Risk Factors For Non-communicable Diseases Research Articles

Implementation of national policies and interventions (WHO Best Buys) for non-communicable disease prevention and control in Ghana: a mixed methods analysis.

The World Health Organization (WHO) encourages all member states to adopt and implement a package of essential evidence-based interventions called the Best Buys to reduce the burden of non-communicable diseases (NCDs). To date, little is known about the implementation of national policies and interventions for NCD control in the WHO member states in sub-Saharan Africa. Our study aimed to evaluate the implementation of national policies and interventions (WHO Best Buys) for non-communicable disease prevention and control in Ghana. This was explanatory mixed methods research which started with a document review of Ghana's WHO Best Buys scores from the 2015, 2017, 2018, 2020 and 2022 WHO NCD Progress Monitor Reports. Thereafter, we conducted 25 key informant interviews and one focus group discussion (11 participants) with key policymakers and stakeholders in the NCD landscape in Ghana to understand the implementation of the NCD policies and interventions, and the policy implementation gaps and challenges faced. Data from the NCD Progress reports were presented using mean scores whilst the qualitative data was analysed thematically. Ghana has shown some advancements in the implementation of the WHO Best Buys measures. Ghana's implementation scores for 2015, 2017, 2020 and 2022 were 5.0, 9.0, 5.0 and 5.5 respectively, against the mean implementation scores of 7.6/19 for lower-middle-income countries and 9.5/19 for upper-middle-income countries. Efforts to decrease major risk factors such as excessive alcohol consumption and unhealthy diet have been progressing slowly. The most common challenges were related to a) the role of socio-cultural factors, b) stakeholder engagement, c) enforcement and implementation of public health policies, d) implementation guidelines, e) public awareness and education on NCDs, f) financing of NCD prevention and control, g) curative-centered health systems, and h) over-centralization of NCD care. Ghana has made progress in adopting the WHO Best Buys targeting risk factors of NCDs. However, the country faces contextual barriers to effective implementation. With the retrogression of some measures over time despite making progress in some earlier years, further investigation is needed to identify facilitators for sustained implementation of the WHO Best Buys interventions.

Risk Factors for Non-Communicable Diseases in Refugees, Asylum Seekers, and Subsidiary Protection Beneficiaries Resettled or Relocated in Portugal Between 2015 and 2020

Non-communicable diseases, previously thought of as a problem of high-income countries, now coexist in low- and middle-income countries, including the countries of origin for many refugees traveling to Europe. We aimed to describe the prevalence of risk factors for non-communicable diseases among refugees, asylum seekers, and subsidiary protection beneficiaries resettled or relocated in Portugal between 2015 and 2020 and compare these to the prevalence of risk factors in the 12 months before they left their country of origin. A cross-sectional study was conducted between 2019 and 2020 of all refugees, asylum seekers, and subsidiary protection beneficiaries attending a Lisbon, Portugal refugee center. Behavioral and biological risk factors were assessed using the WHO STEPwise modified questionnaire. A descriptive statistical analysis was conducted, which included 80 respondents, mainly men, with an average age of of 30.3 ± 9.8 years. The prevalence of several behavioral risk factors for non-communicable diseases among refugees, asylum seekers, and subsidiary protection beneficiaries was higher at the time of the study than in the 12 months before leaving the country of origin. Differences between men and women were noted in tobacco (49.1% vs. 25.9%) and alcohol use (43.4% vs. 18.5%) in the receiving country. Overweight and obesity also showed differences by gender (7.5% vs. 11.1% and 39.6% vs. 48.1%). The prevalence of suicidal ideation and suicidalplanning was high, and varied from 6.3% and 20% in the country of origin to 16.3% and 38.5% respectively in the receiving country, however the prevalence of suicide attempts was lower in the receiving country (66.7%) compared to the country of origin (100.0%). Information on health and social determinants is critical to identify priorities and increase access to access to gender-specific health and community level interventions, including mental health, to reduce risk factors associated with refugee relocation and resettlement.

