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ZALMA ABDUL RAZAK Nutrition Division Ministry of Health Malaysia
Ministry of Health Malaysia
National Health & Morbidity Survey 2015; NCD Risk Factors
Introduction § The National Health and Morbidity Survey (NHMS) is a
nationally representative health survey of population in Malaysia.
§ NHMS was first initiated in 1986. The 2nd NHMS was
conducted ten years later in 1996 than followed by the 3rd NHMS in 2006.
§ The Minister of Health had suggested a more frequent
survey to ensure timely information for policy makers particularly to support the implementation of health care transformation and the 5-yearly Malaysia Plan.
2
Introduction § Starting from 2011, the survey was planned to be
conducted as 4 yearly cycles with annual data collection (2011-2014).
§ NHMS 2015 was conducted as the first survey in a new
cycle of NHMS (2015-2018).
3
Objectives § To supplement community-based data on the pattern of
common health problems, health needs and expenditure on health in the community to enable the Ministry of Health to review priorities and activities of programmes, plan future allocation of resources.
4
Scopes of NHMS 2015 1. Healthcare Demand 2. Non-Communicable Diseases & NCD risk factors
a. Non-Communicable Diseases • Diabetes Mellitus • Hypertension • Hypercholesterolemia
b. NCD risk factors • Nutritional Status & Obesity • Dietary Practice • Physical Activity • Smoking
3. Family Health 4. Others
5
A. Non-Communicable Diseases I. Diabetes Mellitus II. Hypertension III. Hypercholesterolemia
6
Prevalence of Diabetes, ≥18 years
Known DM 8.3%
Undiagnosed DM 9.2%
Total DM 17.5%
3.5 million people
affected
7
I. DIABETES MELLITUS
11.6
15.2
17.5
7.0 7.2 8.3
4.5
8.0 9.2
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
vale
nce
(%
)
Total diabetes Known Undiagnosed
8
Trend of Diabetes, ≥ 18 Years NHMS (2006, 2011 & 2015)
Trend of Diabetes, ≥ 30 Years, NHMS (1996, 2006, 2011 & 2015)
8.3
14.9
20.822.5
6.5
9.510.7 10.6
1.8
5.4
10.1
11.9
0.0
5.0
10.0
15.0
20.0
25.0
NHMS 1996 NHMS 2006 NHMS 2011 NHMS 2015
Total Known Undiagnosed
Pre
vale
nce
(%
) 9
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
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
45.0
Pre
vale
nce
(%
)
Known Undiagnosed Total diabetes
10
Prevalence of Diabetes, ≥18 Years, By Age Groups (NHMS, 2015)
Prevalence of Diabetes, ≥18 Years, by Sex (NHMS, 2015)
16.7
18.3
7.6
9.19.1 9.2
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
18.0
20.0
Male Female
Total DM Known DM Undiagnosed DM
11 P
reva
len
ce (
%)
Prevalence of Diabetes, ≥18 Years, by Ethnicity (NHMS, 2015)
14.6
9.09.8
5.2
12.0
7.7 7.7
3.8
22.1
16.0
11.9
7.7
10.7
6.88.1
3.1
7.4
2.5
8.6
4.3
0.0
5.0
10.0
15.0
20.0
25.0
Total Diabetes Known Diabetes Undiagnosed DM IFG
Malay Chinese Indian Other Bumiputras Other
12 P
reva
len
ce (
%)
17.7
8.7 9.1
4.7
16.7
7.2
9.5
5
0.0
5.0
10.0
15.0
20.0
Total Diabetes
Known DM Undignosed IFG Total Diabetes
Known DM Undignosed IFG
Urban Rural
Pre
vale
nce
(%
) 13
Prevalence of Diabetes, ≥18 Years, By Locality (NHMS 2015)
11.1
13.6 11.7
15.2 15.3
12.1
14.9
12.6 13.5
12.0 11.1
6.4
10.0
12.6 13.4
22.5
19.7
17.1
22.0
16.7 15.0
16.2
24.8
16.5
11.6
9.0
12.3 11.3
8.8
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
vale
nce
(%
)
NHMS III (2006) NHMS 2011 NHMS 2015
14
Prevalence of Diabetes, ≥18 Years by State NHMS (2006, 2011 & 2015)
Prevalence of Hypertension, ≥18 years NHMS 2015
Known Hpt 13.1%
Undiagnosed Hpt
17.2%
Total Hpt 30.3%
6.1 million people
affected!!
