STEPwise Approach To Surveillance Research Articles

Self-reported prevalence of asthma and its associated factors among adult rural population in Bangladesh: a cross-sectional study using WHO PEN protocol

ObjectiveFor over a decade, the prevalence of asthma remained unchanged at around 7% in Bangladesh. Although asthma causes significant morbidity among both children and adults, updates on epidemiological data are...

Two-decade trends and factors associated with overweight and obesity among young adults in Nepal.

Overweight and obesity are global epidemics in the adult population, and also affect young people. This study estimated the long-term trend (1996-2019) of overweight and obesity among young adults aged 18 to 29 years in Nepal by sex based on the World Health Organization (WHO) and Asian cut-offs for body mass index (BMI). We also investigated the demographic factors associated with overweight and obesity in the latest survey. This study utilized data from nationwide studies, Demographic and Health Surveys (DHSs) and WHO STEPwise approach to surveillance (STEPS) surveys. The trends in overweight and obesity were studied using trend analysis and joinpoint regression. Average annual percent changes (AAPCs) and their 95% confidence intervals (CIs) were calculated for the trends. Multivariable logistic regression was used to study the factors associated with overweight and obesity. The study findings showed significant upward trends in both overweight and obesity for women with AAPCs of 10.5 (95% CI 6.4-14.7) and 15.8 (95% CI 10.9-20.8) respectively. In the 25-29 age-group, the prevalence of overweight/obesity increased among women from 2.2% to 24.7% between 1996 and 2019, and among men from 8.8% to 25.4% between 2007 and 2019. Increased odds of overweight (AOR 9.15, 95% CI 6.64-12.60), and obesity (AOR 42.09, 95% CI 10.12-175.04) were found in 2019 compared to 1996. Older age and female sex, being married and urban residence were significantly associated with overweight and obesity. In conclusion, this study showed rapid upward trends in overweight and obesity among young adults in Nepal with an accelerated trend among women; the predictors for overweight were older age, female sex and married status, and those for obesity were older age, female sex, and urban residence.

“Current incidence of injuries in Iran; findings of STEPS survey 2021”

BackgroundThe updated epidemiology of injuries at the national and sub-national levels are required for policymakers to effectively handle the burden of injuries. This paper aimed to assess the incidence and risk factors of different injuries in Iran based on a recent national survey. MethodsWe used data from Iran Stepwise approach to surveillance (STEPS) Survey 2021, a population-based study in urban and rural areas of Iran's 31 provinces. A multistage clustered probability design and weighting adjustments were used to select eligible individuals and generate estimations. We estimated the incidence of injuries, assessed sociodemographic variables, and identified potential behavioral risk factors associated with injuries, and results were reported for sociodemographic and geographic stratifications. ResultData from 27,874 participants of the STEPS survey were assessed, of which 1538 (5.5 %, 95 % CI: [5.2–5.8]) reported having an injury in the past 12 months. Falls (44.4 %) were the most common cause of injury, followed by road traffic injury (21.7 %) and exposure to mechanical forces (16.5 %). Except for falls and burns, males had a higher proportion of all types of injuries. Logistic regression analysis showed that being male (OR: 1.7, [1.5, 2.0]) and being an occasional or heavy alcohol drinker (OR: 2.0, [1.3, 3.0] and OR: 2.7, [1.7, 4.1] respectively) were significant risk factors associated with road traffic injuries. Seatbelt use was 90.0 % among both drivers and front-seat passengers, while the use of safety car seats for children was as low as 9.4 %. Injury incidence varied significantly among provinces, with the highest incidence among males observed in Razavi Khorasan (11.2 %) and among females observed in Tehran (12.0 %). ConclusionThis study investigated the updated epidemiology of injuries in Iran and revealed socioeconomic and geographic disparities across country. This epidemiological information can be used to modify injury prevention programs.

