINDI AN INTEGRATED PART OF CINDI

CONCEPTUL MODEL IN MACEDONIA, CONCEPTUL MODEL IN MACEDONIA, 20022002

INSITUTE OF SPORTS MEDICINE, NUTRITION UNIT, SKOPJE, MACEDONIAINSITUTE OF SPORTS MEDICINE, NUTRITION UNIT, SKOPJE, MACEDONIA

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Community and primary care-based demonstration project for health promotion and noncommunicable diseases (NCD) prevention has been prepared as an integrated part of conceptual model for CINDI National Programme.

Republic of Macedonia is in the process of joining CINDI and implementing the CINDI concept through the process of health care reform.

In focus of the reform in primary health care is the implementation of health promotion and NCD prevention measures in preventive practice of “family” doctors.

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The purpose of the study:  1. To analize professional reasons that justify realization of the CINDI Programme based on information of health status in the Republic of Macedonia. 2. Assessment of national capacity in primary health care to realize CINDI project on promoting healthy nutrition and physical activity in different age groups. 3. The role of National Health Autority in CINDI team to confirm the Macedonian CINDI-Plan of action in health promotion heart disease and other chronic disease prevention in related to physical activity and nutrition over the next 5 year.

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M e t h o d s :

1.-Secondary data obtained from mortality/morbidity statistics in the Republic of Macedonia (1990-2001). -The results for family aggregation of common risk factors for chronic diseases obtained from medical research (BMI Systolic/diastolic BP T.Chol. TG HDL LDL Glyc. smoking decreased VO2max dietary habit and stress) in

randomized simples (Demonstation Projects 1990 and 1998).

2. National capacity in primary health care obtained from WHO questionnaire connected with “Assessment of national capacity for noncomunicable disease prevention & control” in 2001 year.

3. Protocol and quidelines about CINDI principles and strategies for health promotion and disease prevention (WHO CINDI publications).

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Results and Conclusions:

1. NCD are the main cause of morbidity and mortality during the last 10 years in the Republic of Macedonia. ( figures-1 and figure-2).

In the last three decades the cardiovascular disease, esspecialy coronary heart disease, malignant neoplasm's, and diabetes mellitus remains the most common cause of death for the Macedonian population.

In 1972 mortality from them accounting for 37% from total mortality, and year by year this percentage has increasing significantly up to 55.6% in 2001 with continuous trend to this days.

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Figure 1. Mortality rate from noncommunicable diseases in The Republic of Macedonia for the period 1991- 2001 up to 100.000 population 

359.5385.9

464.9 468.6

108.3 111.4 129.5 140.5 142.6 150.3

458.7464.9

0

50

100

150

200

250

300

350

400

450

500

1991 1993 1995 1997 1999 2001

KVBCancer

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Figure 2. Morbidity rate from circulatory diseases in the Republic of Macedonia up to 100.000 population

0

5000

10000

15000

20000

25000

1972 1978 1984 1990 1991 1992 1993 1994 1995 1997 1998

Hypertensia

Ischemic hard disease

Cerebro vascular

Circulatory diseases

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The results of common risk factors for NCD include: 1. BMIBMI distribution varies significantly according to the stage of transition of a country.

Figure-3 illustrates the tendency for rapidly increase in the proportion of the population with high BMI than the proportion of the population with low BMI in the early stage of transition. The distribution of BMI tends to change again in the later phases of transition with an increase in the prevalence of high BMI among the poor.

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Figure 3. BMI Distribution in adult population in Skopje in the last 10 years (1990-2000 year)

75.865.5

58.8

41.6

14.915.9

18.2

41.5

9.3

18.623

16.8

0

10

20

30

40

50

60

70

80

BMI < 25 BMI > 25-29.9 BMI > 30

1990

1995

1998

2000

%

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Figure 4. Prevalence of systolic and diastolic blood pressure in adult population in Skopje

88.7

80.9

10

16.6

1.2 2.4

68.373.8

23.7

11.97.9

14.3

0

20

40

60

80

100

<140 >140 >160 <90 >90 >95

1990

1998

%

systolic BP diastolic BP

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Figure 5. Prevalence of risk factors for NCD in adult population from central region in Skopje 

28.2

75

2.5

23.418.2

12.5

3.7

35.235.9

18.215.8

28.823.8

14.2

0

20

40

60

80

19901998

%

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2. There are great potencial within primary health care to realize CINDI project for health promotion and the primary prevention of major chronic diseases through changes of lifestyle of the population such as increased physical activity and balanced diet (average 1488 population per one MD).

The territory of Republic of Macedonia is divided into five regions with distrinct centresfor the implementation of all NCD related preventive activities ( figure 6).

