Non-communicable Disease Surveillance Research Articles

Using electronic health record data for chronic disease surveillance in low- and middle-income countries: the example of hypertension in rural Guatemala

Hypertension is the leading preventable cause of death worldwide. Two-thirds of people with hypertension live in Low- and Middle-Income Countries (LMIC). However, epidemiological data necessary to address the growing burden of hypertension and other Non-Communicable Diseases (NCDs) in LMICs are severely lacking. Electronic Health Records (EHRs) are an emerging source of epidemiological data for LMICs, but have been underutilized for NCD monitoring. The objective of this study was to estimate the prevalence of hypertension in a rural Indigenous community in Guatemala using EHR data, describe hypertension risk factors and current treatment in this population, and demonstrate the feasibility of using EHR data for epidemiological surveillance of NCDs in LMIC. We conducted a cross-sectional analysis of 3646 adult clinic visits. We calculated hypertension prevalence using physician diagnosis, antihypertensive treatment, or Blood Pressure (BP) ≥140/90 mmHg. We noted antihypertensives prescribed and BP control (defined as BP<140/90 mmHg) for a total of 2496 unique patients (21% of whom were men). We constructed mixed-effects models to investigate the relationship between BP and hypertension risk factors. The estimated hypertension prevalence was 16.7%. Two-thirds of these patients had elevated BP, but were not diagnosed with or treated for hypertension. Most patients receiving treatment were prescribed monotherapy and only 31.0% of those with recognized hypertension had controlled BP. Male sex, older age, increasing weight, and history of hypertension were associated with increasing systolic BP, while history of hypertension, history of diabetes, and increasing weight were associated with increasing diastolic BP. Using EHR data, we estimated comparable hypertension prevalence and similar risk factor associations to prior studies conducted in Guatemala, which used traditional epidemiological methods. Hypertension was underrecognized and undertreated in our study population, and our study was more efficient than traditional methods and provided additional data on treatment and outcomes; insights gleaned from this analysis were essential in developing a sustainable intervention. Our experience demonstrates the feasibility and advantages of using EHR-derived data for NCD surveillance and program planning in LMICs.

Prevalence of common risk factors of major noncommunicable diseases among sexual and gender minorities in Kathmandu valley, Nepal.

Four noncommunicable diseases (NCDs): cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes, account for 71% of global deaths. However, little is known about the NCDs risk profile of sexual and gender minorities (SGMs). This study aimed to determine the prevalence of NCDs risk factors among the SGMs of Kathmandu valley, Nepal. A cross-sectional study was conducted among SGMs in the Kathmandu valley, Nepal. We recruited 140 participants using the snowball sampling method. A face-to-face interview was done using a structured questionnaire adapted from World Health Organization Step Wise Approach to Surveillance (STEPS instruments V2.2 2019) along with blood pressure and anthropometric measurements. Data were analyzed using Statistical Package for Social Science (SPSS.v20). More than two-thirds of the participants, 96 (68.6%), had co-occurrence of NCDs risk factors. The prevalence of insufficient fruits and vegetables consumption, current smoking, harmful alcohol consumption, overweight/obesity, and hypertension were 95.7%, 40.0%, 32.9%, 28.5%, and 28.6%, respectively. There was a significant association between hypertension, harmful alcohol consumption, and overweight/obesity with the participants' age, employment status, and marital status, respectively. Study findings indicated a higher prevalence of NCDs risk factors among SGMs. National-level NCDs surveillance, policy planning, prevention, and targeted health interventions should prioritize the SGMs.

Behavioural risk factors for non-communicable diseases among South African Durban-based refugees: a cross-sectional study.

