NCD FINAL

NON-COMMUNICABLE DISEASE

DEFINITION

• usually thought of as chronic conditions that do not result from an acute infectious process.

• These conditions cause death, dysfunction, or impairment in the quality of life, and they usually develop over relatively long

• result from prolonged exposure to causative agents, many associated with personal behaviours and environmental factors.

- Malaysian Family, Physician, 2010

AIM

• To create awareness among population about the healthy lifestyles and adverse lifestyle-related diseases in the community.

• To restore and maintain high quality of the health of the individual and community

OBJECTIVES

• Surveillance and Descriptive Epidemiology– Identify public health NCD and their

magnitude– Identify high risk populations amenable to

intervention– Monitor health of the population

• To instill healthy lifestyles in order to reduce the risk of NCD through education, mass media, health campaign and support groups.

Trend in Malaysia• Communicable disease are slowly being

replaced by noncommunicable.• 6 major NCD in Malaysia are:

– IHD– Mental Illness– Stroke– Road Traffic Accident– Cancer– Asthma– Diabetes Mellitus

GLOBAL BURDEN

• This epidemiological change accounted for 47% of the global burden of disease and 60% of all deaths.

• From a projected total of 58 million deaths from all causes in 2005,

- it was estimated that chronic diseases accounted for 35 million, which is double the number of deaths from all infectious diseases, maternal and perinatal conditions and nutritional deficiencies combined.


• about 80% of chronic disease deaths : occurred in the low and middle income countries

• and 50% of these deaths : occurred prematurely in people under 70 years of age.


GOAL

• The WHO has proposed a global goal with a target of an additional 2% annual reduction in projected chronic disease death rates between 2005 and 2015.2,3


CURRENT SITUATION• The NCD team has developed a comprehensive approach to

chronic disease care. • NCD Program in Ampangan Health Clinic which represents

many typical government health clinics in Malaysia and the processes by which it was developed. Included are specific examples of the tools and how they can be used by individual clinicians in caring for patients.

• The integration of Chronic Disease Management Services into health care systems is the direction being undertaken to tackle the burden of chronic disease.

• Disease management supports the shift in healthcare from an emphasis on managing the acute episode to managing the entire disease course, highlighting both prevention and maintenance of wellbeing for patients with chronic diseases.

HEALTH STATUS IN MALAYSIA

• Ninth Malaysia plan (2006-2010);- RM2.0 billion-spent on developing rural health services, an increase of more than 150% from 2001-2005. - R&D, that saw only RM28.9 million in the last five years, receive RM250.0 million.- Allocation for training has tripled.

Principle Cause of Deaths in Ministry of Health, Malaysia (MOH) -2006

Diseases Percentage

Septicaemia 16.87

. Heart Diseases & Diseases of Pulmonary Circulation

15.70

Malignant Neoplasms 10.59

Cerebrovascular Diseases 8.49

Pneumonia . 5.81

Accidents 5.59

. Diseases of the Digestive System 4.47

. Certain Conditions Originating in The Perinatal Period

4.20

Nephritis, Nephrotic Syndrrome & Nephrosis

3.83

Ill-define conditions 3.03

Noncommunicable Diseases and Mental Health Cluster (NMH)

• The mission : is to provide leadership and the evidence base for international action on surveillance, prevention and control of noncommunicable diseases, mental health disorders, malnutrition, violence and injuries

Excerpt from the Tenth Malaysia Plan2011-2015

Expanding the Healthy Lifestyle Campaign• The campaign, which emphasises healthy

eating, physical activity, anti-smoking and mental health, will specifically target school children, adolescents, women and the elderly to ensure better health outcomes; and

Encouraging healthy and active lifestyles• Sports and recreational activities will be promoted to

enable people to adopt a healthy and active lifestyle. • Existing sports and recreational amenities will be

upgraded and the private sector will be encouraged to build new facilities in accessible locations.

• To instill the active lifestyle culture amongst children, participation in at least one sports activity will be made compulsory for students in schools beginning in 2011.

