Major Risk Factors For Non-communicable Diseases Research Articles

Implementation of School Nutrition Policies to Address Noncommunicable Diseases in Uzbekistan and Kyrgyzstan.

Noncommunicable diseases (NCDs), including cardiovascular diseases, cancer, and diabetes, account for over 80% of mortality in Uzbekistan and Kyrgyzstan in 2019, and unhealthy dietary behaviors are a major risk factor for NCDs in both countries. In 2021, national stakeholders, in consultation with the World Health Organization, identified school nutrition policies (SNPs) as a major approach to reducing the burden of NCDs in both countries. The SNPs included interventions implemented through a multistakeholder and multisectoral arrangement that aimed to improve the health and nutrition status of children and young people by providing healthy food/beverages and restricting unhealthy foods or beverages in schools. We used a multimethod approach of document review, participatory workshops, and key informant interviews to generate theories of change for the large-scale implementation of SNPs and describe the implementation processes to date, including key implementation and health system challenges, salient implementation strategies, and implementation outcomes in both countries. Multiple pathways for enacting and implementing SNPs successfully were identified. However, significant health system challenges, such as the lack of accountability for contracting and tender processes and coordination among different sectors, continue to hamper the large-scale implementation of these policies in both countries. The pathways, theories, and implementation outcomes identified will facilitate the development of implementation strategies and systematic learning and evaluation around SNPs for NCD prevention and control programs in the Central Asian region and other low- and middle-income countries more broadly.

Assessing literacy on the interconnection between non-communicable diseases and climate change among youth in Nairobi, Kenya: An interventional study

This study investigates the efficacy of mixed-method educational interventions in enhancing literacy levels among youth in Nairobi concerning the intricate relationship between climate change and non-communicable diseases (NCDs). The education methods used in this study included a continuous trainer-of-the-trainer approach, and peer learning combined with digital health interventions including the NCDs 365 App and the NCDs for Public Health Online course. Utilizing a rigorous methodology, the study engaged 70 participants at baseline and 65 at endline, with a minimal attrition rate. The study focused on key indicators, including literacy levels, positive behavioral changes, and the integration of digital health technologies. Results indicate a commendable increase in literacy levels, with 95.4% of respondents accurately recognizing NCDs at the endline, compared to 81.4% at baseline. Positive shifts were evident in the understanding of examples and major risk factors of NCDs. Climate change awareness notably improved, with 76.9% defining it as a long-term shift in weather patterns at the endline, compared to 44.3% at baseline. The association between climate change and NCDs was acknowledged by 86.2% at endline, up from 57.1% at baseline. Attitudinal and behavioral changes were prominent, as 95.4% expressed intent to participate in NCDs and climate change activities at the endline, compared to 81.4% at baseline. Digital health technologies demonstrated substantial engagement, with 87.7% downloading the NCD365 app. Further, 93.8% enrolled in the online course, and 75.4% frequently used the NCD365 app. Encouragingly, 94.7% would recommend the app to friends. The study concludes that educational interventions significantly enhance knowledge, attitudes, and behaviors related to climate change and NCDs among youth in Nairobi. Recommendations include expanding similar initiatives, incorporating interactive elements, and continuous monitoring for long-term impact assessment. This research contributes pivotal insights to addressing 21st-century challenges through targeted education and technological integration.

Assessment of non-communicable disease risk factors among Andhra Pradesh state road transport corporation bus drivers of Vijayawada

Background: Non-communicable diseases (NCDs) are lifestyle disorders, which contribute to 41 million total deaths globally. In India, it contributes to around 6 million (60%) of all deaths in 2021. The main objective of the study was to assess the socio-demographic factors, prevalence, and association between demographic profile and major NCD risk factors among Andhra Pradesh state road transport corporation bus drivers of Vijayawada. Methods: It is a cross-sectional study conducted from July to October 22 among APSRTC bus drivers aged above 20 years in Vijayawada. Data was collected by using a pre-designed modified world health organization questionnaire. Results: The results(n=120) from the current study showed that the majority of the driver’s mean age was 46.4±10.9, 37.5% had hypertension, 24.2% had diabetes, 54.2% had insufficient sleep, and 79.2% had work-related stress. Conclusions: Occupational groups like bus drivers have more prevalence of NCD risk factors and which creates a burden on the healthcare system. A vigorous effort is needed to develop strategies for preventing and managing NCDs.

