Stepwise Approach To Chronic Disease Risk Factor Surveillance Research Articles

Risk factor profile for non-communicable diseases: findings of a STEPS survey among the support staff at the University of Pretoria, South Africa

Background: Non-communicable diseases (NCDs) are an important problem in South Africa; they account for 60% of all deaths. Early screening could help lower NCD incidences and long-term consequences. Objective: The study aimed to profile NCD risk factors among insourced support staff at the University of Pretoria in 2018. Design: A cross-sectional, descriptive study was conducted at the University of Pretoria, Hatfield Campus. The World Health Organization (WHO) STEPwise approach to chronic disease risk factor surveillance (STEPS) questionnaire was administered to collect data in three steps. The participants’ behavioural risk profiles were gathered using the face-to-face interview technique (STEP I), followed by their physical risk profile using anthropometric and blood pressure measurements (STEP II). Last was the biochemical risk profile, including finger-prick blood glucose and cholesterol measurement (STEP III). Data were analysed using Epi-Info, version 3.54. Subjects: A convenient sample of participants aged 18–64 years from the Departments of Industrial Hygiene and Building Services, Landscape Services, Sports Fields Management, and Security Services (n = 146, 60% were females) took part in the study. Results: Most participants (97.8%) had low daily fruit and vegetable intake. Some 80% of the study population always or often added salt to their food when cooking. Daily alcohol consumption was reported by a quarter of the sample. More than two-thirds of all the participants were overweight or obese and 61% had central obesity. Conclusion: The study identified a high prevalence of several NCD risk factors. Tailored nutrition education and monitoring are needed to lower the elevated risk.

Assessment of risk factors for hypertension among undergraduate students in a medical college of Himachal Pradesh, India

Background: Hypertension is a commonest cardiovascular disorder and is major cause of premature death worldwide. An estimated 1.28 billion adults aged 30-79 years worldwide have hypertension, most (two-thirds) living in low and middle-income countries. So present study was undertaken to assess the risk factors for hypertension among First year MBBS students so that suitable preventive measures may be undertaken. Methods: It is cross sectional study conducted among first year MBBS students in DRKGMC Hamirpur. The duration of study is three months. The tools of study used were modified structured pretested self-administered questionnaire; WHO stepwise approach to chronic disease risk factor surveillance (STEPS). Weighing machine, measuring tape, digital BP apparatus and steadiometer. Results: A total of 115 students of MBBS first year participated in the study. There were a total of 31.3% (36) boys and 68.7% (79) girls. Thirty three percent (38) had a family history of hypertension. 16.52% (19) had a BMI more than the normal. Among the study participants only 5 students (4.35%) used to consume alcohol and smoke cigarettes. Most of study participants consume fast food and junk food. Conclusions: High prevalence of different modifiable risk factors for hypertension revealed among the study subjects.There is need to screen the modifiable risk factors from very early age.

Tobacco consumption in Mozambique in 2005 and 2015.

The burden related to smoking exposure is growing in many low-income settings. We aimed to quantify the use of smoked and smokeless tobacco in Mozambique in 2014/2015, and to compare the estimates with those obtained in 2005. A cross sectional study was conducted in 2014/2015 on a representative sample of the Mozambican population aged 15 to 64 years, following the World Health Organization Stepwise Approach to Chronic Disease Risk Factor Surveillance (STEPS). Prevalence estimates with 95% confidence intervals were computed for different categories of tobacco consumption. The age-standardised prevalence in the age-group 25-64 years was compared with results from a STEPS survey conducted in 2005. Between 2005 and 2014/2015, the prevalence of daily smoking decreased from 9.1% to 3.4% (p < 0.05) in women and from 33.6% to 27.3% (p < 0.05) in men. There was a significant decrease in the daily consumption of hand-rolled cigarettes among women (from 3.1% to 1.4%, p < 0.05). Among men, there was a decrease in the prevalence of daily consumption of smokeless tobacco (from 3.5% to 1.0%, p < 0.05). In 2014/2015, both manufactured and hand-rolled cigarette consumption were more prevalent among men, while the use of smokeless tobacco was more common among women; the consumption of both hand-rolled cigarettes and smokeless tobacco were more prevalent in rural settings. In Mozambique, there was a decrease in the prevalence of daily smokers in both genders and of daily consumption of smokeless tobacco among men between 2005 and 2014/2015. Efforts are needed to maintain the positive trends.