Policy Statement

• Prevention, control and management of Cardiovascular Disease and Diabetes will be made accessible for all population with participation in partnership with various stakeholders and integrated into the social, economic and environmental systems to establish a robust platform for effective reduction of these diseases.

NHMS III

• The results of the National Health Morbidity Survey III (NHMS III) in 2006 showed that prevalence of Hypertension and Diabetes has increased significantly i.e. prevalence of known diabetes and hypertension among adult above 30 years old was 14.9% and 42.6% respectively.5,6


CURRENT HEALTH PROBLEMS IN MALAYSIA

“Cardiovascular Disease - Heart Failure”

DEFINITION:• Cardiovascular disease refers to the class of diseases

that involve the heart or blood vessels (arteries and veins)*

• The No. 1 Fatal Disease in MALAYSIA and WHOLE world

• Mainly Heart Failure- Inability of cardiac output to meet the demand of the body

*http://en.wikipedia.org/wiki/Cardiovascular_disease

ETIOLOGY

• 1) Heart attack - damaged heart muscle = “acute myocardial infarction”

• 2) Prolonged pumping against a chronically increased afterload – eg: during hypertension and stenotic valves

• Heart diseases are on the rise in Malaysia despite improvement in health services and facilities.

• They were the second leading cause of death in 2006, accounting for 15.5 per cent of those who died in government hospitals.

• According to the Malaysia Noncommunicable Disease Surveillance 2005/2006, the prevalence of risk factors such as physical inactivity was 60.1 per cent, smoking 25.5 per cent, obesity 16.3 per cent, obesity 48.6 per cent, hypertension 25.7 per cent, raised blood glucose 11 per cent and hypercholesterolemia 53.5 per cent.

• National Heart of Association of Malaysia

National Cardiovascular Database (NCVD) ?

• Is a service supported by the Ministry of Health (MOH) • to collect information about cardiovascular disease in

Malaysia, - which will enable us to know the incidence of

cardiovascular disease, - and to evaluate its risk factors and treatment in the

country. • This information is useful in assisting the MOH, Non-

Governmental Organizations, private healthcare providers and industry in program planning and evaluation, leading to cardiovascular disease prevention and control.

The objectives of the NCVD • Determine the number and the time trend of acute coronary

syndromes in Malaysia. • Determine the socio demographic profiles of these patients to

better identify the high-risk group in our Malaysian population. • Determine the efficiency of, and adherence to current guidelines

of treatment guidelines • Determine the number, evaluate and monitor the outcomes of

percutaneous coronary intervention (PCI) based on selected performance indicators.

• Determine the cost to the nation by cardiovascular disease and the cost-effectiveness of treatment and prevention programs

• Stimulate and facilitate research of cardiovascular disease using this database.

-National Cardiovascular database

The theme Workplace Wellness is the overarching topic of World Heart Day 2010,(26 September) with the aim to promote the workplace as the ideal setting to adopt healthy behaviours in order to prevent heart disease and stroke. World Heart Day will call on individuals to take their first of 10 Steps to Heart Health.

The Heart Foundation Malaysia

http://www.world-heart-federation.org/what-we-do/awareness/world-heart-day/world-heart-day-2010/2010-theme/what-we-do/awareness/world-heart-day/world-heart-day-2010/10-simple-steps/

OVERWEIGHT AND OBESITY

Definitions of overweight and obesity

Based on Body mass index (BMI) =

weight (kg)/height (m)2

•Overweight: BMI 25-29.9 OR BMI >=25

•Obesity: BMI >= 30

•Healthy weight: BMI 18.5-<25

• Khambalia and Seen (2010) reviewed the overweight and obesity trends in Malaysian adult from 1996 to 2009.

• The risk for overweight and obesity was higher in women than men and the levels of overweight and obesity were highest among adults 40-59 y.

• Overweight levels were highest among Indians, followed by Malays, Chinese and Aboriginals, while the prevalence of obesity by ethnicity was less consistent.

