Jabbar, Abdul

Wasay, Mohammad

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eCommons@AKUDepartment of Medicine Department of MedicineApril 2009Fight against chronic diseases (High bloodpressure, Stroke, Diabetes and Cancer) in Pakistan;cost-effective interventionsMohammad WasayAga Khan UniversityAbdul JabbarAga Khan UniversityFollow this and additional works at: http://ecommons.aku.edu/pakistan_fhs_mc_med_medPart of the Endocrinology, Diabetes, and Metabolism Commons, Nervous System DiseasesCommons, and the Neurology CommonsRecommended CitationWasay, M., Jabbar, A. (2009). Fight against chronic diseases (High blood pressure, Stroke, Diabetes and Cancer) in Pakistan; cost-effective interventions. Journal of Pakistan Medical Association, 59(4), 196-197.Available at: http://ecommons.aku.edu/pakistan_fhs_mc_med_med/131The burden of chronic diseases including High BloodPressure, Stroke, Diabetes and cancer was re emphasized byWorld Health Organization in 2005 as neglected global healthissues.1 These diseases were responsible for more than 60%deaths (35 Million) worldwide and 80% of these deathsoccurred in developing countries including Pakistan.2Age adjusted death rate related to Chronic diseaseswas estimated to be 750 per 100,000 population translatinginto 0.15 Billion US Dollar GDP loss.2Pakistan has the world's sixth largest population (165million in 2007) which is continuously growing at about1.83% every year. We know from our national heath surveysthat 33% of Pakistani population above the age of 45 hashypertension.3 Further analysis of this data revealed that theprevalence is 19% (95% CI; 18.9-19.1) in people of age 15 orabove.4 Moreover, Pakistan ranks at number six in terms ofnumber of people with diabetes worldwide. It was estimatedthat in 2000 there were 5.2 million diabetic patients and thiswill rise to 13.9 million by 2020, leading Pakistan to 4th mostpopulous country for patients with diabetes mellitus.5According to the National Health Survey of Pakistan, 25% ofpatients over the age of 45 years suffer Diabetes Mellitus.Further analysis of this data revealed that prevalence of DMamong population aged 15 years and above was 5.4% (95%CI; 4.9-5.9) with significant ethnic differences.6 Prevalence ofsmoking has been reported to be 14-21% in adolescents andadults, being more common in men.7-9 The estimated annualincidence of stroke in Pakistan is 250/100,000, translating to350,000 new cases every year.10Authorities have suggested four major, cost effectiveinterventions to fight against epidemic of these diseases indeveloping countries. It is estimated that scaling up of theseinterventions will avert more than 10 Million deaths in next 8-10 years.11 These four interventions include Low salt intake,smoking cessation, physical activity or exercise and costeffective pharmacological therapy.The reduction of salt intake has a robust effect onblood pressure based on current evidence. The human bodyrequires about 50 mg of Sodium daily. WHO recommendeddaily salt requirement to be 5 grams per day (one tea spoon).12WHO also recommended a five pronged approach fortobacco control; 1) increase in taxation, 2) comprehensive banon smoking at work place, 3) warnings about tobacco, 4) banon tobacco advertising and 5) media campaign againstsmoking. It is estimated that over 3 years these interventionsmay lead to 24% reduction in smoking.13,14The beneficial effect of physical activity has beendemonstrated by many trials. Data from more than 40observational studies showed clear evidence of an inverserelation ship between physical activity and all causemortality.15 Regular physical activity of about forty fiveminutes daily is associated with a significant 20-30%reduction in risk of all cause mortality.16These cost effective interventions are not easy toimplement. Although cost more than one dollar per person peryear yet it translates into about 150 Million USD initially toimplement these interventions in Pakistan.17 They requiresubstantial life style modifications and involvement of allstake holders most importantly Government, physicians,professional organizations, Non Governmental organizations(NGO)  and Media. Strong advocacy efforts are needed togather all these stake holders at one platform to startproductive, coordinated activities.18 Recently, representativesof governments of various Asian and African