Tobacco consumption patterns among Iranian adults: a national and sub-national update from the STEPS survey 2021

Smoking is recognised as a critical public health priority due to its enormous health and economic consequences. Constant monitoring of the effectiveness of tobacco control programs calls for timely population-based data. This study reports the national and sub-national patterns in tobacco consumption among Iranian adults based on the results from the STEPwise approach to chronic disease risk factor surveillance (STEPS) survey 2021. This study was performed through an analysis of the results of the STEPS survey 2021 which had been conducted as a nationally representative cross-sectional study. Participants included Iranian adults aged ≥ 18 years in all provinces of Iran, who were selected via multistage cluster sampling method. Data were analyzed via survey analysis while considering population weights. The total number of participants was 27,874, including 15,395 (55.23%) women and 12,479 (44.77%) men. The all-ages prevalence of current tobacco smoking was 14.01% overall, 4.44% among women, and 25.88% among men. The all-ages prevalence of current cigarette smoking was 9.33% overall, 0.77% among women, and 19.95% among men. The all-ages prevalence of current hookah smoking was 4.5% overall, 3.64% among women, and 5.56% among men. The mean (SD) number of cigarettes smoked per day was 12.41 (10.27) overall, 7.65 (8.09) among women, and 12.64 (10.31) among men. The mean (SD) monthly times of hookah use was 0.42 (7.87) overall, 2.86 (23.46) among women, and 0.3 (6.2) among men. The national all-ages prevalence of second-hand smoking at home was 24.64% overall, 27.38% among women, and 20.26% among men. The national all-ages prevalence of second-hand smoking at work was 19.49% overall, 17.33% among women, and 22.94% among men. The tobacco consumption in Iran remains alarmingly high, indicating the current tobacco control policy implementation level is ineffective and insufficient. This calls for adopting, implementing, and enforcing comprehensive packages of evidence-based tobacco control policies.

Current Tobacco Smoking Prevalence Among Iranian Population: A Closer Look at the STEPS Surveys.

Objectives: To determine the current tobacco smoking prevalence among Iranian adults, its geographical distribution in 2011, 2016, and time trend during 2004-2016.Methods: We conducted a pooled analysis of the published reports of 2004, 2007, 2008, 2009, and the data of 2011 and 2016 of the STEPwise approach to chronic disease risk-factor surveillance (STEPS) surveys.Results: The prevalence of current tobacco smoking and current daily cigarette smoking in 2016 was 14.1 and 9.7%, respectively. Only 0.2% of participants smoked water-pipe. Current tobacco smoking prevalence remained unchanged during 2004-2016 for both men and women. The prevalence of passive smoking at home or workplace was 27.4%. Current tobacco smoking prevalence and current daily cigarette smoking was significantly lower among women than men. Current tobacco smoking prevalence showed a geographical pattern throughout the country. In both 2011 and 2016, current tobacco smoking prevalence was higher among men who lived in the western provinces, especially the north-west, than those who lived in the eastern and southern provinces.Conclusions: The current tobacco smoking prevalence among Iranian population has not changed significantly during 2004-2016 and does not conform to the international guidelines. Therefore, it remains crucial yet challenging that effective nationwide policies be implemented to reduce the use of tobacco products. One cannot hope for any reductions in smoking prevalence until a cocktail of interventions are built around strong commitment to government policy.

Magnitude of Obesity/Overweight and Its Associated Factors Among HIV/AIDS Patients on Antiretroviral Therapy in Jimma Zone Hospitals, South West Ethiopia: Hospital-Based Cross-Sectional Study.

