PENGENDALIAN PERKHIDMATAN PENYAKIT TIDAK
BERJANGKIT (NCD) UNTUK PARAMEDIK
KEMENTERIAN KESIHATAN MALAYSIA
ANJURAN : BAHAGIAN PEMBANGUNAN KESIHATAN
KELUARGA DAN BAHAGIAN KAWALAN PENYAKIT
Modul Latihan Perkhidmatan NCD Untuk Paramedik KKM
Kuliah 1: Epidemiology Of NCD
Penyakit-Penyakit
Tidak Berjangkit ?
• Penyakit Kronik yang tidak berjangkit semakin meningkat diseluruh dunia
• Juga dikenali sebagai penyakit-penyakit kronik yang mana pergerakan penyakit adalah perlahan
• Termasuklah
- Diabetes
- Hipertensi
- Hypercholestrolaemia
- Penyakit jantung
- Strok (Angin Ahmar)
- Kanser
- Penyakit sistem pernafasan kronik
- Mental
• Menyerang semua golongan umur, kelas dan bangsa.
Modul Latihan Perkhidmatan NCD Untuk Paramedik KKM
60 % Kematian
didunia adalah
disebabkan
oleh penyakit
kronik
Modul Latihan Perkhidmatan NCD Untuk Paramedik KKM
80 %
Kematian akibat
penyakit kronik
berlaku di negara-
negara mundur
dan sedang
membangun
Modul Latihan Perkhidmatan NCD Untuk Paramedik KKM
10 Sebab-Sebab Kemasukan Ke Hospital Kerajaan & Swasta, 2013
1. Pregnancy, childbirth and the puerperium 20.77%
2. Diseases of the respiratory system 12.41%
3. Certain infectious and parasitic diseases 9.40%
4. Injury, poisoning and certain other consequences of external causes 8.29%
5. Diseases of the circulatory system 7.53%
6. Diseases of the digestive system 6.37%
7. Certain conditions originating in the perinatal period 5.39%
8. Diseases of the genitourinary system 5.22%
9. Neoplasms 4.10%
10. Factors influencing health status and contact with health services 3.73%
• Penyakit NCD termasuk didalam 10 sebab-sebab kemasukan pesakit
ke hospital kerajaan & swasta
Modul Latihan Perkhidmatan NCD Untuk Paramedik KKM
1. Diseases of the circulatory system 24.71%
2. Diseases of the respiratory system 21.70%
3. Certain infectious and parasitic diseases 13.66%
4. Neoplasms 13.62%
5. Diseases of the digestive system 4.93%
6. Injury, poisoning and certain other consequences of external causes 4.75%
7. Diseases of the genitourinary system 4.07%
8. Certain conditions originating in the perinatal period 2.47%
9. Endocrine, nutritional & metabolic diseases 2.05%
10. Diseases of the nervous system 1.83%
10 Sebab-Sebab Kematian Pesakit Di Hospital Kerajaan & Swasta, 2013
• Penyakit NCD termasuk didalam 10 sebab-sebab kematian pesakit di
hospital kerajaan & swasta
Modul Latihan Perkhidmatan NCD Untuk Paramedik KKM
Kadar Kematian, Malaysia (% jumlah kematian, semua peringkat umur, kedua-dua jantina)
Kemungkinan meninggal dunia antara umur 30 dan 70 tahun daripada
4 NCD utama ialah 20%
Modul Latihan Perkhidmatan NCD Untuk Paramedik KKM
19.4%
15.7%
8.5%
7.3%
7.0%
5.0%
2.3%
0.2%
0.1%
22.8%
1.2%
9.1%
8.1%
8.2%
7.1%
0.3%
0.2%
0.1%
25% 20% 15% 10% 5% 0% 5% 10% 15% 20% 25%
High BP
Tobacco
Diabetes Mellitus
High Cholesterol
High BMI
Physical Inactivity
Alcohol
Underweight
Poor Water & Sanitation
Male Female
Kematian Mengikut Faktor Risiko