Exploring Non-Communicable Disease Risks in Postmenopausal Rural Women of Bangladesh: A Cross-Sectional Study

Background: Non-Communicable Diseases (NCDs) pose a significant health challenge globally, particularly in countries underwent rapid demographic transitions like Bangladesh. Rural populations, including postmenopausal women, are disproportionately affected by NCDs due to various socio-economic and lifestyle factors. This study aimed to investigate the prevalence of NCD risk factors among postmenopausal women in a rural village. This cross-sectional study was conducted in a rural village of Gazipur, Bangladesh from November 2023 to February 2024. Materials and methods: A sample of 108 postmenopausal women was selected using a convenience sampling technique. Data on socio-demographic characteristics, lifestyle habits and health outcomes were collected through structured interviews and assessments. Chi-square tests were employed to analyze the associations between sociodemographic variables, lifestyle factors and the presence of NCDs. Results: The study revealed a high prevalence of NCD risk factors among postmenopausal rural women. Engaging in physical activity for 2-4 hours daily was significantly associated with both Diabetes Mellitus (p 0.04) and Hypertension (p 0.006). Similarly, occupation showed a significant association with Hypertension (p 0.012) with housewives exhibiting higher prevalence rates. However, there were no significant associations between salt intake, sweet consumption and the presence of NCDs. Conclusion: This study highlights the urgent need for targeted interventions to address NCD risk factors among postmenopausal rural women in Bangladesh. Strategies focusing on promoting physical activity and addressing occupational factors could help mitigate the burden of NCDs in this vulnerable population. By understanding the socio-demographic and lifestyle determinants of NCDs, policymakers and healthcare providers can develop effective public health interventions tailored to the needs of rural communities. IAHS Medical Journal Vol 7(1), June 2024; 35-39

Burden of Non-Communicable Disease and It’s Association with Weight Status: A Cross-Sectional Study in a Rural Community of Bangladesh

Background: Non-Communicable Diseases (NCDs) are now the leading causes of morbidity and mortality worldwide. Bangladesh has also experienced a rapid epidemiological shift from communicable diseases to non-communicable diseases due to growing urbanization and lifestyle alteration over the last few decades and this transition is also prominent in rural community of the country. Among all modifiable factors, overweight or obesity is the key risk factor for NCDs. This study aimed to determine the burden of NCD and its link to the body weight status of the rural population of Bangladesh. Materials and methods: This cross-sectional study was conducted in a village of Gomostapur Upazila under Chapainawabganj district from February to April 2024 among 135 people. The data were collected with face-to-face interview and Body Mass Index was measured. The data were compiled and tabulated according to key variables and analyzed with IBM SPSS 29.0.2. Results: Majority 44.5% of the study people belonged to age group 21-40 years. Among them 47.4% were male and 52.6% were female. Maximum respondents were of low-middle socioeconomic condition. Among them around 3/4th of the population was suffering from NCDs. Most of the respondents 24.4% had bone and joint pain followed by Hypertension, Asthma, COPD, Diabetes and Heart Disease at 20.7%, 17.0%, 14.1% and 10.4% respectively. Hypertension, Diabetes, Cardiovascular Disease, Stroke and Cancers were more prevalent in the older age group. Hypertension, Diabetes, Stroke and Bone-Joint Pain were seen more in female participants whereas male respondents had more prevalence of Asthma, COPD. Most of the study population had BMI above 25 kg/m2 and the study showed maximum NCDs were prevalent considerably in overweight and obese groups. Conclusion: The study revealed that, NCDs are highly prevalent among obese older rural population of Bangladesh while management, prevention, awareness and research are low. The integrated programs must be designed and implemented through a primary health care approach and high risk-group targeted interventions should be procurable to combat the rising burden of NCDs. IAHS Medical Journal Vol 7(1), June 2024; 74-79

Changes in weight distribution and trends in obesity among children and adolescents in East Asia: Insights from NCD-RisC data.

Pediatric obesity is a serious global health challenge. In East Asia, rapid socioeconomic changes have increased obesity rates. This study examines weight distribution and obesity trends in East Asian children using WHO criteria. Data from the Non-Communicable Disease Risk Factor Collaboration was used to analyze weight categories (thinness, normal weight, overweight, and obesity) among children aged 5 to 19 in China, Japan, South Korea, and Taiwan. Data were collected through probabilistic sampling and national surveys and classified using WHO BMI standards. Age standardized prevalence rate enabled cross-country comparisons for boys and girls from 2010 to 2022. Statistical methods included arithmetic statistics, linear regression, and time series analysis using the ARIMA model, with SAS 9.4 and SPSS for analysis. Significant trends were found (p for trend < 0.05). Taiwan and South Korea showed increased thinness, while China and Japan showed decreases. Normal weight prevalence declined, notably among South Korean boys. Overweight and obesity rates rose, especially among South Korean boys and Chinese girls. Japan's rates remained stable, while Taiwan showed minor fluctuations. Boys had higher overweight and obesity rates than girls in all countries. The highest rates were among children aged 10 to 11 years. East Asia, particularly South Korea and China, has seen rising obesity rates. Increasing thinness in South Korea and Taiwan also requires attention. The decline in healthy-weight children is concerning. Interventions should target children before ages 10 to 11. Urgent, tailored public health interventions are needed.