The global agenda on obesity: what does this mean for Singapore?

The global agenda on obesity: what does this mean for Singapore?

Best Investments in Chronic, Noncommunicable Disease Prevention and Control in Low- and Lower–Middle-Income Countries

AbstractThe world remains off-track for the sustainable development goal (SDG) target 3.4, which calls for a one-third reduction in noncommunicable diseases (NCDs) mortality by 2030. This paper presents benefit–cost analyses of various NCD interventions in low-income (LICs) and lower–middle-income (LMCs) countries. We looked at 30 interventions recommended by the Disease Control Priorities Project, including six intersectoral policies (e.g., taxes) and 24 clinical services. We used a previously published model to estimate intervention costs and benefits through 2030, discounted at 8%. We focused on interventions with benefit–cost ratios (BCRs) > 15 and their contribution toward achieving the SDG target. We found that intersectoral policies often provided great value for money, with BCRs ranging from 40 (trans-fat bans) to 100 (tobacco excise taxes). However, seven clinical interventions (e.g., basic treatment of cardiovascular disease or breast cancer) also had BCRs > 15. The overall population impact of clinical interventions over the 2023–2030 period would be much higher than that of the intersectoral policies, which can take many years to reach their peak effects. Fully implementing the best-investment interventions would accelerate progress toward SDG 3.4 everywhere, but only one in 10 countries would achieve the target. This strategy would require an additional US$ 2.4 billion annually across all LICs and LMCs. We conclude that there are several cost-beneficial opportunities to tackle NCDs in LICs and LMCs. In countries with very limited resources, the best-investment interventions could begin to address the major NCD risk factors and build greater health system capacity, with benefits continuing to accrue beyond 2030.

Pattern of Self-Reported Behavioural Risk Factors of Non-Communicable Diseases among Doctors Working in a Tertiary Care Hospital

Background: Behavioural risk factors reduction is a key to Non-Communicable Diseases (NCDs) control. The doctors are educated and aware of society, yet their lifestyle and work habits have led them to suffer from NCDs. This study was carried out to determine the prevalence of the behavioral risk factors of major NCDs among doctors working at Chittagong Medical College Hospital (CMCH).
 Materials and methods: This cross-sectional study included 145 doctors working at CMCH from April 2020 to September 2020. A structured self-administered questionnaire based on the WHO STEPS instrument for NCDs risks factors surveys was used to collect data.
 Results: Out of 145 respondents, 104 doctors (71.7%) were males, and 41 doctors (28.3%) were females. Most doctors (50.3%) were aged 23 to 35 years and 29.7% were 35-44 years. The proportion of doctors currently smoking tobacco, drinking alcohol, being sedentary in daily life, and taking low vegetables and fruits was 8.3%, 8.3%, 18.6%, and 72.4%, respectively. No female doctor reported smoking or drinking. Ninety-one (62.8%) of doctors had one risk habit and 17.2% with two risk habits.
 Conclusion: It is desirable that doctors voluntarily strive to have a favourable lifestyle and that medical institutions actively enlighten doctors’ working at their institutions about this issue.
 Chatt Maa Shi Hosp Med Coll J; Vol.21 (2); July 2022; Page 14-17

Burnout and allostatic load among health workers engaged in human resourced-constrained hospitals in Accra, Ghana