PurposeObesity is on the rise worldwide, not only in the general population but also in PLWHA. Being overweight and obese are themselves risk factors for cardiovascular and other diseases. Despite this, few studies have been conducted to determine the magnitude of obesity/overweight and its associated factors among HIV/AIDS patients in Ethiopia, which necessitates this study.MethodsHospital-based cross-sectional study was conducted from December to January 2019 at selected Jimma zone hospitals. WHO STEP-wise approach to chronic disease risk factor surveillance (STEPS) questionnaire and document review for HIV-related clinical factors was applied. Weight, height and waist circumference and hip circumference were measured. Data were analyzed using SPSS version 20.ResultsA total of 252 participants with a response rate of 95.8% were included. The prevalence of obesity/overweight was 21%. After adjusting for these variables, age category of greater than 50 years [AOR = 0.4, 95% CI (0.2, 0.9), p = 0.03], WHO clinical stage III and above [AOR = 0.04, 95% CI (0.002, 0.6), p = 0.02], presence of mild to moderate physical activity [AOR = 1.3, 95% CI (5.5, 33.3), p ≤ 0.001)], plasma CD4 count between 351 and 500 copies/mL [AOR=0.15, 95% CI (0.04, 0.6) p=0.024], and female sex [AOR = 2.6, 95% CI (1.25, 10) p=0.03)] were significantly associated with obesity/overweight.ConclusionThere was a high prevalence of obesity/overweight among HIV/AIDS patients. It was found that older age, female sex, early stage of the disease, lower CD4 count and presence of mild to moderate physical activity were significant predictors of obesity/overweight. Clinicians should be aware of the health consequence of obesity and consider instituting targeted weight management programs as a part of routine HIV care.

Development and Validation of a New Diabetes Risk Score in Guyana.

IntroductionWe present a new diabetes risk score developed and validated in a multi-ethnic population in Guyana, South America. Measurement of in-country diabetes prevalence is a vital epidemiologic tool to combat the pandemic. It is believed that for every person diagnosed with type 2 diabetes there is another undiagnosed. The International Diabetes Federation (IDF) recommends a two-step detection programme using a risk score questionnaire to identify high-risk individuals followed by glycaemic measure.MethodsData on 798 persons from the 2016 STEPwise Approach to Chronic Disease Risk Factor Surveillance (STEPS) were used to correlate responses to 36 questions with glycated haemoglobin (HbA1C) and fasting plasma glucose (FPG) results. Bootstrapping was used to internally validate the derived seven-variable model. This model with the addition of family history questions was tested in a convenience sample of 659 Guyanese adults and externally validated in a cohort of another 528.ResultsAn 8-item Guyana Diabetes Risk Score (GDRS) was derived. The final model performed with an area under the curve (AUC) of 0.812ConclusionsThe validated eight-item Guyana Diabetes Risk Score will be extremely useful in identifying individuals at high risk of having diabetes in Caribbean, Black or East Indian populations.Electronic Supplementary MaterialThe online version of this article (10.1007/s13300-020-00775-4) contains supplementary material, which is available to authorized users.

Prevalence of overweight and obesity in Mozambique in 2005 and 2015.

The ongoing demographic, nutritional and epidemiological transitions in sub-Saharan Africa highlight the importance of monitoring overweight and obesity. We aimed to assess the prevalence of overweight and obesity in Mozambique in 2014/2015 and compare the estimates with those obtained in 2005. Cross-sectional study conducted in 2014/2015, following the WHO Stepwise Approach to Chronic Disease Risk Factor Surveillance (STEPS). Prevalence estimates with 95 % CI were computed for different categories of BMI and abdominal obesity, along with age-, education- and income-adjusted OR. The age-standardized prevalence in the age group 25-64 years was compared with results from a STEPS survey conducted in 2005. Mozambique. Representative sample of the population aged 18-64 years (n 2595). Between 2005 and 2014/2015, the prevalence of overweight and obesity increased from 18·3 to 30·5 % (P < 0·001) in women and from 11·7 to 18·2 % (P < 0·001) in men. Abdominal obesity increased among women (from 9·4 to 20·4 %, P < 0·001), but there was no significant difference among men (1·5 v. 2·1 %, P = 0·395). In 2014/2015, the prevalence of overweight and obesity was more than twofold higher in urban areas and in women; in the age group 18-24 years, it was highest in urban women and lowest in rural men. In Mozambique, there was a steep increase in the prevalence of overweight and obesity among adults between 2005 and 2014/2015. Overweight and obesity are more prevalent in urban areas and among women, already affecting one in five urban women aged 18-24 years.