Head-to-head comparison of the WHO STEPwise approach with immediate unattended and delayed unattended automated blood pressure measurements during household-based screening: a diagnostic accuracy study in Lesotho

WHO introduced the STEPwise approach to surveillance (STEPS) to monitor trends in non-communicable diseases. For arterial hypertension, the STEPS protocol takes the average of the last two out of three standard blood pressure measurements (SBPM). This study assesses the diagnostic accuracy of SBPM, same-day and next-day unattended automated measurement (uABP), with 24 h ambulatory measurement (24h-ABPM) as reference. This diagnostic accuracy study was done within a population-based household survey on cardiovascular risk factors in two districts in Northern Lesotho. Adults (aged ≥ 18 years) with elevated SBPM (defined as ≥140/90mmHg), and 2:1 age- and sex-matched participants with normal SBPM during the survey were recruited. Following SBPM, first uABP readings were obtained on survey day. Afterwards, participants received a 24h-ABPM device. Second uABP readings were taken 24h later, after retrieval of the 24h-ABPM. The main outcome was overall diagnostic accuracy of all screening measurements (SBPM, first uABP, and second uABP), determined using area under the receiver operating characteristic curve (AUROC), with 24h-ABPM as a reference. Between November 2, 2021 and August 31, 2022, 275 participants (mean age 58 years (SD: 16 years), 163 (59%) female) were enrolled, 183 of whom had elevated and 92 had normal SBPM. Mean difference between systolic daytime 24h-ABPM and screening measurements was highest for SBPM (mean difference:-13mmHg; 95% CI:-14 to-11). Mean difference between diastolic daytime 24h-ABPM and diastolic SBPM was-2mmHg (95% CI:-4 to-1), whereas no difference was found for mean diastolic first uABP (mean difference:-1mmHg; 95% CI:-2.0 to 0.3); and mean diastolic second uABP (mean difference: 1.0mmHg; 95% CI:-0.4 to 2.3). White coat hypertension was highest with SBPM (55 [20%]), followed by first uABP (27 [9.8%]), and second uABP (18 [6.5%]). Using systolic daytime 24h-ABPM as a reference, the uABPs had higher AUROC (first uABP: 87% [95% CI: 83-91]; second uABP: 88% [95% CI: 84-92]); SBPM: (79% [95% CI: 74-85]). This difference was significant between first uABP and SBPM (P=0.0024), and between second uABP and SBPM (P=0.0017). uABP had better diagnostic performance than SBPM. Integration of uABP into STEPS protocol should be considered. Swiss Agency for Development and Cooperation under the ComBaCaL project, and the World Diabetes Foundation.

The relationship between the intake of fruits, vegetables, and dairy products with hypertension: findings from the STEPS study.

The current research aimed to evaluate the relationship between fruit, vegetable (FV), and dairy consumption with the odds of developing hypertension based on nationwide Stepwise approach to surveillance (STEPS) data in Iran. This cross-sectional study was accomplished by the research center of non-communicable diseases (NCDs) in Tehran. In total, 29,378 individuals' data were analyzed. Participants were classified into normal, elevated BP, stage I, and stage II hypertension according to systolic blood pressure (SBP) and diastolic blood pressure (DBP) examinations. Based on the STEPS questionnaire, the consumption of FVs and dairy products was evaluated. Multinomial logistic regression was applied to assess the relationship between the consumption of FVs and dairy products with hypertension. The findings revealed that only fruit consumption (≥ 2 servings/day) was negatively related to stage I hypertension (odds ratio (OR) = 0.81; 95% confidence interval (CI): 0.69-0.95) in two servings per day and OR = 0.81; 95% CI: 0.68-0.96 in > two servings per day) in the adjusted model. There was no significant relationship between consuming vegetables and dairy products with elevated BP and hypertension. Our study showed that increasing fruit consumption was related to reducing hypertension odds. Regarding the consumption of dairy products and vegetables, no significant relationship was found with the odds of hypertension. More studies, especially cohorts, are needed to evaluate the impacts of FV and dairy products on the risk of hypertension.

