PROF. G.C. ONYEMELUKWE (MON) ROLE OF MEDICAL WOMEN ASSOCIATION OF NIGERIA IN NON-COMMUNICABLE DISEASES BY PROF. G.C. ONYEMELUKWE (MON) CHAIRMAN, NATIONAL EXPERT COMMITTEE ON NON-COMMUNICABLE DISEASES AREWA HOUSE KADUNA 23RD NOVEMBER 2004

_ _____ _ ______ ______ _____ ______ ____ ______ ____ WHAT DO WOMEN WANT? _ _____ _ ______ ______ _____ ______ ____ ______ ____

LIST OF NON COMMUNICABLE DISEASES 10. Coronary heart disease 11. Cerebrovascular disease (stroke) 12 Heart Disease a. Cardiomyopathies b. Endomyocardial fibrosis c. Peripartum Cardiac failure (PPCF) 13. Cancers a. Hepatoma b. Prostate c. Cervix d. Breast Hypertension Diabetes Mellitus Sickle Cell Disease Mental ILL Health & drug abuse Asthma Violence (Road traffic accident, domestic, conflict Blindness Oral Health Rheumatic fever/rheumatic heart disease

Road traffic Accidents 14.25% 2. Infections and Septicaemia 10.80% 3. MORTALITY STATISTICS (1999-2001) ABUTH, ZARIA (Source: Community Medicine) 1. Road traffic Accidents 14.25% 2. Infections and Septicaemia 10.80% 3. Hypertension 9.32% 4. Protein calorie malnutrition 8.53% 5. Tuberculosis 5.09% 6. HIV/AIDS 4.75% 7. Cancers 4.07% 8. Mellitus 3.29% 9. Cerebrovascular Accidents (Stroke) 2.35% *44% of deaths are due to NCDs

*2003 SURVEILLANCE DATA LAGOS (SW ZONE) BP systolic =>140mmHg BP diastolic =>90mmHg Female : 22.6% Male : 22.1% Female: 29.5% Male : 30% Rural (all) : 13.7% Urban (all): 28.7% Rural : 20.6% Urban : 36.9% * Risk of CVS damage doubles for every 10 point increase in diastolic and 20 point systolic increase. * ¼ to 1/3 of women in rural and urban areas are hypertensive.

NATIONAL MENTAL HEALTH SURVEY DEPRESSION SYMPTOMS HIGH (Female>male) ANXIETY SYMPTOMS HIGH NB: Severe depression can lead to violence and suicide

BURDEN OF NON COMMUNICABLE DISEASE (DALYs) %DISTRIBUTION IN SUB SAHARAN AFRICA

WHAT IS RISK FACTOR? A risk factor is a condition that places an individual at risk of developing a health related problem. A risk factor can be genetic or acquired. It may be identified as a single measurement (e.g. a physical feature such as weight), a disease (e.g. Hypertension) or a lifestyle characteristics (e.g. smoking)

WHAT IS RISK FACTOR? Cont. In order to be considered a risk factor for a disease, the condition must be associated with that disease in a manner which is beyond chance alone. A casual link is therefore implied A risk factor will however not necessarily lead to the development of the disease Risk factors/habits begin in youth/in womb.

RISK FACTORS IN NCD’s I √ Physical inactivity Alcohol Excess Hypertension Diabetes Mellitus Strokes Cancer CAD Mental Illness Violence Heart Disease/ PPCF Physical inactivity √ Alcohol Excess Drug Abuse/Use Tobacco Use/Smoking Salt Excess X Unhealthy Diets Obesity Abnormal Blood Lipids Psychological Stress Low Economic Status Unsafe Sex Age Family History/Heredity Gender

RISK FACTORS IN NCD’s II Asthma/COPD Sickle Cell Disease Blindness Oral Health Osteoporosis/ Nutrition Physical inactivity √ X Alcohol Excess Drug Abuse/Use Tobacco Use/Smoking Salt Excess Unhealthy Diets Obesity Abnormal Blood Lipids Psychological Stress Low Economic Status Unsafe Sex Age Family History/Heredity Gender

REASONS FOR EXPLOSION OF NCDs 1. Western Lifestyle Leading to INSULIN RESISTANCE 2. ROLE OF INFECTIONS Cancer Liver HBV, HBC (25-40% CARRIERS) Cervix – Papilloma/Herpes genitalis Bladder – Schistosomiasis Coronary artey disease – Chlamydia Rheumatic heart disease – streptococci Blindness – filaria/chlamydia.

