Women Health

Theory & practice

The Gap
 To keep women in:
the best state of,
physical, Mental &Social
wellbeing all through her
life stages
“People with osteoporosis do not
just die;
they slowly break apart.” —

Linda Johnson
Osteoporosis is a
disease of women
80
70
60
50
40
30
20
10
0
Hip Lung Breast Cervical Ovarian Endo- Ischemic Stroke
Fracture Cancer Cancer Cancer Cancer Metrial Heart
Cancer Desease
Mortality (x 1,000)
 Etiology

1. genetic parameters (Danker-Hopfe and Delibalta)

2. socioeconomic conditions (Belmaker 1994),

3. general health and life-style (Parazzini et al.

4. nutritional status (Osteria 1994; et al. 1997),

5. physical activity (Malina 1983; Baker 1985),

6. altitude level (; Kapoor and Kapoor 1986)

Number of Dxa Machines
Number of DEXA

160

140

120

100

80

60

40

20

0
Cairo Shebin El Kom Mansoura Beny Sweif El Menya
Number of DEXA
 Access to Treatment
Access to Treatment

20%
18%
16%
14%
12%
10%
8%
6%
4%
2%
0%

Access to Treatment
 Women Understanding About
Osteoporosis
Women Understanding

90%

80%

70%

60%
50%
40%
30%

20%

10%

0%

Women
Understanding
Fracture rate% in
treated patients   Difference in efficacy from control agent
Power Power
80% 90%

10 30 50 10 30 50

1.2 235 000 18 080 4 178 313 700 23 944 5 484

 Age T- score
-5 -4.5 -4 -3.5 -3 -2.5 -2 -1.5 -1
50 54 6.0 3.6 2.3 1.5 1.1 0.9 0.7 0.6 0.5
55 59 5.5 3.5 2.3 1.7 1.2 1.0 0.8 0.7 0.6
60 64 5.3 3.5 2.5 1.8 1.3 1.1 0.8 0.7 0.6
65 69 5.9 4.1 3.0 2.3 1.7 1.4 1.1 0.9 0.8
70 74 7.0 5.2 3.9 3.0 2.4 1.9 1.5 1.3 1.1
75 79 8.5 6.4 4.9 3.8 2.9 2.3 1.8 1.6 1.4
80 84 10.0 7.6 5.9 4.5 3.5 2.8 2.2 1.9 1.6

For all age bands, the results for alendronate let

to the most favourable cost per QUALY results,
followed by the results of risedronate.
National Institute for Health and Clinical Excellence - UK
Drug Vertebral Fx Hip, Pelvis and Proximal humerus,
other Femural Fx rib, sternum,
scapula & fibula fx

Alendronate ▼44% ▼38% ▼19%

0.46 0.68 0.40 0.98 0.68 0.97
Trials/ Participants 4 / 7039 4 / 7881 6 / 9973
Risedronate ▼39% ▼26% ▼24%
0.50 0.75 0.59 0.93 0.64 0.91
Trials/ Participants 3 / 2301 3 / 11770 5 / 12399
Etidronate ▼60% ▼50% ▲4%
0.20 0.83 0.05 5.34 0.64 1.69
Trials/ Participants 3 / 341 2 / 180 4 / 490
Raloxifene ▼35% ▲13% ▼8%
0.53 0.97 0.66 1.96 0.79 1.07
Trials/ Participants 1 / 4551 2 / 6971 1/ 6828
Teriparatide ▼65% ▼50% ▼35%
0.22 0.55 0.09 2.73 0.43 0.98
Trials/ Participants 1 / 1326 1 / 1637 1 /1637
 Is quality of pharmaceuticals a
problem?
Substandard drugs is a big problem - antibiotics,
antimalarials, antituberculosis drugs included.
Incorrect
ingredient
16%
breakdown of data on
Incorrect 325 cases of
amount substandard drugs -
17% including antibiotics, the
world to WHO database
No active
ingredient
Other errors 60%
7%
 e
nc
ia
pl
m
Co Safety
y
ac
fic
Ef
Best treatment compliance
reported in this survey was 7
months in Mansoura.
and
The most frequent rate was
4 months reported in most of
the study sites.
Why women Do Not
Comply?
Because they are

women
Drug price
 Osteoporosis treatment
expenditure (L.E.) in Egypt

20000000
18000000
16000000 ACTONEL
FOSAMAX
14000000
BONAPEX
12000000 RISALDENE
10000000 MIACALCIC
PROTELOS
8000000
ZOMETA
6000000 EVISTA
4000000 RALOX

