1. National NCD Program
in Oman
Dr. Ali Jaffer Mohammed
Advisor Health Affairs MOH
1
Ministry of Health
Oman

2. Presentation Overview
• Five Year Plans
• NCD’s Burden in Oman
• Diabetes as an example
• Program Implementation
-National Level
-District Hospital level
-PHC level
-Community Level
2
Ministry of Health
Oman

3. The Five year Plans
3 7th Five Year Plan 2006-2010 8th Five year plan 2011-2015
Ministry of Health
Oman

4. Five Year Plan -Domain 13:NCD’s
7th Five Year Plan 2006-2010 8th Five year plan 2011-2015
4
Ministry of Health
Oman

5. Scope & Rational
• High Prevalence of NCDs in Oman (Ages
20+ years): Behavioral/individual Risk
factors
• Diabetes 12%
• Hypertension 35%
• Dyslipidaemia 40%
• Overweight & obesity 48%
• Tobacco use 23% 14.7%
Source: OWHS-2008 (2008) (2011)
5
Ministry of Health
Oman

6. Insulin Resistance Syndrome
(Metabolic Syndrome)
Central/abdominal
obesity 24.6%
High TG 20.7%
Microalbuminuria
Low HDL 75.4% Prevalence of
metabolic syndrome
HBP 23.1%
Oman
21% Endothelial
USA dysfunction
High FPG 18.1%
23%
Atherosclerosis, cardiovascular disease
6 Source: Nizwa 2001
Ministry of Health
Oman

7. Deaths attributable to diseases and injuries, all ages,
Oman, 2002.
Total Deaths
attributable to NCDs
=62%
7
Ministry of Health
Source :WHO Global Burden of Disease 2002. Oman

8. Disability-adjusted life years lost attributable to
diseases and injuries, all ages, Oman, 2002.
Total DALYs lost
attributable to
NCDs=23%
8
Ministry of Health
Source: WHO Global Burden of Disease 2002 Oman

9. Rational
In the WHO Global Action Plan for Prevention
and Control of NCD objective # 3 is
To promote interventions to reduce the
main shared modifiable risk factors for
non-communicable diseases : tobacco
use, unhealthy diets, physical inactivity
and harmful use of alcohol.
So the Oman NCD prevention and control program
is carrying out the activities at different health
care levels
9
Ministry of Health
Oman

10. The Top 10s (prevalence %)
Till 2010 Oman was ranked in top 10, but in 2011 when the
International Diabetes Federation(IDF) recalculated the prevalence
using different criteria, it has become 43rd Rank with a 10.75%
prevalence
8th
(
43rd
43. Oman 10.75
IDF Atlas, V5, 2011
10
Ministry of Health
Oman

11. Country/territory Comp. prevalence (%)
WHO Standard
Kuwait 21.10
6th
Lebanon 20.17
Qatar 20.17
Saudi Arabia 20.02
Bahrain 19.88
UAE 19.22 To
Egypt 16.94
Libyan 14.19
Jordan 12.37
Iran 11.34
Oman 10.75 11th
11 IDF Atlas, V5, 2011 Ministry of Health
Oman

12. Annual and Cummulative Number of People with Diabetes on the Register
70000
New registered diabetic Total registered diabetic 61583
60000
57167 56036 =11.50%
54599
50000 48972
42017
40000
No. of Cases
37286
30000 31704
>40 years
27432
population=
23386
20000 535344 (2011
data )
10000 4862 5167 5482 5393 5413
3590 3487 3548 4177 4372
0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Annual Health Reports 2000-2009 Year
12
Ministry of Health
Oman

13. 40-59 Years Old Most Affected
1800
1600
1400
1200 20-29
No. of Cases
1000 30-39
800
40-49
600
400 50-59
200 60-69
0
70+
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Annual Health Reports 2000-2009 Year
13
Ministry of Health
Oman

14. Action by in MOH
• High Political Commitment
• Established NCD Department 2003
– Priority Diseases section (DM, CVD, Cancer,
Renal)
– Specific Diseases (eye, ear)
– Mental Health
– Tobacco Control
• Formation of National Diabetes
Committee
14
Ministry of Health
Oman

15. Surveillance of NCDs
• Oman-pioneered applying the WHO
protocol for the Diabetes Survey in 1991,
• Then Surveys were carried out 10 yearly-
in 2000, and 2008(as part of Oman WHS
• National Diabetes Register
15
Ministry of Health
Oman

16. •Risk Factors(enter the number)
Baseline •Weight( Kg )
First Year • Height (cm)
• Duration of Diabetes
•Clinical findings -
Blood Pressure
Peripheral Pulses
Neuropathy
Fundus Retinopathy
Foot Ulcer
Five years •Laboratory Investigations
-Blood Glucose-(Fasting &2 hrs pp)
-OGTT –(fasting & 2 hr pp)
-Fasting Lipids-(cholesterol,
LDL, HDL,TG)
-Renal Function ( Blood urea,
creatinine, Urine-protein,
sugar, ketones)
-HbAIC
-ECG
•Type of Diabetes
•Treatment
• Remarks
Twelve years
16
Ministry of Health
16 Oman