Adopting Non-invasive Approaches into Precision Colorectal Cancer Screening.

Effective screening is essential to reducing CRC incidence and mortality by detecting the disease at early stages and identifying non-invasive precursors. While colonoscopy remains the most sensitive modality to visualize and remove neoplastic lesions thereby reducing CRC and the related death, its high cost and invasive nature limit its widespread use. The fecal immunochemical test (FIT), which offers a non-invasive alternative with higher public acceptance and comparable cost-effectiveness to colonoscopy, has become the preferred screening method in many regions. Newer non-invasive tests, such as multitarget stool DNA or RNA tests, have shown improved sensitivity for CRC and advanced adenomas, although their high costs and lower specificity present challenges for large-scale implementation. Blood-based circulating cell-free DNA test also offer promise but still require optimization to be cost-effective. The heterogeneity of the screening population further complicates the effectiveness of CRC screening programs. Variations in non-communicable disease risk factors, such as metabolic syndrome, lifestyle habits, and comorbidities, can significantly influence CRC risk and screening outcomes. Moreover, diverse screening behaviors, including inconsistent adherence to recommended screening intervals and the interchangeable use of different screening modalities, add complexity to achieving uniform effectiveness across populations. This variability underscores the need for personalized screening strategies that consider individual risk profiles and screening behaviors, as well as the application of cutting-edge technologies such as big data analytics, artificial intelligence, and digital twin approaches to evaluate its effectiveness. This article reviews the current CRC screening strategies, the advantages of non-invasive methods, and the potential of fecal hemoglobin concentration, to tailor screening intervals and improve risk stratification. It also discusses the emerging role of real-world data and advanced technologies in enhancing CRC screening accuracy and effectiveness, particularly in complex real-world scenarios where traditional methods may fall short. Before novel non-invasive approaches, such as ctDNA tests or polygenic risk scores, are validated and proven cost-effective, exploring the clinical utility of FIT and its quantitative measurement in both screening and surveillance by integrating real-world clinical big data seems a feasible direction for achieving sustained development in population screening.

Elevated Blood Pressure and Behavioral Risk Factors of Non-Communicable Disease Among School-Going Adolescents in Chengalpattu District, India: A Cross-Sectional Study

Background: Elevated Blood Pressure (BP), often termed the "silent killer," is characterized by a BP of 140/90 mmHg or higher, influenced by modifiable and non-modifiable factors, particularly during adolescence. Hypertension prevalence among Indian adolescents varies from 2% to 20.5%. Despite the critical impact of adolescent health on India's overall health landscape, literature on the non-communicable disease (NCD) burden and risk factors among Indian adolescents remains limited. The aim is to assess the prevalence of elevated BP and associated risk factors among school-going adolescents in Chengalpattu district. Methodology: A cross-sectional study was conducted in Chengalpattu district schools. Utilizing ChatGPT, multi-stage simple random sampling was performed to select 206 adolescents. They were surveyed using adapted questionnaire from the WHO Global School-Based Student Health Survey, covering sociodemographic details, behavioral risks, and anthropometric data and data analysis was conducted using SPSS. Results: Among the 206 participants, 54 (26.2%) had elevated BP. Key predictors of elevated BP were age, gender, family history, physical education, and serious injuries. Cyberbullying was also associated with elevated BP (P=0.020). Conclusions: The increasing trend of NCDs necessitates school and community-based campaigns for risk reduction. Further research on cyberbullying and long-term health interventions is recommended to improve adolescent health and reduce NCDs in Chengalpattu and beyond.

What is the most influential factor associated with youth smoking in Bantul Indonesia?

Smoking is one of the risk factors for non-communicable diseases. Smoking worsens a person's health and can even cause death. This smoking behaviour is primarily initiated in adolescence. The aim of this study was to identify the determinants of youths' smoking behaviour. The design of this study is cross-sectional, with a sample size of 368 youths (aged 15 to 24 years) in Bantul Regency, Special Region of Yogyakarta, Indonesia. The sampling technique used is multistage random sampling. The statistical test used is logistic regression. This study showed that 67.9% of the sample were smokers. The results of the logistic regression test show that gender, occupational, attitudes and the role of peers have a significant effect on the smoking behaviour of youths. From our findings, gender is the most influential variable, in terms of having the highest odds ratio, on youth smoking behaviour.

