World Health Statistics 2012

World Health Statistics 2012 is the World Health Organization’s annual report of health-related data from all 194 WHO member states. The report includes a summary of the progress made towards achieving the health-related Millennium Development Goals and associated targets. This year, it also includes highlight summaries on the topics of noncommunicable diseases, universal health coverage and civil registration coverage.

Select data from the report:

• Measles deaths declined by 74% between 2000 and 2010.
• In 2010, 85% of children age 12-23 months worldwide were immunized against measles.
• Hypertension is considered directly responsible for 7.5 million deaths in 2004–about 12.8% of all global deaths.
• In Africa, more than one third of people are estimated to have high blood pressure and this condition is increasing.
• Globally, 2.8 million people die each year as a result of being overweight or obese.
• Worldwide prevalence of obesity almost doubled between 1980 and 2008.
• In 2008, 10% of men and 14% of women (half a billion people) in the world were obese.

The report is available in English, French and Spanish.

Citation:
1. World Health Organization. World Health Statistics 2012. Geneva: WHO, 2012.

Using HIV programs to support NCD services

Although HIV and non-communicable diseases (NCDs) are traditionally thought of as two very different health challenges, some of the systems, tools and approaches developed for HIV programs could be used for NCDs as well, according to an article published in the Journal of Acquired Immune Deficiency Syndromes.

The availability of treatment has transformed HIV into a chronic condition, and local HIV program in low- and middle-income countries have the capability to support continuity care. For example, the appointment books, defaulter tracking, patient counseling, medical records, standardized treatment protocols, referral networks, and linkages to laboratory and pharmacy services available through HIV clinics—and all critical for continuity care—could be used for diabetes and hypertension services.

“Strengthening health systems to deliver continuity care is likely to enhance the performance of both HIV and NCD programs and is a shared priority,” the article concludes.

Citation:
1. Rabkin M, Nishtar S. Scaling up chronic care systems: Leveraging HIV programs to support noncommunicable disease services. Journal of Acquired Immune Deficiency Syndromes 2011; 57: s87-s90. (open access)

Case management guide for diabetes, heart disease and related conditions

The UK Department for International Development has made available Type 2 Diabetes, Cardiovascular Disease, Obesity and Hyperlipidaemia Care in Adults: Case Management Desk Guide. This document guides health care workers on the screening, detection and management of type 2 diabetes and its related conditions (hypertension, obesity, high cholesterol, alcoholism and smoking). The guide is currently in draft form.

Click here to access a PDF of the guide.

High blood pressure, high cholesterol and diabetes rates in Switzerland

High blood pressure, high cholesterol and diabetes rates in Switzerland have increased in the last decade, according to data from three national health surveys conducted in 1997-2007.

The prevalence of self-reported hypertension, hypercholesterolemia and diabetes was 22.1 percent, 11.9 percent and 3.3 percent in 1997, respectively; and increased to 24.1 percent, 17.4 percent and 4.8 percent in 2007.

Self-reported treatment rates among people with these three cardiovascular risk factors also increased from 52.1 percent, 18.5 percent and 50 percent in 1997 to 60.4 percent, 38.8 percent and 53.3 percent in 2007 for hypertension, hypercholesterolemia and diabetes, respectively.

Self-reported control levels increased from 56.4 percent, 52.9 percent and 50 percent in 1997 to 80.6 percent, 75.1 percent and 53.3 percent in 2007. Finally, screening during the last 12 months increased from 84.5 percent, 86.5 percent and 87.4 percent in 1997 to 94 percent, 94.6 percent and 94.1 percent in 2007.

Source:
1. Estoppey D, Paccaud F, Vollenweider P, Marques-Vidal P. Trends in self-reported prevalence and management of hypertension, hypercholesterolemia and diabetes in Swiss adults, 1997-2007. BMC Public Health 2011; 11: 114. (open access)

Improving diabetes and hypertension guidelines in Barbados

A study has shown numerous deficiencies in the quality of hypertension and diabetes primary care in Barbados, despite distribution of regional guidelines.

Current hypertension and diabetes guidelines were considered by some primary health care providers to be outdated, unavailable, difficult to remember and lacking in advice to tackle barriers. Practitioners thought that guidelines should be circulated widely, promoted with repeated educational sessions and kept short. Patient-oriented versions of the guidelines were welcomed.

Patient factors causing barriers to ideal outcome included denial and fear of stigma; financial resources to access an appropriate diet, exercise and monitoring equipment; confusion over medication regimens, not valuing free medication, belief in alternative medicines and being unable to change habits.

System barriers included lack of access to blood investigations, clinic equipment and medication; lack of human resources in polyclinics; and an uncoordinated team approach.

Patients faced cultural barriers with regards to meals, exercise, appropriate body size, footwear, medication taking and taking responsibility for one’s health; and difficulty getting time off work to attend a clinic.

Suggestions for how the health care system could help providers improve the health of those with diabetes and hypertension included educating both the public and persons with the condition, screening programs, providing free home monitors and adequate staffing.