Burden of Disease Study Malaysia, 2014, slide courtesy of Dr Mohd. Azahadi Omar, Institute for Public Health
Modul Latihan Perkhidmatan NCD Untuk Paramedik KKM
Penyakit Tidak Berjangkit (NCDs)
• Berkongsi faktor risiko
Faktor Risiko Penyakit NCD • Penggunaan tembakau
• Pemakanan Tidak Sihat
• Kurang Aktif Fizikal
• Alkohol
Modul Latihan Perkhidmatan NCD Untuk Paramedik KKM
Faktor Tidak
Langsung
•Globalisasi
•Urbanisasi
• Penduduk Tua
Faktor Risiko yg
Umum
i. Boleh Diubah
•Pemakanan Tak
Sihat
• Kurang Aktiviti
Fizikal
•Tembakau & Arak
ii. Tidak Boleh
diubah
•Umur
•Keturunan
Fakto Risiko
Pertengahan
•Lebih Berat Badan
/obes
• Paras Glukosa
Darah Naik
•Tekanan Darah Naik
•Paras Cholesterol
Naik
PTB
•Sakit Jantung
•Diabetes
•Hipertensi
•Stroke/ Angin Ahmar
•Kanser
•Penyakit Paru2
•Kronik
Kesan Melalui Saringan
Intervensi Rawatan
Faktor Risiko dan Proses Berlaku Penyakit NCDs
Modul Latihan Perkhidmatan NCD Untuk Paramedik KKM
11.6
15.2
17.5
7.0 7.2 8.3
4.5
8.0
9.2
4.2 4.9 4.7
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
18.0
20.0
NHMS III (2006) NHMS 2011 NHMS 2015
Pre
va
len
ce (
%)
Total diabetes Known Undiagnosed IFG
Malaysia : Prevale e of Dia etes, ≥ 8 years (2006, 2011, 2015)
NHMS II
(1996)
NHMS III
(2006) NHMS 2011 NHMS 2015
Age group years years years Est. Population ≥ 8 years Prevalence 8.3% 11.6% 15.2% 2,622,284 17.5%
Known diabetes 6.5% 7.0% 7.2% 1,247,366 8.3%
Undiagnosed 1.8% 4.5% 8.0% 1,374,918 9.2%
IGT* / IFG** 4.3% * 4.2% ** 4.9% ** 481,477
Modul Latihan Perkhidmatan NCD Untuk Paramedik KKM
Malaysia : Prevalence of Diabetes, ≥ 30 Years, NHMS (1996, 2006, 2011 and 2015)
Modul Latihan Perkhidmatan NCD Untuk Paramedik KKM
0.0 0.7
1.4
3.4 3.4
6.9
10.5
14.8
20.6
26.5
24.4
27.9
24.4
5.5 5.2
7.4 7.2
9.5
11.0 11.5 12.2 12.4
11.8
13.6
11.2 12.6
5.5 5.9
8.9
10.6
12.9
17.6
22.0
27.0
32.9
38.3 38.0 39.1
37.0
3.6 3.6 3.9 3.9 4.6
6.0 5.8 5.8 5.9 5.5 4.8
5.4 6.0
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
45.0
Pre
va
len
ce (
%)
Prevalence of Diabetes, ≥ 8 years, by age groups (2015)
Known Undiagnosed Total diabetes IFG
Prevalence of Diabetes, ≥ 8 years, by Ethnicity (2015)
%
Modul Latihan Perkhidmatan NCD Untuk Paramedik KKM
19.8
25.4
18.5
16.7
19.3
14.8
18.1
19.4 20.6
15.5
18.6
14.2 14.8
17.4
19.2
0.0
5.0
10.0
15.0
20.0
25.0
30.0
Pre
va
len
ce (
%)
Prevalence of Diabetes, ≥ 8 years, by States (2006, 2011 & 2015)
NHMS III (2006) NHMS 2011 NHMS 2015
Modul Latihan Perkhidmatan NCD Untuk Paramedik KKM
Malaysia : Prevale e of Hyperte sio , ≥ Years, NHMS (1996, 2006, 2011 and 2015)
Pre
va
len
ce (
%)
Modul Latihan Perkhidmatan NCD Untuk
Paramedik KKM
0.7 1.9 2.8
3.9 5.8
11.9
15.0
23.1
29.3
37.1 39.1
50.4
46.1
6.0 7.5
10.4 12.0
18.1 20.3
23.8 26.2 26.2
27.9 28.7
25.0 27.3
6.7
9.4
13.2
15.9
23.9
32.2
38.8
49.3
55.5
65.0
67.8
75.4 73.4
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
Prevalence of Hypertension by Age Groups,
≥18 years (2015)
Known Undiagnosed Total HPT
Pre
va
len
ce (
%)
36.4
38.2
