1. Achievements in NCD Surveillance English-speaking Caribbean
Dr. Glennis Andall-Brereton
Caribbean Epidemiology Centre (CAREC/PAHO/WHO)
WHO-IUMSP International Seminar on the Public Health Aspects of NCDs
Lausanne, Switzerland,
August 10-18, 2010

2. Outline of Presentation
Introduction and background
Achievements in NCD and Risk Factor surveillance
Plans for the biennium ( )

3. Introduction and Background

4. CAREC Member Countries
Population Grouping
Country
<100,000
Anguilla
Antigua and Barbuda
Bermuda
British Virgin Islands
Cayman Islands
Dominica
Montserrat
St. Kitts and Nevis
Turks and Caicos Islands
>=100,000 to <=400,000
Aruba
Bahamas
Barbados
Belize
Grenada
Netherlands Antilles
St. Lucia
St. Vincent and the Grenadines
>400,000
Guyana
Jamaica
Suriname
Trinidad and Tobago
CAREC provides epidemiological support to 21 Member Countries
English and Dutch speaking
Bermuda in the North to Suriname in the South
Varying population sizes
Montserrat, 4,681 – Jamaica, 2,600,723
Countries have well developed primary health care systems, secondary care services and some tertiary care services mainly in larger countries

7. Leading Causes of Death in CARICOM Countries by Sex, 2004
MALES
FEMALES
Heart Disease
Cancers
Injuries and violence
Stroke
Diabetes
HIV/AIDS
Hypertension
Influenza/pneumonia
Heart Disease
Cancers
Diabetes
Stroke
Hypertension
HIV/AIDS
Influenza/pneumonia
Injuries and violence

8. Recognizing the Problem & Commitment to the surveillance of NCDs
Recommendation of CAREC’s Scientific Advisory Committee – 2002
Report of Caribbean Commission on Health and Development
Prime Ministerial Summit on NCDs
Declaration of Port of Spain,
“That we will establish, as a matter of urgency, the programmes necessary for research and surveillance of the risk factors for NCDs with the support of our Universities and the Caribbean Epidemiology Centre/Pan American Health Organization (CAREC/PAHO);”

9. Achievements in NCD and Risk Factor Surveillance

10. Development of Regional NCD Minimum Data Set Background
2003
CAREC NCD Minimum Data Set Developed and Agreed (Epidemiologists Meeting)
2006
Regional Strategy and Plan on Action for Chronic Disease for the Americas approved
PAHO HQ agreed to use NCD Minimum Data Set developed by CAREC as starting point for developing NCD Minimum Data Set for Americas
2007
PAHO Inter-programmatic Chronic Disease Surveillance Working Group established
Representation from countries in the Americas
Agencies: PAHO, WHO, CAREC, PHAC,CDC
(March June 2008) – NCD Minimum Data Set developed for the Region of the Americas
Stepwise approach - core, expanded and optional

11. Declaration of Port of Spain
Prime Ministerial Summit on NCDs
Declaration of Port of Spain
“That we will establish, as a matter of urgency, the programmes necessary for research and surveillance of the risk factors for NCDs with the support of our Universities and the Caribbean Epidemiology Centre/Pan American Health Organization (CAREC/PAHO);”

12. Minimum Data Set for NCD Surveillance Components
Mortality from/with selected NCDs (12 core indicators)
Age-standardized mortality rates per 100,000 population
PYLL (potential years of life lost) per 100,000
Prevalence/incidence selected conditions (6 core indicators)
Risk factors for chronic diseases :
Adult ( 17 core indicators) & Youth (8 core indicators)
Health System Performance Indicators (19 indicators - 9 core)
Socioeconomic and context indicators (16 indicators – 5 core)

13. Implementing NCD Minimum Data Set in the Caribbean
August Training to Pilot NCD Minimum Data Set
Bahamas, Barbados, Belize, Bermuda, Cayman Islands and Dominica
March Meeting for Evaluation of the Pilot
March-September 2009 – Revision of NCD Minimum Data Set based on outcome of Pilot
October – Training for the Implementation of the Minimum Data Set in CAREC Member Countries
18 countries participated (Epidemiologists & NCD Focal Point)
Agreed start date for annual country reporting on NCD Minimum Data Set to CAREC: May 2010