Behavioural risk factors for non-communicable diseases (NCDs) are rising among refugees, increasing chronic disease prevalence that causes morbidity and mortality. This study aimed to ascertain the prevalence, awareness and management of behavioural risk factors for NCDs among South African Durban-based refugees. A once-off quantitative, cross-sectional design was conducted on the behavioural risk factors for NCDs among 122 randomly selected Durban-based refugees using a modified version of the World Health Organisation (WHO) STEPwise approach to NCDs surveillance (STEPS) instrument. Participants' awareness and management of risk factors for NCDs were determined with a behavioural NCD awareness and management of behavioural NCD risk factor questionnaire. Smoking and alcohol prevalence were 4.1% and 20.7%, respectively, with 40.8% consuming fewer than five servings of fruit and/or vegetables daily. Participants performed more than 150 min of moderate physical activity per week. A significant 30.8% (p < 0.001) was aware that consuming alcohol poses an extremely large risk, similarly for smoking (38.7%; p < 0.001]. A significant 56.2% (p < 0.001) believe that regularly eating raw vegetables presents no risk, likewise for being physically active (51.7%; p < 0.001). A significant 40.6% (p < 0.001) of the participants always drink water or non-alcoholic drinks to manage their alcohol consumption, 54.2% (p < 0.001) manage their unhealthy diet by sometimes filling half their plates with fruits and vegetables, and 49.2% manage their physical activity levels by sometimes choosing a range of physical activities (p < 0.001). Refugees' lack of awareness of behavioural risk factors for NCDs highlights the importance for health service providers to present health promotion programs to make refugees aware of their behavioural NCD's risk factors and how it impacts their health.

A review of GIS applications in public health surveillance

This paper comprehensively reviews Geographic Information Systems (GIS) applications in public health surveillance. Tracing the historical evolution of GIS in public health, the literature review highlights key concepts, definitions, and frameworks. The role of GIS in disease surveillance is explored, encompassing tracking infectious diseases, monitoring environmental health, emergency response, and surveillance of non-communicable diseases. While GIS proves indispensable in providing a spatial lens for understanding health-related phenomena, challenges such as data quality, privacy concerns, and resource constraints must be addressed. Future directions and innovations, including integrating emerging technologies and improved spatial resolution, promise to propel GIS into a pivotal role in shaping the future of public health surveillance.

Prevalence of Risk Factors for Hypertension Among Faculty at an Urban University in Uganda.

Hypertension is a major contributor to morbidity and mortality worldwide. Many people however are not aware of their possession of risk factors for hypertension. There is a paucity of literature in Uganda describing the risk profile of faculty at public universities. The purpose of this study was to determine the prevalence of hypertension risk factors among university teaching staff. This study was conducted among faculty at Makerere University in Uganda. The modified World Health Organization STEP-wise approach for non-communicable disease surveillance was used in data collection. Hypertension was defined as having a systolic blood pressure of ≥140mmHg and/or a diastolic blood pressure of ≥90mmHg, or being on antihypertensive medications. Participants were enrolled from the faculty lists by proportionate to size systematic sampling until the sample size for each college was obtained. Data was collected from January to March 2018. Multivariate logistic regression was used to determine factors associated with hypertension. A total of 141 participants were recruited into the study. The prevalent risk factors for hypertension include physical inactivity (78.7%), overweight (46.8%), obesity (20.6%), addition of extra salt to food (46.8%), current alcohol consumption (33.3%), history of smoking (10.6%), inadequate fruit and vegetable servings per day (100%), family history of hypertension (40.4%) and a family history of diabetes (22.7%). Hypertension was prevalent at 26.2% (95% CI 18.94-33.46%). The risk factors significantly associated with hypertension included a family history of hypertension (p=0.009), obesity (p=0.008) and male gender (p = 0.029). The prevalence of known hypertension risk factors among university teaching staff in urban Uganda is high. Majority of these risk factors are modifiable highlighting the need for continuous screening as well as introduction of prevention and health promotion strategies to reduce the risk burden.

Prevalence of non-communicable Diseases (NCDs) in an urban area in Sudan and the role of medical students in health promotion of patients with NCDs

Introduction: Chronic non-communicable diseases are prevalent conditions in developing countries, such as Sudan. The World Health Organization (WHO) recommends ongoing surveillance of non-communicable diseases (NCDs). This study aimed to assess the prevalence of NCDs in urban area in Sudan and the role of medical students in health promotion of patients with NCDs. Materials and methods: A community–based cross-sectional study, conducted in 2022 among families in Wad-Medani city in central part of Sudan. A structured interviewer- administered; questionnaire was used for data collection, it included demographic data, the presence of any type of NCDs. The last part of the questionnaire was filled by medical students about their role in health promotion and health education to patients with NCDs. Results: The total number of population who participated in this study was 607. The prevalence of NCDs in the study population was 20%. Out of those who had NCDs 35% had diabetes mellitus, 40% had hypertension. Bronchial asthma was found in 12% of the individuals, cardiovascular diseases were found in 4%. There were significant association between the age of the patient and the occurrence of diabetes and hypertension (P-value. 0.000 and 0.001) respectively. Role of medical students in the health promotion of patients with NCDs was health education, advised for regular follow up in PHC centres to 40% 0f patients. Conclusion: The prevalence of NCDs among the study population was high with hypertension as the most prevalent chronic condition. Medical students play great role in the health promotion of patients with NCDs.