27.9
32.8 34.1
29.9 28.4
42.9
41.1
28.7
26.8
29.1
40.5
27.1
22.5
27.4
37.5
33.8
25.8
32.5
28.5 29.8
36.4 35.4
25.5 26.9 26.8
37.3
33.8
24.1
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
45.0
Pre
vale
nce
(%
)
Malaysia : Prevalence of Hypertension by State,
≥18 years (2011 & 2015)
2011 2015
29.3
13.2
16.1
33.5
12.8
20.7
0
5
10
15
20
25
30
35
Total hypertension Known Undiagnosed
Prevalence of Hypertension by Strata,
≥18 years (2015)
Urban Rural
Pre
va
len
ce (
%)
Modul Latihan Perkhidmatan NCD Untuk Paramedik KKM
Prevale e of Hyper holesterole ia, ≥ Years, NHMS (1996, 2006, 2011 and 2015)
Pre
va
len
ce (
%)
Modul Latihan Perkhidmatan NCD Untuk Paramedik KKM
22.0
26.5
33.7
44.0
49.7
57.2
60.1
65.5
68.8
65.3
61.6 62.7
58.3
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
Prevalence of Hypercholesterolemia by age groups,
≥ 8 years 5
Known Undiagnosed Total Hchol
Pre
va
len
ce (
%)
50.1
8.7
41.4
47.5
11.0
36.5
50.1
12.3
37.8
45.4
11.2
34.2
37.4
2.2
35.2
0.0
10.0
20.0
30.0
40.0
50.0
60.0
Overall Chol Known Undiagnosed
Pre
va
len
ce (
%)
Prevalence of Hypercholesterolemia by Ethnicity,
≥ 8 years (2015)
Malay Chinese Indians Other Bumiputras Others
Modul Latihan Perkhidmatan NCD Untuk Paramedik KKM
37.7
43.4
33.8 35.9
39.7
31.7 32.7
45.0 45.1
31.9
34.9
31.1 33.5
29.4
33.3
45.8
53.5 51.7
46.6
49.5
56.2
52.2
48.3 47.0
43.5
52.1
40.9
48.6
52.9
46.4
0.0
10.0
20.0
30.0
40.0
50.0
60.0
Malaysia : Prevalence of Hypercholesterolemia by
States, ≥ 8 years (2011, 2015)
NHMS 2011 NHMS 2015
Pre
va
len
ce (
%)
Modul Latihan Perkhidmatan NCD Untuk Paramedik KKM
47.7
9.7
38.0
47.7
7.1
40.5
0
10
20
30
40
50
60
Overall Chol Known Undiagnosed
Pre
va
len
ce (
%)
Prevalence of Hypercholesterolemia by Strata,
≥ 8 years (2015)
Urban Rural
Modul Latihan Perkhidmatan NCD Untuk Paramedik KKM
DEFINITION
BMI STATUS (CPG 2004)
• U der eight .5
• Normal = 18.5 – 22.9
• Pre-obese = 23.0 – 27.4
• Obese .5
BMI STATUS (WHO 1998)
• U der eight .5
• Normal = 18.5 – 24.9
• Overweight = 25.0 – 29.9
• Obese
Modul Latihan Perkhidmatan NCD Untuk Paramedik KKM
Malaysia : Prevalence of obesity and overweight, ≥ 8 years
(WHO 1998)
Modul Latihan Perkhidmatan NCD Untuk Paramedik KKM
Malaysia : Prevalence of obesity by state (WHO 1998)
29.8 33.2
28.8
36.0 35.6 32.5
27.8 29.5
36.0 32.7 32.5
23.9
32.3 29.6
43.0
0.0
10.0
20.0
30.0
40.0
50.0
60.0
Pre
va
len
ce(%
)
Modul Latihan Perkhidmatan NCD Untuk Paramedik KKM
Malaysia : Prevalence of obesity by sex, (WHO 1998)
24.0
26.8
0.0
5.0
10.0
15.0
20.0
25.0
30.0
Male Female
Pre
va
len
ce(%
)
Modul Latihan Perkhidmatan NCD Untuk Paramedik KKM
Malaysia : Prevalence of obesity among adults by
ethnicity, (WHO 1998)
28.5
19.2
36.5
25.8
15.6
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
45.0
Malays Chinese Indians Other
Bumiputras
Others
Pre
va
len
ce(%
)
Modul Latihan Perkhidmatan NCD Untuk Paramedik KKM
DEFINITION
Current smoker :
• Smoker who daily or occasionally smokes any tobacco product.
