Title: Ministry of Health and Population Preventive and Primary Health Care Sector Epidemiology and Disease Surveillance Unit (EDSU)
1Arab Republic of Egypt
Ministry of Health and Population Preventive and
Primary Health Care Sector Epidemiology and
Disease Surveillance Unit (EDSU)
NON-COMMUNICABLE DISEASE SURVEILLANCE SYSTEM,
EGYPT 2006
Presented by Dr. Eman A. Ellabany Medical
Epidemiologist Supervised by Dr Abdel-Nasser
M.A Executive director of Epidemiology and
Disease Surveillance Unit
2Geography
3Introduction
- Chronic diseases represent a major problem and
public health burden in developing countries. - It represents 73 of deaths and 60 of global
disease burden. -
4In 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
5 Stepwise is a frequent community based survey
dealing with prevalence of chronic diseases
(diabetes mellitus, hypertension , cardiovascular
diseasesetc) 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
6Stepwise Surveillance
- STEP 2
- Physical
- Height
- Weight
- BP
- Waist circumference
- STEP 3
- Biochemical
- Fasting glucose
- Cholesterol
- Triglycerides
- HDL
- STEP 1
- Self Report
- Demographics
- Physical activity
- Diet
- Smoking
- Alcohol
- NCDs
7The 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
8Sampling frame and design
- Technique
- 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.
9Sampling frame and design
- Working 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
10Sampling frame and design
- Tools
- 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).
11 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
12Results of Egypt Steps survey
13Sample size
- Out of 10,000 a total of 9780 adults participated
in the Egyptian Steps survey. - The overall response rate was 97.8
14Population Pyramid of Egypt
15Age distribution by Gender of 9870 Egyptian
participants
16Prevalence Of Education Achieved By The Survey
Participants
17Employment Status Of Participants
18Prevalence of Tobacco smokers
19Burden of smoking
20Prevalence of Alcohol consumption
Percentage of current drinkers (who drank alcohol
in the past 12 months)
21For those who drank alcohol in the last 12 months
22Percentage who ate 5 or more combined servings of
fruit vegetables per day
23Physical activity
Percentage with low levels of activity (defined
as lt600 MET-minutes/week)
24Results of Egypt Steps survey
Step 2
25Physical Measurements (Overweight and obesity)
26Prevalence of Hypertension(Percentage with
raised BP)
27Results of Egypt Steps survey
Step 3 Biochemical Measurements
28Prevalence of DiabetesPercentage with raised
fasting blood glucose ( 7.0 mmol/L)
29Prevalence of raised total Cholesterol
30Conclusion 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
31Conclusion 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.
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