15
II. HYPERTENSION
32.2 32.730.3
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
NHMS III (2006) NHMS 2011 NHMS 2015
Prevalen
ce (%
)
16
Trend of Hypertension, ≥ 18 Years NHMS (2006, 2011 and 2015)
Trend of Hypertension, ≥ 30 Years NHMS (1996, 2006, 2011 and 2015)
32.9
4743.5
39.8
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
45.0
50.0
NHMS 1996 NHMS 2006 NHMS 2011 NHMS 2015
Pre
vale
nce
(%
) 17
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
Known Undiagnosed Total HPT
Pre
vale
nce
(%
) 18
Prevalence of Hypertension, ≥18 Years by Age Groups, (NHMS, 2015)
30.8
12.2
18.6
29.7
14.015.6
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
Total Hypertension
Known hpt Undignosed hpt
Total Hypertension
Known hpt Undignosed hpt
Male Female
19
Prevalence of Hypertension, ≥18 Years By Sex, (2015)
31.1
12.5
18.6
30.8
15.2 15.6
32.4
17.0 15.4
33.4
15.7
17.6
20.0
5.2
14.9
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
Overall Known Undiagnosed
Malays
Chinese
Indians
Other Bumiputras
Others
20
Prevalence of Hypertension, ≥18 Years By Ethnicity, (NHMS, 2015)
Pre
vale
nce
(%
)
29.3
13.2
16.1
33.5
12.8
20.7
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
Total hypertension Known Undiagnosed
Urban Rural
Pre
vale
nce
(%
) 21
Prevalence of Hypertension, ≥18 Years By Locality, (NHMS, 2015)
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
2011 2015
22
Prevalence of Hypertension, ≥18 Years By State, NHMS(2011 &2015)
Pre
vale
nce
(%
)
Prevalence of Hypercholesterolemia, ≥18 years, NHMS 2015
Known hypercholesterolemi
a 9.1%
Undiagnosed hypercholesterolemia
38.6%
Total hypercholesterolemia 47.7%
9.6 million people affected !!
4 out 5 affected people were
unknown cases
23
III. HYPERCHOLESTROLEMIA
Trend of Hypercholesterolemia, ≥ 30 Years, NHMS (1996, 2006, 2011, 2015)
11.7
28.2
43.9
56.8
0.0
10.0
20.0
30.0
40.0
50.0
60.0
NHMS 1996 NHMS 2006 NHMS 2011 NHMS 2015
Pre
vale
nce
(%
) 24
25
0.2 0.8 2.2 4.2 5.4
9.8 12.2
17.4 20.2
25.2 23.5 24.3
22.3
21.9 25.6
31.4
39.8
44.2 47.4 47.9 48.1 48.5
40.0 38.1 38.4
36.0
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
Known Undiagnosed Total Hchol
Pre
vale
nce
(%
)
Prevalence of Hypercholesterolemia, ≥18 Years by Age Groups, (NHMS, 2015)
43.5
8.5
35.0
52.2
9.8
42.4
0.0
10.0
20.0
30.0
40.0
50.0
60.0
Total Hypercholesterol
Known Undiagnosed Total Hypercholesterol
Known Undiagnosed
Male Female
Pre
vale
nce
(%
) 26
Prevalence of Hypercholesterolemia, ≥18 Years By Sex, (NHMS, 2015)
27
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
vale
nce
(%
)
Malay
Chinese
Indians
Other Bumiputras Others
Prevalence of Hypercholesterolemia, ≥18 Years By Ethnicity, (2015)
47.7
9.7
38.0
47.7
7.1
40.5
0.0
10.0
20.0
30.0
40.0
50.0
60.0
Overall Chol Known Undiagnosed
Pre
vale
nce
(%
)
Urban Rural
28
Prevalence of Hypercholesterolemia, ≥18 Years By Locality, (2015)
29
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
NHMS 2011 NHMS 2015
Pre
vale
nce
(%
)
Prevalence of Hypercholesterolemia, ≥18 Years By State, NHMS (2011 &2015)
B. NCD RISK FACTORS I. Nutritional Status including Obesity II. Dietary Practices III. Physical Activity IV. Smoking V. Alcohol consumption
30
(Aged ≥ 18 years old)
31
I. NUTRITIONAL STATUS
Trend of Overweight and Obesity, ≥18 Years NHMS (1996, 2006, 2011 & 2015
4.5
14 15.117.716.6
29.1 29.4 30
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
1996 2006 2011 2015
Pre
va
len
ce (
%)
obesity overweight
32
33
Prevalence of Overweight and Obesity, ≥18 Years by Sex (NHMS, 2015)
Pre
vale
nce
(%
)
31.6
15.0
28.3
20.6
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
