Implementation Of National Action Plan Needed To Control Diabetes

By Rafia Haider Diabetes has assumed serious proportions in the country despite presence of a well-defined strategy and national action plan to control all noncommunicable diseases (NCDs) approved at the highest level in the country years ago.

KARACHI, (UrduPoint / Pakistan Point News - 13th Nov, 2018 ) :by Rafia Haider Diabetes has assumed serious proportions in the country despite presence of a well-defined strategy and national action plan to control all noncommunicable diseases (NCDs) approved at the highest level in the country years ago.

Experts talking to APP Tuesday mentioned that the disease leading over time to cause serious damage to the heart, blood vessels, eyes, kidneys, and nerves has emerged to be a major public health problem fast emerging into a pandemic.

"Control of NCDs, that predominantly include Diabetes, has remained a part of every health policy or strategy drafted or approved at Federal or provincial level in the last two decades, yet there appears to be a major unexplained gap between policy and implementation in this regard," said Dr. Ghulam Nabi Kazi, a senior public health specialist of the country.

He observed with concern that despite the alarming prevalence of noncommunicable diseases the authorities concerned seem ill-prepared to cope with the major epidemics of diabetes, cancers, cardiovascular diseases and chronic respiratory illnesses.

Pakistan was said to be celebrating World Diabetes Day 2018 Wednesday with the theme Family and Diabetes amidst the fact that people pertaining to all age groups and gender are increasingly inflicted with the chronic, metabolic disease.

"The findings of second National Diabetes Survey of Pakistan.

2016-2017 clearly demonstrates that diabetes has reached epidemic proportions underlining the need for urgent Primary preventive and control strategies to ensure early diagnosis and effective management," said the seasoned professional.

Dr. Kazi with a long term experience of working with World Health Organization (WHO) said the situation in Pakistan can also be largely attributed to the high prevalence of nutritional disorders, with huge and unacceptable proportions of wasting and stunting.

"Yet these figures also mask and divert attention from the flip side of the coin that is childhood overweight and obesity, which usually continues on to haunt us in other stages of the lifespan, particularly in case of females," he said.

In reply to a question, he said the other risk factors for diabetes In Pakistan, mainly include rapid urbanization with unhealthy lifestyle changes, genetic factors and a singular lack of awareness leading to erroneous lifestyles.

With specific reference to the latest National Diabetes survey, he said the overall age-adjusted weighted prevalence of diabetes was found to be over 26%, of which 19% had known diabetes while 7% were newly diagnosed while an additional 14.4% were found to be asymptomatic pre-diabetes at a high risk for developing diabetes.

"The significant risk factors for diabetes were age (=43 years), family history of diabetes, hypertension, obesity and dyslipidemia," said the public health socialist emphasizing that more than half of the participants had at least primary level education, while around 30% had positive family history of diabetes, and 14.5% were tobacco users.

In this context he reminded that the role of diabetes in exacerbating infectious diseases has been well documented and these significantly include lower respiratory tract infections, urinary tract infections, skin and mucous membrane infections, post-surgical infections, dengue hemorrhagic fever, tuberculosis, human immunodeficiency (HIV) syndrome, hepatitis C virus, sepsis, pneumonia and urinary tract infections.

To a question about interventions needed in the country, Dr. Kazi said local policy makers have largely focused on maternal, neonatal and child health (MNCH) and communicable diseases control (CDC).

These, he said have always been considered as constituting the main agenda of our primary health care system, with few tangible steps taken to address the fearsome burden of non-communicable diseases (NCDs) and mainstreaming them in primary health care in the country.

"I understand Punjab is the only province to initiate the process in this direction with an approved allocation of modest resources through a PC-I proforma," he said reiterating that provinces will also need to simply move beyond their existing agenda and take on greater challenges, within their mandate, Diabetes, he reiterated is a major threat to the public life as it not only doubles a person's risk of early death but also contributes to a higher risk for Ischemic heart disease, strokes, blindness, kidney failure, extremity amputations, and other chronic conditions.

It was said to equally enhance vulnerability of the sufferers to severe acute respiratory syndrome, herpes zoster, herpes simplex, enterovirus and hospital-acquired infections besides leading to retinopathy, nephropathy or neuropathy, and peripheral vascular diseases while excess adiposity is the most important risk factor for diabetes.

"In the given circumstances NCD holds crucial importance and also not likely to strain or overwhelm the health system, which is otherwise well structured though lacking in efficiency due to certain failings," said the public health specialist.

Mentioning that WHO has come up with several recommendations to address obesity and diabetes, he said the feasibility of each must be weighed and adapted in the country context.

Pakistan, he said urgently needs to facilitate the development of provincial and district food policies, eliminating any subsidies for dietary fats/oils and sugar, taxing sugar-sweetened beverages and high fat foods.

"We also need to implementing mandatory nutritional standards and guidelines for quality assurance and procurement of healthy food alone, effectively limiting oils, sugar and salt while reducing the use of frying and sweetening of foods," said Dr. Kazi.

At the community level, he said there was need to promote healthy physical activity and environmental action, particularly in schools, extend availability of sports facilities and informal recreational and sporting activities, with less reliance on personal vehicles.

Engaging with the private sector food providers and outlets to eliminate trans fats and progressively reduce total and saturated fat, salt and sugars is likely to be beneficial and constitutes the way forward.

"Promoting exclusive breastfeeding for the first six months of life by empowering women and implementing the International Code of Marketing of Breast-milk Substitutes are some other imperatives foraction," reiterated the expert.