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1877

149

384

150

167

Figure 6. Organizational structure – CINDI HEALTH MONITOR SURVEY CENTRES in the Republic of Macedonia

 

389

222

1877

149

167

150

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3. The role of the Macedonian Health Authority in CINDI - team is to accept an alternative classification system for prevention strategies aimed at chronic multifactorial conditions.

This is based on three levels of preventivntion directed at everyone in the population (public health promotion) an above/average risk groups (selective prevention) and at high-risk individuals (targeted prevention).

In this new scheme promotion and prevention are used to describe those action that occur before the full development of the condition.

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This project form a link between precede medical research and the application of new index as mathematical model for predicting the effects of non-pharmacological interventions in the population at above/ average and high risk for NCD such as truncal obese individuals with atherogenic risk factors.

Logistic model in form of equation is: ln “RR” =108.2588–1.7689 DKN-B in +1.7087 - BMI in+0.3993- Hb 2.9423-VO2max OPV –

10.5402 WHO in + 0.0770-50% kcal/h

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Exponent B can be interpreted in terms of relative risk (“RR”) in cohort studies. The proposed non-pharmacological intervention is hypocaloric hiperprotein diets of 1200kcal/d and 1400kcal/d (second phase) since the relative risk is less than 1 (ln“RR”<1).

Increased physical activity by the recommendations of ACSM (1993) and CDC (2001) statistically significant promotes development of VO2max.

Change in level of VO2max at 17.16% from baseline

promotes significant greater reduction in level of WHR OS sm %fat (%M) body weight (TTkg) LBM kg BMR kcal/d

and LDL/HDL in PAD(physical activity and diet) than those in D (diet) group obese subjects (figure 7). 

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Figure 7. Change in level of VO2max and “major” risk factors for NCD in FAD

(physical activity and diet) and D (diet) group of truncal obese subjects 

BMR

-5,2

%FAI

-10,2

VO2-OPV

14,8

VO2max17,1

HDL10,4

LDL/HDL

-28,6

OS

-9,5

WHR

-4,5

LBM

-3,3

%M

-10,3

TT

-7,9

-35

-25

-15

-5

5

15

25 %

FAD

D

-5.3 -6.3

-1.8-3.3

-5.6

-7.7 -9.3

-3.1

 

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Koordinativen SINDI Centar

Administrativen del

INTERVENTNI PROCESI

demonstaciono podra~je randomizirani grupi

komunalno nivo populaciono

primeneti od SINDI programata

MONITORING I EVALUACIJA

grupi (pol vozrast)lokacija(u~ilkolekt)

inic. indikatori:1.morfo-fiziolo{. rizik-faktori :BMI; WHRHTAmmHg; fc-mir/maxTot. holest; TGHDL2-holestVO2 max METTs.

2.rizik- faktori na odnesuvuvawe :ishrana; pu{ewehipokinezija.

fin. indikatori:1. rizik-faktori2. morbiditet na “major” HNB3. mortalitet

nezavisni varijabli

promenlivi varijabli

-aktiviranost na zaednica-masovno vklu~ organiz. grupi i individui-skrining na: rizik-faktiriedukac./promoc

1.li~ni zdravst. karakteristiki2.socio-demogr. karakteristiki3.socij.okolina.  

-znaewe-na~. na odnes.-semejstvo-kultur. nivo-socij.podr{ 

SINDI PROGRAMA VO MAKEDONIJA-KONCEPTUALEN MODEL 

Ministerstvo za zdravstvo

Administrativen del

INTERVENTNI PROCESI

demonstaciono podra~je randomizirani grupi

komunalno nivo populaciono

primeneti od zdravst. slu`bi

primeneti od SINDI programata

MONITORING I EVALUACIJA

grupi (pol vozrast)lokacija(u~ilkolekt)

inic. indikatori:1.morfo-fiziolo{. rizik-faktori :BMI; WHRHTAmmHg; fc-mir/maxTot. holest; TGHDL2-holestVO2 max METTs.

2.rizik- faktori na odnesuvuvawe :ishrana; pu{ewehipokinezija.

fin. indikatori:1. rizik-faktori2. morbiditet na “major” HNB3. mortalitet

nezavisni varijabli

promenlivi varijabli

-aktiviranost na zaednica-masovno vklu~ organiz. grupi i individui-skrining na: rizik-faktiriedukac./promoc

1.li~ni zdravst. karakteristiki2.socio-demogr. karakteristiki3.socij.okolina.  

-znaewe-na~. na odnes.-semejstvo-kultur. nivo-socij.podr{ 

SINDI-Konceptualen model Makedonija 2002 godinaPrim.dr Simovska Vera PhD