BackgroundBurnout syndrome is a psycho-social disorder which develops in an individual exposed to chronic stress on the job. Health workers in sub-Saharan Africa (SSA) are at increased risk of burnout due to job-related challenges. Burnout does not only affect the job performance of employees, but could result in dysregulation of multiple physiological systems (allostatic load) in victims and predispose them to non-communicable diseases (NCDs). This study examined the association between burnout and allostatic load among health workers engaged in human resourced-constrained hospitals in Accra, Ghana.MethodThis study was a hospital-based cross-sectional study involving 1264 health workers (clinicians and non-clinicians) from three public hospitals in Accra, Ghana who were recruited using a proportionate stratified random sampling technique. The participants completed a questionnaire which collected general and burnout information. In addition, each participant’s anthropometric; biochemical and hemodynamic indices were measured. The allostatic load in the participants was determined using eleven (11) biomarkers from the neuro-endocrine, cardiovascular, metabolic and anthropometric measures. The relationship between burnout and allostatic overload (high allostatic load) was determined at the bivariate and multivariable levels. The data analysis was done with the aid of Stata 15.0 at a 95% confidence level.ResultsThe prevalence of burnout was 20.57%, higher in non-clinicians than clinicians (26.74% vs 15.64, p < 0.001). Also, non-clinical participants had higher levels of emotional exhaustion and depersonalization than the clinical participants. Over a quarter (26.27%) of the participants had allostatic overload manifesting as high allostatic load. Furthermore, for a one unit increase in overall burnout, the odds of experiencing allostatic overload was increased by 17.59 times (AOR = 17.59, 95% CI: 11.7-26.4) as compared to those without burnout and similar findings were found for the individual components of burnout syndrome with high allostatic load.ConclusionBurnout among health workers is associated with multi-system physiological dysregulation manifesting as high allostatic load; a major risk factor for NCDs. It is recommended that measures aimed at reducing burnout and allostatic overload such as structured psychological counseling and healthy lifestyle patterns are recommended for health workers engaged in stressful work settings to reduce their risk of NCDs.

Sociodemographic predictors for smoking persistence among young males in Indonesia

The prevalence and burden of non-communicable diseases (NCDs) in Indonesia are increasing. One major risk factor for NCDs is smoking. Thus, this study assessed sociodemographic predictors of smoking persistence among young males in Indonesia, who are at high risk for smoking and NCDs. We analysed the Indonesian Demographic and Health Survey (IDHS) conducted in 2017, a nationally representative survey in 34 provinces of Indonesia. We included data from 9957 young males aged 15-24 who had tried smoking and were interviewed by the IDHS enumerators for their smoking patterns and sociodemographic characteristics. Logistic regression analyses were used to assess the predictors of smoking persistency. Our analyses uncovered that those who started smoking at high-school age, lived in rural areas, had an occupation, and had lower education levels, had higher odds of smoking persistence than other young males. The use of internet, also increased the odds of smoking persistence, while those reading newspapers had lower odds of smoking persistence. Regarding household characteristics, young males who came from poor households, whose household heads were smokers or not married, also had higher odds of smoking. In conclusion, this study also showed the significance of several individual variables and household sociodemographic factors related to smoking persistence. Based on our findings, we recommend the need for intervention that aims not only at large-scale policy to ban smoking and educational campaigns through the internet but also specific educational intervention targeting families, particularly poor families with active smokers. The educational campaign is also needed to target the younger population, who are at higher risk for smoking persistence if they start smoking earlier.

Self-Assessment of Non-communicable Diseases related Competencies among Interns of a Medical Institute of Nepal

Introduction: One of the essential strategies to tackle rising burden of non- communicable diseases (NCD) is development of competent local human resource. Assessing the level of competencies in pre-service curriculum is the first step towards building an NCD-ready health workforce. This study aimed to assess perception of competence in delivering World Health Organization Package of Essential Non- communicable diseases (WHO-PEN) interventions among interns of Maharajgunj Medical Campus of Institute of Medicine (IOM). Methods: A survey was conducted at Maharajgunj Medical Campus of Institute of Medicine among interns using online questionnaire. The questionnaire contained seven sections on different competencies to prevent and manage NCDs. Ethical approval was obtained from Institutional Review Committee of IOM. Descriptive analysis was done to identify the level of competencies. Statistical analysis was performed using Microsoft Excel and IBM SPSS version 20. Results: Majority of the interns expressed low to moderate confidence in managing patients with presenting complaints of major NCDs. Most interns could perform diagnostic procedures and screening related to NCDs and mental disorders under supervision only (56.9%-68.6%), and one third felt they were unable to perform spirometry and visual inspection of cervix with acetic acid. Most interns could provide counseling on major NCD risk factors, self-care and palliative care only under supervision. Majority could not identify key NCD service performance measures and their data sources. Conclusion: Skills of independently diagnosing and screening for NCDs, counselling on healthy lifestyle, alcohol and tobacco cessation and conduct motivational interviewing, self-care and palliative care were limited.