Non-communicable diseases household survey data analysis in Sana’a City, Yemen, 2017

Non-communicable diseases (NCDs) claim 41 million lives annually, accounting for 71% of global mortality. The Middle East sees a rapid increase in NCD cases, yet Yemen remains underexplored in this context. This study aims to investigate NCD epidemiology in Sana&amp;rsquo;a City, Yemen, for 2017. Raw data from a 2017 house-to-house survey conducted by the Ministry of Public Health and Population were analyzed. Household heads reported any of the following five NCDs in the household: hypertension (HTN), diabetes mellitus (DM), bronchial asthma (BA), mental disorders (MD), and epilepsy. Data were entered and analyzed using Epi info 7.2, using 2017 projections from the 2004 census. The study encompassed 241,310 households, housing 1,592,646 individuals. Among these, 59,061 households (24.48%) included 70,178 individuals with at least one NCD. The overall NCD prevalence was 4.4%, with specific prevalence: HTN 2.3%, DM 2.2%, BA 0.4%, MD 0.27, and epilepsy 0.19%. NCD prevalence was significantly higher among females than males (5.1% vs. 3.8%; odds ratio [OR] 1.35, 95% confidence intervals [CI]: 1.33 &amp;ndash; 1.35), a trend mirrored in HTN (3.1% vs. 1.6%; OR = 1.94, 95% CI: 1.90 &amp;ndash; 1.98), DM (2.3% vs. 2.1%; OR = 1.11, 95% CI: 1.09 &amp;ndash; 1.13), and BA (0.5% vs. 0.3%; OR = 1.56, 95% CI: 1.49 &amp;ndash; 1.65). Conversely, MD was more prevalent among males than females (0.35% vs. 0.16%; OR = 2.2, 95% CI: 2.06 &amp;ndash; 2.31). NCD prevalence increased with age, with nearly 18% of patients having more than one NCD, including 35.2% of HTN patients also having DM. One-quarter of surveyed households had at least one member with one or more of the five NCDs, emphasizing an overall NCD prevalence of 4.4%. These findings rely only on self-reported diagnosed cases, lacking standardized measures. In light of these findings, it is crucial to increase focus on NCDs, enhance health-care provision, improve data collection, implement an NCDs stepwise survey, and establish an NCD surveillance system.

Surveillance of non-communicable diseases

Surveillance of non-communicable diseases

Uncontrolled Hypertension, Treatment, and Predictors among Hypertensive Out-Patients Attending Primary Health Facilities in Johannesburg, South Africa.

