NCD Surveillance in Sleman District dr. Fatwa Sari T.D., MPH, PhD Public Health Division Faculty of Medicine, UGM

Background: Increasing the prevalence of NCD in Indonesia Maternal/ Perinatal Communicable Diseases Non-commu- nicable diseases Injury Source: Riskesdas 2007

Disease prevalence in Indonesia and in Yogyakarta Province Risk factors/disease Prevalence (%) Indonesia Yogyakarta Province Lowest Prevalenc e Highest prevalenc e Smoking Physical inactivity Low fruit and vegetable intake Alcohol drinking Hypertension Heart diseases Stroke Diabetes Tumor Source: Riskesdas 2007

Causative factors for NCD Environ- mental risk factors Behavioral risk factors Biological risk factors NCD Heart disease Stroke Diabetes Chronic respiratory disease Cancer High blood glucose Hypertension Abnormal serum lipids Abnormal waist/hip ratio Abnormal lung function Unhealthy diet Physical inactivity Tobacco use Harmful use of alcohol Globalization Urbanization Poverty Low education Stress WHO: Monitoring the progress of NCD in LMIC

Goal: To develop a surveillance system of NCD risk factors to monitor the progress of NCD in Yogyakarta Provides evidence based intervention for policy maker Encourages networking in NCD control and prevention Facilitates research in NCD areas

Methodology

 Sleman District  Population : 15 – 75 yrs old  Total sample : 3600  Based on WHO STEPS guideline  Consideration:  sex and age group/stratum  20% non response

Table 1. Minimal sample size for NCD risk factor’s survey Sex Sample size of each group 15-24yr25-34yr35-44yr45-54yr55-64yr65-75yr Male250 Female250 Total = % non response = 3600 Sample size

Sampling method  Scenario 2 – WHO STEPS sample design  Multi-stage cluster sampling- PPS  Cluster based on dusun (hamlet)  Number of cluster = 10% of total hamlet(1221)  Stage  1 st = cluster selection  STEPS sampling software  2 nd = household selection  STEPS sampling software  3 rd = respondent/participant selection  Kish respondent selection  1 household 1 respondent

Population, samples and sampling design (STEPwise guidance) Adult (15-75 years) No physical disability Population (1212 hamlet) 122 hamlets Random selection of 10% of hamlets 1100 households Develop a sampling list from selected households Proportionate to size random selection of households Random selection of 3600 respondents 3600 respondents

Variable  Demographic  Risk  Tobbaco use  Alcohol consumption  Types of activity  Sedentary lifestyle  Physical examination  Height, weight, waist circumference, blood pressure

Instrument  WHO STEPS Instrumen – translate-Indo version WHO STEPS Instrumen Indo version  STEPwise instrument core version (WHO, 2006)

The plan of data collection Baseline survey Repeated cross-section II Repeated cross-section III.... September

Data analysis Sex15- (years) 25- (years) 35- (years) 45- (years) 55- (years) (years) Men250 Women250 Minimum number of respondents= 3000 Sex15- (years) 25- (years) 35- (years) 45- (years) 55- (years) (years) Men Women Weighted by number of population by sex and age- groups in certain year

The prevalence of NCD risk factors in Yogyakarta city, 2004 and 2009 ManWoman

The prediction of people at high risk of getting CVD according to sex and SES

The initiation of men and women at high risk of getting CVD in Yogyakarta city year 2004 and 2009 ManWoman Age groups