Suggestions for how the wider society could help providers improve the health of those with diabetes and hypertension involved educational outreach to promote family support in managing the condition (cooking, encouraging exercise, giving insulin); a greater role for volunteer groups and retired persons in providing education, support, exercise groups and screening programs; starting associations for hypertension, hyperlipidemia and diabetes; the provision by the government of sidewalks and bicycle lanes for safe exercise; healthy food choices at schools and work places; a tax on unhealthy fast food and an attempt to bring down the cost of healthy food by the government; a requirement that fast food outlets provide healthy alternatives; labeling of all food to include fat, salt and calorie content; encouraging a kitchen garden program; time off by employers to attend appointments; and prominent persons with the disease should speak out to reduce stigma, and give hope that a good life can be had while living with chronic disease.

Source:
1. Adams OP, Carter AO. Diabetes and hypertension guidelines and the primary health care practitioner in Barbados: knowledge, attitudes, practices and barriers-a focus group study. BMC Family Practice 2010; 11: 96. (open access)

Famine linked to non-communicable diseases in Nigeria

Fetal and infant undernutrition is associated with significantly increased risk of hypertension, overweight and impaired glucose tolerance or diabetes among Nigerians who were born during the famine that afflicted the Biafra region of Nigeria during its civil war (1967-1970). Of the one to three million Igbo people that are estimated to have lost their lives during the Nigerian Civil War, only about 10 percent died of military violence. The majority succumbed to starvation.

 Prevention of undernutrition during pregnancy and in infancy should therefore be given high priority in health, education and economic agendas.

 Source:
1. Hult M, Tornhammar P, Ueda P, et al. Hypertension, diabetes and overweight: looming legacies of the Biafran Famine. PLoS ONE 2010; 5(10): e13582. (open access)

Labeling patients as prehypertensive

Studies have shown that labeling patients as “hypertensive” has some negative effects. But a new study has found that informing patients that they have prehypertension as part of a message designed to prevent hypertension does not seem to be harmful.

However, labeling patients as prehypertensive does not seem to be helpful, either. The study found no evidence that it motivates people to adopt recommended lifestyle changes that help prevent hypertension.

“The most important lesson from this study may be that a clinical strategy currently plays a limited role in the prevention of hypertension,” the study researchers said.

A person’s lifetime risk of hypertension is estimated to be 90 percent in the United States. Therefore, almost all Americans are prehypertensive, according to the study.

Population-level strategies (e.g., sodium reduction in the food and restaurant industry and efforts to combat obesity and physical inactivity) hold much more promise for preventing hypertension.

Source:
1. Viera AJ, Lingley K, Esserman D. Effects of labeling patients as prehypertensive. Journal of the American Board of Family Medicine 2010; 23: 571–583. (open access)

Air pollution linked to emergency hospital visits for hypertension

A study conducted in Beijing found that elevated concentrations of gaseous air pollutants were associated with emergency hospital visits for hypertension. The findings provide additional information about the health effects of air pollution, and may have implications for planning local environmental protection and public health interventions in China.

Source:
1. Guo Y, Tong S, Li S, et al. Gaseous air pollution and emergency hospital visits for hypertension in Beijing, China: a time-stratified case-crossover study. Environmental Health 2010; 9: 57. (open access)

Cardiovascular disease risk factors in Uganda

A study has found that more than 22 percent of men and women in Uganda have high blood pressure. While prevalence of other cardiovascular disease risk factors were not as high, the study said that population-based data on the burden of these risk factors can aid in the planning and implementation of an effective response to the double burden of communicable diseases and non-communicable diseases in Uganda and other low-income countries undergoing an epidemiological transition.

The prevalences of diabetes and high blood sugar were 0.4 percent and 2.9 percent, respectively. But most Ugandans with diabetes or hyperglycemia were not aware of it. Less than one percent of men and four percent of women were obese, with 3.6 percent of men and 14.5 percent of women being overweight. The proportions of male and female smokers were only 13.7 percent and 0.9 percent, respectively.

Existing research infrastructure for HIV surveys in Africa can provide a platform for assessing the prevalence of other conditions such as cardiovascular disease risk factors, according to the study.

Source:
1. Maher D, Waswa L, Baisley K, et al. Distribution of hyperglycaemia and related cardiovascular disease risk factors in low-income countries: a cross-sectional population-based survey in rural Uganda. International Journal of Epidemiology, published online 5 Oct 2010. (open access)

Non-communicable disease risk factors in rural India

India’s current epidemic of non-communicable diseases has resulted from increased urbanization, changing lifestyles and people living longer. But a study has found that non-communicable disease risk factors, including tobacco smoking and obesity, are strikingly high even among rural populations.

The study focused on rural populations because two thirds of India’s one billion people still live in rural areas. Rural populations have limited access to health care and can least afford to pay for the high treatment costs associated with chronic conditions.

The prevalence of non-communicable (NCD) risk factors was the following:

• Tobacco use (40 percent men, four percent women)
• Low fruit and vegetable intake (69 percent men, 75 percent women)
• Obesity (19 percent men, 28 percent women)
• High cholesterol (33 percent men, 35 percent women)
• Hypertension (20 percent men, 22 percent women)
• Diabetes (six percent men, five percent women)
• Underweight (21 percent men, 18 percent women)

Read more at Suite101.com.

Source:
1. Kinra S, Bowen LJ, Lyngdoh T, et al. Sociodemographic patterning of non-communicable disease risk factors in rural India: a cross sectional study. BMJ 2010; 341: c4974. (open access)