Prevalence of obesity and abdominal obesity and their association with metabolic-related conditions in Vietnamese adults: an analysis of Vietnam STEPS survey 2009 and 2015

The abdominal obesity trends and prevalence are important contributing factors to significant rise of many noncommunicable diseases in Vietnam but have not been well-documented in the literature. This study aimed to describe the prevalence and trends of obesity and abdominal obesity in Vietnam from 2009 to 2015 and evaluate how different definitions of obesity and abdominal obesity are associated with metabolic-related conditions. We conducted a secondary analysis based on the Vietnam STEPS (STEPwise approach to Surveillance) cross-sectional Survey 2009 and 2015. Obesity and abdominal obesity were defined using the body mass index (BMI), waist circumference (WC), and waist-hip ratio (WHR) cut-offs from the World Health Organization (WHO) and International Diabetes Federation (IDF). Depending on the specific cut-offs, from 2009 to 2015, obesity prevalence increased from 0.8%-10% to 1.7%-16.4% in women and from 0.8%-10.3% to 1.7%-15% in men; abdominal obesity prevalence increased from 3%-31.3% to 8%-41.7% in women and from 0.3%-19.3% to 0.4%-25% in men. Abdominal obesity using WC-IDF and WHR-WHO definitions had noticeably higher sensitivity and lower specificity for metabolic-related conditions compared to the other four criteria. All anthropometric measurements were statistically correlated with biomarkers/blood pressure in 2009 and 2015 except for fasting glucose. Only WC-IDF and WHR-WHO definitions showed consistent association with all reported metabolic-related conditions regardless of sex and survey years. The prevalence of obesity and abdominal obesity in Vietnam is increasing rapidly, especially abdominal obesity in women regardless of the criteria used. More studies are needed to investigate how using different diagnostic criteria for obesity and abdominal obesity could better identify metabolic-related conditions. Authors received no funding for this study.

Cascade of diabetes care in Bangladesh, Bhutan and Nepal: identifying gaps in the screening, diagnosis, treatment and control continuum

Diabetes has become a major cause of morbidity and mortality in South Asia. Using the data from the three STEPwise approach to Surveillance (STEPS) surveys conducted in Bangladesh, Bhutan, and Nepal during 2018–2019, this study tried to quantify the gaps in diabetes screening, awareness, treatment, and control in these three South Asian countries. Diabetes care cascade was constructed by decomposing the population with diabetes (diabetes prevalence) in each country into five mutually exclusive and exhaustive categories: (1) unscreened and undiagnosed, (2) screened but undiagnosed, (3) diagnosed but untreated, (4) treated but uncontrolled, (5) treated and controlled. In Bangladesh, Bhutan, and Nepal, among the participants with diabetes, 14.7%, 35.7%, and 4.9% of the participants were treated and controlled, suggesting that 85.3%, 64.3%, and 95.1% of the diabetic population had unmet need for care, respectively. Multivariable logistic regression models were used to explore factors associated with awareness of the diabetes diagnosis. Common influencing factors for awareness of the diabetes diagnosis for Bangladesh and Nepal were living in urban areas [Bangladesh-adjusted odd ratio (AOR):2.1; confidence interval (CI):1.2, 3.6, Nepal-AOR:6.2; CI:1.9, 19.9].

PERFORMANCE OF STANDARD, IMMEDIATE AND DELAYED UNATTENDED AUTOMATED BLOOD PRESSURE MEASUREMENTS DURING HOUSEHOLD-BASED SCREENING IN RURAL AFRICA: A DIAGNOSTIC ACCURACY STUDY

