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The WHO STEPwise approach to chronic disease risk factor surveillance Overview in EMR

The WHO STEPwise approach to chronic disease risk factor surveillance Overview in EMR. October 2006, Cairo, Egypt. Introduction. Worldwide, NCD are major causes of disability and premature deaths Currently in EMR, 45% of disease burden is attributed to NCD and will rise to 60% by 2020

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The WHO STEPwise approach to chronic disease risk factor surveillance Overview in EMR

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  1. The WHO STEPwise approach to chronic disease risk factor surveillance Overview in EMR October 2006, Cairo, Egypt

  2. Introduction • Worldwide, NCD are major causes of disability and premature deaths • Currently in EMR, 45% of disease burden is attributed to NCD and will rise to 60% by 2020 • This global and regional epidemic is attributed to population aging and high prevalence and exposure to NCD risk factors RF • Modifiable RF include: smoking, physical inactivity, low vegetables and fruit diet, diabetes, obesity, and high lipid profiles. • WHO’s efforts is primarily directed to prevention and control of NCD RF.

  3. Challenges for surveillance in EMR • Lack of national NCD & RF surveillance systems • Inadequate national capacity in surveillance & methodologies in both low & middle income countries • Lack of reporting chronic diseases attributes (risk factors, morbidity and mortality) in the annual health reporting systems • No link of mortality data to NCD prevention and control

  4. Percentage of countries reported covering NCD in their surveillance system

  5. Progress: percentage of countries reported having routine NCD surveillance system in EMR Note: One country is excluded for best comparability between the 2 surveys

  6. Percentage of countries reported having annual health reporting system and surveillance system for NCD

  7. Objectives of workshop • To upgrade capacity to manage, analyse, interpret and report through: • Training on data entry, verification, checking and cleaning • Sample design issues • Descriptive and analytic statistics • Weighting and clustering • Skills in interpreting data (e.g confidence intervals) • Standardization of reporting • Keeping STEPS sustainability (interest, commitment and political support)

  8. Focus • Situation of Stepwise approach to NCD RF in EMR (Implementation & reporting ) • Sampling issues • Remarks regarding: • Methodology • Documentation / Data presentation • Comparability of data • Generalization and applicability • DM as an example

  9. Implementation & reporting in EMR : Implemented: 12 out of 22 countries Reported results: 8 out of 22 countries

  10. STEPS in EMR countries

  11. Implementation issues of 8 EMR countries according to STEPS reporting * Notmentioned *

  12. Sampling issues of 8 EMR countries according to STEPS reporting

  13. Sample size and response rate

  14. Remarks in methodology: • Inclusion criteria of target population except for age • Phases of the study and time intervals • Sample size: • Basis of determination • Non-response rate in prevalence studies (at different levels) • Sample design: • Multi-stage cluster sample with stratification • Basis of stratification was not clear • Clusters, sampling units (primary) or enumeration areas EA were selected in PPS • Households units (individuals, or legible family members) were selected in a systematic way in some countries (e.g Jordan and Pakistan) • Tools and instruments: • Generic or modified, version • Variable lists, codes, values

  15. Remarks in documentation and data presentation: • No specific format for documentation /data presentation • Summary was there, far away from fact sheet • Sequence of results, Step I, II, III • Tabulations was not ideal sometime invalid • Numbers & % • Row, column %, • Confidence intervals (small numbers) , Totals

  16. Prevalence of DM in some EMR countries according to STEPS results Table ( ) Prevalence of Diabetes in some EMR countries according to STEPS survey results

  17. Comparabilityandgeneralization • Clinical vs subcinical diabetes • Age categories are not the same; prevalence increases with age • Cut-off points for diagnosing diabetes were not standardized. • Sample size is too small to generalize (Iraq) • National vs sub-national. Although sample size was relatively large in Pakistan study , yet sub-national. In Iraq sample size was too small and study sub-national to be representative.

  18. Conclusions • KI interview with NCD focal points after the GS for assessing national capacity for NCD showed the ultimate need for technical support in chronic diseases and risk factor surveillance by both low & middle income countries in EMR • Appropriate sampling is crucial for reliable and valid survey results • Standardized methodologies, tools, instruments could yield reliable and comparable estimates nationally and regionally • A good surveillance and survey system covering NCDs and related risk factors without question is still a key investment shaping the evidence-based decision making in NCD prevention and control

  19. Thank You

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