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NCD Risk Factor Surveillance in India: Leveraging Research to National … · 2007-10-29 ·...
Transcript of NCD Risk Factor Surveillance in India: Leveraging Research to National … · 2007-10-29 ·...
NCD Risk Factor Surveillance in India: Leveraging Research to National Action
Dr Prashant Mathur
Assistant Director GeneralDIVISION OF NONCOMMUNICABLE DISEASES
INDIAN COUNCIL OF MEDICAL RESEARCHNEW DELHI, INDIA
Email: [email protected]
5th International Conference Behavior Risk Factor Surveillance, 24-26th October 2007, Rome, Italy
‘Grave’ picture for 2005, India
Diabetes2%
Injuries11%
Chronic resp diseases
7%
Cancer8%
CVD28%Comm.
disease36%
Total projected deaths 10.4 million
Chronic disease death 5.5 million
60 million deaths over the next decade
Communicable disease deaths reduction by 15 %
Deaths from diabetes increase by 35%
Reddy KS, Cherian V, Shah B, Ramadoss A. Responding to the threat of chronic diseases in India. LANCET Oct 5, 2005
National Programs for NCD
National Program for the Prevention and Control of BlindnessNational Cancer Control ProgramNational District Mental Health ProgramNational Policy for the Elderly
National Program for CVD, Diabetes & Stroke
Rehabilitation program- Accident &TraumaOral Health Program
Vision for NCD Surveillance
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BackgroundLack of standardized community based data from various regions of country
2001 - ICMR identified as Nodal agency by WHO & Govt. of India to undertake NCD RFS
Identification of key partners in NCD surveillance to expand it at a National level
The WHO STEPwise approach to Surveillanceaddresses a step wise collection of data depending on capacity &resources permits a reasonable amount of flexibility provides opportunity for international comparison of data
Challenge Tackled at Policy Level
Interpretation of STEPS data asrepresentative of the prevalence of various parameters in the community
need to differentiate between ‘survey’ and ‘surveillance’
Development of Sentinel Health Monitoring Centers In India, 2003-05
(ICMR-WHO Collaboration)
Goal: To develop a sustainable system for NCD Surveillance in IndiaAim: To set up Regional Sentinel Health Monitoring Centers
6 sites; 15-64 years (decadal age groups) Urban/Rural/Slum; M/F 44800 respondents (STEP 3 in 20% sub-sample)
Alcohol consumptionTobacco consumptionInadequate intake of fruits & vegetablesPhysical inactivity
ObesityBody Mass Index (BMI)Waist circumference
Elevated blood pressure
Biochemical Parameters (Fasting)
LipidsTotal CholesterolHDL cholesterolTriglycerides
Plasma glucose
Risk Factors Studied
Nagpur
Trivandrum
Chennai
Dibrugarh
BallabgarhDelhi
ICMR’s NCD Risk Factor Surveillance Centers in IndiaCoordinating Unit : Division of NCD, ICMR
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Smokers Daily
88.3% 86.7%84.5%
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BMI Categories (Kg/m2)
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Urban Rural Slum
% daily smokers amongst current smokersAge at Initiation of Smoking
ICMR-WHO NCD RF Study: Glimpses of Results
Servings of Fruit Consumption/day BMI: Overweight
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Urban Rural Slum
Quality Assurance
Common protocol Field staff training by the centre PIAdapted Questionnaire was translated into local language and back translatedCentral supply of instrumentsSite visits and close monitoring through
Telephone, fax, e mails, frequent meetings
Quality Assurance
Common data entry template in Epi-info 6.0 developed and distributed10% double data entryCentre specific data analysis and reportingCombined data analysis in SPSS (12.0) by the central coordinating unit
Leveraging Research to National Action Plan
Identification of experienced partners in 5 regions of India
Data collected through a uniform study protocol in a time frame
Team of investigators at local & regional levels
Locally relevant translated study instrument & field manual
Strong coordination, monitoring, supervision, data management
Commitment of participating institutions
Interaction with planners, policy makers & International agencies
Developed a template for National NCD RF Surveillance
The Concept of IDSP(Integrated Disease Surveillance Program)
World Bank funded project through Ministry of HealthThereafter to be run by the Govt. of India (National Rural Health Mission)
DecentralizedIntegratedAction orientedBrings together communicable and NCD under one surveillance activity.