Lifestyle related health risk factors regarding non-communicable diseases among adults in Morang District

Introduction: Non-communicable diseases are the leading causes of disease burden worldwide. According to World Health Organization estimates, NCDs are responsible for 74% of all deaths globally, with around 77% of premature deaths from NCDs occurring in low- and middle-income countries. This study aims to assess the lifestyle related health risk factors of non-communicable diseases among adults in Nepal, in which two- third of annual deaths are attributable to non-communicable diseases. Methods: A cross sectional study was conducted among adults in Morang district, Nepal. Data collection involved the assessment of the risk factors of obesity, smoking, alcohol consumption, inadequate fruits and vegetable consumption, inadequate physical activity, are raising blood pressure. Ethnical approval was obtained. Results: Two hundred forty participants participated in the study, of which the most prevalent risk factor was obesity (58.3%). Out of total participants, 41.6% had consumed tobacco, 31.2% had consumed alcohol, 41.6% had consumed inadequate fruits and vegetables, 30.4% had inadequate physical activity, and 29.1% had raised blood pressure. Similarly, education is statistically associated with lifestyle risk factors. Male participants of age above 40 years were found to be statistically associated with current tobacco and alcohol consumption. Conclusion: Health related risk factors are causes of non-communicable disease. Most of the participants had two or more risk factors for non-communicable disease. Education is significantly associated with all the risk factors among the participants.

РЕГИОНАЛЬНЫЙ МОНИТОРИНГ ФАКТОРОВ РИСКА РАЗВИТИЯ ХРОНИЧЕСКИХ НЕИНФЕКЦИОННЫХ ЗАБОЛЕВАНИЙ ПОСЛЕ ПЕРЕНЕСЕННОГО COVID-19

Annotation. Chronic non-communicable diseases (NCD) represent a major public health problem in recent decades. NCD kill 41 million people annually, accounting for 74% of all deaths worldwide. WHO predicts that the total number of deaths from NCD will rise to 55 million by 2030 unless drastic measures are taken. Cardiovascular disease, cancer, chronic respiratory disease and diabetes are the four leading causes of premature mortality among NCD. Multimorbidity affects 65% of people over 65 years of age, requiring more patient-centred and complex models of care. The aim of the study was to conduct regional monitoring of risk factors for chronic noncommunicable diseases in geriatric patients. Outpatient charts of 152 patients aged 60 years and older who had undergone COVID-9 and had undergone an in-depth adult check-up were used for the study. The average age of the patients who underwent the dispensary was 70.0±5.7 years. Questionnaire survey of 152 patients aged 65 years and older to identify NCD and senile asthenia showed that the highest proportion of patients had risk factors for cardiovascular diseases - 63.2%, osteoporosis - 40.8%, GI diseases - 28%, senile asthenia - 27% and polypragmasia - 20.4%. 32.2% of respondents noted a decrease in memory, perception of material, impaired comprehension, loss of ability to distribute time, 30.9% experienced a decrease in mood, loss of energy, depressive state, 24.3% each experienced vision and hearing problems that impair the quality of life, and 22.4% of persons over 65 experienced difficulty in walking. Based on the results of the study, data collection modules based on the STEPS system were identified for the step-by-step assessment of risk factors for the development of chronic non-communicable diseases, and a model for a comprehensive approach to improving the health of citizens aged 60 years and older, who have the highest risk of developing NCD, was proposed.

