Non-Communicable Diseases Risk Factors Survey in Georgia 2006-2007 National Center for Disease Control and Public Health of Georgia Manana Beruchashvili 2010

Geopolitical Context From: http://members.tripod.com/ggdavid/georgia/maps.htm

Country Characteristics: Population – 4.371 millions Population Growth Rate – 0.1% per year Surface Area – 69.700 Km2 Population Density – 65.2 (People per km2) GDP per capita (PPP* US$) – 2 588 (US$) Per capita government allocation to health - 4,5 $/person/year Population =< $1 per day – 39.53% Population =<$2 per day – 80.9% Average life expectancy (Total) – 72 years Male – 69 years Female – 75 years (Source: Ministry of Economic Development of Georgia, Department of Statistics; 2004-2005) *purchasing power parity

Country Characteristics: Infant Mortality – 18.0 per 1000 live births * Neonatal Mortality Rate – 15.3 per 1000 live births * Under 5 mortality – 20.0 per 1000 live births * Maternal Mortality Ratio – 45.3 per 100000 live births * Contraceptive Prevalence Rate – 24.7%/Women 15-49 ¤ Total fertility rate – 1.37%* The leading causes of adult mortality: CVD (72%) & neoplasm's (11%), etc.* The leading causes of infant mortality: perinatal period conditions (65%), infectious diseases (10%), diseases of respiratory system (10%), etc.* Georgia has not experienced the pattern of alcohol related deaths common elsewhere in the FSU *NCDC and Medical Statistics; 2004 ¤ Reproductive Health Survey; 1999-2000 *Ministry of Economic Development of Georgia; Department of Statistics; 2004-2005

Healthy Life Expectancy (HALE)

In Georgia, NCDs accounted for 94% of all deaths in 2002; CVD – 75% ▪ Total deaths = 61,000. ▪ Total deaths related to chronic disease =57,000.

Shares of total deaths attributable to 10 leading diseases in Georgia, 2002 European health report 2005: Public health action for healthier children and populations

Non-Communicable Diseases Risk Factors Survey in Georgia 2006-2007 was conducted by CINDI Georgia Team as the part of Priority 4 of Biennial Collaborative Agreement (BCA) between the Ministry of Labour, Health and Social Affairs (MOH) of Georgia and the Regional Office for Europe of the World Health Organization 2006/2007: Reducing Burden of Preventable Non-communicable Diseases.

Objectives To obtain detailed information from the examined sample To estimate the prevalence of NCD behavioral risk factors (tobacco, physical inactivity, diet, alcohol), as well as biological risk factors (hypertension, hypercholesterolemia, hyperglycemia, overweight and obesity) in the Tbilisi adult (25-65) population To utilize the information for developing the needs and to plan future interventions for strengthened capacity for integrated NCD prevention and control. To establish an NCD survey teams, which will be able to provide surveys in other parts of Georgia and at the National level

Goal To establish an NCD surveillance system in Georgia To provide of epidemiological information on chronic non-communicable diseases and the prevalence of their risk factors in the community. This information will be used to plan National strategy for NCD prevention and control To provide international comparisons of rates and trends in different member countries and demonstration areas

Diseases of the circulatory system, morbidity rates per 100000 population, Georgia, 2000 – 2008

Hypertensive disease, morbidity rates per 100000 population, Georgia, 2000- 2008

Cerebrovascular diseases, rates per 100000 population, Georgia, 2000 – 2008

Diabetes mellitus morbidity, rates per 100000 population, Georgia, 2000 – 2008

Incidence of diseases of the respiratory system, Georgia, 2000 – 2007

Incidence of malignant neoplasm by stages, 1988-2008

Malignant neoplasms morbidity, rates per 100000 population, Georgia, 2000 – 2008

Age specific incidence of the breast cancer, rates per 100000 women, Georgia, 2008

Shares of total deaths attributable to 10 leading risk factors in Georgia, 2002

TOP 5 WHO Member Countries with the highest mean blood pressure (mmHg)

 Conclusions One of the main goals is: Collection of necessary quality information for planning and implementing of the adequate surveillance system of non-communicable disease prevention and control. Problems associated with healthcare system: Poor reliability of statistics available in the country Lack of the national policy for tackling non-communicable diseases in the country Deficit of availability of comprehensive, continuous, coordinated, high-quality medical service at the primary healthcare level Problems associated with medical personnel Population-associated problems

Recommendations • Improvement of the non-communicable diseases’ morbidity and mortality statistical data collection system in the country; • Adapting of the non-communicable diseases risk-factors screening and monitoring programs at the country level; • Planning of the national policy tackling non-communicable diseases with real cooperation of the State healthcare structures and professional associations; • Elaboration of the cost-effective program of Arterial Hypertension as the main CVD risk-factor management for decreasing the mortality caused by the circulatory system diseases; • Diabetes Mellitus program provision at the State and Municipal levels; • Expanding cancer screening activities in framework of the existing State and Municipal programs; • Expending respiratory diseases’ screening;

Recommendations • Improving the quality of primary healthcare services for identifying, evaluating, preventing and treating chronic diseases and using modern standards; • Implementation of the non-communicable diseases’ management unified guidelines in the healthcare system and their periodic renewal, based on evidence; • Elaboration of nutrition recommendations considering Georgian population nutritional and cultural characteristics by identifying the share of ingredients in the food ratio;

Recommendations • Improvement of the doctors’ professional knowledge and skills for increasing the level of consent of patients to prolonged treatment; • Improvement of the nurse education model; • Integrated approach to the non-communicable diseases’ management – medical doctor, nurse, pharmacist, health educator – for effective collaboratio

Distribution of the respondents by age groups and gender NCD Risk Factors Survey, Georgia 2006-2007 Distribution of the respondents by age groups and gender NCD Risk Factors Survey, Georgia 2006-2007

NCD Risk Factors Survey, Georgia 2006-2007 Distribution of the respondents according to current smoking status by age groups and gender

NCD Risk Factors Survey, Georgia 2006-2007 Proportion of daily smokers advised by health professional to quit smoking

BMI by age groups and gender NCD Risk Factors Survey, Georgia 2006-2007 BMI by age groups and gender