17. Actions: At District Hospital
– Distinct clinic for diabetes
• Specialist physician
• Nurse
• “Educator” •Insulin
•Oral hypoglycemics
– Medication for Rx of DM- •Antihypertensives
•Statins
are available at all
– Glycated HbA1c Care levels.
The Higher PHC
Committee and
Diabetes Committee
will approve new
medicines as per
17 requirement Ministry of Health
Oman

18. Diabetic clinics in Poly Clinics
20
18
16
Clinics
14
12
diabetic clinics in PC
Target by 2010
10
8
2005 2006 2007 2008 2009
Department of NCD, MOH, Oman
Year
18
Ministry of Health
Oman

19. Combined Clinics
25
DM & Obgyn
20 Target
15
Clinics
10
5
0
2005 2006 2007 2008 2009
Department of NCD, MOH, Oman Year
19
Ministry of Health
Oman

20. At PHC level
Increase in Mini-Diabetes Clinic
120
100 100
88 90
80
60 61
50 50 50 50 50
40
30
20 Mini Diab & HTN Clinics
Target
0
2005 2006 2007 2008 2009
Department of NCD, MOH, Oman
20
Ministry of Health
Oman

21. … At PHC
• Training of GPs
and Nurses
21
Ministry of Health
Oman

22. 22
Ministry of Health
Oman

23. Diabetic Foot
Training Omanis on Podiatry
(Outside Oman) + (in Oman)
• In 2008 , 5 Omanis
were sent to Australia
for doing their BSc IN
Podiatry at La Trobe
University
• They then carried out
Training for Nurses in
Podiatry in Oman.
23
Ministry of Health
Oman

24. Training for Nurses in Podiatry carried out
by Glasgow Caledonia University
24
Ministry of Health
Oman

25. Nurse-Run in Foot Clinics
25
Diabetic Foot Clinics 23
20
No. of Clinics
15 15
10
5
1 1 1
0
2005 2006 2007 2008 2009
Department of NCD, MOH, Oman Year
25
Ministry of Health
Oman

26. 1
Oman Sea
UAE
5
Distribution of 1
3
2
Diabetes Foot 1
4 2
3
Clinics Kingdom of
Saudi Arabia
(April 2009) 0
1
Yemen Arabian Sea
26
Ministry of Health
Oman

27. Reduction in Amputation
Amputations/10,000 Patients/yr
50
Foot amputation
45
40
35
30
25
20
15
10
5
0
2001 2002 2003 2004 2005 2006 2007 2008 2009
Year
Department of NCD, MOH, Oman
27
Ministry of Health
Oman

28. Secondary Prevention
SCREENING TOOLS
28
Ministry of Health
Oman

29. Non-Invasive Tool
Diabetes Risk Score
(Has Not been implemented in Oman
as Screening for Common NCDs
for >40 years old
is implemented
29
Ministry of Health
Oman

30. 2.4.1 The National NCD Screening
Program 2006
30
Ministry of Health
Oman

31. 31 Ministry of Health
Oman

32. In PHC
• Screening for common NCD
conditions:
(only for 40+ years)
– Diabetes (FBS)
– Hypertension (BP measurement)
– Chronic Renal disease (GFR)
– Dyslipidaemia (TC, HDL, LDL, TG)
– Obesity (BMI, WC)
32
Ministry of Health
Oman

33. NCD Screening Results (2008)
Males Females Both
No.
Screened 6,785 10,894 17,679
(38%) (62%)
BMI>30 23% 36% 31%
Abnormal 54% 76% 68%
WC
Pre-HTN 15% 14% 14%
HTN 21% 19% 19%
Pre-DM 36% 35% 35%
DM 8% 6% 7%
High Choles. 43% 47% 46%
eGFR < 90
33 32% 26% 28% Ministry of Health
Oman

34. At Community Level
34
Ministry of Health
Oman

35. Community Based Initiatives
• The Nizwa Healthy Lifestyle project – WHO
Community Based Program supported by MOH.
-1st baseline risk factor survey.
- In 2010 Evaluation of project was done by
WHO Consultant.
-It has been extended to other areas like Sur etc.
• School Health Program
-The Health Promoting Schools program
-Facts of Life
35
Ministry of Health
Oman

36. Tobacco Control Oman
• Oman Ratified FCTC 2005
• Smoking ban in all public places
• Pictorial Health Warning ( all GCC)
• Maintaining the status quo is a big
challenge
-due to tobacco lobbyists
-Increased Shisha useage in
older age group in both men and women
36
Ministry of Health
Oman

37. Challenges (1)
• PHC structure needs further changes
• Inadequate number trained staff to deal
with complex NCD conditions
• Unavailability of latest medications
(e.g.insulin Analogue) due to cost
constraints
• Limited lab services for tests in PHC –No
electronic linkages for test results from
Hospitals
37
Ministry of Health
Oman

38. Challenges (2)
• Need for electronic record system for
defaulters follow-up, monitoring &
evaluation
• Shortage of health educators
38
Ministry of Health
Oman

39. Thank You
39
Ministry of Health
Oman