A Literary Review on Lifestyle Intervention Through Ayurveda in Increasing Pattern of Non-Communicable Diseases due to Urbanization.

Non-communicable diseases (NCDs) are of increasing concern for global health due to their high mortality rate. The major risk factors of NCDs can be classified into categories of self-management, genetic factors, socio-demographic factors, environmental factors and factors of medical conditions. Consuming alcohol, smoking, physical inactivity and unhealthy dietary habits are the vulnerable risk factors. NCDs are driven by factors like rapid unplanned urbanization, unhealthy lifestyle and aging also. The metabolic risk factors include hypertension, increased blood sugar level &amp; blood pressure may be due to unhealthy diet and physical inactivity, lead to NCDs.&#x0D; The description of bahudosha, snatarpanjanya vyadhi, medoroga and santarpanjanya prameha in Ayurveda has similarity to metabolic risk factors. The management of these conditions in Ayurveda involves predominantly Aahara (proper diet), Vihara (physical activity, exercise and stress management) and shodhana (purification). The main focus is on the elements of self-management and to understand the importance of lifestyle intervention and risk factors modification in order to prevent NCDs at all stages of life.&#x0D; This paper will discuss epidemiological data of non-communicable disease and urbanization. The review of this condition along with its management from Ayurveda perspective and its importance in clinical practice will be discussed.

Effect of brief interventions to promote behavior change on clinical outcomes of selected non-communicable diseases: The World Health Organization (WHO) Package of Essential Non-communicable disease (PEN) Interventions for primary health care settings – study protocol of a quasi-experimental study

BackgroundThe World Health Organization designed a minimum set of interventions, the World Health Organization Package of Essential Noncommunicable disease interventions (WHO PEN), for detection, prevention, treatment, and care of Non-communicable diseases (NCDs) in resource constraint settings. This intervention study examines the effectiveness of the integration of components of WHO PEN protocols on improved clinical outcomes among patients of cardiovascular disease and diabetes mellitus in urban and rural primary health care settings. MethodsIn this quasi-experimental study (pre-test post-test control group design), trained non-physician health workers will provide behavior change interventions regarding four major NCD risk factors, i.e., tobacco use, excessive alcohol intake, physical inactivity, an unhealthy diet; using ‘Brief Advice’ to the NCD patients enrolled in the experimental arm. The health centers in the control arm will provide the usual care to all the NCD patients. The intervention will last for six months, and the two groups will be followed up at two months, four months, and six months since enrolment in the study. ResultsThe primary outcome is improved mean blood pressure levels and the proportion of patients with controlled blood pressure levels. The secondary outcomes assess medication adherence, self-reported reductions in tobacco and alcohol intake, consumption of a heart-healthy diet, and regular physical activity. DiscussionThis intervention trial will provide evidence for the utility of individual-level behavioral interventions for adequate management of NCDs.Trial registration: Clinical Trial Registry of India: CTRI/2018/12/016707.

Behavioral risk factors for noncommunicable diseases associated with depression and suicide risk in adolescence.

Noncommunicable diseases (NCDs) and mental disorders cooccur in adulthood, which is why their determinants and common risk factors should be addressed at an early age. Therefore, we estimated the association of the major risk factors for NCDs with depression and suicide risk by structural equation modeling considering pathways triggered by social vulnerability or mediated by obesity. This population-based study included 2,515 Brazilian adolescents. The following exposures were the major risk factors for NCDs: substance use behaviors (variable deduced from alcohol, tobacco, and drug use), physical inactivity, and components of unhealthy eating markers (added sugar and saturated fat). Obesity was assessed using the fat mass index. The outcomes were depression and suicide risk. Depression was associated with substance use behaviors (SC = 0.304; p < 0.001), added sugar (SC = 0.094; p = 0.005), and females (SC = 0.310; p < 0.001). Suicide risk was also associated with substance use behaviors (SC = 0.356; p < 0.001), added sugar (SC = 0.100; p = 0.012), and females (SC = 0.207; p < 0.001). In adolescents, these associations may help explain the cluster of NCDs and mental disorders in adulthood.

