1. Ministry of Health and Population Preventive and Primary Health Care Sector 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

2. Geography

3. Introduction Chronic diseases represent a major problem and public health burden in developing countries. It represents 73% of deaths and 60% of global disease burden.

4. I n 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 diseases…etc) 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

6. Stepwise Surveillance STEP 1 Self Report –Demographics –Physical activity –Diet –Smoking –Alcohol –NCD’s STEP 2 Physical –Height –Weight –BP –Waist circumference STEP 3 Biochemical –Fasting glucose –Cholesterol –Triglycerides –HDL

7. The 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

8. 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.

9. Sampling 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

10. Sampling 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

12. Results of Egypt Steps survey Step 1

13. Sample size Out of 10,000 a total of 9780 adults participated in the Egyptian Steps survey. The overall response rate was 97.8%

14. Population Pyramid of Egypt

15. Age distribution by Gender of 9870 Egyptian participants

16. Prevalence Of Education Achieved By The Survey Participants

17. Employment Status Of Participants

18. Prevalence of Tobacco smokers

19. Burden of smoking

20. Prevalence of Alcohol consumption Percentage of current drinkers (who drank alcohol in the past 12 months)

21. For those who drank alcohol in the last 12 months

22. Percentage who ate 5 or more combined servings of fruit & vegetables per day

23. Physical activity Percentage with low levels of activity (defined as <600 MET-minutes/week)

24. Results of Egypt Steps survey Step 2

25. Physical Measurements (Overweight and obesity)

26. Prevalence of Hypertension (Percentage with raised BP)

27. Results of Egypt Steps survey Step 3 Biochemical Measurements

28. Prevalence of Diabetes Percentage with raised fasting blood glucose (≥ 7.0 mmol/L)

29. Prevalence of raised total Cholesterol

30. Conclusion and Recommendation Stepwise 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

31. Conclusion & 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.

32. Thank You