REASONS FOR EXPLOSION OF NCDs Cont. 3. CULTURAL Large body image “pot” belly/ “cash madam” Cultural pre-matual fattening “Kunu Kanwa” heating postpartum heart failure “Mai – Shanu” consumption lipidemia Traditional African cooking vitamins antioxidants destroyed 4. INTRAUTERINE LOW BIRTH WEIGHT (BAKER’S HYPOTHESIS – Stress, infection, under-nutrition, smoking. 5. NUTRITIONAL TRANSITION CHILD STUNTING; REFEEDING – SHORT OBESE ADULT

CHILDHOOD UNDER NUTRITION ENVIRONMENT GENES PHYSICO-CHEMICAL-MICROBIAL ENVIRONMENT PSYCHOSOCIAL ENVIRONMENT INTRAUTERINE ENVIRONMENT VS HIGH STRESS LACK OF EXERCISE HIGH FAT SMOKING HIGH RISK BEHAVIOUR HIGH SALT ALCOHOL UNSAFE SEX DRUG ABUSE FETAL UNDER NUTRITION OBESITY, HYPERTENSION, DIABETES, ASTHMA, CANCERS, MENTAL ILL-HEALTH, CORONARY ARTERY DISEASE OSTEOPOROSIS ETC CHILDHOOD UNDER NUTRITION

TEN COMMAND CIVIC DUTIES OF ALL NIGERIANS S/N DUTIES BENEFITS 1. Exercise daily (including walks) Prevention of hypertension, diabetes, obesity, mental ILL health, cancers etc. 2. Know blood pressure from age 30 and above (annually/six monthly) Detect hypertension early (blood pressure increases with age) 3. Know blood sugar from age 40 years Detect diabetes mellitus (blood sugar increases with age) 4. Know sickle cell genotype of all family For counseling of family 5. Monthly breast self examination by females from age 17 To detect lumps and early breast cancer 6. Know presence of hepatitis B surface antigen in blood of family members Prevent liver cancer and other diseases. 7. Know prostate specific antigen (PSA) blood level (men 50 years) To detect prostate cancer 8. Women screen cervical smear (PAP Smear) every 2 – 3 years To prevent, detect early cervical cancer. 9. Know blood cholesterol by obese or overweight people from age 40 years Prevent coronary heart disease 10. Know body mass index (BMI) (weight in kg Height x height (mtrs) To watch nutritional excess or deficiency Issued by NCD Expert Committee on Non-Communicable Disease Note: BMI >30kg/mtr2 is Obesity BMI >25kg/mtr2 is overweight BMI <18.5kg/mtr2 shows under-nutrition

POLITICAL WILL – Lack IN STATES of NCDs, SILENT KILLERS CARING/COMPASSIONATE SOCIETY FIRM VOICE; FIRM AGENDA BY (WOMEN) STRATEGIC GATES OF WOMEN AND CONSEQUENCES 1. Gate to stomach 2. Gate into world (womb – intrauterine) 3. Gate to Child/Family Destiny – Children risk factors 4. Gate to Domestic Finance

CONCLUSION ROLES: INFORMATION, EDUCATION, COMMUNICATION – RADIO TALKS SCREENING LIFESTYLE RISK FACTOR MODIFICATION (MULTIFACTOR APPROACH) RESEARCH IN WOMEN HEALTH – BRITISH WOMEN/USA DONE NATIONAL ACTION ON TOBACCO CESSATION HEPATITIS B VACCINATION OF CHILDREN

MAY GOD’S PUPPOSE FOR NIGERIA BE PERFORMED