Exposure to and Burden of Major Non-Communicable Disease Risk Factors in Brazil and its States, 1990-2019: The Global Burden of Disease Study.

INTRODUCTION: Non-Communicable Diseases (NCDs) have become the main cause of disease burden in Brazil. Our objective was to describe trends (1990 to 2019) in prevalence and attributable burden of five modifiable risk factors and related metabolic risk factors in Brazil and its states. METHODS: In Global Burden of Disease 2019 analyses, we described trends in prevalence of modifiable risk factors and their metabolic mediators as percentage change in Summary Exposure Value (SEV). We estimated deaths and disability-adjusted life years (DALYs) attributable to the risk factors. RESULTS: Age-adjusted exposures to alcohol [41.0%, Uncertainty Interval (UI): 24.2 - 63.4], red meat (61.2%, UI: 42.4-92.3), low physical activity (3.9%, UI: -5-17.5) and ambient particulate matter pollution (3.3%, UI: -48.9-128.0) have worsened. Those for smoking (-51.4%, UI: -54.7- - 47.8), diet low in fruits (-28.1%, UI: -39.1- -18.7) and vegetables (-19.6%, UI: -32.7 - -8.7), and household air pollution (-85.3%, UI: -92.9- -74.3) have improved. All mediating metabolic risk factors, except high blood pressure (0.7%, UI: -6.9-8.3), have worsened: BMI (110.2%, UI: 78.6-161.7), hyperglycemia (15.1%, UI: 9.3-21.2), kidney dysfunction (12.0%, UI: 8.4-17.2), and high LDL-c (11.8%, UI: 6.9-17.2). CONCLUSIONS: A variable pattern of progress and failure in controlling modifiable risk factors has been accompanied by major worsening in most metabolic risk factors. The mixed success in public health measures to control modifiable risk factors for NCDs, when gauged by the related trends in metabolic risk factors, alert to the need for stronger actions to control NCDs in the future.

Estimates of major non-communicable disease risk factors for India, 2010 & 2015: A summary of evidence.

The National Monitoring Framework for the prevention and control of NCDs in India has set targets for reduction of risk factors relative to the measure recorded in 2010. Estimates for 2010 and 2015 were established using meta-analyses in the absence of a national risk factor survey till 2017. We searched national survey reports and also articles published in English from India between 2008 and 2017 in PubMed, Google Scholar and Cochrane review databases for specific risk factors among 18-69 yr Indians. Quality of studies was evaluated using Joanna-Briggs tool, but all studies were included in analyses. Estimates for each of the eight strata by age, gender and place of residence, respectively, were generated. MetaXL was used to calculate the pooled estimate for 2010 and 2015 using a random effects model. Strata-specific estimates were combined to arrive at national estimate using population weight of each stratum. The credibility of the estimates was determined using four parameters - average Briggs score; representativeness of the contributing studies and precision and stability of the estimates. The estimates [95% confidence interval (CI)] for 2010 for different risk factors were as follows: current alcohol use, 15.7 per cent (13.2-18.2); current tobacco use, 27 per cent (21.4-32.6); household solid fuel use, 61.5 per cent (50.2-72.5); physical inactivity, 44.2 per cent (37.8-50.6); obesity, seven per cent (3.8-10.2) and raised blood pressure, 20.2 per cent (18.4-22.1). In 2015, compared to 2010, tobacco use showed a relative decline of 18 per cent, household solid fuel use of nine per cent and physical inactivity of 15 per cent. The estimates were stable for alcohol use, raised blood pressure and obesity between 2010 and 2015. All estimates varied between moderate and high degrees of credibility. The estimates are consistent with other available estimates and with current national-level initiatives focused on tobacco control and improving access to clean fuel. These estimates can be used to monitor progress on non-communicable disease risk factor targets for India.

