1. The Magnitude of Non-communicable diseases & their Risk factors in Malawi
Malawi NCD STEPS SURVEY 2009
BY DR KELIAS MSYAMBOZA

2. What are NCDs
A group diseases used to be regarded as “diseases of the west, affluent, rich, or urban people”
Include:
Cardiovascular diseases (Hypertension, Heart diseases, Stroke)
Cancer
Chronic respiratory diseases e.g. asthma
Diabetes
Mental diseases etc

3. Importance of NCDs to Malawi
Because of change in life styles, NCDs are increasingly becoming significant causes of morbidity and mortality in developing countries
In Malawi, in adults, NCDs are probably the 2nd commonest cause of illness, lost of productive days and death after HIV/AIDS
NCDs are part of 1st objective of PoW for SWAp :
“To reduce the disease burden due to communicable & Non-communicable diseases thru improving access to quality EHP, essential non-EHP services Emergency and Trauma services mainly targeted at the poor”

4. NCD STEPS Survey objectives
To determine the magnitude of selected NCDs:
High blood pressure (Hypertension)
Diabetes
People with or at risk of Heart diseases (Raised cholesterol)
To determine the magnitude of risk factors:
Tobacco smoking
Excessive alcohol intake
Overweight/obesity
Physical inactivity
Inadequate fruits and vegetable intake
To use data to advocate for resources, policies, regulations etc for NCDs

5. Materials & Methods Method Outcome Participants - 25-64 year olds
Sample size
N=z2p(1-p)/e2
5,760
Survey design
Population based
National sample
EA selection
PPS
144 EAs selected
HH selection
Systematic
40 per EA
Participant
Kish
1 per Household
Sample size for non-response rate (20%) i.e. divide by 0.8, design effect (1.5 multiply), age-sex estimates years (8-10 yr interval (multiply by 8)

6. STEPS Component Equipment STEP 1 Questionnaire PDA STEP 2
Physical measurements
(BP, HT, WT, waist & hip circ)
Weighing scales, tape measures, rulers, BP machines
STEP 3
Biochem tests
(FBS, total chol
Accutrend plus machines

7. Results Age group (yrs) Males Females Both sexes n % 25-34 719 30.8
1616
69.2
2335
44.9
35-44
459
34.7
862
65.3
1321
25.4
45-54
296
32.8
604
67.1
902
17.3
55-64
216
33.2
434
66.8
650
12.5
25-64
1,690
32.5
3,516
67.5
5,206
100.0

8. Magnitude of selected NCDs by Gender
Prevalence(%)
Males
Females
Both sexes
Hypertension (HT)
38.0*
28.8
31.6
Diabetes
6.6
4.8
5.3
Raised cholesterol
7.0
11.3*
10.0
SBP= Systolic blood pressure, DBP= diastolic blood pressure, Majority (94.4%) of people with hypertension and or diabetes did not know that they have a problem

9. Magnitude of selected NCDs by Urban/Rural
Prevalence(%)
Urban
Rural
Both
High Blood pressure
27.9
32.0
31.6
Diabetes
7.4
9.2
5.3
SBP= Systolic blood pressure, DBP= diastolic blood pressure, Majority (94.4%) of people with hypertension and or diabetes did not know that they have a problem

10. NCD risk factors by Gender
Prevalence (%)
Males
Females
Both
Tobacco smoking
26.3*
2.9
10.4
Alcohol
30.3*
4.1
12.6
Heavy drinking
19.2*
2.3
7.8
Physical inactivity
6.4
12.6*
10.6
Overweight
16.1
28.0*
23.9
≥3 risk factors
18.0
15.4
16.2
* Statistically significant (males vs females), Physical inactivity, WHS 2002, Males 5.5%, Females 9.8% (participants 18 yrs or more, N=5,297)

11. NCD risk factors by Urban/Rural
Prevalence (%)
Urban
Rural
Both
Tobacco smoking
6.6
10.9*
10.4
Alcohol
13.4
12.5
12.6
Physical inactivity
24.1*
8.7
10.6
Overweight
38.6*
21.9
23.9
≥3 risk factors
22.6
15.5
16.2
* Statistically significant (males vs females)

12. People with or at risk of NCDs (N=4,561,430; 2008 census)%
No. of people
High BP
31.6
1,459,658
Diabetes
5.3
241,756
High Cholesterol
10.0
456,143
Tobacco smokers
10.4
638,600
Alcohol drinkers
12.6
574,740
Overweight
23.9
1,090,182
≥3 NCD risk factors
16.2
738,951

13. Conclusion
NCDs & their risk factors are major public health problems in Malawi
Majority (94.4%) of people with high blood pressure and diabetes do not know that they have a problem
Thus what we are seeing at health facilities is only 6% of people with High blood pressure and or diabetes.

14. Proposed way forward There is need to establish NCD control programme
There is need to develop multi-sectoral comprehensive Plan of Action & policies for NCDs
There is need to allocate resources for NCDs within and or outside SWAp

15. Proposed way forward cont…
There is need to support and or strengthen the existing efforts such as:
Age limit for alcohol drinking,
Drinking and driving
Opening and closing hours for alcohol selling
Taxation on alcohol
Age limit for tobacco smoking
Ban on public smoking and workplaces
Taxation on cigarettes & other tobacco products
Consider ban on tobacco advertising, promotion & sponsorship

16. Acknowledgments MoH- Clinical Department WHO Data collectors DHOs HSAs
Chiefs
Participants

17. Prevalence of NCDs & their risk factors in some countries in the region% MW MZ
ZWE
BTW
Tobacco
10.4
18.7
11.8
19.5
Alcohol
12.6
77.2
24.5
27.4
Obesity
5.5
7.1
14.1
15.7
EBP
31.6
33.1
17.9
32.11
EBS
5.3
1.4
2.4