Hypertension is a poorly controlled risk factor for cardiovascular disease in South Africa, particularly among patients receiving care in the public sector who are mostly from low socioeconomic backgrounds. This cross-sectional study investigated uncontrolled hypertension, treatment, and predictors among hypertensive out-patients attending primary health care facilities in Johannesburg, South Africa. The WHO STEPwise approach to the surveillance of non-communicable diseases was used to collect data, including sociodemographic and lifestyle factors, health status, and measurements for anthropometry and blood pressure along with self-reported adherence to treatment, estimated through the general medication adherence scale. Uncontrolled hypertension was defined as systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg in diagnosed patients receiving anti-hypertensive treatment. Overweight and obesity were defined as a body mass index ≥25 and ≥30 kg/m2, respectively. Logistic regression models were used to assess the predictors of uncontrolled hypertension. Four hundred (n = 400) hypertensive out-patients (mean age: 50 ± 8 years) participated in this study, with most living in poor sociodemographic environments. The prevalence rate of uncontrolled hypertension was 57%. Obesity (62% vs. 42%, p ≤ 0.0001), salt consumption (90% vs. 55%, p ≤ 0.0001), alcohol intake (42% vs. 19%, p ≤ 0.0001), a smoking habit (23% vs. 4%, p ≤ 0.0001), alternative medicine use (51% vs. 40%, p = 0.043), and comorbidities (64% vs. 36%, p ≤ 0.0001) were higher in the uncontrolled group than the controlled group, whereas the prevalence of physical activity (38% vs. 15%, p ≤ 0.0001) was high in the controlled group vs. the uncontrolled. Overall, 85% of the patients moderately adhered to treatment, only 2% exhibited high adherence, and 13% demonstrated low adherence; over half of the patients received tri-therapy treatment. The predictors of uncontrolled hypertension are a number of prescribed antihypertensive therapies [adjusted odds ration = 2.39; 95% confidence interval: 1.48-3.87], treatment adherence [0.46; 0.21-0.97], salt consumption [28.35; 7.87-102.04], physical activity [0.22; 0.13-0.37], current alcohol use [2.10; 1.22-3.61], and current cigarette smoking [4.79; 1.88-12.18]. The high prevalence of uncontrolled hypertension in this study suggests a need to optimize prescriptions, adherence to BP-lowering medications, and lifestyle modifications. The management of comorbidities such as diabetes could offer considerable benefits in controlling blood pressure.

Energy and macronutrients intake of the elderly aged 75 years and above in China in 2015

To analyze the intake of energy and macronutrients in the elderly aged 75 years and above in China. The data was sourced from the China National Chronic Non-communicable Disease and Nutrition Surveillance, which adopted a multi-stage stratified clustered random sampling method and selected 298 monitoring points from 31 provinces across the country to carry out chronic non-communicable disease and nutrition surveillance of Chinese adults. The condiments weighting method and 3-day 24-hour dietary review method were used to collect dietary data for residents. Based on the dietary survey result of 3368 elderly people aged 75 years and above in the surveillance, the intake of energy and macro nutrients of elderly people was analyzed. Among the elderly aged 75 years and above included in the analysis, there were 1727 males and 1641 females, 1511 people in urban areas and 1857 people in rural areas, 1956 people aged 75-79, 1412 people aged ≥ 80. The average energy intake of the elderly aged 75 years and above in China was(1601.0±473.4)kcal, and the average intakes of carbohydrate, protein and fat were(219.6±76.6)g, (48.2±18.6)g and(60.2±31.5)g, respectively. The energy supply ratios of carbohydrate, protein and fat were 54.9%, 12.0% and 33.1% respectively. The carbohydrate intake and its energy supply ratio of the urban elderly((200.0±74.0)g and 51.8%) were significantly lower than those of the rural elderly((235.5±75.0) and 57.4%), while the protein intake and its energy supply ratio((50.2±18.9)g and 13.0%), fat intake and its energy supply ratio((61.2±30.2)g and 35.2%)of the urban elderly were significantly higher than those of the rural elderly((46.5±18.2)g and 11.2% for protein, and(59.4±32.5)g and 31.4% for fat). According to Chinese dietary reference intake standard, only 28.1% of the elderly aged 75 and above reached the recommended value of energy, 71.9% of the elderly did not take enough energy, the proportion of insufficient protein intake was 72.2%, 68.5% in urban areas and 75.2% in rural areas, the proportion of people with fat to energy ratio more than 30% was 58.5%, 65.3% in urban areas and 52.9% in rural areas. The energy intake of the elderly aged 75 years and above in China was insufficient, the protein intake was low, the fat to energy ratio was too high, and the dietary structure was unreasonable.

National and Provincial Prevalence of Cigarette Smoking in Iran; A Systematic Analysis of 12 Years of STEPS Experience.