Predictors of Hypertension among Adult Female Population in Kpone-Katamanso District, Ghana.

Background. Hypertension is an independent risk factor of cardiovascular disease, which is one of the biggest health challenges today. The objective of this study was to estimate the prevalence of the problem and other factors related to hypertension among women who are 25 years and above. Methods. A community-based cross-sectional study was conducted from September and November 2017. A multistage cluster sampling technique was used to select the study participants. The data was collected using a structured questionnaire and physical measurements adapted from “WHO STEPwise approach to chronic disease risk factor surveillance (STEPS).” Data were examined using the SPSS program IBM version 20. Descriptive statistics, including proportions, frequencies, and cross-tabulations, were used to summarize the study variables. A binary logistic regression was fitted variable with a p value of < 0.7. The bivariable analyses were entered in the multivariable analysis to control the possible effect of confounders. Multivariable logistic regression analysis was used to identify factors associated with hypertension. The Adjusted Odds Ratio (AOR) with a 95 % Confidence Interval (CI) was computed to show the level of certainty. A p value of <0.05 was considered statistically significant. Results. The study indicated that the prevalence of hypertension (BP ≥ 140/90 mmHg) was 33.8% (95% CI 27.4-40.2) which increased with age. At the time of the study, women aged 45-64 years [AOR =2.19, (95% CI: 1.11-4.34, p<0.02)] and 65+ years [AOR =5.13, (95% CI: 2.20-11.99), p<0.001] were two to five times as likely as those with age of 25-44 years to be hypertensive. Women who had a higher body mass index (BMI) ≥30 kg/m2were two times as likely as those with normal weight to be hypertensive [AOR 2.38, (95% CI; 1.14-4.95, p<0.02)]. Women who did not consume fresh fruit daily were three times as likely as those women who consume fresh fruit daily to be hypertensive [AOR 3.17 (95% CI; 1.05-9.55, p<0.04)]. Conclusion. Increasing age, obesity, and women who did not consume fresh fruits daily were associated with hypertension, indicating opportunities for health education and other prevention measures.

Epidemiological Profile of Obesity among Health Staff at the Yaound&amp;#233; Central Hospital and at the Yaound&amp;#233; University Teaching Hospital

Background: Obesity is a real pandemic and with ever increasing prevalence. Health professionals play a vital role in the fight against this condition. They are also affected by obesity and could be even more affected than the general population. These health workers sometimes have a wrong perception of their own weight which interferes with their ability to counsel their patients. The purpose of this study was to determine the prevalence and factors associated with obesity among health care workers and increase their awareness of the problem. Methodology: This was a cross-sectional study conducted at the Yaounde Central Hospital (YCH) and the Yaounde University Teaching Hospital (YUTH) during a 6 months period. The data were collected through a questionnaire structured according to WHO STEP wise approach to chronic disease risk factor surveillance (STEPS). We measured weight, height, waist circumference, and blood pressure according to the WHO STEPS procedure. The Chi square test and logistic regression were used to measure the association between the qualitative variables. A p value 0.05 was considered statistically significant. Results: A total of 350 health personnel participated in this study. The prevalence of obesity was 30.3%. That of abdominal obesity was 46.9%. The factors independently associated to overall obesity were age > 40 years [OR = 2.22 95% CI (1.28 - 3.87)], nursing assistant profession [OR = 2.31 95% IC (1.21 - 4.41)] and high blood pressure [OR = 3.38 95% CI (1.16 - 9.84)] and to abdominal obesity, age > 40 years [OR = 3.35 95% CI (1.96 - 5.71)], female gender [OR = 5.47 95% CI (2.95 - 10.14)], marriage [OR = 1.84 95% CI (1.08 - 3.14)], and High blood pressure [OR = 3.76 95% CI (1.01 - 13.94)]. Conclusion: Obesity is very common among YCH and YUTH staff. Staff awareness and the introduction of proper lifestyle promotion programs are more than ever needed to win the fight against obesity.