OVERWEIGHT AND OBESE AMONG ADULTS

OVERWEIGHT BASED ON ETHNICS (SEP 06)

• Two studies undertaken in 2002 and 2008 among primary school children found that overweight rose from 11.0% to 12.8% within a period of 6 years, and obesity rose from 9.7% to 13.7% over the same period.

• The scenario among adults is even more alarming. The prevalence of overweight and obesity amongst Malaysian adults had tripled within the last ten years.

• Obesity rose from 4.4% in 1996 to 14.0% in 2006. The same trend was observed for the prevalence of overweight which rose from 16.6% in 1996 to 29.1% in 2006.

• This means that 2 in 5 adults are now either overweight or obese.

HYPERTENSION

HYPERTENSION

• Hypertension is an increasingly important medical and public health issue globally.

• The prevalence of hypertension increases with advancing age to the point where more than half of people 60–69 years of age and approximately three-fourths of those 70 years of age and older are affected.

JNC 6 CATEGORY JNC 7 CATEGORY

SBP/DBP

OPTIMAL <120/80 NORMAL

NORMAL

BOARDERLINE

120–129/80–84

130–139/85–89 PREHYPERTENSION

HYPERTENSION >140/90 HYPERTENSION

Stage 1 Stage 2 Stage 3

140–159/90–99

160–179/100–109>180/110

STAGE 1

STAGE 2

• This new designation is intended to identify those individuals in whom early intervention by adoption of healthy lifestyles could reduce BP, decrease the rate of progression of BP to hypertensive levels with age, or prevent hypertension entirely.

• Hypertension can be classified as either primary (or essential) hypertension and/or secondary hypertension.

• Primary hypertension has no specific origin but is strongly associated with lifestyle.

• It is responsible for 90 to 95 percent of diagnosed hypertension and is treated with stress management, changes in diet, increased physical activity, and medication(if needed).

• Secondary hypertension is responsible for 5 to 10 percent of diagnosed hypertension. It is caused by a preexisting medical condition such as congestive heart failure, kidney failure, liver failure, or damage to the endocrine (hormone) system.

• Evidence showed that greater SBP is a major risk factor for Cardiovascular Diseases.

• The prevalence of systolic hypertension increases with age, and above 50 years of age, systolic hypertension represents the most common form of hypertension.

• DBP is a more potent cardiovascular risk factor than SBP until age 50; After that, SBP is more important.

• Clinical trials have demonstrated that low systolic hypertension reduces total mortality, cardiovascular mortality, and stroke.

• In February 2009, Malaysian Health Minister YB Dato’ Sri Liow Tiong Lai reiterated that as Malaysia approaches a developed nation status by 2020, the prevalence of chronic lifestyle diseases such as hypertension is unfortunately bound to increase.

• According to his report at the 7th ASIAN-PACIFIC CONGRESS OF HYPERTENSION 2009 the latest National Health and Morbidity Survey in 2006 showed that the prevalence of hypertension among Malaysian adults 30 years old and above was 43%, a shock 10 point leap from the 33% recorded 10 years earlier.

• A separate survey conducted by the Ministry’s Institute for Health Management on the outpatient management of hypertension in government clinics. That survey found that only 28.5% of patients treated for hypertension in government clinics achieved the target blood pressure.

• With these figures, it is now estimated that there are 4.8 million individuals with hypertension in Malaysia.

• The estimated figure worldwide is a staggering 1 billion individuals. It is also alarming to note that close to two thirds of individuals with hypertension in Malaysia were not aware that they have hypertension.

• There were more Indian (12.2%) and Chinese (11.5%) hypertensives whose blood pressure was controlled when compared to Malays (7.0%).

• There were slight improvement in the awareness of hypertension (33% vs 36%), and overall control rates (6% vs 8%).

• However, there was no difference in control rates among those treated (26%).

CANCER

• The National Cancer Registry of Malaysia (NCR) records 21,773 Malaysians being diagnosed with cancer but estimates that almost 10,000 cases are unregistered every year.