2000000
0

09
05

06

08
03

04

07

20
20

20

20

20
20

20

s
s

le
le

le

le

le
le

le

Sa
Sa

Sa

Sa

Sa

Sa

Sa

e
LE

LE

LE

LE

LE

LE

at
tim
Es
 Drug units sales in Egypt.
200000
180000
160000 ACTONEL
FOSAVANCE
140000
FOSAMAX
120000 MIACALCIC
100000 BONIN NASAL
MIACALCIC PLUS
80000
PROTELOS
60000 EVISTA
40000 RALOGEN

20000
0
Patients days of therapy (1000) in
different countries.
160000
140000
120000
Total France
100000 Total italy
Total Lebnon
80000 Total KSA
Total Egypt
60000 Total Jordan
Total Arab
40000
20000
0
 Patients days of therapy(000) in
Arab countries compared to France
  2003 2004 2005 2006 2007 2008 2009

Egypt 5,455 5,537 5,703 5,768 5,681 5,847 5,921

Lebanon 4,403 5,344 5,304 5,523 5,973 6,099 8,885

KSA 1,156 1,420 1,917 2,771 2,945 3,146 4,650

Jordan 760 736 810 901 952 980 811

France 213,619 233,525 256,538 276,239 301,966 322,906 338,822

IMS international
 The Tragedy of Osteoporosis
1. Painless disease
2. First presentation usually by the end point.
3. Complex etiology.
4. Difficult diagnosis.
5. Very poor compliance for treatment.
6. No cost reimbursement by MOH.
 Our concern is:

All aspects
related to
Women Health
Health stresses that affect
women mainly due to
gender difference
Not necessarily absolute
(pregnancy &Labour)

But also relative

Anemia, osteoporosis, ca.breast &
colon.
80

70

60

50

40

30

20

10

0
1000 B.C. 100 B.C. 1900 2000
Women Life Expectancy
 Women
Health Survey
Egypt
2005-2009
Results
 Most frequent health problems
in Egyptian women.
30 28%
24%
25
20 17% 16%
15 13%

10 6%
5%
5 2%
0

32
ve
bo
Ia
M
B
Most frequent health problems
encountered during our study.

Anemia 28%
Hypertension 24%
Hyperlipidemia 17%
 The percentage of level of education

69.60%
Level of education No. (%) 80.00%

60.00%

Less than a preparatory school

including Illiterates (%)
12528 69.6 40.00%
17.25%
13.15%
20.00%

High-school (Preparatory-
Secondary) graduate (%) 3105 17.25
0.00%

Less than a preparatory school including Illiterates (%)

University Graduates (%) 2367 13.15 High-school (Preparatory-Secondary) graduate (%)
University Graduates (%)
 The Incidence & Distribution Of Monthly Income

80.00%
Egyptian pound 62.30%
Monthly income
60.00%
Freq. %

100-300 LE 40.00%
5004 27.8% 27.80%

300-500 LE 20.00%
11376 62.3% 6.75%
3.15%
500-1000 LE
1215 6.75% 0.00%
Monthly Income
>1000 LE
567 3.15% 100-300 LE 300-500 LE 500-1000 LE >1000 LE
 Distribution of monthly income in relation to BMD in urban and
rural populations

Income Normal Osteopenia Osteoporosis Total χ2 P

100-300 90 819 1359 2268

300-500 54 3987 1026 5067

Urban 500-1000 270 162 117 549 397.1 <0.001

>1000 81 90 81 252

Total 495 5058 2583 8163

100-300 108 990 1638 2736

300-500 63 4833 1251 6147

Rural 500-1000 324 198 144 666 476.8 <0.001

>1000 99 108 108 315

Total 594 6129 3141 9864

 The World Economic Forum in
Sharm El Sheikh 2005
•In a report measuring the global gender gap
:placed Egyptian women last in the league table of
58 nations.