Knowledge of dietary habit and behavior-related determinants of non-communicable disease in women of urban setting of Eastern Nepal

Background: The non-communicable diseases (NCDs) are one of the leading causes of death globally which accounts for 68% out of world’s 56 million deaths in 2012. Around 82% of the premature deaths due to NCDs occur in the low-and middle-income countries and 40% of global NCD-related deaths take place before the age of 70. The study aimed to assess knowledge of dietary habits and behaviour-related determinants of NCD in urban Nepalese women of Eastern Nepal.&#x0D; Materials and Methods: A cross-sectional study was designed by using interviewer-administered questionnaire regarding knowledge on NCD. The definitions used for the study adopted the WHO STEP wise approach to chronic disease risk factor surveillance (STEPS) survey. A total 706 women aged 20–59 years were selected randomly from Inaruwa Municipality of Eastern Nepal.&#x0D; Results: The overall knowledge scores was found to be 62.14% with standard deviation 14.93% and it build up that the diet- and behaviour-related causes (mean score 75.25%), diet quality (mean score 45.27%) fruit and vegetable link (mean score 30.02%), health consequences of obesity (mean score 76.82%), causes of cardiovascular disease (mean score 77.08%) and causes of certain cancers (mean score 36.10%) were calculated. The total score of knowledge regarding NCD was found to be significant with caste/ethnicity, education level, occupation, socioeconomic status, physical activity and fruit intake.&#x0D; Conclusions: Findings revealed the population had good overall knowledge concerning diet and nutrition related to NCD in the relatively new context of the obesity epidemic in urban set up of Nepal. However, there was poor knowledge of the benefit of eating fruit and vegetables and other preventable causes of certain cancers. Nutrition education messages need to be communicated within the general population of women. Education targeting the benefits of vegetables and fruit may have the positive impact on NCD prevention.

PREVALENCE OF CARDIOVASCULAR RISK FACTORS IN THE RURAL AREAS OF KHYBER PAKHTUNKHWA

Objective: To assess the prevalence of cardiovascular disease (CVD) risk factorsin the rural areas of Khyber Pakhtunkhwa, Pakistan. Methodology: This was a community based cross sectional study carried out,from February 2011 to July 2013. We evaluated healthy subjects following theWHO Stepwise approach to Chronic Disease Risk Factor Surveillance (STEPS).Individual consent was obtained. Data was collected on proforma prepared in thelight ofWHOcore version 2.1, during a free medical camp campaign. Social class(Upper, Middle, Lower) was assigned to each participant based on theiroccupation. The variables recorded were pertinent clinical history, BP, body massindex (BMI), waist circumference, tobacco use, dietary habits, physical activity,Random Blood Sugar and total Cholesterol. Data was analyzed using SPSSversion 16. Results: A total of 2569 adults were analyzed. Mean age was 45.97 ±12.1 (25-64) years. Prevalence of hypertension (BP 140/90) was 26.7% with 11.1%newly diagnosed cases. Mean BMI & waist circumference were 23.64 ±2.69(17-35) and 86.30 ±7.98 (70-108), respectively with abdominal obesity moreprevalent in females (21.7% vs. 18%, p<0.0001). Prevalence of DM was 7.9%,more in male 4.6%, with 2.1% newly diagnosed cases. Tobacco use and Physicalinactivity was 24.4% and 23.6% respectively. Positive CVD family history waspresent in 11.9%. Conclusion: There is higher prevalence of CVD risk factors in the rural populationof Khyber Pakhtunkhwa.

Self-reported physical activity behavior of a multi-ethnic adult population within the urban and rural setting in Suriname.

