NCD Control Programmes IRAN-MINISTERY OF HEALTH & EDUCATION

NCDC includes offices: Surveillance Genetic diseases & maternal anomalies Cancer control Cardiovascular diseases Endocrine Oral health control Eye( vision) Asthma & CRD Epidemiology and statistics group

Burden attributable to 16 leading risk factors in :Iran, 2003 100000 200000 400000 300000 50000 150000 450000 250000 350000 Obesity and over weight Blood pressure Physical inactivity Cholesterol Drug abuse Unsafe water, hygiene Ergonomic stressor Anaemia Tobacco Use Indoor smoke from fuels Diabetes Mellitus COPD Low fruit &vegetable Unsafe sex Alcohol Underweight It is perhaps of no surprise that 97% of the deaths attributable to the leading 16 selected risk factors in developed countries in 2000 were related to noncommunicable (NCD) disease risk factors. What is more surprising is that more than one third (38%) of the deaths attributable to these leading risk factors were related to noncommunicable (NCD) disease risk factors in High Mortality Developing countries. The equivalent deaths attributed to NCD risk factors in Low Mortality Developing countries was 77% 4 4

DIABETES CONTROL & PREVENTION PROGROM INTEGRATION planned in: 1997 by INDAC(national diseases control advisory committee )& Center for Disease Control (CDC). Implemented in pilot areas covering 25 districts in 1999 People aged 30 and above, and pregnant women resident in the area screened. pilot programme was revised in 2002 The Program was implemented in the primary health care system (rural) in 2004 Screening & case finding was started in the whole rural areas of the country

Cancer registry in Iran Cancer is the third cause of mortality and morbidity in Iran. The law of obligatory record and report of cancer was approved by Islamic legislature in October 1984 Revised in 1992 by Cancer Office in The CDC Was implemented in 1995 across the country Improved and became automated and computerised in 2000 38000 cancer cases collected from pathology centres from all over the country in 2004 as the first result It is estimated that more than 70,000 of new cases occur in Iran annually More than 30,000 Iranians die with cancer annually According to this law, all medicinal agencies, pathology and medical diagnosis laboratories (public or private) are obliged to examine any tissue or organ taken from a human body for any reason to “diagnose, treat, and research”, and report privately the biopsy result and necessary information to the related authorities. In 2007, about 62040 new cases of cancer were registered, the data are being analyzed. (completeness will be over 86.7%) Common cancers in men : 1-Skin 2-Stomach 3-Bladder 4-Prostate 5-Colon & Rectum Common cancers in Women : 1-Breast 2-Skin 3-Colon & Rectum 4-Stomach 5-Esophagus

High Blood Pressure Control Programme Main goal: Control of HBP & its complications. Started in : 1992 in pilot areas covering areas under coverage of the 6 Medical universities. Integrated in the whole rural areas of Iran in:1994 Main activities: Taking blood pressure of people aged 30 and above, in three years interval. Results of reviewing and evaluating the programme in 2002: Coverage 92%, HBP 9%, At risk people under care programme 95%

The National Newborn Screening Program for Congenital Hypothyroidism 1,200,000 births / Year Cost-benefit ratio = 1 to 15 Designed in 1382 Piloted in 1383 Implemented in the Health System In Mehr 1388

congenital hypothyroidism Results: from Jun 2004 till march 2008 Newborns Screened : 1,685,672 Male:48.6% Female:51.4% Diagnosed Patients: 3990 (both permanent & transient) Coverage = > 90%

Thalassaemia control programme as a model for Iran’s 1997))community genetics programme   Results of Thalassaemia Screening Prognance ( 2008-2009) Coverage: 100% Carrier Couples Detected: 86% PND (Prenatal Diagnosis) Coverage: 800%( Refrence is to year,1997) Prevention Rate: 75% Couples Screened: 98,344

Pilot programs Colorectal cancer Screening and prevention General program of cancer control Cardiovascular prevention programme Skin cancer Screening and prevention Institution of Health Providing Sites (HPSs)

Proposal ( not yet done ) Cervical cancer screening and prevention Breast cancer Screening and prevention MI registry DIABETES CONTROL & PREVENTION PROGROM in town

Thank you for your attention

MEAN Waist circumference IN 4 NATIONAL SURVEY IN IRAN