09 Sep 2011
In the course of the given research chronic non-communicable diseases prevalence and their risk factors development among adult urban population of some Kazakhstan’s cities and preventive measures influence on risk factors occurrence dynamics have been studied. It has been revealed that before starting preventive interference chronic non-communicable diseases prevalence amounted to 19.69% including 17.92% amongst males and 21.25% amongst females. Digestive apparatus sicknesses have been claimed the most commonly encountered chronic non-communicable diseases group (35.35%), prevalence second place was taken by cardiovascular diseases (20.28%), then come chronic nonspecific lungs diseases (11.63%), urinary chronic diseases (11.77%), diabetes mellitus (6.94%). Risk factors occurrence indexes such as smoking, excessive alcohol abuse, low physical activity, overweight used to be high till launching the preventive measurers and then were reduced after various models of preventive interference introduction that proved prevention effectiveness in facing the challenge of fighting chronic non-communicable diseases high rates.
Preventive health care in particular Chronic non-communicable Diseases (CND) is one of important medical care tools rendered to population. Meanwhile nowadays preventive measures are considered as some auxiliary sphere of medical activity.
Disease and death rates issue due to chronic pathology is actual for Kazakhstan as official statistics documents data show which were obtained during recent years [1, 2, 3]. A whole bunch of authors in their scientific researches has proved the fact that the current situation is stipulated by some changes in the public life style: highly popularized smoking, low physical activity, fat high-caloric products with high cholesterol content dominating in basic diet, widely spread alcohol consumption often in large quantities, stresses, and as their consequences increasing number of overweight people, high occurrence of arterial hypertension – these and other factors which are important development aspects of Chronic Non-communicable Diseases have become prevailing among population of Kazakhstan led to high incidence and death rates due to chronic pathology [4, 5, 6 and others.]. This fact calls for tackling the actual problem of promoting public health state. One of the most effective ways of reducing high incidence and death rates due to Chronic Non-communicable Diseases is developing a comprehensive approach for cutting down CND incidence rate and creating a national integrated strategy on Chronic Non-communicable Diseases Prevention based on scientifically proven results of revealing common risk factors of primary diseases development, preventive interference effectiveness assessment, application of new preventive technologies, health management scientific foundations promotion [7, 8, 9, 10].
This research objective is to determine the effectiveness of preventive measures taken for mitigating risk factors prevalence among adult urban population.
Materials and methods
A social and hygienic study has been done to evaluate public health state in terms of Chronic Non-communicable Diseases spreading and life pattern factors amongst adult urban citizens of Astana, Almaty, Semipalatinsk and Shymkent. The study covered 5709 people between the ages of 15-64 living in the stated above cities, males contributed 2 659 (46.58 %), and females 3050 (53.42 %). To evaluate preventive measures influence on CND prevalence risk factors and to check their efficiency the epidemiological situation comparison of risk factors in Astana, Almaty, Semipalatinsk and Shymkent has been carried out after introducing some preventive measures. The study covered 4807 people between the ages of 15-64 in the 4 cities of Kazakhstan. Males numbered 2271or 47.24% of the whole population and females numbered 2536 or 52.76%. The first study was carried out in 2000 and the second one was held in 2003. For proper evaluation of risk factors prevalence a special questionnaire was applied as recommended by the World Health Organization for nations – members of Countrywide International Non-Communicable Diseases Implementation Program.
Contemporary statistical analysis methods were used to process all obtained data. All data received during the study were mathematically and statistically processed by means of the SPSS software. For measuring frequency level on different variables the frequency study method was introduced (in percentage) with calculating average and standard mean square errors. Exactness authenticity was checked by the Student coefficient (t). To figure out the relationship between independent and dependent variables correlation coefficients were calculated. To compare samples average values and to compute the discrepancies significance level the variance analysis has been introduced. During the study the statistical modeling combined with the regression analysis were conducted which let to envisage the relative risk of possible chronic pathology development in the population part being considered. The population attributive risk prognosis was made through the regression analysis and formulating trend lines.
The study results showed that population has a high occurrence of such diseases as the Cardiovascular ones (CVD) the incidence number of which numbered 20.28%, the Chronic Nonspecific Lungs Diseases (CNLD) (11.63%), Chronic Diseases of Digestive Organs (CDDO) — (35.35%), Urinary Organs Diseases (UOD) — (11.77%), Diabetes Mellitus (DM) — (6.94%).