• The critical criteria used in this study were:

1. Economic opportunity .
2. Participation .
3. Health and wellbeing .
4. Educational attainment .
5. Political empowerment.
The numbers are staggering.

Here are few examples:

 
• There are nearly 37 million women in Egypt.

•Of the working adult population of Egypt, only 22% are

women.

•On average, working Egyptian women earn nearly one

third less than men.

•Only 9% of working women are in managerial and

administrative jobs.

•More than 22% of adult women are unemployed

compared with just more than 5% unemployed men.
•One third of women aged 15-24 years cannot read or
write

•In 2000, 84 women died of pregnancy and birth for

every 100,000 babies born alive

•Of those 84 mothers, 46 were 15-19 years old

•Of all women aged 15 – 19 only 15% are or were ever

married

•Egypt ranks 82nd in the world on her maternal

mortality ratio and 123rd on her infant mortality ratio

•Of the 545 members of Parliament, only 9 are women

(2% representation for 50% of the population)
Women  in Egypt
have a problem.
 

They also face

enormous challenges
 Preventive medicine

Prevent the disease

better than treating it.
(Attack the cause)
 Check up policy

Prevent the risk

factor
Compression of Morbidity

Severe Disease

Clinical Threshold

}
Latent

0 20 40 60 80
100
 Comprehensive approach
for women health problems
 Comprehensive approach

• entails many diseases and social

factors :

• as state of housing, education,

culture & financial state.

• But in underdeveloped countries most of the health

expenditure for diagnosis & treatment are directed

mainly towards other problems like infectious

diseases and life threatening conditions

• That are supplied for free or reimbursed for the less

privileged people.

• which is not the case in women health issues.

 The climacteric and HRT
Development of HRT
• 1889 Brown-Sequard pioneered the concept of HRT
• 1893 Injected ovarian extract used
• 1923 Allen & Doisy isolated ovarian hormone (estrogen)
• 1930 Dodds & Robertson used oestrin
• 1941 Organon Labs developed estradiol implant
• 1943 Premarin was introduced
• 1952 Organon developed estriol tablets (Ovestin®)
• 1966 Robert Wilson wrote Feminine forever
• 1975 Unopposed estrogen established as a risk factor
for endometrial carcinoma
• 1980s Introduction of sequential therapies and transdermal
delivery of estrogens
• 1990s Introduction of continuous combined therapies
Development of Tissue-Specific therapies and SERMs
 Early Study termination
on July8th 2002(5.2 years)

• Increased risk of breast cancer 1.26

• 8 more cases / 10000

• Increased risk of CHD 1.29

• 8more cases / 10000

• Stroke 1.41
• 9more cases /10000

• Pulmonary embolism 1.13

• 7more cases / 10000
 I have a dream….
WE
&
Me & all of you…..

Women Health stakeholders..

• Will come to a detailed programme for the

optimum policy for better Quality of Women's Life

 The programme

Must be
consistent
,institutionalized
and
self supported
 Mission

is to help women
from all walks of
life to fulfil their
potential.
 This fulfilment is
achievable through
better quality of life in all its aspects:
• health and wellbeing; economic independence;
• social and political participation;
• access to information;
• achieving higher intellectual capabilities through
education and knowledge;
• the exercise of informed choice; and the awareness of
women’s issues and rights worldwide
• 
 ISAWHER
International Society for the
Advancement of Women’s
Health and Rights
 ISAWHER has its focus
on women in 3 groups:

• Adolescents.

•Adults in their reproductive

years.

•women in the change of life and

the elderly
ISAWHER addresses the critical factors in
achieving better quality of life for women
and reducing the gender gap

•Health and wellbeing.

•Economic opportunity.
•Economic participation.
•Educational attainment.
•Political empowerment.