Objective: The World Health Organization's STEPwise approach to surveillance (STEPS) recommends three standard blood pressure measurements over five minutes (SBPM) to monitor trends of hypertension in low-income countries. The objective of this study was to assess the diagnostic accuracy of SBPM, same-day and next-day unattended automated measurement (uABP), with 24hr ambulatory measurement (24h-ABPM) as reference during a population-based prevalence survey in Lesotho. Design and method: Participants with elevated SBPM (> = 140/90 mmHg) and age- and sex-matched participants with normal SBPM during a household-based survey were recruited. For SBPM and uABP, participants sat and rested for 5 minutes before three measurements were taken each 2 min apart. For both, the mean of second and third measurements was taken as final blood pressure. 1st uABP readings were obtained on survey day. Afterwards participants received a 24h-ABPM device. 2nd uABP readings were taken 24h later after retrieval of the 24h-ABPM. Discrimination was determined for all screening measurements (SBPM, 1st, 2nd uABP) using area under the receiver operating characteristic curve (AUROC), and 24h-ABPM as reference. Results: We enrolled 275 participants [mean age 58 years, 163 (59%) female], 183 with elevated and 92 with normal SBPM. Mean difference between systolic daytime 24h-ABPM and screening measurements was highest for SBPM (mean difference: -12 mmHg; 95%CI: -14 to -9). Mean difference between diastolic daytime ABPM and diastolic SBPM was -2 mmHg (95%CI: -3 to -0.7), whereas no difference was found for mean diastolic 1st uABP (mean difference: -0.6 mmHg; 95%CI: -1.9 to 0.6); and mean diastolic 2nd uABP (mean difference: 1.0 mmHg; 95%CI: -0.4 to 2.4). Misclassification as having hypertension (Figure 1) was highest with SBPM (55 [20%]), followed by 1st uABP (27 [9.8%]) and 2nd uABP (18 [6.5%]). Using systolic daytime 24h-ABPM as reference, the uABPs had higher AUROC (1st uABP: 87% [95%CI: 83-91]; 2nd uABP: 88% [95%CI: 84-92]); SBPM: (79% [95%CI: 74-85]). This difference was significant between 1st uABP and SBPM (p = 0.002), and between 2nd uABP and SBPM (p<0.001). Conclusions: uABP measurements had better diagnostic performance compared to SBPM. Integration of uABP into the STEPS protocol should be considered.

Prevalence of undiagnosed hypertension and related risk factors in Wad-Medani Alkobra locality in Gezira State, Sudan, 2022

Background: Hypertension is defined as blood pressure ≥140/90 mm Hg. It is emerging as one of the major healthcare challenges in low- and middle-income countries. Hypertension is considered as a silent killer and is the leading risk factor for cardiovascular mortality and accounts for a large proportion of premature deaths in developing countries. Most people with hypertension are asymptomatic and are undiagnosed for years. Objectives: This study aimed to find out the prevalence of undiagnosed hypertension and related risk factors among adults in Wad Medani Alkobra locality in Gezira State, Sudan. Methods: A community-based cross-sectional study involving 464 adults in different locations in Wad-Medani Alkobra locality, from June 2022 to August 2022 was performed in collaboration with the Sudanese Society of Hypertension within May Measure Month (MMM) 2022 study. WHO Stepwise Approach to Surveillance (STEPS) questionnaire was used to collect data, and was analyzed by SPSS version 20. Demographics, blood pressure, pulse, and socioeconomic status were measured. Diagnosis of hypertension was defined based on a systolic and diastolic blood pressure of ≥140 mmHg and ≥90 mmHg, respectively and three readings were obtained. Blood pressure was measured in all women and men aged 15 years and above. Results: Total number of study population was 464, males were 239 (52%), females were 225 (48%). Mean age was 45 years. 68 were known hypertensive (15%). Of those who are hypertensive, 27 (39%) had high blood pressure. Undiagnosed hypertension in the study population was found to be 10% (39 individual) which equals to 59.1% from the total number of the populations who had HTN (66). The prevalence of HTN (new and old cases) in this study group was 25%. There was positive relation between high blood pressure and old age, diabetes mellitus increased body weight and sex (more common in males}, P-value was (,0.00, 0.026, 0.014, 0.033) respectively. Conclusions: The prevalence of hypertension was high and associated with some modifiable risk factors which should be addressed. Frequent screening and proper treatment is required to prevent complications of this hidden epidemic.