• It is estimated that one in four Malaysians (1:4) will develop cancer by 75 years old.

• Increasing population and longer life spans contributes to rise of cancer. Less than 10% of cancers happen in children compared to over 50% in men and 35% in women aged 50 and above.

• Cancer occurs more in females than males with a ratio of male to female 1:1.2

• The cancer incidence out of 100,000 people are: – 4,058 Malay males and 4,753 Malay females are diagnosed with

cancer– 4,078 Chinese males and 4,422 Chinese females are diagnosed with

cancer– 629 Indian males and 1065 Indian females are diagnosed with cancer

• Although considered the 3rd leading cause of premature death in Malaysia, only 30-40% of all deaths from cancer are medically certified, meaning there is no exact figure of people dying from cancer.

• Findings show that 10.3% of Malaysians risk dying from the disease before 75 years old. (Globocan, 2008)

• Cancer is becoming a leading cause of death due to avoidable risk factors like smoking and tobacco exposure, poor diet, alcohol, inadequate exercise or being overweight.

• It is estimated that nearly 40% of all cancers are preventable, including colorectal, lung and cervical cancers, with smaller effects in breast and nasopharyngeal cancer.

• Improvement in early detection and treatment leads to better survival rates for people with cancer.

MAKNA (Majlis Kanser Nasional or the National Cancer Council)

• is a not-for-profit social enterprise • mainly tasked to pool and utilise every effort,

expertise and financial aid from every faction of society, and to fight cancer and reduce the related pain, suffering and morbidity that cancer patients and their families often experience.

• registered under the Register of Societies on 10th November 1994 and officially launched on 30th March 1995.

• MAKNA was founded by Dato’Mohd Farid Ariffin.

Mission

• To mobilise resources in order to provide curative, preventive, research and support services to cancer patients and their families, high-risk groups and the general public, in Malaysia and the World.

Focus Areas• To keep abreast of the latest findings information, technology and development

in the cure for cancer. • To provide consistent cancer awareness and education programmes to educate

and promote an understanding of a healthy lifestyle. • To raise sufficient funds for cancer-related services to the community. • To have a pool of well-trained and equipped staff to provide the best care and

treatment to cancer patients. • To provide screening and early diagnostic facilities to enable early detection of

cancer. • To source, collate and disseminate information effectively to all levels of society. • To encourage, support and conduct research in basic sciences and clinical

research on cancer, which could lead to innovative treatment approaches. • To manage a bursary programme that provides financial assistance to cancer

patients unable to meet the cost of treatment.

• A total of 21,773 cancer cases were diagnosed among Malaysians in Peninsular Malaysia in the year 2006 and registered in the National Cancer Registry.

• It comprises of 9,974 males and 11,799 females. • The Age standardised Incidence Rate (ASR) for all

cancers in the year 2006 regardless of sex was 131.3 per 100,000.

• The five most common cancer among population of Peninsular Malaysia in 2006 were breast, colorectal, lung, cervix and nasopharynx.

National Cancer Registry,2006

Home Grown On - Going Campaigns Sen Saves Lives (SSL)• The objective : to help the poor cancer patients, to

conduct cancer research and to enhance cancer awareness.

• It's a home grown project supported by Bank Negara Malaysia for the purpose of bringing back the velocity of these coins - which we can do as a national service.

• MAKNA collects loose change such as 5 sen, 10 sen, 20 sen and 50 sen through this nationwide campaign.

• Small, medium and giant donation boxes will be distributed and displayed at high traffic locations throughout the country.

Direct Debit Donor Programme (DDDP)

• MAKNA fundraising solution that provides the organisation with a regular and predictable flow of funds.

• This sustainable source of income allows MAKNA to plan for the future and is invaluable in the fulfilment of its mission to help as many cancer patients as possible.

Payroll Giving (PG)

• For a monthly donation of as little as RM1.00 or more, you can give relief and hope to cancer patients throughout Malaysia.

• Through Payroll Giving Programme, donation is deducted directly from payroll, making donation giving more convenient and easy.