Smoking is a modifiable risk factor for six of the eight leading causes of death. Despite the great burden, there is lack of data regarding the trend of cigarette smoking in Iran. We described the national and provincial prevalence of cigarette smoking and its 12-year time trend utilizing six rounds of Iranian stepwise approach for surveillance of non-communicable disease (STEPS) surveys. We gathered data from six STEPS surveys done in 2005, 2007, 2008, 2009, 2011, and 2016 in Iran. To estimate the data of missing years, we used two separate statistical models including the mixed model and spatio-temporal analysis. The overall prevalence rate of cigarette smoking was 14.65% (12.81‒16.59) in 2005 and 10.63% (9.00‒12.57) in 2016 in Iran. The prevalence of cigarette smoking in 2005 and 2016 was 25.15% (23.18‒27.11) and 19.95% (17.93%‒21.97%) for men and 4.13% (2.43‒6.05) and 1.31% (0.06-3.18) for women, respectively. The prevalence of smoking in different provinces of Iran ranged from 20.73% (19.09‒22.47) to 9.67% (8.24‒11.34) in 2005 and from 15.34% (13.68‒17.12) to 6.41% (5.31‒7.94) in 2016. The overall trend of smoking was downward, which was true for both sexes and all 31 provinces. The declining annual percent change (APC) of the prevalence trend was -2.87% in total population, -9.91% in women, and -2.08% in men from 2005 to 2016. Although the prevalence of smoking had a decreasing trend in Iran, this trend showed disparities among sexes and provinces and this epidemiological data can be used to modify smoking prevention programs.

Detection of Non-Communicable Disease Risk Using Android-Based Application (Design of DERI PTM Application)

Non-communicable diseases (NCDs) are chronic diseases often not realized by sufferers and continue to experience a significant increase. They are the largest contributor to the cause of death in the world. NCDs also affect a person's susceptibility to exposure to coronavirus 19 (covid 19) and increase the severity of covid 19 sufferers. This study aimed to design a health application that the community can use for early detection of NCD risk factors, especially modifiable behavioral risk factors and metabolic risk factors. The application design method used the prototype method. Needs analysis and application trials were conducted at Sriwijaya University. A needs analysis was performed by conducting in-depth interviews with five students, three lecturers, three employees, a leadership of faculty, and ahead of the university's healthy campus program. User trial results are evaluated through Zoom and by filling out a questionnaire on Google Forms. The results of the needs analysis survey showed that most users want the design of an Android-based health application that assesses the risk of NCDs and recommendations for the results of risk assessment. In conclusion, an android-based health application has been designed to independently detect the risk of non-communicable diseases under the name DERI PTM. This application can be developed into an effective educational media for preventing and controlling non-communicable diseases in the community. It can be utilized as an information system (surveillance) of NCDs at Sriwijaya University.

Hypertension among persons living with HIV-Zambia, 2021; A cross-sectional study of a national electronic health record system.

Hypertension is a major risk factor for cardiovascular disease, which is a common cause of death in Zambia. Data on hypertension prevalence in Zambia are scarce and limited to specific geographic areas and/or populations. We measured hypertension prevalence among persons living with HIV (PLHIV) in Zambia using a national electronic health record (EHR) system. We did a cross-sectional study of hypertension prevalence among PLHIV aged ≥18 years during 2021. Data were extracted from the SmartCare EHR, which covers ~90% of PLHIV on treatment in Zambia. PLHIV with ≥2 clinical visits in 2021 were included. Hypertension was defined as ≥2 elevated blood pressure readings (systolic ≥140 mmHg/diastolic ≥90 mmHg) during 2021 and/or on anti-hypertensive medication recorded in their EHR ≤5 years. Logistic regression was used to assess for associations between hypertension and demographic characteristics. Among 750,098 PLHIV aged ≥18 years with ≥2 visits during 2021, 101,363 (13.5%) had ≥2 recorded blood pressure readings. Among these PLHIV, 14.7% (95% confidence interval [CI]: 14.5-14.9) had hypertension. Only 8.9% of PLHIV with hypertension had an anti-hypertensive medication recorded in their EHR. The odds of hypertension were greater in older age groups compared to PLHIV aged 18-29 years (adjusted odds ratio [aOR] for 30-44 years: 2.6 [95% CI: 2.4-2.9]; aOR for 45-49 years: 6.4 [95% CI: 5.8-7.0]; aOR for ≥60 years: 14.5 [95% CI: 13.1-16.1]), urban areas (aOR: 1.9 [95% CI: 1.8-2.1]), and on ART for ≥6-month at a time (aOR: 1.1 [95% CI: 1.0-1.2]). Hypertension was common among PLHIV in Zambia, with few having documentation of treatment. Most PLHIV were excluded from the analysis because of missing BP measurements. Strengthening integrated management of non-communicable diseases in HIV clinics might help to diagnose and treat hypertension in Zambia. Addressing missing data of routine clinical data (like blood pressure) could improve non-communicable diseases surveillance in Zambia.