14. Status of Country Reporting on Regional NCD Minimum Data Set
Reports submitted to date:
7 countries: BVI, Barbados, Bermuda, Dominica, St. Lucia, St. Kitts and Nevis, St. Vincent and the Grenadines
Missing data
Additional time requested for reporting:
5 countries: Aruba, Bahamas, Belize, Jamaica, Montserrat, Suriname
No reports or contact with CAREC
Anguilla, Antigua, Cayman Islands, Curacao, Grenada, Guyana, Trinidad and Tobago, Turks and Caicos Islands

15. Implementing Risk Factor Surveillance Using STEPS Methodology

16. The Survey Methodology Pan Am STEPS
Standardized system for surveillance of chronic disease risk factors
Designed for implementation in low and middle income countries
Assesses biological and behavioural risk factors
Flexible : Allows different levels of assessment of risks
STEP 1 Questionnaire
STEP2 Physical measurements
STEP 3 Biochemical measurements
Core, Expanded and Optional Modules
Individual randomly selected for interview at the household level

17. Implementing Risk Factor Surveillance
6 countries have completed National Risk Factor Surveys using the Pan Am STEPS methodology as a starting point for surveillance of RFs for chronic diseases:
2005 Bahamas
2007 Aruba
2008 Barbados, Dominica, St. Kitts
2009 British Virgin Islands
First country to use Electronic Methodology (E-STEPS)

18. Prevalence of Overweight Persons (BMI ≥25 kg/m2) by Gender

19. Comparison of Physical Activity and Overweight

20. Comparison of the Prevalence of Current Drinkers and of Binge Drinking (harmful use of alcohol)

21. Mean Daily Servings of Fruits and Vegetables

22. Risk for Development of Chronic Diseases
Raised Risk ≥ 3 risk factors

23. Implementing Risk Factor Surveillance contd..
Two other countries completed National RF surveys using different methodologies and questionnaires
Jamaica (2001 & 2008) Lifestyle Survey-Tropical Medicine Research Inst.
Belize (2007) CAMDI Project

24. Implementing Risk Factor Surveillance in the Caribbean contd..
Ten (10) other countries trained in implementing RF surveys using Pan Am STEPS methodology and involved at various stages of the planning process
Anguilla
Bermuda
Curacao
Grenada (fieldwork 2010)
Guyana
Nevis (Part of the Federation of St. Kitts and Nevis)
St. Lucia
St. Vincent and the Grenadines
Suriname
Trinidad and Tobago (fieldwork 2010)
Turks and Caicos Islands
2nd National RF Survey
Bahamas (fieldwork 2010)

25. Providing Feedback on CD & NCD Surveillance in the Caribbean
Developing and implementing an Integrated Surveillance System at CAREC
Infobase
Caribbean CHARTS
Being developed in collaboration with the PAHO Health Information Platform (PHIP) to facilitate:
Country use of CD & NCD information for planning and programming
Sub-Regional Reporting on POS Declaration
Advocacy

26. Outputs of Integrated Surveillance System (NCD and CD)
Country profiles
Sub-Regional profiles
Age-specific profiles
Disease profiles
Maps
Ad-hoc queries

27. Chronic Disease Profile

28. Plans for 2010-2011 Continue technical support to countries:
Reporting on NCD Minimum Data Set
Implementing risk factor surveillance
Development and implementation of routine data collection on limited number of morbidity indicators for chronic disease
e g. amputations, incident heart attacks, retinopathy
Revision of Country Surveillance Manuals to include indicators on NCDs along with CD indicators.

29. Plans for contd….
Develop and implement multimode approach to risk factor surveillance to accomplish continuous surveillance of risk factors
Addition of few selected risk factor indicators to routine country surveys eg. Labour Force Surveys, National census
Addition of selected risk factor indicators to routine primary health care data collection e.g., clinic registration information, patient record cards
Collection of risk factor data on segments of the population e.g. use of telephone interviews etc.
Provide technical support to encourage/strengthen use of Disease Registries
Develop and implement proposals for conducting research in the area of cervical cancer prevention and control

30. Thank You for Your Kind Attention