Inequalities in the prevalence, diagnosis awareness, treatment coverage and effective control of diabetes: a small area estimation analysis in Iran

ObjectiveThis study aims to assess geographic inequalities in the prevalence, awareness of diagnosis, treatment coverage and effective control of diabetes in 429 districts of Iran.MethodsA modelling study by the small area estimation method, based on a nationwide cross-sectional survey, Iran STEPwise approach to surveillance (STEPS) 2016, was performed. The modelling estimated the prevalence, awareness of diagnosis, treatment coverage, and effective control of diabetes in all 429 districts of Iran based on data from available districts. The modelling results were provided in different geographical and socio-economic scales to make the comparison possible across the country.ResultsIn 2016, the prevalence of diabetes ranged from 3.2 to 19.8% for women and 2.4 to 19.1% for men. The awareness of diagnosis ranged from 51.9 to 95.7% for women and 35.7 to 100% for men. The rate of treatment coverage ranged from 37.2 to 85.6% for women and 24.4 to 80.5% for men. The rate of effective control ranged from 12.1 to 63.6% for women and 12 to 73% for men. The highest treatment coverage rates belonged to Ardebil for women and Shahr-e-kord for men. The highest effective control rates belonged to Sanandaj for women and Nehbandan for men. Across Iran districts, there were considerable differences between the highest and lowest rates of prevalence, diagnosis awareness, treatment coverage, and effective control of diabetes. The concentration indices of diabetes prevalence, awareness of diagnosis, and treatment coverage were positive and significant for both sexes.ConclusionFindings of this study highlight the existence of inequalities in diagnosis awareness, treatment coverage, and effective control of diabetes in all Iran regions. More suitable population-wide strategies and policies are warranted to handle these inequalities in Iran.

The relationship between intake of fruits, vegetables and dairy products with overweight and obesity in a large sample in Iran: Findings of STEPS 2016.

The present study aimed to investigate the association between fruits and vegetables (FVs) and dairy product intake with body weight based on the data from the nationwide Stepwise approach to surveillance (STEPS) survey in Iran. STEPS is a national-based cross-sectional study conducted on 3,0541 people selected by stratified cluster random sampling in Iran from April to November 2016. The outcome of the current study was body mass index (BMI) which was classified as normal weight, underweight, overweight, and obese. Also, as exposure variables, dietary intakes of fruits, vegetables and dairy products were extracted from the STEPS questionnaires. Multinomial logistic regression was used to evaluate the association between dairy products, FVs consumption, and BMI category in the crude and adjusted models. In the adjusted model, we observed 41% [odd ratio (OR) = 0.59; 95% confidence intervals (CI): 0.50, 0.68, P < 0.001], 27% (OR = 0.73; 95% CI: 0.62, 0.84, P < 0.001), and 26% (OR = 0.74; 95% CI: 0.63, 0.87, P < 0.001) lower odds of being overweight, and 46% (OR = 0.54; 95% CI: 0.46, 0.64, P < 0.001), 29% (OR = 0.71; 95% CI: 0.60, 0.84, P < 0.001), and 21% (OR = 0.79; 95% CI: 0.65, 0.95, P = 0.014) decrease in obesity odds among the participants who consumed 1, 2, and more than 2 servings of fruits per day in comparison to less than one serving, respectively. Also, we observed participants who consumed 1, 2, and more than 2 servings in comparison to less than one serving of dairy products per day had 31% (OR = 0.69; 95% CI: 0.58, 0.81, P < 0.001), 23% (OR = 0.77; 95 %CI: 0.65, 0.91, P = 0.002), and 21% (OR = 0.79; 95% CI: 0.67, 0.94, P = 0.011) lower odds of being overweight and 47% (OR = 0.53; 95% CI: 0.44, 0.64, P < 0.001), 36% (OR = 0.64; 95% CI: 0.53, 0.77, P < 0.001), and 32% (OR = 0.68; 95% CI: 0.56, 0.83, P < 0.001) lower odds of obesity, respectively. In addition, compared to participants who consumed less than 2 servings of vegetables per day, participants who consumed 2, 3, and more than 3 servings had 40% (OR = 0.60; 95% CI: 0.47, 0.76, P < 0.001), 29% (OR = 0.71; 95% CI: 0.56, 0.90, P = 0.006), and 26% (OR = 0.74; 95% CI: 0.57, 0.96, P = 0.027) lower odds of being overweight, respectively. Furthermore, we observed 36% lower odds of obesity among participants who ate 2 servings of vegetables per day compared to less than 2 serving (OR = 0.64; 95% CI: 0.49, 0.84, P = 0.002). Our findings showed that intake of FVs and dairy products is associated with a healthier weight status in adults. Further studies are needed to confirm these findings.

