Dr Carmichael Patu MBBS Lecturer Oceania University of Medicine Samoa NCD situation in Samoa Dr Carmichael Patu MBBS Lecturer Oceania University of Medicine Samoa

How I got here…

Finally…..

Samoa Total Land Area: Population: Average Life Expectancy: 2934 km2 180,741 56% (15-65) Mean Age- 20.5 Average Life Expectancy: Male- 71.5 yrs Female- 74.2 yrs Source: Samoa Census 2006 -Independent nation -Least developed country

Health System structure Health reform 2006 Public Sector MOH Regulatory role NHS Service provider Private Sector GPs Association NKF OUMS SAMOA HEALTH SECTOR

Lets get into it now

The biggest killers…(Mortality) ICD- Code Description of Underlying Cause Sex Male Female Total 1 E10-E14 Diabetes Mellitus 33 20 53 2 C00-D48 Cancers (All sites) 24 22 46 3 I60-I69 Cerebrovascular Diseases 42 4 I26-I51 Ischaemic Heart Diseases 15 35 5 J12-J18 Pneumonia 17 12 29 6 A40-A41 Septicaemia 13 25 7 S00-T65 Injuries & Poisoning 18 8 I20-I25 Other Heart Diseases 16 9 I10-I14 Hypertension Diseases 10 14 K71-K92 Liver Diseases Source: Annual Report:PATIS / WHO ICD-10 (2007-2008) NCDs Table 5: Ten Leading Causes of Mortality for all deaths reported to All Public Health Facilities for FY 2007/2008

Ten leading causes of Morbidity (2007-2008) ICD- Code Diseases Description Number 1 J12-J18 Pneumonia 1,427 2 O20-O29,O67-O71, O70-O75,O81-O84 Other complications of pregnancy and delivery 1,066 3 S00-T65 Injuries and Poisoning 852 4 L00-L08 Infections of skin and subcutaneous tissue 761 5 E10-E14 Diabetes Mellitus 599 6 J20-J21 Acute Bronchitis and acute bronchiolitis 436 7 I10 Essential (primary) hypertension 412 8 O30-O43,O47-O48 Other maternal care related to fetus and amniotic cavity 318 9 A09 Diarrhea and gastroenteritis 310 10 A01 Typhoid and paratyphoid fevers 274 Source: PATIS (Patient Information System)

NCD outlook in Samoa Data collection: Utilization of WHO STEPwise approach to chronic disease risk factor surveillance (STEPS) Step 1 Demographic information Behavioural measurements (SNAP) Step 2 Physical measurements (BP, HR, BMI, WC) Step 3 Biochemical measurements (Glucose, Lipids) -developed from this WHO intrument

Samoa STEPS Implemented in 2002 Population studied: Some issues: 25-65ys 2804 (total) Some issues: Yet to be published Problems with data entry Manpower issues Fiji, Nauru, Am Samoa, Tokelau

Samoa NCD Risk Factors STEP report: Smoking status 40.3 % 2 in every 5 adults Alcohol use 29.4 % (current drinkers) Diet 35.6% have fruitless diets Tinned fish was the most popular Define current Drinkers

Samoa NCD Risk Factors STEP report: Physical Activity: 50.3% were physically inactive 1 in 2 Obesity/Overweight: 85.2% were classified as overweight Women > men Mean BMI – 31.4kg/m2 Hypertension: 21.2% were identified as Hypertensives 1 in 5 adults

Samoa NCD Risk Factors STEP report: Diabetes: 21.5 % were found to be Diabetics 1 in 5 adults 16.7% - impaired Fasting Glucose levels 38.2% with Diabetes and Pre-Diabetes Blood Cholesterol: 13.7% - levels > 5.2 mmol/L 33.8% of the adult population had at least 3 of the 5 risk factors studied (1 in 3 adults)

What is the Samoa Health Sector doing about it? Top Health priority NCD Policy 2010 Spearheaded by the MOH Key Areas: Strengthen health promotion and primordial prevention Quality health care service delivery Governance, Human Resources for Health and Health System Strengthening Health Financing Partnership Commitment Donor Participation and Harmonization - Review NCD 2004-2008 strategy

Health Sector Activities MOH Regulator Policy pusher Health Promotion/Education programs Smokefree sports/ Physical activity programs Healthy eating programs NHS Primary health care (GPs)

Health Sector Activities Private Sector: Oceania University of Medicine Rotary 5000 program

Successes Resurrection of Primary Health care Tobacco Health Act Smoke-free Schools, workplaces, Public Transportation, clubs etc. Health nutrition programs implemented on all islands Food and drugs act Banning of Turkey tails Country-wide Physical Activity programs

Difficulties Surveillance Information System (PATIS) Minimal integration within the Health sector Reform still new

Challenges Changing the culture Manpower Being Bigger is a sign of wealth Manpower “Many talk few walk” Brain drain

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