SAFETY OF DIRECT ORAL ANTICOAGULANTS IN PATIENTS WITH ATRIAL FIBRILLATION 80 YEARS AND OLDER: CLINICAL RISK FACTORS

BACKGROUND: Direct oral anticoagulants (DOACs) use is complicated by bleeding, especially in the geriatric population. Most studies focus on predicting major bleeding, while clinically relevant non-major bleeding (CRNMB) is no less important for practice. АIM: of the study was to evaluate the ability of clinical factors to predict the risk of CRNMB while taking DOACs in patients with atrial fibrillation (AF) aged 80 years and older. MATERIALS AND METHODS: 367 patients were examined with non-valvular AF aged 80 years and older (median age 84 [82; 88] years) taking DOACs. The main population parameters (gender and age composition of groups, body mass index), risk of ischemic stroke according to the CHA2DS2-VASc scale, risk of bleeding according to the HAS-BLED scale, comorbidity, Charlson comorbidity index, risk factors for chronic non-communicable diseases, number of medications taken, objective examination data, vascular wall stiffness, and laboratory test results were assessed. RESULTS: In univariate analysis, significant risk factors for developing CRNMB with all DOACs were: higher frequency of walking (p=0.022), lower heart rate (p=0.08), and history of gastric and duodenal ulcer (GDU) (odds ratio (OR) 5.34 [95% confidence interval (CI): 2.31; 12], p0.001). As a result of multivariate analysis, a model for predicting CRNMB was developed, with age, type of DOAC, liver disease, acute cerebrovascular accident, history of GDU selected as predictors. The resulting model was characterized by 62.6% [95% CI: 57.4; 67.6] predictive accuracy, 66.5% [95% CI: 59.4; 73.1] sensitivity and 58.2% [95% CI: 50.4; 65.7] specificity. CONCLUSION: The study identified specific modifiable, potentially modifiable, and non-modifiable risk factors for the development of CRNMB in patients with AF over 80 years of age taking DOACs. The results of the study can be used to create an electronic system to support medical decision-making, manage risk factors, and improve the quality of life of the population.

Artificial intelligence to predict estimates of physical activity in small geographic areas

Abstract Background Artificial intelligence (AI) predictive models have been used to estimate the risk of a certain outcome occurring, using all available variables. Methods Using AI methods we have developed a small area estimation (SAE) technique to estimate the prevalence of leisure-time physical activity (LTPA), or who practices 150 minutes of LTPA per week, in small areas, in Belo Horizonte, Brazil, between 2009 and 2018, by the usage of k-means clustering. The VIGITEL, national telephone survey of Risk Factors for non-communicable diseases, was the main source. We applied available data to estimate prevalence of LTPA in 3300 census tracts, aggregated in 150 Primary Health Care (PHC) areas. The prevalence of PA was analyzed between two time periods, due to the low number of census tract interviews. With the available data, we estimate vulnerability clusters, derived from a Health Vulnerability Index (IVS), for the city of Belo Horizonte, according to socioeconomic, sanitation and health indicators, which measure the percentage of the population living in areas of vulnerability in the city. The index main purpose is to support public policy implementation. Results Nine clusters were identified according to the Silhouette coefficient analysis, i.e.: low (LO-0, LO-1), medium (ME-0, ME-1), high (HI-0, HI-1, HI-2) and very high) vulnerability (VH-0, VH-1. The prevalence of physical activity ranged from 23.7% (worst prevalence), in area of high vulnerability cluster (VH-1) to 45.5% in a low-risk cluster (LO-1) in period from 2009 to 2014. The prevalence of physical activity increased to 31.4% (high vulnerability cluster) to 52.81% (low-risk cluster) from 2014 to 2018. Conclusions The use of AI to estimate the prevalence of physical activity in small areas proved to be effective and highlighted important differences in the city. Thus, national surveys, with a small number of interviews per census sector, can be used to predict risks and health outcomes for small areas. Key messages • The study highlights the importance of using artificial intelligence to predict estimates of risk factors for chronic non-communicable diseases in small geographic areas. • The study showed less physical activity (PA) in areas of greater vulnerability. This can support health promotion policies and programs that encourage PA.

Physical activity and sedentarism among non-binary gender identified university students

Abstract Background Physical inactivity (PA) and sedentary behavior (SB) are modifiable risk factors for non-communicable diseases (NCDs). Data indicates that non-binary gender identified people find it difficult to perform PA, this is a disadvantage for them to reach their full health potential. Methods Students were selected by convenience sampling to complete a survey between October-November 2023. A validated PA questionnaire was included. PA and SB were classified into 4 levels: Active but sedentary, extremely sedentary, physically active and discreetly active. Data were analyzed using Statistical Package for the Social Sciences (SPSS). Results Out of 32 students did not identified themselves as binary gender. In our sample, 28,1% (vs 12.9% binary students) don’t do PA. Of those doing PA, 52,2% don’t meet World Health Organization recommendations. Among those who perform PA, there no difference in the amount of minutes/week of moderate or intense physical activity performed. Regarding SB, 93,8% spend &amp;gt;6 hours/day in SB (vs 84.7% binary students, mean 7,82 vs 8,75, Sg. 0,032). When grouped into PA/SB categories 65,6% (vs 40,5%) were extremely sedentary in contrast to 1,4% physically active (vs 8.8%). Conclusions In Spain, 1 in 4 young people does not identify with the male/female categories. In our sample, physical inactivity and sedentarism are higher among those who do not identify as male/female. Once they commit to physical activity, there is no difference in the time spent between those who meet the WHO recommendations. More research is needed to understand the reasons for these differences and ensure barrier-free access to healthy lifestyle habits on campus. Key messages • Non-binary gender identified students are less physically active and more sedentary than their peers. • Once they commit to physical activity recommendations, there are no differences among their performance.