countriesgathered at Kampala, Uganda for first Asian and AfricanChronic Disease Summit. The summit was attended by WHOofficials, public health specialists, researchers, members ofvarious NGOs and academicians from 23 Asian and Africancountries. The participants agreed to "Implement WHO Noncommunicable disease action plan, create the basis for amultisectorial NCD alliance in Asia-Africa, and to accelerateprogress by sharing resources, expertise and experiences topromote an integrated and evidence based approach to reducethe health and economic burdens of chronic diseases"(Kampala Statement). We believe that a sense of urgency is needed for sucha multisectorial alliance at the national level in Pakistan.Chronic diseases are controllable and preventable. Hundredsand thousands of lives could be saved by moderate,coordinated efforts.  References1. WHO. Preventing chronic diseases: A vital investment: WHO global report,Geneva: World Health Organization, 2005.Vol. 59, No. 4, April 2009 196EditorialFight against chronic diseases (High blood pressure, Stroke,Diabetes and Cancer) in Pakistan; cost-effective interventionsMohammad Wasay,1 Abdul Jabbar2Department of Medicine, Section of Neurology,1 Endocrinology,2 Aga Khan University, Karachi.2. Abegunde DO, Mathers CD, Adam T, Ortegon M, Strong K. The burden andcosts of chronic diseases in low-income and middle-income countries. Lancet2007; 370:1929-38.3. Chronic diseases. National Health Survey of Pakistan; 1990-94. Health profile ofpeoples of Pakistan. Pakistan Medical Research Council 1998; 49-69.4. Jafar TH, Rahbar MH, Khan AQ, Hattersley A, Schmid CH, Chaturvedi N.Ethnic subgroup differences in hypertension in Pakistan. J Hypert 2003;21:905-12.5. Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of Diabetes:estimates for year 2000 and projections for 2030. Diabetes Care 2004; 27:1047-53.6. Jafar TH, Levey AS, White FM, Gul A, Jessani S, Khan AQ, Jafary FH, SchmidtCH, Chaturvedi N. Ethnic differences and determinants of diabetes and centralobesity among South Asians of Pakistan. Diabet Med 2004; 21:716-23.7. Alam SE. Prevalence and pattern of smoking in Pakistan J Pak Med Assoc 1998;48:64-6.8. Rozi S, Akhtar S, Ali S, Khan J. Prevalence and factors associated with currentsmoking among high school adolescents in Karachi, Pakistan. Southeast Asian JTrop Med Public Health 2005; 36:498-504.9. Ahmad K, Jafary F, Jehan I, Hatcher J, Khan AQ, Chaturvedi N, Jafar TH.Prevalence and predictors of smoking in Pakistan: results of the National HealthSurvey of Pakistan. Eur J Cardiovasc Prev Rehabil 2005; 12:203-8.10. Khealani BA, Wasay M. Burden of stroke in Pakistan. Int J Stroke 2008; 3:293-6.11. Gaziano TA, Galea G, Reddy KS. Scaling up interventions for chronic diseaseprevention: the evidence. Lancet. 2007; 370:1939-46.12. WHO. Diet, nutrition and the prevention of chronic diseases; report of a jointWHO/FAO expert consultation. WHO Technical report series, No 916. Geneva,Switzerland: World Health Organization, 2003.13. Shibuya K, Ciecierski C, Guindon E, Bettcher DW, Evans DB, Murray CJ; WHOFramework Convention on Tobacco Control: development of an evidence basedglobal public health treaty. BMJ 2003; 327:154-7.14. Asaria P, Chisholm D, Mathers C, Ezzati M, Beaglehole R. Chronic diseaseprevention: health effects and financial costs of strategies to reduce salt intakeand control tobacco use. Lancet. 2007; 370:2044-53.15. Kahn EB, Ramsey LT, Brownson RC, Heath GW, Howze EH, Powell KE, StoneEJ, Rajab MW, Corso P. The effectiveness of interventions to increase physicalactivity. A systematic review. Am J Prev Med 2002; 22(4 Suppl):73-107.16. Lee IM, Skerrett PJ. Physical activity and all-cause mortality: what is the dose-response relation? Med Sci Sports Exerc 2001; 33(6 Suppl):S459-71.17. Lim SS, Gaziano TA, Gakidou E, Reddy KS, Farzadfar F, Lozano R, Rodgers A.Prevention of cardiovascular disease in high-risk individuals in low-income andmiddle-income countries: health effects and costs. Lancet 2007; 370:2054-62.197 J Pak Med Assoc

Fight against chronic diseases (High blood pressure, Stroke, Diabetes and Cancer) in Pakistan; cost-effective interventions

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Fight against chronic diseases (High blood pressure, Stroke, Diabetes and Cancer) in Pakistan; cost-effective interventions

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