Population-level interventions targeting risk factors of diabetes and hypertension in South Africa: a document review

BackgroundSouth Africa bears an increasing burden of non-communicable diseases (NCDs), particularly diabetes, cardiovascular diseases, and cancer. The objective of this study was to identify which population-level interventions, implemented at the level of governmental or political jurisdictions only, targeting risk factors of diabetes and hypertension were included in policies in South Africa. We also looked at whether these have been implemented or not.MethodsA review of relevant reports, journal articles, and policy documents was conducted. Documentation from government reports that contains information regarding the planning, implementation and evaluation of population-level interventions targeting diabetes and hypertension were considered, and various databases were searched. The identified population-level interventions were categorized as supportive policies, supportive programs and enabling environments according to the major risk factors of NCDs i.e., tobacco use, harmful consumption of alcohol, unhealthy diet/nutrition and physical inactivity, in accordance with the WHO ‘Best buys’. A content document analysis was conducted.ResultsThe source documents reviewed included Acts and laws, regulations, policy documents, strategic plans, case studies, government reports and editorials. South Africa has a plethora of policies and regulations targeting major risk factors for diabetes and hypertension implemented in line with WHO ‘Best buys’ since 1990. A total of 28 policies, legislations, strategic plans, and regulations were identified - 8 on tobacco use; 7 on harmful consumption of alcohol; 8 on unhealthy diet and 5 on physical inactivity - as well as 12 case studies, government reports and editorials. There is good progress in policy formulation in line with the ‘Best buys’. However, there are some gaps in the implementation of these policies and programs.ConclusionCurbing the rising burden of NCDs requires comprehensive strategies which include population-level interventions targeting risk factors for diabetes and hypertension and effective implementation with robust evaluation to identify successes and ways to overcome challenges.

Legal strategies to improve physical activity in populations.

The World Health Assembly has adopted the World Health Organization’s (WHO) recommended target of achieving a 15% reduction in physical inactivity by 2030. The WHO Global Action Plan on Physical Activity provides a framework for countries to achieve this, using a systems-based approach to address the social and environmental determinants of physical inactivity. Lack of progress in many countries indicates a need to identify new ways of addressing this public health priority. WHO continues to highlight the importance of legislative and regulatory measures within the multicomponent and multisectoral action needed to reduce physical inactivity. Yet research into the role of law for addressing physical inactivity has been limited, in contrast to the legal approaches to other major noncommunicable disease risk factors such as smoking and alcohol use. Conceptual frameworks for public health law offer a method for mapping and understanding the determinants, mechanisms and outcomes of law-making for the promotion of physical activity within populations. We describe the development and application of a framework that aligns legal strategies with the WHO Global Plan policy objectives. This new framework – the Regulatory Approaches to Movement, Physical Activity, Recreation, Transport and Sport – can help policy-makers to use the untapped potential of legal interventions to support or strengthen a whole-system response for promoting physical activity. The framework illustrates the role of legal interventions to improve physical activity and identifies opportunities for research to advance understanding, implementation and evaluation of legal responses to this issue.

Environmental and Genetic Determinants of Major Chronic Disease in Beijing–Tianjin–Hebei Region: Protocol for a Community-Based Cohort Study

Introduction: Personal lifestyle and air pollution are potential risk factors for major non-communicable diseases (NCDs). However, these risk factors have experienced dramatic changes in the Beijing–Tianjin–Hebei (BTH) region in recent years, and few cohorts have focused on identifying risk factors for major NCDs in this specific region. The current study is a large, prospective, long-term, population-based cohort study that investigated environmental and genetic determinants of NCDs in BTH areas. The results of this study may provide scientific support for efforts to develop health recommendations for personalized prevention.Methods: About 36,000 participants 18 years or older would be obtained by multistage, stratified cluster sampling from five cities for the baseline assessment. Participants underwent seven examinations primarily targeting respiratory and circulatory system function and filled out questionnaires regarding lifestyle behavior, pollutant exposure, medical and family history, medication history, and psychological factors. Biochemistry indicators and inflammation markers were tested, and a biobank was established. Participants will be followed up every 2 years. Genetic determinants of NCDs will be demonstrated by using multiomics, and risk prediction models will be constructed using machine learning methods based on a multitude of environmental exposure, examination data, biomarkers, and psychosocial and behavioral assessments. Significant spatial and temporal differentiation is well-suited to demonstrating the health determinants of NCDs in the BTH region, which may facilitate public health strategies with respect to disease prevention and survivorship-related aspects.