Study on the relationship between secondhand smoke exposure and dyslipidemia in adult residents in Beijing

Objective: To understand the relationship between secondhand smoke exposure and dyslipidemia among adults in Beijing and to provide a scientific basis for relevant intervention. Methods: Data were from Beijing Adult Non-communicable and Chronic Diseases and Risk Factors Surveillance Program in 2017. A total of 13 240 respondents were selected by multistage cluster stratified sampling method. The monitoring contents include a questionnaire survey, physical measurement, collection of fasting venous blood, and determination of related biochemical indicators. SPSS 20.0 software was used for the chi-square test and multivariate logistic regression analysis. Results: The prevalence of total dyslipidemia (39.27%), hypertriglyceridemia (22.61%), and high LDL-C (6.03%) were the highest among those exposed to daily secondhand smoke. Among the male respondents, the prevalence of total dyslipidemia (44.42%) and hypertriglyceridemia (26.12%) were the highest among those exposed to secondhand smoke daily. Multivariate logistic regression analysis after adjustment for confounding factors showed that compared with no exposure to secondhand smoke, the population with an average exposure frequency of 1-3 days per week had the highest risk of total dyslipidemia (OR=1.276, 95%CI: 1.023-1.591). Among the patients with hypertriglyceridemia, those exposed to secondhand smoke daily had the highest risk (OR=1.356, 95%CI: 1.107-1.661). Among the male respondents, those exposed to secondhand smoke for 1-3 days per week had a higher risk of total dyslipidemia (OR=1.366, 95%CI: 1.019-1.831), and the highest risk of hypertriglyceridemia (OR=1.377, 95%CI: 1.058-1.793). There was no significant correlation between the frequency of secondhand smoke exposure and the risk of dyslipidemia among female respondents. Conclusions: Secondhand smoke exposure in Beijing adults, especially men, will increase the risk of total dyslipidemia, especially hyperlipidemia. Improving personal health awareness and minimizing or avoiding exposure to secondhand smoke is necessary.

The Global Threat of Non-Communicable Diseases

The World Health Organization has reaffirmed its mission to provide leadership for international action on surveillance, prevention and control of non-communicable diseases across the world. Why is this issue so important for population health?

Potential Effect of the Changing Urban Climate on Non-Communicable Diseases: A Case Study on Barasat City, India

Rapid land use change in urban areas creates a unique climate, which risks the health of its inhabitants. The unique urban climate is attributable to a phenomenon recognized as the Urban Heat Island (UHI). Under such circumstances, the urban regions become hotter than their rural surroundings, creating an island of higher temperatures. Human exposure to excessively warm heat islands, particularly in humid climates like India, is becoming an increasingly serious public health issue. This paper briefly analyses the formation of surface urban heat islands (SUHI), identified by estimating the Land Surface Temperature (LST) and also its potential impacts on the occurrence of heat-related Non-Communicable Diseases (NCD) within a city. Barasat city of India has been chosen to demonstrate this work. LST has been estimated from the Landsat data using a remote sensing platform. It has been observed that the high LST in Barasat city perfectly followed an emitting shape in descending order from the city center to the suburban areas. A primary household survey was conducted in 2018 in the month of March-April, where 200 samples were collected. The information has been collected from the samples regarding their occupation, average hours of exposure to high heat zones, and the NCDs they have suffered from. It has been found that heat cramps, heat stress, heat strokes, and respiratory diseases are common for people exposed to the high heat zone. Although NCDs increase the socioeconomic burden in developing cities, NCD surveillance is limited in India. This study will assist in formulating a better urban neighborhood considering the city’s population exposed to UHI.

Non-communicable Diseases Surveillance: Challenged by COVID-19.

Non-communicable diseases as a leading cause of death have a surveillance system in most countries. This is disturbed by the emergence of coronavirus disease-2019 (COVID-19) in December 2019. In this regard, health system managers at decision-making levels tried to overcome this problem. Therefore, strategies to deal with this issue and bring the surveillance system to an ideal state were proposed and considered.

