According to the 2015 National Health and Morbidity Survey (NHMS), about two-thirds of Malaysians have at least one of three non-communicable diseases (NCDs), i.e. diabetes, high blood pressure (hypertension) or high cholesterol levels (hypercholesterolaemia).
More than one in four (26.3%) have at least two of these NCDs and 7.2% have all three NCDs.
The report revealed the prevalence of such diseases in those aged more than 18 years:
• High blood pressure – 30.3%.
High blood pressure was diagnosed in 13.1% and undiagnosed in 17.2%, i.e. for every two persons diagnosed with high blood pressure, there were three undiagnosed.
• Diabetes – 17.7%.
Diabetes was diagnosed in 8.3% and undiagnosed in 9.2%, i.e. for every one person diagnosed with diabetes, there was one more undiagnosed.
• High cholesterol levels (hypercholesterolaemia) – 47.7%.
High cholesterol levels were diagnosed in 9.1% and undiagnosed in 38.6%, i.e. for every one person diagnosed with high cholesterol levels, there were four undiagnosed.
Ischaemic heart disease, cerebrovascular disease and chronic kidney disease are the first, second and ninth causes of deaths in 2016, with an increase of 39.6%, 23.8% and 34.3% respectively since 2005.
Ischaemic heart disease and cerebrovascular disease are the top two causes of death and disability combined in 2016.
Hypertension ranks as the second risk factor of death and disability combined in 2016, with a 47.2% increase since 2005 and contributed to 42.2% of deaths.
Of the diagnosed hypertensives, 58% were treated at Health Ministry (MOH) clinics, 18% at MOH hospitals, 19% at private clinics and 3% at private hospitals, with 2% self-medicating by purchasing medications directly from pharmacies (NHMS 2015).
A team from the MOH and the Universities of Malaya and Melbourne studied the data on hypertension in NHMS 2011.
They found that the “age-standardised” prevalence of hypertension was estimated to be 33.9%.
Only 39.0% of adults with hypertension had been diagnosed by a medical practitioner, 35.7% had been on treatment, and 9.6% had blood pressure controlled under treatment.
The diagnosis, treatment and controlled treatment coverage were higher for older persons compared to younger persons.
There were no differences in the diagnosis and treatment coverage between urban and rural areas, and between ethnic groups.
The prevalence of diabetes increased from 6.3% in 1986 to 8.2% in 1996, 11.6% in 2006 and 17.7% in 2015 (NHMS 1986, 1996, 2006 & 2015).
At the current rate of increase, about one in four to five Malaysians will be diabetic in 2020 and three in 10 in 2025.
Of the diagnosed diabetics, 59% were treated at MOH clinics, 20% at MOH hospitals, 15% at private clinics and 4% at private hospitals, with 1.5% self-medicating by purchasing medications directly from pharmacies (NHMS 2015).
The majority of the diabetics had other co-morbidities – 75% had hypertension and 70% hypercholesterolaemia (diagnosed or undiagnosed).
Those whose co-morbidities were controlled were 29% and 48% for hypertension and hypercholesterolaemia respectively. (NHMS 2015)
Of the diagnosed diabetics, only 38% had blood glucose levels that were within treatment targets, suggesting that there were more than a million uncontrolled diabetics.
The prevalence of hypercholesterolaemia increased from 28.2% in 2006 to 47.7% in 2015 respectively.
It was diagnosed in 9.1% and undiagnosed in 38.6%, with the increase due to an increase of undiagnosed hypercholesterolaemia from 26.6% in 2011 to 38.6% in 2015. (NHMS 2015)
Of those with diagnosed hypercholesterolaemia, 50% were treated at MOH clinics, 19% at MOH hospitals, 24% at private clinics and 5% at private hospitals, with 2.3% self-medicating by purchasing medications directly from pharmacies (NHMS 2015).
Of the diagnosed cases, 45% and 37% of those treated at MOH hospitals and private clinics respectively had their total blood cholesterol levels controlled. However, the survey was limited by having no distinction between LDL and HDL cholesterol.
Although there was a general increase in the prevalence of diabetes and hypercholesterolaemia, some states are affected more – the highest prevalence of diabetes was in the northwest and east coast of Peninsular Malaysia and Sarawak.
Although the prevalence of hypertension throughout Malaysia decreased slightly between 2011 and 2015, Kelantan is the only state that had an increase.
Negri Sembilan, which had a high prevalence of diabetes in 2006, had a decrease in the prevalence between 2011 and 2015.
NCDs accounted for 60% of the disease burden in Malaysia in 1990. This increased to 72% in 2013.
According to the World Health Organization, Malaysia has no operational multisectoral national NCD policy, strategy or action plan that integrates several NCDs and their risk factors.
This incongruence is difficult to understand, particularly when the NCD epidemic in the country shows no sign of slowing down.
The MOH’s targets are to reduce the prevalence of hypertension from 32.2% to 26.0%; halt the rise of diabetes and obesity; and reduce the risk of premature mortality from cardiovascular disease, diabetes, cancer and chronic respiratory disease from 20% to 15% (Source: National Strategic Plan for Non-Communicable Disease 2016-2025, page 14).
However, the details of the roadmap are unclear.
The song of public-private sector collaboration has been sung by Health Ministers for more than two decades. Yet there has been nothing substantive to show for it.
Private sector clinics provide more than half the primary care for the population.
Private registered medical practitioners (RMPs) have provided and continue to provide cost-efficient and patient-centric services, usually in a one-stop patient-friendly facility. Choice, accessibility and affordability have not been major issues for this established service.
It is time that the private sector clinics be officially recognised as part and parcel of the national primary care system. For a start, they can be engaged to combat the NCDs of hypertension, diabetes and hypercholesterolaemia.
The private RMPs can play significant roles in reducing the large numbers of the undiagnosed and poorly controlled NCDs within the parameters of a protocol acceptable to the MOH and themselves.
Private RMPs have a better relationship with patients compared to their public sector counterparts. This crucial factor alone will contribute to better screening, diagnosis, treatment and its compliance, and health education of diagnosed and undiagnosed cases of these NCDs.