Loose Change Campaign (LCC)

• first launched in the year 2003 as Kempen 1 sen (One Cent Campaign) with the participation of primary schools and was extended to secondary schools in 2004.

• With the elimination of 1 sen, now the campaign collectively collects all loose change and the campaign is renamed as Kempen Kutipan Syiling (Loose Change Campaign).

ACTIVITIES

• MBF MAKNA CHARITY CARD PROGRAM

Upcoming events• Valentine’s Screening

Promotion – Feb 2011• World Cancer Day

• National cancer society Malaysia

Past events• FIR Wellness @ Dataran 32

will be running a campaign to raise funds for NCSM from January to March 2011.

• Cervical Cancer Month – January 2011

DIABETES IN MALAYSIA

DIABETES MELLITUS• In Malaysia, diabetes is a growing concern. • Through the Ministry of Health's six year thematic

Healthy Lifestyle Campaign which began in 1991, diabetes mellitus was the theme for the year 1995.

• Here, the promotion of adopting healthy lifestyle practices relating to the prevention of diabetes namely creating awareness and balance diet, maintain ideal body weight and physical activities were encouraged.

• The campaign also emphasised on creating, awareness of the disease and its complications to the public.

• Guidelines on management of diabetes and patient education to the diabetes were also developed.

The glucose tolerance test – WHO criteria

• Normal– Fasting <7.0 mmol/L– 2 h after glucose <7.8 mmol/L

• Impaired glucose tolerance – Fasting <7.0 mmol/L – 2 h after glucose 7.8–11.0 mmol/L

• Diabetes mellitus– Fasting >7.0 mmol/L– 2 h after glucose ≥11.1 mmol/L

• From the survey, the national prevalence of known diabetes in Malaysia was found to be 5.7% (5.4% - 6.1%).

• However, through the 2 hour- post- glucose load test, the national prevalence of undiagnosed diabetes was 2.5% (2.3-2. 7%).

• Taking into account these 2 categories of diabetes, hence the prevalence of diabetes in Malaysia would be 8.3% (7.8% - 8.7%).

• The survey revealed geographical variations in the observed prevalence of diabetes by states.

• The highest observed prevalence of known diabetes occurred in the more developed states like Selangor (7.3%, 6.1 - 8.4%) and Penang (7.3%, 5.3 - 9.4%).

• Similarly, the prevalence of undiagnosed diabetes was highest in the more developed states like Negeri Sembilan (4. 1%, 2.8 - 5.401o), Penang (3, 5%, 2.4 - 4.5%) and Melaka ( 1%, 1.9% - 4.2%).

• The same findings were found among IGT. States like Melaka (6.6%, 4.6 - 8.6%), Wilayah Persekutuan Kuala Lumpur (5.3%, 3.8-6.9%) and Johor (5.4%, 4.1%-6.7%) recorded highest prevalence of IGT.

• The prevalence was significantly higher among urban compared to rural areas ( 12.1% vs 10.5%).

• No gender difference in the prevalence was observed. • Based on ethnicity, the Indians had the highest

prevalence of diabetes (19.9%), followed by Malays (11.9%) and Chinese (11.4%).

• Those with primary education or less, have a higher prevalence of diabetes.

• There was no difference in prevalence of diabetes by income status.

• The prevalence of diabetes is increasing.• Surveys in 1960’s & 1970’s showed prevalence of 1-2%• National Health and Morbidity Survey (NHMS) is a

nationwide population survey of Malaysian adults done every 10 years

1986 NHMS I 6.3% ( > 30 yrs)1996 NHMS II 8.2% ( > 30 yrs)2006 NHMS III Estimated > 10%• Malaysian population 2006 : 26.64 million ≥ 18 yrs :

12,923,504 ( ≥ 18 – < 30 = 3,496,060, ≥ 30 = 9,424,769)

NHMS III - OBJECTIVES

General Objective :• To determine the prevalence of diabetes in the• general population of MalaysiaSpecific objectives : To determine1) The prevalence of people with :- known diabetes- undiagnosed diabetes- impaired fasting glucose (IFG)2) The health seeking behaviour among people with diabetes3) The proportion of people with known diabetes with specific

complications4) The association of risk factors with diabetes

Recommendations

Health Promotion• A National Programme on ‘Staying Healthy Together’ with

involvement of multiple stakeholders (multiple ministries, local councils and NGOs’) with the purpose of enhancing or inducing change of public behaviour.

