COSTA RICA 51.200Km Guatemala Honduras El Salvador Nicaragua Panamá Costa Rica 51.200Km

COSTA RICA Population: 4,600,000 (four million six hundred thousand) Life expectancy: 79 years old Social Security coverage: 90% of population Margarita Claramunt Ministry of Health National coordinator of Non Communicable Disease (NCD

Five principle causes of mortality in Costa Rica Ministry of Health, 2011

BIOLOGICAL RISK FACTORS ECNT OF NCD IN COSTA RICA, 2010 Overweight and obesity in adults Total 62% , men 58,4 % women 65, 8% Hipertention in adults 37,8 % CCSS Overweight children< 5 años 8,1% ENN 2009 Diabetes en adultos 10,5 % CCSS Overweight and obesity in adolescentes 21,0%, ENN 2009

BEHAVIOURAL RISK FACTORS ECNT OF NCD IN COSTA RICA, 2010 Fruits and vegetables consumption (>o= 5 portions per day ) Total 22,3% Adult smokers of tobacco Total 14%, Smoking teenagers of tobacco Total 8,9 % Low physical activity in adults 50 % MEN 38% WOMEN 63% Low physical activity in Adolescentes 72% EGA

Some main achievements in Costa Rica in tackling NCDs and their risk factors Law antitbacco and regulation Food regulation in student cafeterias Elimination of trans fats in processed foods Food guide diffusion Food security Policy and National Plan 2011-2021 National Plan in Physical Activity 2011-2021 National Plan to reduce consmption of salt sodium 2011-2021

IMPROVEMENT OF THE QUALITY OF ATTENTION IN HIPERTENTION Intervention to improve NCD in health care system IMPROVEMENT OF THE QUALITY OF ATTENTION IN HIPERTENTION AND DIABETIC PATIENTS CROSS SECTION METHODOLOGY Establish national standards to measure quality attention using indicators and instruments in different phases: diagnosis, process and results. Elaboration of Guidelines in Hipertention and Diabetes

Results of the evaluation in health services Net Equipments badly calibrated in 3 levels of attention (local, regional and national) Lack of knowledges of health professionals in the levels of hypertention and diabetes Lack of knowledges in the correct measurement of the arterial pressure by doctors and nurses Lack of information to the patients on the management of their disease ACTIONS Implementation of a Plan to improve the quality attention of the patients Calibration of equipments every 6 months in public health services Training to health professional in measuring the arterial pressure and knowledge of the hypertention levels and diabetes levels - Group methodology of innovative nutritional education

Multisectorial intervention to reduce risk factors in NCD Food regulation in school cafeteria Decree of Ministry of Education and Ministry of Health (2012) to regulate saturated fat, sugar, sodium and calories of food that is offered in school cafeterias Results Food industry started to reduce fat, sugar and sodium in some processed food Training to supervisors of cafeterias in schools Information, education and communication to students, teachers,parents and education community about healthy food and food that is not allowed because of its high content in sugar, salt and fat. No evaluation yet about nutritional habits but is in process.

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