Population life style analysis has shown that at average 31.91% of the respondents smoke, 62.82% — drink alcohol immoderately, over 2/3 (71.98%) lead inactive life (that is they feature behavioral risk factors), over 1/3 of population or 36.39% have Overweight, and 12.77% of the respondents have arterial hypertension (biological risk factors). The highest number of behavioral risk occurrence is encountered in the age group under 45, especially in the ages between 25-34 and 35-44, whereas biological risks are typical for people over 45.
A Mathematical Modeling has been held as well as CND Spreading Prognosis according to the study risk factors data has been made. The analysis showed that smoking increases exposure to CVD cases by 1.17 times, CNLD – by 1.13 times, DOI – by 1.24 times, DMI – by 1.15 times. Alcohol abuse increases risks of developing CVD by 1.11 times, Diabetes Mellitus Diseases – by 1.18 times, Urinary Organs Diseases – by 1.10 times. EBW increases risks of developing CVD by 2.01 times, CDDO – by 2.70 times, DM – by 1.92 times. Also the biological risk factors were evaluated which resulted from the behavioral ones in particular hypercholesterolemia and arterial hypertension. The results showed that hypercholesterolemia increases ratio of CVD likelihood to CVD unlikelihood by 1.52 times, CNLD – by 1.43 times, UOD – by 1.77 times, DM – by 1.72 times; and Arterial Hypertension increases risks of CVD occurrence by 2.85 times, CNLD – by 1.22 times, DM – by 1.90 times.
As it was mentioned above the most effective ways to solve the problem of high incidence and death rates due to CND are the comprehensive integrated approach and development and introduction of various models of preventive interference. Various models of preventive interference intended for separate population groups were elaborated and introduced in the experimental areas in particular an Educational Model for comprehension school teenagers, a Medical Model intended for treating population through rendering first medical and sanitary aid system (district medical service and family medical ambulance stations) and a Preventive Interference Model at Work Place. All the Models had common approaches and used integration principle. At the same time the Models had their own features which constituted according to various population groups differences being exposed to preventive influence introduction, chronic pathology prevalence regional peculiarity as well as life style risk factors.
Our results showed that various models of preventive interference had their own features. Thus the Educational Model includes: close interdepartment cooperation between Health Care and Education systems; active participation of teenagers themselves in creating healthy life style, development of skills and habits for building up their own proper healthy way of living; promoting positive attitude towards themselves, the healthy man image; acquiring healthy life style knowledge and skills as a part of educational and mentoring process; creating favorable environment for personality self-development within school and family through active involvement and training teachers and parents.
The Medical Prevention Model according to the research results has such peculiarities as: increasing medical staff role significance in preventive medical care for population; enhancing medical staff knowledge and professional skills in the field of CND prevention at population, group and individual levels; preventive measures coverage opportunity over the whole population (employed and unemployed people) subjected to a particular medical-prophylactic facility.
Preventive Interference Model at Work Place was specified by rendering preventive aid to able-to-work people; work conditions supervising opportunity and evaluating preventive interference in one singled out target group; obtaining by an enterprise medical efficiency as a result of preventive interference.
On the whole applying different prevention approaches and constructing preventive interference models enabled to make distinct discrimination of responsibilities and operation areas for all concerned parties, maximized target groups coverage and effectively organized preventive activity. Building up preventive interference models based on situation assessment scientific data with using the integrated approach which included additionally participation of non-medical organizations in prevention activity intended for prophylaxis the first priority risks of population life style and chronic diseases major categories, combining different strategies in treating population and prevention kinds (population, group, individual, high risk strategy, primary and secondary prevention) – all these let to develop adequate prevention approaches aimed at separate population categories.
To evaluate the introduced models efficiency the second epidemiological research has been held to study risk factors occurrence amongst adult urban population. The second study showed that the 2-year prevention interference has resulted in reducing CND cases occurrence major risk factors among the target cities population. At average smoking occurrence has been decreased by 5.09% (р<0.05), Alcohol Consumption – by 5.01% (р<0.05), Excessive Body Weight – by 2.68%, Low Physical Activity –by 8.66% (р<0.05).
Hereby according to the given data the most common risk factor among adult urban population is Low Physical Activity to blame (71.98%) which is an independent risk factor of some chronic diseases cases and also favors gaining excessive body weight thereby deteriorating the picture of chronic non-infectious diseases high incidence.
The second place in terms of frequency is taken by Alcohol Consumption in dangerous quantities that is its consumption over 280 grams a week. This stipulates both direct and indirectly high incidence of Digestive Organs Diseases (35.35%) and CVD (20.28%) among population.
