1. NCD surveillance Melanie Cowan, Technical Officer, Surveillance Surveillance and Population-based Prevention Unit Dept. of Chronic Diseases and Health Promotion

2. NCD Surveillance at WHO
NCD Country Capacity Survey (CCS)
Comparable Estimates for Key Risk Factors
STEPS (adults)
GSHS (adolescents)

3. NCD Country Capacity Survey
To gather information about individual country capacity for NCD prevention and control.
Assessment focused on current strengths and weaknesses related to: NCD infrastructure, policy response, surveillance and health systems response and partnerships and health promotion.
3rd wave of surveillance in 2010 – previous surveys in 2000 and A further wave planned for 2013.
96% response rate from Member States in 2010.
Periodic monitoring of national progress would assist countries in identifying gaps in prevention and control efforts and assist with future planning.

4. Comparable estimates for selected NCD Risk Factors
GBD 2008 update, includes many NCD risk factors
Metabolic risk factors – BMI, Blood pressure, Blood Glucose, Cholesterol
Country consultation conducted on all comparable risk factor estimates between September and December 2010 and again during July2011.
For inclusion in the NCD Global Status Report released in April 2011 the NCD Country Profiles launched in September 2011.
Lancet papers released in April 2011, showing 30 year trends in metabolic risk factors. Also included in Country profiles.

5. Comparable estimates – overweight/obesity/mean BMI
Lancet paper released in April 2011, showing 30 year trends in overweight and obesity.
In 2008, 35% adults overweight globally (34% men and 35% women).
10% men and 14% women obese in 2008.
Worldwide obesity has more than doubled since 1980.
In 2008, 1.5 billion adults, 20 and older, were overweight. Of these over 200 million men and nearly 300 million women were obese.

6. Age-standardized prevalence of overweight in adults aged 20+ years by WHO Region and World Bank income group, comparable country estimates, 2008

7. Global Health Observatory (GHO)

8. Prevalence of overweight (BMI 25+), 2008, ages 20+, age adj

9. Prevalence of raised blood pressure*, 2008, ages 25+, age std
*defined as less systolic BP 140+ and/or diastolic BP 90+ or on medication for raised BP

10. NCD Country Profiles

11. STEPwise approach to chronic disease risk factor surveillance (STEPS)

12. STEPS- adult risk factor surveillance Objectives
Empower Member States to gather information on chronic disease risk factors for use in planning health programmes and interventions.
Provide standardized questionnaire that allows for comparisons, but is flexible to meet Member States' needs.
Build capacity in Member States in all aspects of national survey implementation; in particular, develop skills in sample design, data collection and data analysis.

13. # in field / data entry or analysis work
Current Activity
# planning
# in field / data entry or analysis work
# reporting completed
Total # active
# trained but inactive
# with 1 or more repeats
AFRO 10 18 15 43
(3) 7
AMRO 13 8 1 22
EMRO 2 9
(1)
EURO 3
(0)
SEARO
WPRO 11 25
120

14. Questionnaire Overview
Different levels of risk factor assessment:
STEP 1 – questionnaire
STEP 2 – physical measurements
STEP 3 – blood samples
Three modules per Step:
Core
Expanded
Optional

15. Questionnaire Overview, cont.
Behavioural Risk Factors
Tobacco use
Harmful alcohol consumption
Unhealthy diet (low fruit and vegetable consumption)
Physical inactivity
Biological Risk Factors
Overweight and obesity
Raised blood pressure
Raised blood glucose
Abnormal blood lipids
Optional Modules on Injury and Violence, Oral Health, Sexual Health

16. *(Personal Digital Assistant)
STEPS Methodology
Targets a nationally-representative sample of adults aged 25 – 64.
STEP 1 (questionnaire) and STEP 2 (physical measures) are conducted in the household by trained interviewers.
STEP 3 (biochemical measures) is typically clinic-based.
Pocket PCs (PDAs*) are used for data collection: "eSTEPS"
Repeat survey should be done every years.
*(Personal Digital Assistant)

17. Global School-based Student Health Survey (GSHS)

18. Global School Based Student Health Survey (GSHS) Overview & Objectives
System for surveillance of behavioural risk factors and protective factors in school-aged children
Help countries develop priorities, establish programmes, and advocate for resources
Establish trends in the prevalence of health behaviors and protective factors by country
Allow countries and international agencies to make comparisons across countries

19. GSHS: Methods Self-administered questionnaire and generic answer sheet
Targets grades with students aged 13 – 15 years
Completed by students during one classroom period
Anonymous and confidential
10 Question Modules are available, from which countries can select a minimum of 6:
Alcohol, diet, drugs, hygiene, mental health, physical activity, protective factors, sexual behaviours, tobacco, violence & injury

20. GSHS: Current Implementation
Worldwide, 114 countries across all six WHO regions have been trained and 77 have finished GSHS data collection (including 13 countries with repeat surveys).

21. Questions?