Evaluating the impact of results-based motivating system on noncommunicable diseases risk factors in Iran: Study protocol for a field trial.

Background: Risk factors of noncommunicable diseases (NCD) are increasingly contributing to morbidity and mortality in Iran. Health care providers’ competencies and motivation are essential factors for the success and efficiency of primary health care. This field trial aims to evaluate the impact of a results-based motivating system on population level of the NCD risk factors field trial (IRPONT) in Iran. Methods: Population groups of 24 rural or urban catchment areas from 3 provinces were randomized to 1 of the 4 types of study groups. The groups were defined based on a set of 4 intervention packages. Extra 8 rural or urban catchment areas in a separate city were considered as independent nonintervention (control) group. Population levels of major NCD risk factors in all 32 population groups were measured at the beginning of the trial, at the end of the first year, and will be measured in the second year through standardized population surveys. As the outcome measure, the difference in population levels of the risk factors will be compared among the study groups. Study group IV will be compared with combined control groups (study groups I, II, and III). Also, we will conduct subgroup analysis to determine the effects of interventions 2, 3, and 4. Ethics: This trial has received ethical approval from National Institute for Medical Research Development in Iran (IR.NIMAD.REC.1396.084) in 2017. Trial Registration Number: This trial has been registered on the Iranian Registry of Clinical Trials (identifier: IRCT20081205001488N2). Registered on 3 June 2018 and updated on 12 April 2020.

Use of mHealth technology for modification of behavioural risk factors of noncommunicable diseases in primary health care settings

Noncommunicable diseases (NCDs) kill 41 million people each year, of which more than three-quarters occur in low- and middle-income countries. Four groups of diseases, namely cardiovascular diseases, cancers, respiratory diseases, and diabetes, account for over 80% of all premature NCD deaths, and four common modifiable behaviors, namely tobacco use, physical inactivity, unhealthy diet, and the harmful use of alcohol, increase the risk of NCDs. The use of mHealth interventions for Behavior Change Communication has been shown to be effective in modifying the behavioral risk factors, through various studies. The present study proposes to conduct a systematic review and meta-analysis to assess the effectiveness and feasibility of the use of mHealth in improving diet and increasing physical activity, which are two of the major behavioral risk factors of NCDs. Research reported on this, from countries in the South-East Asian Region, during the past 20 years, will be included in this review.

Estimating the impact of achieving Turkey's non-communicable disease policy targets: A macro-simulation modelling study.

SummaryBackgroundThe Burden of non-communicable disease (NCDs) has continued to rise globally, particularly in low- and middle-income countries. In Turkey, NCDs account for 89% of all deaths, with nearly one in five deaths occurring before age 70. This study investigates the number of NCD deaths that could be prevented if Turkey met national and international targets for major modifiable NCD risk factors.MethodsPreventable deaths were estimated using the World Health Organization (WHO) ‘Preventable Risk Integrated ModEl’ (PRIME), by combining: 1) Baseline exposure data for risk factors, referenced from national surveillance and cohort studies; 2) Aetiological associations from published meta-analyses; and 3) Demographic and mortality statistics obtained from the Turkish Statistical Institute (TurkStat). Confidence intervals were estimated using Monte Carlo simulations.FindingsIf Turkey met its NCD risk factor targets for reducing tobacco and salt consumption by 30%, and physical inactivity by 10% in 2017, an estimated 19,859 deaths (95%CI: 12,802 to 26,609) could have been prevented. Approximately two thirds of these preventable deaths were in men, and one in three were in adults below 75 years. A 30% relative reduction in the consumption of alcohol, tobacco, and salt, as well as physical inactivity, would prevent 180 (107 to 259); 4,786 (3,679 to 5,836); 13,112 (5,819 to 19,952); and 7,124 (5,053 to 9,212) deaths, respectively.InterpretationAmong major modifiable NCD risk factors, population-level reductions in salt intake and physical inactivity present the greatest opportunity for reducing NCD mortality in Turkey. These findings can help Turkey prioritise interventions to meet the Sustainable Development Goal target of reducing NCD mortality by one third, by 2030.