Empowerment and interprofessional collaboration in health promotion centre Murska Sobota

Abstract Background Health promotion centres (HPCs) were introduced in Slovenian primary health care centres to provide interventions against risk factors for noncommunicable diseases (NCDs). HPCs integrate a multidisciplinary and community-based primary care approach to the prevention of NCDs and provide free lifestyle intervention programmes. This study aims to explore the perspectives of health care professionals on promoting health of local community members, as well as their perceptions of interprofessional collaboration in HPCs. Methods Two group discussions were conducted with a total of 11 health care professionals at the HPC Murska Sobota. Data collection was accompanied by a dual role interpreter in accordance with the principles of cross-language qualitative research. The data was transcribed, semantically translated and thematically analysed. Results Health care professionals emphasize the importance of health-related empowerment of individuals for the success of health promotion activities and therefore for the improvement of individuals’ quality of life. This is based on shared decision-making, self-management and educational measures in a combination of population- and individual-based approaches. The need for efficient interprofessional communication, characterized by a flat hierarchy, is stressed. Structured cooperation with other health care facilities, as well as close collaboration with communities and local media, are described as crucial for reaching all individuals and promoting health equity. Conclusions Interprofessional collaboration, health-related empowerment of individuals and collaboration with local communities are fundamental for the success of health promotion activities, achieving health equity and preventing NCDs. Understanding how these activities are implemented from the health care professionals’ perspective can help other health facilities developing and improving local health promotion strategies. Key messages • Slovenian health care professionals see interprofessional collaboration as fundamental for the implementation of health-promotion strategies. • Health-related empowerment of individuals and collaboration with local communities play an important role in achieving health equity in health promotion activities.

Traditional medicine use to manage hypercholesterolemia, hyperglycaemia and hypertension in Ecuador

Abstract Background Although the use of traditional medicine (TM) to manage health issues is frequently reported, clinical guidelines often overlook this practice. This study aimed to describe the frequency of TM use to control 3 cardiometabolic risk factors for non-communicable diseases (arterial hypertension, hypercholesterolemia, and hyperglycaemia, collectively referred to as CMRF here); and associated sociodemographic, economic, and clinical characteristics. Methods Descriptive cross-sectional study with a representative population of two health districts in Ecuador, one urban in southern Quito and one in a forested rural area with diverse ethnic groups in Esmeraldas. We included 602 individuals with at least one CMRF and calculated the proportion of those who reported regular use of TM (herbal or traditional remedies) to control their CMRF. We used a multivariable logistic regression model to calculate Odds Ratios for TM use according to sociodemographic, economic, and clinical characteristics. Results TM was commonly used to control CMRF in both sociocultural contexts (39.4% Esmeraldas, 31.1% Quito), often in combination with conventional medicine (CM). A notable percentage of people (33.9% Esmeraldas, 39.0% Quito) did not take any treatment for their CMRF, and the rest used CM alone. In both settings, education was significantly associated with TM use. While in Quito people with higher education were more likely to use TM (aOR 2.04, 95%CI 1.03-3.90), in Esmeraldas, it was more common among people without formal schooling (aOR 3.76; 95%CI 1.59-8.88) as well as those of younger age (aOR per year 0.97; 95%CI 0.95-0.99) and from Afro-Ecudorian ethnicity (aOR 2.13; 95%CI 1.02-4.45). Conclusions Traditional medicine is used by a significant portion of Ecuador’s population, highlighting the need for a more accessible and intercultural approach to healthcare. Key messages • The use of traditional medicine to address hypertension, hypercholesterolemia, and hyperglycaemia appears to be widespread in different sociocultural and economic contexts of Ecuador. • To promote intercultural health, understanding the diverse sociocultural patterns associated with the use of traditional medicine, often combined with conventional medicine, is crucial.