The 15-year national trends of genital cancer incidence among Iranian men and women; 2005–2020

BackgroundCancer is a major health problem and cause of mortality worldwide. Despite the prevalence of other cancers in males and females, genital cancers are especially important because of their psychological effects on individuals. Currently, cervical cancer, corpus uteri neoplasm, and ovarian cancer are the most common gynecological cancers in Iran. Prostate cancer has increased in Iranian men in the last decade. Therefore, this study aimed to investigate the 15-year national trend in the incidence of genital cancers in the Iranian population.MethodsIn this study, we used Iranian cancer registration data collected by the Ministry of Health and Medical Education, demographic information from the reports of the Statistics Center of Iran, STEPs (STEPwise approach to non-communicable diseases risk factor surveillance), and Caspian (childhood and adolescence surveillance and prevention of adult non-communicable disease). A list of potential auxiliary variables and secondary variables at all levels of the province-age-sex were evaluated during the years. We used mixed-effects Poisson regression to model the data and calculate the incidence of each cancer.ResultsOur results show an enhancement in the outbreak of all types of male cancers, but the most important are prostate (11.46 in 2005 to 25.67 in 2020 per 100,000 males) and testicular cancers (2.39 in 2005 to 5.05 per 100,000 males). As for female cancers, there has been an increase in ovarian and corpus uteri neoplasm incidence with 6.69 and 4.14 incidences per 100,000 females in 2020, making them the most occurring female genital neoplasms. While the occurrence of cervical cancer has decreased over the years (4.65 in 2005 to 3.24 in 2020). In general, the incidence of genital cancers in men and women has amplified in the last 15 years.ConclusionsOur study examined the trend of change for each malignant genital neoplasm for 15 years in Iranian men and women in each province. Considering the growing trend of the elderly population in Iran, patient awareness and early screening are essential in reducing mortality and costs imposed on patients and the health care system.

NON-COMMUNICABLE DISEASE SYNDEMICS AMONG LOW-INCOME POPULATIONS: PAKISTAN AND WAY FORWARD

Non-communicable diseases (NCDs) have substantially contributed to morbidity and mortality of populations. The emergence of the novel coronavirus SARS-CoV2 pandemic took centre stage toppling over the global health and economies leading to high morbidity and mortality rates. Presently as many as one in five with underlying NCDs are at risk of severe Covid-19[3].In May 2020, the World Health Organization (WHO) undertook a fast evaluation survey, which revealed that 75% of nations have experienced service outages related to NCDs. Public health campaigns and NCD surveillance programmes were among the hardest damaged. Gains against COVID-19 are hollow wins when the risky interactions between NCDs and virus infection are not perceived as syndemics along with social and economic disparities.

Putting non-communicable disease data to work in Vietnam: an investigation of community health surveillance capacity

IntroductionDespite the public health system’s critical role in non-communicable disease (NCD) surveillance in Vietnam, limited evidence exists on the implementation of NCD surveillance activities within these systems and the need for capacity building across different system levels to meet expected NCD surveillance goals. This study aimed to evaluate the status of and describe factors affecting the implementation of NCD surveillance activities and to identify the NCD surveillance capacity building needs of the public health system in Vietnam.MethodsWe used a mixed-methods approach in four provinces, conducting self-completed surveys of staff from six Preventive Medicine Institutes (PHI), 53 Centres for Disease Control (CDC) and 148 commune health stations (CHS), as well as 14 in-depth interviews and 22 focus group discussions at four PHI, four CDC, and eight district health centres and CHS.ResultsStudy findings highlighted that although Vietnam has a well-functioning NCD surveillance system, a number of quality issues related to NCD surveillance data were salient. Multifactorial reasons were identified for incomplete, unconfirmed, and inaccurate mortality data and current disease surveillance data. Data on NCD management and treatment were reported to be of better quality than data for screening, targeted treatment, and counselling communication. Main factors affected the effective implementation of NCD surveillance, namely lack of complete and specific guidelines for NCD surveillance, limitations in human resource capacity within NCD departments, and shortage of funding for NCD surveillance activities.ConclusionStudy findings provide practical strategies for strengthening health system capacity for NCD surveillance through developing policies, guidelines, and standardised tools to guide NCD surveillance and a road map for integrated NCD surveillance, developing training packages and manuals for all levels of the health system, and conducting utilisation-focused surveillance training programs.