The results analysis showed that almost 1/3 of people are averagely smokers (31.91%). This factor is mainly distributed among rather males (50.66%±1.36) than females (15.57%±1.66) (р<0.05). The biggest occurrence was noticed in the age group between 25-34 (41.27%±2.28), among males – 62.86%±2.86 and among females accordingly – 22.84%±3.46 (р<0.05). Studying the relationship and forecast of CND incidence and risk factors let me have all the necessary info for planning preventive measures in particular to define population categories and approaches to preventive interferences considering attributes of risk factors and CND occurrences within the target cities.
On the basis of received data preventive interference models were developed with one common goal of reducing risk factors of developing CND by means of promoting the Package through existing Health Care organizations and non-medical organizations intended for preventing and controlling major risk factors conducive to CND development. Major guidelines of preventive work were: training professionals, population literacy regarding healthy life style, risk factors roles in developing CND, correcting risk factors among population through first medical and sanitary service system, elaborating professional literature and training aids for population, holding additional and control scientific researches to determine dynamics of risk factors prevalence as a consequence of preventive activities having held.
On the whole the performed activities promoted reducing risk factors prevalence which in turn showed that Situation of behavioral risk factors occurrence under monitoring among adult urban population of Kazakhstan turned up to be capable of being modified and controlled. The introduced prevention models enabled to decrease behavioral risk factors occurrence, define positive tendencies of reducing the incidence of separate biological risks and which showed medical efficiency achieved during the experiment. Considering mutual interconnection between risk factors with appearance and development of chronic pathology among the target contingent one can suppose that chronic non-infectious diseases spreading would reduce on condition if dynamics of risks occurrence related to life style is kept. Theoretical projects were embodied in practical Health Care in Kazakhstan at both national and regional levels. Pursuing the goal to introduce them into practical Health Care several documents were elaborated and applied which enabled to advance prevention normative-legislative basis, medical professionals training system for both under- and postgraduate levels was arranged, guidelines and recommendations for practitioners and middle class medical personnel were drawn up, particularly standard protocols for preventing major non-infectious diseases risk factors and prevention action plans for first medical-sanitary aid personnel, some regional prevention programs of several first priority diseases were carried out.
- Public Health state of the Republic of Kazakhstan and Health Care organizations activity in 2003, (Statistics annual) Astana-Almaty, 2004
- Public Health state of the Republic of Kazakhstan and Health Care organizations activity in 2004, (Statistics annual) Astana-Almaty, 2005
- Public Health state of the Republic of Kazakhstan and Health Care organizations activity in 2005, (Statistics annual) Astana-Almaty, 2006
- Akanov A.A. Major chronic non-infectious diseases epidemiology and prevention among rural population of the Republic of Kazakhstan. [dissertation], Bishkek; 1992.
- Germanyuk T.A. Theoretical and methodological basis of promoting KZ public health state under conditions of social and economical transformations. [dissertation], St-Petersburg; 2001.
- Kairbekov A.K. Cardiovascular and some chronic non-infectious diseases prevention and its efficiency among rural population exposed to agrochemical factors. [dissertation]; 1998.
- Lissitsyn Y.P. Public Health and Health Care. Moscow 341 p. 2002.
- Oganov R.G. Preventive Cardiology: successes, failures, perspectives. (Cardiology).pp. 4-8, 1996:3.
- Dobrossy L. editors. Prevention in primary care. Recommendation for promoting good practice. Copenhagen: WHO, Regional Office for Europe. 216 p. 1994.
- Oganov R.G., Glazunov I.S., Ivanov A.V., Grabausskas V.I. Developing an Integral Program of Non-Infectious Diseases Prevention. (Regional Archive). pp.6-8. 1989. V.61:1.
Значение профилактики в условиях высокой заболеваемости хроническими неинфекционными заболеваниями в популяции Казахстана
Хронические неинфекционные заболевания представляют собой основное бремя здравоохранения в большинстве стран мира, в том числе и в Казахстане. Одним из эффективных путей борьбы с высокой заболеваемостью и смертностью от хронической патологии является медицинская профилактика. Хотя работники здравоохранения представляют собой огромную силу, их потенциал в профилактике хронических неинфекционных заболеваний не используется полностью. Анализ уровня подготовленности медицинских работников по медицинской профилактике показал неудовлетворительное положение в данной области. Построение эффективной системы медицинской профилактики подразумевает разработку комплексной программы по подготовке медицинских работников, образованию населения, развитию нормативно-законодательной базы профилактики, создание системы мониторирования неинфекционных заболеваний и факторов риска образа жизни.
The Kazakh National Medical University named after S.D.Asfendiarov