Population Screening• For purposes of population screening, both fasting and post prandial

lucose levels should be used.Diabetic eye screening• To create awareness among patients and health care providers on

the needs of regular eye examination among diabetics. - This is best performed at the primary healthcare level with the use of

a fundus camera.Clinical Practice Guidelines• All health care providers should comply to CPG recommendations on

screening and management of diabetes and its complications

National Diabetes Institute (NADI) AIMS• To be a National Education Resource Centre for the country • To create and maintain a National Diabetes Registry. • To establish and run a comprehensive health facility

(National Diabetes Hospital) for the management of diabetes and its complications.

• To coordinate and conduct research in diabetes and related conditions.

• To be the national reference as well as the National Coordinating Centre for Diabetes in Malaysia in respect to statistics, education, management, research, policy and planning on diabetes and associated diseases.

STROKE

• Stroke is the third largest cause of death in Malaysia.

• Only heart diseases and cancer kill more.• It is considered to be the single most

common cause of severe disability, and every year, an estimated 40,000 people in Malaysia suffer from stroke.

• Anyone can have a stroke, including children, but the vast majority of the cases affect adults.

National Stroke Association of Malaysia (NASAM)

What is a stroke?

•

• A stroke is a brain attack and occurs when the blood supply to the brain is disrupted.

• The brain is the nerve center of the body, controlling every thing we do or think, as well as controlling automatic functions like breathing.


Who is at risk?• Untreated high blood pressure (hypertension)• Diet : A diet high in salt is linked to high blood pressure,

while a diet high in fatty, sugary foods is linked to furring and narrowing of the arteries.

• Diabetes. • A previous TIA.• Atrial fibrillation : increases the risk of blood clots forming

in the heart, which may then dislodge and travel to the brain.

• Smoking. • Regular heavy drinking: raises blood pressures• Certain types of oral contraceptive pill: raise blood

pressure.National Stroke Association of Malaysia (NASAM)

What are the symptoms?

• Sudden weakness or numbness on one side of the body. Signs of this may be a drooping face, a dribbling mouth, weakness in the arm or leg.

• Sudden blurred vision of one eye or both eyes.• Difficulty in speaking or understanding speech,

or slurred speech.• Dizziness, loss of balance, confusion• Sudden severe headache• Nausea or vomiting

© National Stroke Association of Malaysia (NASAM).

Risk factors that cannot be controlled

• Age.- more common in people over 55, and the

incidence continues to rise with age. - because atherosclerosis takes a long time to

develop and arteries become less elastic with age, increasing the risk of high blood pressure.

• Gender :Men are at a higher risk of stroke than women, especially under the age of 65.

• Family history: Having a close relative with a stroke increases the risk


Stroke Rehabilitation

• Early rehabilitation is crucial. • Every stoke survivor must seek rehabilitation

treatment as soon as possible. - Physiotherapy- Occupational therapy- Speech therapy- Counselling


Rehabilitation• The goals : - are to improve function

and gain as much independence as possible.

• Includes a range of services including speech, physical, occupational and recreational therapies and group activities.


MAIN GOAL- to restore the stroke survivor's ability to communicate

accurately, by treating the following areas: • Speech - a stroke survivor with speech problems has

difficulty producing sounds so that others can understand him or her.

• Language - is the use of symbols, such as words, numbers of gestures that have meaning

• Cognition, or thinking skills - a stroke survivor must be able to pay attention, concentrate and use various thinking skills.

• Swallowing - a stroke survivor may have difficulty controlling tongue and swallowing. Therefore, therapy that helps speech can also help swallowing.