Risk Factors for Heart Disease in Working Railwaymen.

Heart diseases are the most common non-communicable diseases worldwide. We examined the prevalence of risk factors for heart disease among a sub-population of working men. In total, 11,059 railway crew workers of the Russian Railways Company were included in the study. We also asked participants to answer several questions based on the WHO STEPwise approach to surveillance (STEPS) translated into Russian. Only 30% of drivers had normal body mass index (BMI), whereas 70% were overweight or obese. In 12% of subjects, total cholesterol was higher than 5 mmol/L. In 15% of participants, glucose level was higher than 5.5 mmol/L. 38% of drivers reported smoking. Physical inactivity was registered in 54% of persons. Only 29% ate according to the key principles of good diet quality. 24% of respondents had a family history of heart disease. MANOVA demonstrated that BMI was determined by age, profession, smoking, physical inactivity, and diet quality. As age increased, the number of people with normal cholesterol levels decreased. It was demonstrated that a correlation existed between glucose levels and BMI. In the total group, the correlation was 0.46 (p < .05). The correlation between those parameters increased due to age, from 0.33 in the <30 years of age group up to 0.52 in the >50 years of age group. This study demonstrated that there is a high prevalence of risk factors for heart disease in train drivers in the Russian Federation.

Two-decade trends and factors associated with overweight and obesity among young adults in Nepal

Abstract Background Young adults are vulnerable to obesity due to different life stresses and challenges, leading to risks of cardiovascular and metabolic disorders. Studies on the long-term trends of overweight and obesity, especially among young people in Nepal are scanty. The problems among this productive age group should be checked and prevented at the earliest. The study aimed to assess more than two decades of trends from 1996 to 2019 of overweight and obesity among Nepalese young adults (18-29 years) and the socio-demographic factors associated with it. Methods We utilized data from the nationwide Demographic and Health Survey (DHS) and WHO STEPwise approach to surveillance (STEPS) survey. These surveys adopted multistage stratified cluster sampling techniques and used house-to-house structured interviews for data collection. We assessed the prevalence of overweight (BMI 25-29.9 kg/m2) and obesity (BMI≥30 kg/m2) in 1996, 2001, 2006, 2011, 2012, 2016, and 2019 among 18,714 young adults in total, and evaluated the associated socio-demographic factors from the 2016 survey, using logistic regression model. Results The preliminary study findings showed that from 1996 to 2019, overweight in women increased from 1.5% to 17.0%, and obesity from 0.1% to 3.4%. For men, overweight rose from 14.4% to 16.6%, and obesity from 1.3% to 2.5% from 2012 to 2019. Higher age was associated with higher odds of overweight and obesity compared to a younger age. Men were less likely to have overweight (AOR: 0.68, CI: 0.53-0.88) and obesity (AOR: 0.42, CI: 0.23-0.78) compared to women. Moreover, urban residents had higher odds of having obesity (AOR: 2.35, CI: 1.25-4.44) compared to rural residents. Conclusions Overweight and obesity have rising trends among young adults in Nepal. Older age, female and urban residence were associated with higher odds of overweight and obesity. Therefore, the interventions targeted to the risk groups can help in curbing the increasing obesity trends in Nepal. Key messages • The information on trends and the factors associated with overweight and obesity may help to identify needs and opportunities to halt the rising obesity trend and prevent risk factors. • The study findings can guide in formulating a national strategy to combat overweight and obesity among Nepalese youths.

EP01.03-013 A Pilot Study of Lung Cancer Screening with Low Dose CT in Georgia (One Centre Experience and Preliminary Data)

Lung cancer is one of the leading causes of mortality in both men and women worldwide, as well as in our country, Georgia. According to the data from the population registry of cancer in Georgia (2015-2017) lung cancer was the most prevalent type of cancer among men, 60% of cases were diagnosed at stage IV . The majority of lung cancer cases are associated with smoking. According to the 2016 results of the non-communicable disease risk factors STEPwise approach to surveillance (STEPS), almost one-third of Georgia’s population (31.1%) smokes.