9.C. Round table: The Global Oral Health Action Plan – Integrating Oral Health into the global health agenda

Abstract Oral diseases (OD) are a global public health problem affecting 3.5 billion people, with a global prevalence of 45%, higher than the prevalence of any other non-communicable disease (NCD). Recognizing the global public health importance, the 76th World Health Assembly (WHA) (May 2023) adopted the WHO’s Global Oral Health Action Plan (GOHAP) 2023-2030; a crucial step to bring momentum and mobilise all actors to address the burden of OD and common risk factors for all NCDs, while integrating oral health (OH) as part of general health and promoting cross-sectoral cooperation on good OH worldwide to reach UHC. Drawing insights from other successful global health action plans, this roundtable (RT) will explore key lessons learned in implementing effective strategies to improve OH outcomes at European and global levels, ensuring access to quality care for all. The objectives of the RT are: 1.To present the GOHAP 2023-2030, incl. challenges and opportunities; 2. To draw insights from other global health action plans; 3. To present good examples of civil society organization (CSO) actions supporting the GOHAP’s implementation - The Manifesto of the Platform for Better Oral Health, calling for policy actions by EU policymakers; 4. To present findings from the EU DELIVER (DELiberative ImproVEment of oRal care quality) and PRUDENT projects, funded by the European Commission, aiming to provide and implement a blueprint model for ensuring access to quality OH care for all; 5. To inform follow-up actions and collaboration across EUPHA sections, its strategy, as well as that of European Member States (MS), CSOs and other institutional partners, and to raise awareness across the European public and global health communities. The structure of the RT will include brief interactive presentations with real-time polling to maximize participant engagement and to consolidate key messages to present at the end of the session, incl. to inform follow-up actions across EUPHA. The first brief presentation on GOHAP will highlight the aims and evidence-informed actions, followed by: 1. Insights from other global health action plans, exploring lessons learned in implementing effective strategies, examining the approaches, opportunities, challenges and outcomes; 2. Good examples of actions taken by CSOs; 3. Preliminary findings from the EU DELIVER and EU PRUDENT will be presented, incl. key co-creation tools of deliberative dialogues and the development of a set of quality indicators for applicability on the practice, community and policy levels. Guided discussion will focus on opportunities and challenges in GOHAP implementation, with the targeted questions to panellists on: What can countries learn from other global health action plans? What should be the priorities of EU MS? What is the role the public health community can play? What are key steps needed to eliminate common NCD risk factors to drastically reduce the prevalence and burden of ODs? Key messages • There is an urgent need in the global and public health communities to better understand the processes involved in implementing the GOHAP, incl. challenges and opportunities. • Interdisciplinary and cross-sectoral collaboration is key to address the common risk factors of NCDs, to inform concerted action and evidence-informed policymaking to improve oral health care. Speakers/Panelists Pauline Vassallo European Association of Dental Public Health, Valletta, Malta Benoit Varenne Dental Officer, Prevention of Non Communicable Disease Department, WHO, Geneva, Switzerland Dympna Kavanagh Chief Dental Officer, Platform for Better Oral Health in Europe, Dublin, Ireland Neville Calleja Department of Health Information and Research, G’Mangia, Malta

Joining forces to accelerate cancer and NCD prevention in Europe

Abstract JA PreventNCD, a Joint Action to prevent cancer and other non-communicable diseases (NCDs) aims to assist authorities in prioritizing the most effective prevention strategies and policies to reduce the burden of cancer and NCDs, focusing on both personal and societal risk factors. A key objective is to tackle social inequalities by addressing the root causes of NCD risk factors and adopting a life-course approach. Recognizing that health is created by policies in several sectors is key when addressing health determinants, including social and commercial determinants of health. Consolidated efforts across countries will be required to tackle some of these determinants. To achieve the project’s objectives, the JA PreventNCD will build a comprehensive European infrastructure for monitoring risk factors, disease burden, and the impact of policies and interventions. Rigorous evaluation will ensure that the project’s deliverables will have an impact at local, national and EU levels. Three technical work packages address common risk factors for NCDs through actions ranging from policies and structural measures at societal level to interventions targeting individuals. Another set of cross-cutting work packages address monitoring, social inequalities, and health in all policies. More than 100 partners across 25 countries are involved, with almost 100 pilots to be conducted over the course of the project’s four years. One way of ensuring sustainability of the project’s outcomes is the building of a sustainable governance structure through the establishment of an EU Consortium on Cancer Prevention. Furthermore, as a mechanism to ensure high policy relevance of this JA, a Policy Decision Maker’s Forum will be established to engage policymakers and ensure feasibility of the project’s recommended actions. Speakers/Panelists Claudia Habl Austrian National Public Health Institute, Vienna, Austria Ane Fullaondo Biosistemak, Bilbao, Spain Arnfinn Helleve Norwegian Institute of Public Health, Oslo, Norway

