NCD situation in Samoa Dr Carmichael Patu MBBS

NCD situation in Samoa Dr Carmichael Patu MBBS Lecturer Oceania University of Medicine Samoa

How I got here…

Finally…. .

Samoa • Total Land Area: – 2934 km 2 • Population: – 180, 741 – 56% (15 -65) – Mean Age- 20. 5 • Average Life Expectancy: – Male- 71. 5 yrs – Female- 74. 2 yrs • Source: Samoa Census 2006

Health System structure • Health reform 2006 • Public Sector – MOH • Regulatory role – NHS • Service provider • Private Sector • GPs Association • NKF • OUMS SAMOA HEALTH SECTOR

Lets get into it now

The biggest killers…(Mortality) ICD- Code Description of Underlying Cause Sex Male 1 E 10 -E 14 Diabetes Mellitus 2 C 00 -D 48 Cancers (All sites) 3 I 60 -I 69 Cerebrovascular Diseases 4 I 26 -I 51 5 Female Total 33 20 53 24 22 46 20 22 42 Ischaemic Heart Diseases 20 15 35 J 12 -J 18 Pneumonia 17 12 29 6 A 40 -A 41 Septicaemia 12 13 25 7 S 00 -T 65 Injuries & Poisoning 18 6 24 8 I 20 -I 25 Other Heart Diseases 13 3 16 9 I 10 -I 14 Hypertension Diseases 4 10 14 Liver Diseases 8 4 12 10 K 71 -K 92 Source: Annual Report: PATIS / WHO ICD-10 (2007 -2008) NCDs

Ten leading causes of Morbidity (2007 -2008) ICD- Code Diseases Description 1 J 12 -J 18 Pneumonia 1, 427 2 O 20 -O 29, O 67 -O 71, O 70 O 75, O 81 -O 84 Other complications of pregnancy and delivery 1, 066 3 S 00 -T 65 Injuries and Poisoning 852 4 L 00 -L 08 Infections of skin and subcutaneous tissue 761 5 E 10 -E 14 Diabetes Mellitus 599 6 J 20 -J 21 Acute Bronchitis and acute bronchiolitis 436 7 I 10 Essential (primary) hypertension 412 8 O 30 -O 43, O 47 -O 48 Other maternal care related to fetus and amniotic cavity 318 9 A 09 Diarrhea and gastroenteritis 310 10 A 01 Typhoid and paratyphoid fevers 274 Source: PATIS (Patient Information System) Number

NCD outlook in Samoa • Data collection: – Utilization of WHO STEPwise approach to chronic disease risk factor surveillance (STEPS) – Step 1 • Demographic information • Behavioural measurements (SNAP) – Step 2 • Physical measurements (BP, HR, BMI, WC) – Step 3 • Biochemical measurements (Glucose, Lipids)

Samoa STEPS • Implemented in 2002 • Population studied: – 25 -65 ys – 2804 (total) • Some issues: – Yet to be published – Problems with data entry – Manpower issues

Samoa NCD Risk Factors STEP report: • Smoking status – 40. 3 % – 2 in every 5 adults • Alcohol use – 29. 4 % (current drinkers) • Diet – 35. 6% have fruitless diets – Tinned fish was the most popular

Samoa NCD Risk Factors STEP report: • Physical Activity: – 50. 3% were physically inactive – 1 in 2 • Obesity/Overweight: – 85. 2% were classified as overweight – Women > men – Mean BMI – 31. 4 kg/m 2 • Hypertension: – 21. 2% were identified as Hypertensives – 1 in 5 adults

Samoa NCD Risk Factors STEP report: • Diabetes: – 21. 5 % were found to be Diabetics – 1 in 5 adults – 16. 7% - impaired Fasting Glucose levels – 38. 2% with Diabetes and Pre-Diabetes • Blood Cholesterol: – 13. 7% - levels > 5. 2 mmol/L • 33. 8% of the adult population had at least 3 of the 5 risk factors studied (1 in 3 adults)

What is the Samoa Health Sector doing about it? • Top Health priority • NCD Policy 2010 – Spearheaded by the MOH • Key Areas: n. Strengthen health promotion and primordial prevention n. Quality health care service delivery n. Governance, Human Resources for Health and Health System Strengthening n. Health Financing n. Partnership Commitment n. Donor Participation and Harmonization

Health Sector Activities • MOH – Regulator – Policy pusher – Health Promotion/Education programs • Smokefree sports/ • Physical activity programs • Healthy eating programs • NHS – Primary health care (GPs)

Health Sector Activities • Private Sector: – Oceania University of Medicine • Rotary 5000 program

Successes • Resurrection of Primary Health care • Tobacco Health Act – Smoke-free Schools, workplaces, Public Transportation, clubs etc. • Health nutrition programs implemented on all islands – Food and drugs act – Banning of Turkey tails • Country-wide Physical Activity programs

Difficulties • Surveillance • Information System (PATIS) • Minimal integration within the Health sector • Reform still new

Challenges • Changing the culture – Being Bigger is a sign of wealth • Manpower – “Many talk few walk” – Brain drain

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