S02 Physical activity surveillance across the life-course: from data to policy

As a major risk factor for non-communicable diseases (NCDs), physical inactivity is a prominent challenge for public health. The purpose of this symposium is to present an overview of physical inactivity prevalence in Europe using data collected through international surveillance initiatives, while highlighting successes and discussing future challenges for utilising data to promote physical activity across the life course.The World Health Organization (WHO) is involved in several physical activity surveillance systems on which discussions during this symposium will be based: 1. The WHO European Childhood Obesity Surveillance Initiative (COSI) is the largest survey of its kind in the world. An overview of results from the most recent round of COSI will be presented focusing on prevalence estimates for physical activity, screen time and sleep. Variations between countries of the socioeconomic determinants of physical inactivity, as well as the impact of the COVID-19 pandemic, will demonstrate the ongoing need for quality data to guide targeted policy actions in support of vulnerable groups throughout the life course.2. The WHO’s STEPwise approach to surveillance (STEPS) survey provides important national level prevalence data on the behavioural and metabolic risk factors for NCDs. For many countries, the STEPS survey has provided the first estimates of physical inactivity and sedentary behaviour in the population and has been essential in raising awareness of the need for national policy actions to increase population levels of physical activity.3. The European Commission, with the support of the WHO Regional Office for Europe, has established the European Union Physical Activity Focal Points Network to monitor implementation of the 23 indicators of the Health-Enhancing Physical Activity (HEPA) monitoring framework on physical activity policy development and implementation.4. Within the European Union Physical Activity Focal Points Network, and during the COVID-19 pandemic, some countries established a survey on physical activity and screen time in children and adolescents.

Prevalence and factors associated with abdominal obesity among Bangladeshi adults: Evidence from a nationally representative survey

This study aimed to estimate the prevalence and determine the associated factors of abdominal obesity among Bangladeshi adults (18–69 years) using the ‘Bangladesh STEPwise approach to surveillance (STEPS) survey 2018’ data. Abdominal obesity was defined as a waist-hip ratio of >0.90 for males and >0.85 for females. Multivariable log-binomial regression and logistic regression were conducted to investigate associated factors and were reported with an adjusted prevalence ratio (APR), adjusted odds ratio (AOR), and a 95% confidence interval (CI). The overall prevalence of abdominal obesity was 42.5%. Individuals aged 30–49 years and 50–69 years, with high educational attainment, being ever married, being overweight/obese, and residing in Barisal, Khulna, Rangpur, and Sylhet division were associated with both higher prevalence and higher odds of abdominal obesity. Females had 50% lower odds of being abdominally obese than male participants. Both urban residents and those with low physical activity had 20% higher odds of having abdominal obesity compared to rural residents and those with adequate physical activity, respectively. High risk groups should be targeted for the prevention and control of abdominal obesity. Multisectoral interventions should be launched by targeting the at-risk population for the underweight and overweight/obesity prevention programs irrespective of work status or place of residence. • The overall prevalence of abdominal obesity was 42.5%. • Females had 50% lower odds of being abdominally obese than male participants. • Older age, with high educational attainment, being ever married were some of the risk factors of abdominal obesity.

Prevalence, awareness, treatment and control of diabetes among Iranian population: results of four national cross-sectional STEPwise approach to surveillance surveys

