1. PSRH BIENNIAL MEETING APIA, SAMOA, 9-12 JULY, 2013 PROF RAJAT GYANESHWAR FIJI NATIONAL UNIVERSITY

2.  BACKGROUND  LITERATURE REVIEW  ANALYSIS OF IMPLICATIONS FOR THE PACIFIC  RECOMMENDATIONS

3. NCDsRH  DIABETES  CARDIOVASCULAR DISEASE  CHRONIC RESPIRATORY DISEASE  CANCER  SEXUAL HEALTH  FAMILY PLANNING AND INFERTILITY  MATERNAL AND CHILD HEALTH  STIs & CANCER

4.  SMOKING - foetal and maternal issues  NUTRITION - Diabetes, hypertension  ALCOHOL - foetal alcohol synd, STIs, preg, cervical ca.  PHYSICAL ACTIVITY - obesity, osteoporosis

5.  MENSTRUAL PROBLEMS  FERTILITY ISSUES  INCREASED PREGNANCY RISKS  URINARY AND FECAL INCONTINENCE  PELVIC FLOOR LAXITY  POST MENOPAUSAL BREAST CANCER  ENDOMETRIAL AND OTHER CANCERS.

6.  Polycystic Ovarian Syndrome – obesity, excessive body hair and anovulation - Common problem in the Pacific - Weight loss is first line of treatment ( Hollmann et al. Human Reproduction. 1996;11:1884-91) - Life style factors important in achieving weight loss. ( Huber-Buchoholz M et al. J Clin Endocrinol Met. 1999;84:1490-4

7.  REDUCED FECUNDITY AND INCREASED TIME TO CONCEPTION ( WiseL LA et al. Human Reprod. 2010; 25:253-264)  HIGH RATES OF INFERTILITY ( British Fertility Society Policy and Practice Guidelines)  LOWER RATES OF SUCCESSFUL PREGNANCY AFTER FERTILITY TREATMENT ( Maheshwari A et al. Human Reproduction Update. 2007;13:433-444)

8. INCREASED RISK OF :  DIABETES (x2 – 5 depending on BMI)  HYPERTENSION AND PET (X3.5)  PRE TERM DELIVERY  LARGE BABY AND SHOULDER DYSTOCIA  CAESAREAN DELIVERY (Linear assoc with BMI)  PPH  PULMONARY EMBOLUS  COST AND LENGTH OF STAY (( W eiss JL et al. Am J Obstet Gynecol 2004, O’Brien TE eta al. Epidemiology 2003, Kabrehel C et al. Obesity 2009, Scott-Pillai R et al 2013, BJOG Torloni MR et al. J Matern Fetal Neonatal Med. 2009)

9.  INCREASED RATES OF : - POST MENOPAUSAL BREAST CANCER - ENDOMETRIAL CANCER - OTHER CANCERS - gut, liver, gall bladder, pancreas and kidney (Renehan AG et al. Lancet 2008;371(9612): 569) (Calle EE et al. N Engl J Med. 2003;348(17):1625)

10.  Each day : 50,000 women die from NCDs 1000 maternal deaths  More women die due to : cardiovascular disease cancer respiratory disease (WHO list of 10 leading causes of death in women)

11.  33% of Fijian women (15-24 age group) are overweight or obese ( 2002 STEPS survey)  Obesity rates have trebled between 1993 and 2004. ( Fiji National Nutrition Survey 2004)  Obesity rates of between 30- 75% reported in 25-64 year olds in the Pacific (STEPS surveys)

12.  SMOKING – 53.2 % of women in Nauru smoke. Rates high for Kiribati,Tokelau, Wallis and Fortuna )  ALCOHOL – 50% Cook Is women  HYPERTENSION – 27.5% American Samoan women  DIABETES – 42.4% - 12%

13.  RISK FACTORS COMMON AND MODIFIABLE  HEALTH PRIOR TO, DURING, AND AFTER PREGNANCY AND CHILDBIRTH CAN HAVE LONG TERM HEALTH IMPLICATIONS  MCH PROGRAMS SHOULD INCLUDE NCD INTERVENTIONS

14.  Empower women and girls to care for their health better – menstrual problems, fertility issues, pregnancy care.  New approach to pregnancy care – weight gain, - nutrition, - cancer screening, - physical activity

15.  Emphasis on health education  Empowering women to take sound decisions about risk taking behaviour.  Take opportunity during antenatal visits to counsel, educate