Physiotherapy

• conducted by physiotherapists

• helps a person return to the highest possible level of physical function.

• Concentrating primarily on controlled and balanced movement, increased strength and stamina for greater mobility


Occupational Therapy• focuses in improving the ability

to perform activities of daily living, self-care and independence at work and leisure.

• involves an assessment of the stroke survivor's cognitive and perceptual functioning, the ability to perform daily tasks such as walking, bathing, dressing, feeding and housework


Speech Therapy• provided by a speech

pathologist• helps a person improve his

or her ability to communicate

• this includes speech, which is how sounds are made, and language, which involves understanding and choosing the correct word to use.


NASAM Centres • function as places for stroke survivors to help

themselves in their rehabilitation process, to interact with fellow survivors, and to get information and group support for themselves as well as for their carers.

• NASAM's two main objectives are: - To provide rehab services to enable stroke survivors to return to as normal a life as possible within the limits of their disabilities.- To promote the concept of stroke prevention by raising public awareness on the risk of stroke.

• NASAM operates seven centres: in Petaling Jaya, Ampang, Penang, Perak, Malacca, Sabah and Johor.


Stroke Awareness Week• a nation-wide week-long

campaign,• to raise public awareness on the

risk of stroke and to encourage the public to take positive steps to adopt a healthier lifestyle to reduce the risk of stroke.

• The programme includes a public launch event to encourage the public to be more physically active, forums held in various town centres, chat shows on TV and radio, and open day at NASAM centres


SMOKING

SMOKINGMALAYSIA•About half of all Malaysian men smoke.•Every day about 50 teenagers below the age of 18 start smoking•Studies show about 30% of adolescent boys (aged 12 to 18) smoke.•Smoking among female teens is rising. According to two studies on teens conducted in 1996 and 1999, the numbers of female teens smoking rose from 4.8% to 8%. Overall, the 1999 study found nearly one in five teens smokes.•Some studies have shown that lung cancer is rising at a rate of 17% a year.•Smoking is estimated to have caused more than half a million coronary events.•Smoking rates are highest in rural Kelantan and lowest in urban Penang and Sarawak.

• Although there are restrictions on advertising, tobacco companies have found ways to bypass these laws through using brand names and remain the top advertisers.

• Heavily advertised products include the Benson and Hedges bistro, Dunhill accessories, Marlboro clothing, Kent Horizon Tours and Salem Cool Planet concerts.

• Malaysia has been dubbed the "indirect advertising capital" of the world.

• Some of the tobacco industry's most blatant efforts to target young people can be seen here.

• Spending on tobacco advertising is extremely high.• In 1997, the industry spent about $90 million, while in the year

2000, two tobacco firms alone reportedly spent more than US$40 million.

• At least two tobacco companies were among the top 10 advertisers in recent years.

• Among those who reported ever having smoked, the quit rate was substantially higher among females (29.7%) than among males (17.3%).

• Women (29.6%) were more likely to smoke ‘rokok daun’ (hand-rolled cigarettes wrapped in a corn leaf).

• The national prevalence for smoking such cigarettes, common in rural areas, was 14%. The proportion of heavy smokers (>20 sticks daily) was higher among males (33.7%) than among females (17.7%) [(Institut Kesihatan Umum, 1997), pp. 120–124].

CONCLUSION• Malaysia's strong dedication to adequately funding its

Ministry of Health will likely prevent the disease from becoming widespread.

• The healthcare provisions in Malaysia's Vision2020 program, put in place in an effort to become a developed nation by the year 2020, add further support for the country's likelihood of successfully curbing the spread of disease over the next 10-15 years.

• It is also likely Malaysia will continue its technological expansion in the healthcare sector and expand its healthcare coverage to include more rural and poverty-stricken areas by building modern facilities and increasing its mobile care capacities.

• KHAW JINN• SAKSHALENI RAJENDIRAN• TAN CHIA HOONG• CHOO KHER WOOI• HARIKRISHNAN

Documents

NCD FINAL