BackgroundPhysical activity (PA) plays an important role in the combat against noncommunicable diseases including cardiovascular diseases. In order to develop appropriate PA intervention programs, there is a need to evaluate PA behavior. So far, there are no published data on PA available for Suriname. Therefore, we aim to describe PA behavior among the multi-ethnic population living in urban and rural areas of Suriname.MethodsThe World Health Organization (WHO) STEPwise approach to chronic disease risk factor surveillance (STEPS) was conducted in a national representative sample (N = 5751; 48.6% men) aged 15–64 years between March and September 2013. Physical activity data were assessed using the Global physical activity questionnaire (GPAQ) and analyzed according to the GPAQ guidelines. The prevalence of meeting the recommended PA level and prevalence ratios (PR) were computed.ResultsOnly 55.5% of the overall population met the WHO recommended PA levels (urban coastal area: 55.7%, rural coastal area: 57.9%, rural interior area: 49.1%). Women were less likely to meet the recommended PA level (49% vs 62.4%; p < 0.0001) and with increasing age the PR for recommended level of PA decreased (p < 0.0001). Compared to the Hindustani’s, the largest ethnic group, the Javanese reported the lowest percentage of people meeting recommended PA level (PR = 0.92; p = 0.07).ConclusionAround half of the population meets the recommended PA level. Future lifestyle interventions aiming at increasing PA should especially focus on women and older individuals as they are less likely to meet the recommended levels of PA.

Model-based patterns of cardiovascular risk factors in Mozambique

Background: Risk factors for cardiovascular diseases tend to cluster, although evidence from settings under epidemiological transition is scarce.Aim: To identify patterns of clustering of cardiovascular risk factors and to quantify their association with sociodemographic characteristics, in Mozambique.Subjects and methods: A national representative sample (n = 3323) of subjects aged 25–64 years was evaluated in 2005, using the World Health Organization Stepwise Approach to Chronic Disease Risk Factor Surveillance (STEPS). Patterns of joint exposure to high blood pressure, high fasting blood glucose, high body mass index, smoking, excessive alcohol consumption, low fruit/vegetables intake and insufficient physical activity were identified through latent class analysis.Results: Three patterns were identified among women: (1) “healthier”, lower frequency of most risk factors (53.0%); (2) “hypertension-overweight” (21.1%), more frequent among older and urban subjects; and (3) “hypertension-smoking-alcohol” (25.9%), whose frequency increased with age and decreased with education. In men, two clusters were identified: (1) “hypertension-overweight” (30.1%); and (2) “smoking” (69.9%). The frequency of the latter pattern was higher in urban areas and increased with age and education.Conclusion: Hypertension, overweight/obesity, smoking and excessive alcohol intake defined the main clusters of cardiovascular risk factors. This should be considered when planning prevention and control strategies for cardiovascular diseases in Mozambique.

Cardiovascular risk in Mozambique

To estimate the proportion of Mozambicans eligible for pharmacological treatment for hypertension, according to single risk factor and total cardiovascular risk approaches. A representative sample of Mozambicans aged 40-64 years (n=1116) was evaluated according to the WHO STEPwise Approach to Chronic Disease Risk Factor Surveillance (STEPS). We measured blood pressure (BP) and 12-h fasting blood glucose levels and collected data on sociodemographic characteristics, smoking, and use of antidiabetic and antihypertensive drugs. We estimated the 10-year risk of a fatal or nonfatal major cardiovascular event (WHO/International Society of Hypertension risk prediction charts), and computed the proportion of untreated participants eligible for pharmacological treatment for hypertension, according to BP values alone and accounting also for the total cardiovascular risk (WHO guidelines for assessment and management of cardiovascular diseases). Among the Mozambicans aged 40-64 years and not taking antihypertensive drugs, less than 4% were classified as having cardiovascular risk at least 20% whereas the prevalence of SBP/DBP at least 140/90 mmHg was nearly 40%. A total of 19.8% of 40-64-year-olds would be eligible for pharmacological treatment of hypertension according to the WHO guidelines, all of whom had SBP/DBP at least 160/100 mmHg. Among the Mozambicans aged 40-64 years not taking antihypertensive drugs and having SBP/DBP at least 140/90 mmHg, only half were eligible for pharmacological treatment according to the WHO guidelines. Taking the latter into account, when defining strategies to control hypertension at a population level, may allow a more efficient use of the scarce resources available in developing settings.

