News
Janelle DeSouza
UNTIL 2004, noncommunicable diseases (NCDs) accounted for more than 60 percent of all deaths in Trinidad and Tobago and were the leading cause of death in that country for the past 20 years, according to the Pan American Organization of Health (OPS).
According to the Department of Health’s 2015 hospital utilization reports, that year, 25 percent of deaths were from heart disease, 14 percent from diabetes, 13 percent from cancer and 10 percent from cerebrovascular diseases (conditions that affect blood flow to the brain).
And, according to the International Diabetes Foundation, in 2021, the prevalence of diabetes among adults in TT was 14.8%.
With these startling statistics, the Ministry of Health has taken steps to educate the public, reduce the risk of contracting NCDs by promoting a healthy lifestyle, provide quality care for the management of NCDs and their contributing factors. risk, and collect data to better inform policies.
Dr Marla Clapperton, director of the ministry’s non-communicable diseases unit, spoke to Newsday earlier this month about some of the programs being implemented to help save lives.
TTMoves is the ministry’s main educational tool and its public advice was to drink more water, move more, eat more fruit and vegetables daily and, recently added, know your health numbers, i.e. -say blood pressure, blood sugar and cholesterol.
Launched in 2018, the campaign organized 5km walks/runs, provided information on healthy living at health fairs and festivals as well as online, installed sports and exercise equipment in community centers and schools, and much more.
Recently, TTMoves has expanded to include an app which, for now, is a step counter, a TV fitness program, and a program for elementary school students.
Clapperton explained Get Moving with TTMoves is a ten-minute fitness program starting at 6:45am on ttt. The six-week program began on June 3 and a new routine is introduced each week.
She said it was designed to be very simple but effective and was aimed at all age groups, fitness levels, as well as people with disabilities.
TTMoves Junior launched in April and hosted a NCD Inspector Academy over the Easter holidays. It took place in all regional health authorities (RRS) for children aged 5 to 11.
The children learned how to eat healthily, garden and improve and increase their physical activity. Depending on the availability and resources of the RRS, some academies offered yoga, dance and did excursions. At the end, they graduated and received a certificate and sticker booklet.
Positive comment
“Back home, they had to share what they had learned about healthy lifestyle habits with their friends, family and neighbors. And anyone caught not following the healthy practices they have learned can be issued sticker fines by noncommunicable disease inspectors.
“This fun activity was truly built on the principle that children are agents of change. We are investing in the younger generation.
She said the feedback on the academy was very positive and the RRS requested the ministry to repeat the activity.
Speaking to the media after a World Blood Donor Day event at the Brian Lara Promenade, Port of Spain, on June 14, Health Minister Terrence Deyalsingh said citizens , especially those belonging to selected target groups, listened to the ministry’s messages on NCDs.
He said about two years ago the ministry launched a program on diabetes in pregnancy. Now all pregnant women are screened for NCDs and health facilities are starting to see more pregnant women whose diabetes is under control.
The ministry also launched a program called Hearts for people with hypertension. He said that at the end of July 2023, 37 percent of people enrolled in Heart were controlled or had a blood pressure of 140/90 or less. By December, the inspection rate had increased to 48 percent.
“So between diabetes and hypertension, which are the two major non-communicable diseases, we have seen great progress,” Deyalsingh said.
“Anecdotally, I see a lot more people drinking water, a lot more people walking around with their water bottles, and that’s good. I see more and more people playing in the savannahs. I see more and more children playing, which is one of my pet peeves: children don’t play enough. So the messages are getting through and I’m grateful.
No data, no information
There is a distinct lack of recent data on NCDs in TT, but Clapperton said the ministry was working to address this.
She said the last PAHO/WHO (World Health Organization) Noncommunicable Disease Prevalence and Risk Factors (STEPS) Survey was conducted in 2011, but another was launched on April 15 and is underway nationwide.
Around 70 field staff from the ministry go door-to-door, wearing high-visibility vests bearing the logos of the Ministry of Health and STEPS, and carrying Ministry of Health ID, to conduct the national STEPS survey. The hope was to have around 5,400 participants.
The survey steps include demographic and behavioral measurements using a questionnaire, physical measurements as well as pulse and blood pressure, and biochemical measurements.
She said the ministry had also included a mental health screening module which was being used for the first time in the Americas.
All data collected will be strictly confidential but the participant will receive a patient information sheet with a summary of their readings. If the results were suspicious, the form could be taken to their doctor or the nearest health facility so that they could be informed accordingly.
“To manage better, you have to measure. This survey is a way for us to better understand which NCD risk factors are prevalent in our population.
“This will give us a holistic picture of an individual’s health status that we can analyze in more detail to gain information on the prevalence of diseases, such as diabetes and hypertension, within our population and obtain additional information on cardiovascular risk – risks of heart attack and stroke. As you can imagine, this is very important because it can help inform and guide the future.
As Deyalsingh mentioned, the ministry was also collecting data through the Hearts program in all health centers. Participants were those attending the chronic disease clinic at local health centers and whose blood pressure was greater than 140/90.
The Hearts Program, a treatment protocol, collects data on blood pressure control levels among people enrolled in the program.
Clapperton said that as of the end of June 2023, 37 percent of the 57,544 enrolled in the program had their blood pressure under control. At the end of December 2023, there were 66,377 participants and the testing rate was 48 percent.
In the pilot phase, being tested at 50 sites, was the NCD registry project in which data on the number of people attending chronic disease clinics with diabetes and hypertension was recorded.
Training is key
“In the long term, once we move out of the pilot phase and reach 105 sites, we will be able to have more real-time data.
“The register tells us about people in the public system who already know their diagnosis while surveillance, like the STEPS survey, is broader. Monitoring is how we will be able to assess any trends, changes and the impact of any programs and interventions we implement.
“So the data in terms of NCD prevalence, we would have it from the national STEPS survey conducted in 2011. In terms of more up-to-date numbers, we are awaiting the completion of the 2024 iteration of the STEPS survey.”
Training has also been a key part of the ministry’s process.
Clapperton told Newsday that since March 25, the ministry has held a series of NCD primary health care symposia, which provide continuing medical education for primary care doctors and nurses.
So far, 325 primary health care workers in the Eastern, South-West and Tobago RHAs have been retrained on NCD-related topics, including the management of asthma, hypertension and diabetes, smoking and alcohol cessation, depression screening, common skin conditions, digital technology. rectal exams, clinical breast exams and more.
“In ensuring that quality care is provided at the primary care level, we must ensure that staff are up to date with their training. »
In January, she said, a national foot screening tool was distributed to all RHAs for use in chronic disease clinics at health centers and district health facilities. They were to be used annually on diabetics to help detect any diabetes-related foot complications.
“As you can imagine, this would allow for early detection and prevent further progression to foot ulcerations and limb amputation. This will also be part of the Diabetes Wellness Clinic.
“Once patients are seen using this tool and foot complications due to diabetes are detected, this also includes the treatment and referral pathway for those individuals who would have been classified as mild, moderate or severe.
Clapperton said a paper from the Inter-American Development Bank (IDB), published in 2017, estimated the annual economic burden of NCDs in that country at around US$1.19 billion ($8 billion), or 4.3 percent of GDP, including loss of productivity.
She said many of the ministry’s NCD programs, including the Inspectors’ Academy and the STEPS survey, were covered by an IDB loan.