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Communicable and noncommunicable diseases & health risk factors and transition in American Samoa
– Reported, April 02, 2012
The health status of the population has improved significantly, and Samoans now enjoy relatively good health.However, persistently high mortality and morbidity rates for communicable diseases call for a renewed surveillance, control and management commitment. Typhoid and dengue are both endemic and periodically reach epidemic levels. Lymphatic filariasis is also endemic, with a standardized antigen prevalence rate of 1.6% in 2003. As the Government has made a firm commitment to eliminate lymphatic filariasis by 2005, intensive mass drug administration (MDA) campaigns have been carried out, with 96% coverage in 2001, 60.3% in 2002, 80% in 2003 and 74.2% in 2008.
There were 16 tuberculosis cases (all forms) diagnosed in 2009, eight with sputum-smear-positive pulmonary TB.The calculated case-detection rate was 51% in 2009. The directly observed treatment, short-course (DOTS) strategy has been established throughout the country and functions well.
The incidence of HIV/AIDS is low, with a cumulative total of 12 known infections since 1990. Other sexually transmitted infections (STI), however, are present at extremely high rates, with 38% of women attending antenatal
clinics being found to have at least one STI in a study carried out in Apia in 1999-2000. Women aged less than 25 years were significantly more likely to be infected. The surprising results of this study indicate the potential for rapid spread of HIV, but also the urgent need to tackle the STI epidemic in its own right. Given the high prevalence and death rates caused by noncommunicable diseases, such as diabetes and suicide, resources for HIV/AIDS programmes are often limited. Whilst the supportive policy and national structures are in place for the coordination and management of HIV/AIDS activities nationally, this infrastructure has been, until recently
with the release of funding from the Global Fund, severely underresourced.
Noncommunicable diseases (NCD), including obesity, diabetes, heart disease, high blood pressure, stroke and cancer, are a top health priority, with high and increasing prevalence rates: the obesity rate is currently 57.0%, the diabetes rate is 23.1% and the hypertension rate is 21.4%. NCD are now appearing in younger age groups and complications are becoming more common. NCD are very costly, accounting for 43.3% of total health care expenditure in 2000. If their prevalence continues to increase, the Government will be unable to continue financing the resultant rising health care costs; hence prevention must remain the mainstay of national NCD management and control. The four main risk factors are smoking (tobacco), poor nutrition, excessive alcohol consumption and physical inactivity. To reduce these risk factors, changes in the lifestyles and the behaviour of
individuals, families and communities are necessary, requiring a coordinated, multisectoral national response.
The total prevalence rate for diabetes is 23.1%: 22.9% in males and 23.3% in females. Prevalence increases with age and overall has doubled since a previous survey in 1991. The disease is more common in urban areas, (Apia 27%, Rural Upolu19.7% and Savaii 20.3%), and the trend is similar for males and females.
In general, for every known case of diabetes that is diagnosed, almost three remain undiagnosed, with the ratio a lot higher in the younger age groups, (in males, for every known case there are 12 unknown cases). Of those with a known history of diabetes, 56.8% of males and 68.5% of females are taking tablets, and only 4% of males and 5.3% of females are taking insulin.
The total prevalence of hypertension is 21.4%.The rate is higher in males (24.2%) than in females (18.2%) and increases with age in both.
High blood pressure is more common in urban areas (Apia 23.5%; Rural Upolu 18.6%; Savaii 21.2%). In general, for every known case of high blood pressure that is diagnosed, another four remain undiagnosed. This ratio is higher in the younger age group, (for every known case there are 22 unknown cases). Most people (more than 90%)
with high blood pressure do not know that they have it.
The total prevalence of obesity is 57.0% (48.4% in males and 67.4% in females) and increases with age. It is more common in urban areas. (For males, Apia 53.1%; Rural Upolu 48%; Savaii 40.2%. For females, Apia 69.3%, Rural Upolu 65.9%, Savaii 65.4%).
Many risk factors for NCD are present among the Samoan population, including: smoking (40% of the total population are smokers: 56.3% of males and 21.8% of females.); poor nutrition: (35.6% of the population eat virtually no fruit.); alcohol consumption (current levels of alcohol consumption place 37.6 % of males and 19.6 % of females at moderate to high risk of developing an NCD); and lack of physical activity (21% of the population do very little or no physical activity). People in Apia are more likely to be inactive (28%) than people in rural areas (15%), and women (27.3%) are more likely to be inactive than men (14.8%). There is a lack of regular health checks. In the last 12
months, only 35% of the population have had a blood sugar check and only 44.9% have had a blood pressure check. Males and younger people are less likely to have checks.
The number of suicide attempts is increasing. However, the proportion resulting in death was only 43.2% in 2006/2007, compared with 60.5% in 1999/2000.
Credits: WHO
More information at: http://www.wpro.who.int/countries/wsm/29SMApro2011_finaldraft.pdf
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