Overweight Obesity
Male
Female
34
Prevalence of Overweight and Obesity, ≥18 Years by Ethnicity (NHMS, 2015)
Pre
vale
nce
(%
)
31.0
21.1
28.1
11.7
35.0
27.1
31.2
18.0
25.3
7.7
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
Overweight Obesity
Malays
Chinese
Indians
Other BumiputrasOthers
35
Prevalence of Overweight and Obesity, ≥18 Years by Locality (NHMS, 2015)
Pre
vale
nce
(%
)
30.7
17.7
28.1
17.5
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
Overweight Obesity
Urban
Rural
15.9 15.216.2
17.716.0 15.3
12.8
16.2
21.7
17.1
14.0
10.6
14.0 13.514.9
18.1
20.5
16.2
21.923.9
19.4
13.8
17.5
22.3
18.7 18.6
13.4
18.4
14.9
25.8
0.0
5.0
10.0
15.0
20.0
25.0
30.0
NHMS 2011 NHMS 2015
36
Prevalence of Obesity, ≥18 years By State, NHMS (2011 &2015)
Pre
vale
nce
(%
)
(Aged < 18 years old)
37
NUTRITIONAL STATUS
38
Trend of BMI-For-Age, (Aged < 18 years old) NHMS (2006*, 2011* & 2015**)
*CDC 2000 Reference ** WHO 2006 Standard & WHO 2007 Reference
Pre
vale
nce
(%
)
8.7
77.7
13.6 6.9
83.1
10.0
0.00
10.00
20.00
30.00
40.00
50.00
60.00
70.00
80.00
90.00
Thinness (BMI for age <-2SD)
Normal (BMI for age -2SD - < +2SD)
Obesity (BMI for age >+2SD)
Pre
vale
nce
(%
)
Male Female
39
Prevalence of Body Mass Index for age * by Sex, (NHMS, 2015)
Prevalence of Body Mass Index for age * by Locality, (NHMS, 2015)
8.0
79.8
12.17.2
81.6
11.2
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
Thinness (BMI) for age <- 2SD) Normal (BMI for age - 2SD - < + 2SD)
Obesity (BMI for age >+ 2SD)
Urban Rural
Pre
vale
nce
(%
) 40
* WHO 2006 & WHO 2007 Reference
41
II. DIETARY PRACTICES
5.6
6.4
0.0
1.0
2.0
3.0
4.0
5.0
6.0
7.0
Male Female
Pre
vale
nce
(%
)
42
Prevalence of Adequate Intake of Fruits or Vegetables (≥ 5 Servings) by Sex (NHMS, 2015)
43
Prevalence of Adequate Intake of Fruits or Vegetables (≥ 5 Servings) by Ethnicity (NHMS, 2015)
4.3
8.3
5.1
10.7
4.2
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
Malays Chinese Indians Other Bumiputras Others
44
III. PHYSICAL ACTIVITY
• NHMS 2006 – respondents aged 18 years and above • NHMS 2011 & 2015 – respondents aged 16 years and above
56.3
64.366.5
64.7
69.571.1
49.5
59.0
61.7
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
NHMS 2006 NHMS 2011 NHMS 2015
Pre
vale
nce
(%
)
Overall Male Female
45
Trends of Physical Activity, NHMS (2006, 2011 & 2015)
65.071.3
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
Urban Rural
Pre
va
len
ce (
%)
46
Prevalence Of Physically Active Adults byLocality, (NHMS, 2015)
61.0
67.9 68.1 69.370.8 73.4 72.4 72.3
63.360.9
57.4
48.1
30.0
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
Pre
vale
nce
(%)
47
Prevalence of Physically Active Adults byAge Groups, (NHMS, 2015)
48
49
Prevalence of Current Tobacco Smoker by Sex, > 18 Years (NHMS 2015)
Pre
vale
nce
%
Prevalence of Current Tobacco Smoker by Age Groups, ≥ 15 years, (NHMS, 2015)
13.2
25.3
27.729.3 29.7
26.3
23.822.1
17.4
14.2 13.5
11.29.2
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
18-19 20-24 25-29 30-34 36-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75+
Pre
vale
nce
%
50
24.7
14.216.5
25.8
35.0
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
MalayChineseIndianOther BumiputrasOthers
Pre
vale
nce
(%
)
51
Prevalence of Current Tobacco Smoker by Ethnicity, ≥ 15 years, (NHMS, 2015)
Prevalence of Current Tobacco Smoker by States, ≥ 15 years (NHMS 2015)
22.2
26.524.6
16.9
20.9
25.5
19.221 22.2
28.425.4
20.922.2
19.1
12.4
0.0
5.0
10.0
15.0
20.0
25.0
30.0
52 P
reva
len
ce %
Thank You Acknowledgement: Institute for Public Health, Ministry of Health Malaysia
53
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