Assessment of Framingham Cardiovascular Disease Risk Among Militaries in the Kingdom of Saudi Arabia

To measure the risk factors for cardiovascular disease (CVD) among militaries in the Kingdom of Saudi Arabia and to assess their Framingham CVD risk. A nationwide survey included 10,500 active military personnel selected by multistage stratified random sampling representing various ranks in the army forces of 5 regions. The study used the World Health Organization STEPwise approach to chronic disease risk factor surveillance (STEPS) in the design of data collection tool. Data included demographic and health behavior information; physical assessment; and anthropometric, random blood glucose, serum cholesterol, and triglycerides measurements. The response rate was 97.4%. The results showed that 9.1% of the sample population had 10% or higher Framingham 10-year office-based CVD risk score, with a mean of 4.5. The risk varied by region, armed force, crowding index, waist-hip ratio, total cholesterol, and triglycerides. Multivariate analysis identified crowding index, physical inactivity, and military rank as independent predictors, apart from Framingham predictors. The prevalence of CVD risk factors is high among militaries in the Kingdom of Saudi Arabia, with an associated high 10-year CVD Framingham risk. The military health services must implement intervention programs to reduce these risks, with follow-up of the participants with identified CVD risk.

Physical activity patterns in Mozambique: Urban/rural differences during epidemiological transition

ObjectiveTo assess the socio-demographic determinants of physical activity, by intensity and domain, across urban and rural areas in Mozambican adults. MethodA national representative sample (n=3323) of subjects aged 25–64years was evaluated in 2005 following the World Health Organization (WHO) Stepwise Approach to Chronic Disease Risk Factor Surveillance (STEPS), which includes the Global Physical Activity Questionnaire. We computed prevalences, and age- and education-adjusted prevalence ratios (PR), with 95% confidence intervals (95%CI). ResultsMost of the Mozambicans reported a high physical activity level, according to the WHO criteria (urban women: 83.2%, 95%CI 77.4, 89.0; rural women: 93.2%, 95%CI 89.0, 97.3; urban men: 78.9%, 95%CI 74.7, 83.1; rural men: 91.6%, 95%CI 85.5, 97.6). The prevalences of <75min/week of vigorous activities were higher in urban settings (women: PR=2.21; men: PR=2.28) and increased with education, regardless of place of residence (PR ranging between 1.75 and 5.72 for more vs. less educated subjects). Work activities were the most important contributor to the overall physical activity, followed by transport. ConclusionMost of the Mozambicans reported to be physically active. Vigorous activities were less common in urban areas and among the more educated subjects, depicting an ongoing shift to more sedentary behaviours in this setting.

Tobacco Consumption in Mozambique: Use of Distinct Types of Tobacco Across Urban and Rural Settings