Evaluation of university food environment and healthy space policy implementation at university

Abstract Issue/problem Unhealthy diets, along with factors like tobacco, alcohol, and inactivity, contribute significantly to non-communicable diseases (NCDs). Prevention strategies should prioritize reducing exposure to these risk factors. It’s also crucial to consider environmental well-being alongside promoting health. Description of the problem During 2023/2024, university cafeterias (UC) were evaluated for healthy eating standards compliance, resulting in a noticeable presence of unhealthy foods together with plastic use, alcohol and tobacco consumption. This led to the development of an accreditation program to boost UC as healthy spaces. Results The developed program includes 5 mandatory standards and 42 recommendations. Priority objectives are offering healthy food options like fruit, avoiding alcohol and sugary drink ads, banning tobacco, promoting physical activity, and reducing waste for example by encouraging unpackaged water consumption. Our policy emphasizes evaluation and monitoring, so accreditation is valid only for two years. Our goal is to establish UC as sustainable, healthy spaces. To encourage compliance, we offer institutional financial support and accreditation seals to UC, showcasing their commitment to community health. Implementation begins in the 2024/2025 academic year, with an initial evaluation scheduled at that time. Lessons Monitoring UC food offerings is crucial for ensuring healthier options. Cafeterias play a key role in promoting healthy habits. Creating environments with healthier options can mitigate non-communicable disease risk factors presence. Key messages • University cafeterias are pivotal in fostering a healthy lifestyle. • Prioritizing policies to address non-communicable diseases is crucial. Clear programs are essential for sustained effectiveness.

Non-Communicable Diseases and Non-Modifiable Risk Factors: Analysis of the Situation in Three Ecuadorian Cities, 2023

Introduction: noncommunicable diseases (NCDs) have become the main causes of morbidity and mortality worldwide and their incidence and prevalence is increasing. Objective: to analyze nonmodifiable risk factors for NCDs in Azogues, Biblián and Déleg. Methodology: observational, descriptive-correlatonial study in a probabilistic sample of 993 people (men and women), over 20 years of age, residents of District 03D01, applying the survey technique, through a validated questionnaire for the detection of disease risk factors chronic-degenerative. Statistical analysis was performed in the Jamovi software, using nonparametric tests such as Chi-square of homogeneity and other coefficients to measure the effect size "Cohen's d" and the strength of association "Cramer's V". Results: median age 39 years, women (69.1%), "mestizos" (99.4%), from rural areas (64.8%), with secondary education (47.4%), married (59.9%), hypertensive (32%), diabetics (12%), chronic respiratory disease (10%), thyroid disease (5%), heart disease (2%), cancer (1%), overweight/obesity (56%), dyslipidemias (23%). Conclusions: Nonmodifiable factors such as age, ethnicity, sex and family history are determining factors in the development of NCDs, and in District 03D01 they are significantly associated (p&lt;0.05), especially with diabetes and arterial hypertension.

Challenges and solutions to banning the advertisement of unhealthy products: a qualitative study

Unhealthy products (food, alcohol, tobacco) are among the main risk factors of non-communicable diseases. To discourage the consumption of these products, Iran has passed a law banning the advertisement of unhealthy products in all media and for all age groups. The purpose of the present study was to identify the challenges of this approach and provide evidence to facilitate the enforcement process and the participation of stakeholders. In this qualitative study participants were selected from the policymakers and experts involved in the banning of advertisements on unhealthy products in Iran. Semi-structured interviews were conducted with 24 specialists and experts. The participants were selected through purposive and snowball sampling. Identified challenges and solutions were divided into three categories and nine themes: external (political, social, and economic); interorganizational (mission and communication); and internal (planning, organization, leadership, and control). Banning the advertisement of unhealthy products involves many challenges due to the existence of key players with different roles and missions. If these challenges are not managed effectively, they will hinder the enforcement and success of this law. Therefore, it is necessary for policymakers and health system managers to take the necessary measures to remove these obstacles.