(2011&2015)
• Respondent who reported to have smoked 100 or more cigarettes
in lifetime and smoked daily or some days in the past one month.
(2006)
• One who reported to be smoking at the time of the survey (1996)
Smokeless tobacco:
• Snuff, chewing tobacco, betel quid with tobacco, electronic
cigarettes, and others.
Modul Latihan Perkhidmatan NCD Untuk
Paramedik KKM
Malaysia : Prevalence of smoking by sex
(1996, 2006, 2011 & 2015)
%
• 1996 &2006 – adult 18 & above Modul Latihan Perkhidmatan NCD Untuk Paramedik KKM
Malaysia : Prevale e of s oki g y states, ≥ 5 years 5
%
Modul Latihan Perkhidmatan NCD Untuk Paramedik KKM
Malaysia : Prevalence of smoking
y age groups, ≥ 5 years old
Pre
va
len
ce %
Modul Latihan Perkhidmatan NCD Untuk Paramedik KKM
Malaysia : Prevalence of smoking by ethnicity
(1996, 2006, 2011 and 2015)
Pre
va
len
ce (
%)
Modul Latihan Perkhidmatan NCD Untuk Paramedik KKM
Malaysia : Prevalence of smoking by
strata
• 1996 & 2006 – adult 18 & above
Pre
va
len
ce (
%)
Modul Latihan Perkhidmatan NCD Untuk Paramedik KKM
• Physical activity level was measured based on the definitions of the International Physical Activity Questionnaire (IPAQ) short form
• There are 3 levels of physical activity:
1. I acti e
2. Mi i ally acti e
3. HEPA-acti e health-enhancing physical activity; a high active category)
• The volume of activity can be calculated by weighting each type of activity by its energy requirements defined as METS (Metabolic Equivalent of Task) which are multiples of the resting metabolic rate
• Respondents who achieved the minimally active level of physical activity (at least 600 MET- i / eek ere classified as acti e
• HEPA-active : more or equal to 3000 MET-min/week
Physical Activities
Modul Latihan Perkhidmatan NCD Untuk Paramedik KKM
• NHMS 2006 – respondents aged 18 years and above
• NHMS 2011 & 2015 – respondents aged 16 years and above
Modul Latihan Perkhidmatan NCD Untuk Paramedik KKM
• Rural population was significantly more active than urban population
Modul Latihan Perkhidmatan NCD Untuk Paramedik KKM
• The prevalence of physically active adults increased from the 16-19 age group, peaking at the 40-44
age group, then decreased with increasing age Modul Latihan Perkhidmatan NCD Untuk Paramedik KKM
NCD boleh dicegah
Hampir 80% penyakit jantung, stroke dan diabetes jenis II, dan lebih 3 kes kanser boleh di cegah daripada berlaku
Penggunaan tembakau, pemakanan tidak sihat, tidak aktif fizikal dan pengambilan alkohol
Dengan menyingkirkan faktor risiko NCD
Modul Latihan Perkhidmatan NCD Untuk Paramedik KKM
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