Monitoring tobacco consumption patterns is essential to define and evaluate strategies to control the tobacco epidemic. We aimed to quantify the use of smoked (manufactured/hand-rolled cigarettes) and smokeless (snuff/chew) tobacco, according to sociodemographic characteristics, in adult Mozambicans. A national representative sample (n = 3,323) of subjects aged 25-64 years was evaluated in 2005 following the World Health Organization Stepwise Approach to Chronic Disease Risk Factor Surveillance (STEPS), which included the assessment of tobacco consumption with the quantification of each type of tobacco used daily. We computed prevalences, and age- and education-adjusted prevalence ratios (PRs), with 95% CIs. Daily smoking was reported by 9.1% (95% CI = 5.0-13.1) of women (manufactured, 3.4%; hand-rolled, 5.6%) and 33.6% (95% CI = 29.3-38.0) of men (manufactured, 18.7%; hand-rolled, 14.8%). Daily manufactured cigarette smoking was significantly more frequent in men (urban: PR = 14.62, 95% CI = 7.59-28.55; rural: PR = 4.32, 95% CI = 2.42-7.71). Daily hand-rolled cigarette smoking was three- to fourfold more frequent among men and nearly 80% less frequent in urban areas, regardless of sex. The prevalence of daily smokeless tobacco use was 7.4% (95% CI = 4.6-10.2) in women (chew, 6.4%; snuff, 1.0%) and 3.4% (95% CI = 1.7-5.2) in men (chew, 1.6%; snuff, 1.8%). Daily smokeless tobacco consumption was significantly less frequent in urban areas only among men (PR = 0.05, 95% CI = 0.01-0.33). Despite the relatively low levels of manufactured cigarette smoking, traditional forms of tobacco consumption are frequent, especially among women and in rural settings, showing the need for control measures to target specifically different patterns of consumption.

Diabetes in Mozambique: Prevalence, management and healthcare challenges

Aim The growing trend towards and deficient management of diabetes in Africa are important public-health challenges requiring surveillance. For this reason, this study aimed to assess the prevalence and awareness of diabetes in urban and rural Mozambique, and to describe its management. Methods In 2005, a representative sample of the national Mozambican adult population ( n = 2343) was evaluated, according to the STEPwise approach to chronic disease risk factor surveillance (STEPS). Twelve-hour fasting blood glucose (FBG) was measured, using fingertip capillary whole blood, to estimate the prevalence of impaired fasting glucose (IFG; FBG ≥ 5.6 mmol/L and less than 6.1 mmol/L) and diabetes (FBG ≥ 6.1 mmol/L, or treatment with insulin and/or oral blood glucose-lowering drugs). Patients’ awareness and management of diabetes were assessed by questionnaire. Results The prevalence of diabetes and IFG was 2.9% [95% confidence interval (95%CI): 1.8–4.0] and 2.5% (95%CI: 1.3–3.7), respectively. Diabetes was more frequent among urban dwellers (OR = 2.92, 95%CI: 1.45–5.86), mostly due to urban–rural differences in age, education, body mass index (BMI) and waist circumference (adjusted OR = 2.27, 95%CI: 0.83–6.26). In all, 13% of those with diabetes were aware of their condition, 10.9% had undergone glycaemia determination during the previous year, and 9% were being treated with oral blood glucose-lowering drugs and 3% with insulin. Conclusion Diabetes prevalence is low in Mozambique, but most diabetic patients were neither aware of their condition nor being treated pharmacologically, thus posing serious challenges to the provision of adequate care in an already disadvantageous context.

Alcohol consumption in Mozambique: Regular consumption, weekly pattern and binge drinking

This study aimed to describe alcohol consumption in Mozambique, discriminating binge drinking behaviour and the weekday variation in drinking patterns, and to quantify the association between socio-demographic characteristics and alcohol intake.A representative sample of 3265 Mozambicans aged 25–64 years was evaluated in 2005 following the World Health Organization Stepwise approach to Chronic Disease Risk Factor Surveillance (STEPS). The consumption of any type of alcoholic beverage, during life and in the previous year, was recorded. Current drinkers were also asked about the number of standard drinks consumed in each day of the previous week.The overall prevalence of current dinking was 28.9% [95% confidence interval (95% CI): 22.6–35.2] in women and 57.7% (95% CI: 49.8–65.7) in men. Forty percent of the current drinkers reported to have had at least one binge drinking occasion in the previous week. The prevalence of current drinking increased with age and education among women and with income among men. No consistent pattern was observed in binge drinking by education in both genders and by annual income among men, but it was significantly less frequent among the more affluent women. Both drinking and binge drinking peaked at the weekend.Knowing the drinking patterns in Mozambique enables the planning of interventions according to the local needs. Future surveys should also include non-adult populations as risk factors for chronic diseases occurs as early as childhood and adolescence, and are associated with increased risk of disease later in life.