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Number indicates Phasing of the Project
Planned in 29 States/UTs in 3 phases (2007-10)To be repeated every 3 yrs at State levelMajor NCD Risk factors identified
Behavioral: tobacco (smoke, smokeless), alcohol, fruits & vegetables, physical activityPhysical: BMI, waist circumference, BPBiochemical: fasting blood glucose, cholesterol
State level estimates of NCD risk factors
IDSP NCD RF Surveillance
Nagpur
Ballabgarh
Dibrugarh
Chennai
Trivandrum
NCD Risk Factor Surveys under IDSP: ICMRs Resource Centers
8 States being covered under Phase I of IDSP
Andhra PradeshKarnatakaKeralaTamilNaduMaharashtraMadhya PradeshUttaranchalMizoram
CSU – IDSPMin of HealthCSU – IDSP
Min of Health
World Bank & Associates
World Bank & Associates
State IDSPState IDSP
ICMRRegional Research Centers
State Survey Agencies
National Nodal Agency
Stakeholders
COMMUNITY
Data collectionIdentification & referral
Technical issues
District Surveillance Committee/ District Health Authority
Co-ordination
Survey Team
Management of referralsProvide logistic support
National Nodal Agency
Survey methodology, questionnaire, training, quality, monitoring, analysis, reporting, dissemination
Medical Colleges
Dissemination, Management of patients, Planning a Response
Administrative Financial Reporting
Regional Research Centres
Training, QC, Technical support
State Survey Agency
National TechnicalAdvisory Committee
Central Surveillance Unit IDSPMin of Health
ICMRQuality, StandardizationAdministrative, Financial Reporting
National Monitoring Committee
Study AreasUrban and Rural
Study PopulationMales and females aged between 15-64 years in the selected urban and rural areas
Study designCross sectional survey (to be repeated every 3-5 yrs)
Sampling StrategyMulti-stage systematic cluster sampling technique
3 sections Check list of household members and eligibility
Household information on SE parameters
Individual respondents questionnaire
Common protocolStandardized trainingStandardized survey methodsMonitoring and coordinating set upsAdvisory Group and ResourcesSite visitsCommon data management mechanismsCritical appraisal
PUBLIC HEALTH INTERVENTIONS
Policy Interventions Educational Interventions
Enabling Environment Health Beliefs and Behaviours
(Financial, Social, Physical) (Community; Individual)
Desired Change
The Future of NCD Surveillance in India
Integrating laboratory parameters in surveillanceState level NCD Policy Community based intervention programsDisease surveillance Integral part of the soon to be launched National Program on Cardiovascular Diseases, Diabetes and StrokeLinkages with Health databases
NCD cell at the centreState NCD cells established in all the States100 Medical Colleges and 200 Districts with capacity for NCD prevention & management 20 Resource Centres establishedIEC strategy implementedHealth sector personnel trained in NCDSurveillance of risk factors initiated and sustained -linkages with IDSP.
National Programme for Prevention and Control of Diabetes, Cardiovascular
Diseases and Stroke (NPCDCS)
NCD Surveillance Team at ICMRDr NK Ganguly
Director General, ICMR
Dr Bela ShahChief, Division of NCD
Dr DK ShuklaDeputy Director General
Dr Prashant MathurAssistant Director General & Program Officer, NCD Surveillance
Dr Geetha MenonResearch Officer
InvestigatorsK Anand – BallabgarhV Mohan – ChennaiJ Mahanta – DibrugarhNG Desai – DelhiPP Joshi – NagpurKR Thankappan - Trivandrum
Advisory CommitteeLM NathKS ReddyRM PandeyMG KarmarkarPadam SinghSK Pradhan
Hope on the Horizon for NCDs!!
THANK YOU !