BackgroundDiabetes as a leading cause of death imposes a heavy burden on health systems worldwide. This study investigated the trends in prevalence, awareness, treatment and control of diabetes among Iranian population aged 25 to 65 years over 12 years (2004-2016).MethodsSecondary data analysis was performed using data from a national population-based survey, STEPwise approach to surveillance (STEPS) for non-communicable diseases (NCDs) in four rounds (2004, 2007, 2011, 2016). The sample sizes were 89,404, 29,991, 12,103 and 30,541 individuals, respectively across the country in both rural and urban areas. Data were analyzed using descriptive statistics and a logistic regression model with odds ratio at a significance level of less than 5% with no adjustment for age and sex. Logistic regression was used to identify socio-demographic factors associated with the levels of awareness, treatment and control of diabetes mellitus.ResultsThe prevalence of diabetes in four rounds was 8.4, 9, 11.1 and 13.2%, respectively. Among people with diabetes, 53.5, 65.6, 70.5 and 82.2% were aware of their condition and 35.9, 42, 46 and 39.6% were treated for this condition, respectively. In four rounds of study, 14.5, 20.8, 20.4 and 18.5% of all diabetic patients had adequate glycemic control, respectively. In the multivariable logistic regression analysis, there was a significant relationship between female gender, age over 40, living in the urban area, being in the third wealth quintile and having health insurance with diabetes prevalence. Female participants were more likely to be aware of the disease. Older participants were more likely to receive treatment and had adequate glycemic control.ConclusionThe prevalence of diabetes in Iran has been increasing and despite the great awareness of the disease, receiving treatment and effective control of the disease are suboptimal. While several national policies to improve diabetes screening and care have been passed in recent years, it seems large gaps remain in disease detection and treatment. It is suggested that more attention be paid to the treatment and control of diabetes by NCDs national policies to prevent the growing burden associated with the disease.

Indian Diabetes Risk Score (IDRS) as a strong predictor of diabetes mellitus: A cross sectional study among urban population of Jhalawar, Rajasthan

Introduction: The patients with Type 2 diabetes Mellitus may often remain asymptomatic for a longer period of time. The Indian Diabetes Risk Score (IDRS), a simple screening tool for prediction of undiagnosed diabetes. Objective: Validation of IDRS with standard test for type 2 diabetes among urban population of Jhalawar, Rajasthan. Material and Methods: A Community based Cross-sectional study was carried out in urban field practice area of Department of Community Medicine, Jhalawar Medical College, Jhalawar, Rajasthan. The study was conducted using a two-stage sampling design. A predesigned, pretested proforma and Indian Diabetes Risk Score (IDRS) sheet was used to collect data from the study participants. The IDRS is based on four parameters: age, family history of diabetes, waist circumference and physical inactivity. Data was collected using the World Health Organization stepwise approach to surveillance (STEPS). Results: Among 450 participants, 12.7% participants were in low risk, 59.1% were in moderate risk and 28.2% were in high risk of developing diabetes according to IDRS score. IDRS score of ?60 turned out to be the best cut point for identifying undiagnosed diabetes with sensitivity 92.3% and specificity 82.6%. Positive Predictive value and Negative Predictive value were 47.3% and 98.5% respectively. Conclusion: Association of IDRS was found significant with diabetes. IDRS score of ?60 turned out to be the best cut point for identifying undiagnosed diabetes. IDRS is found valid screening tool for early detection of Diabetes.

Use of statins for the prevention of cardiovascular disease in 41 low-income and middle-income countries: a cross-sectional study of nationally representative, individual-level data

SummaryBackgroundIn the prevention of cardiovascular disease, a WHO target is that at least 50% of eligible people use statins. Robust evidence is needed to monitor progress towards this target in low-income and middle-income countries (LMICs), where most cardiovascular disease deaths occur. The objectives of this study were to benchmark statin use in LMICs and to investigate country-level and individual-level characteristics associated with statin use.MethodsWe did a cross-sectional analysis of pooled, individual-level data from nationally representative health surveys done in 41 LMICs between 2013 and 2019. Our sample consisted of non-pregnant adults aged 40–69 years. We prioritised WHO Stepwise Approach to Surveillance (STEPS) surveys because these are WHO’s recommended method for population monitoring of non-communicable disease targets. For countries in which no STEPS survey was available, a systematic search was done to identify other surveys. We included surveys that were done in an LMIC as classified by the World Bank in the survey year; were done in 2013 or later; were nationally representative; had individual-level data available; and asked questions on statin use and previous history of cardiovascular disease. Primary outcomes were the proportion of eligible individuals self-reporting use of statins for the primary and secondary prevention of cardiovascular disease. Eligibility for statin therapy for primary prevention was defined among individuals with a history of diagnosed diabetes or a 10-year cardiovascular disease risk of at least 20%. Eligibility for statin therapy for secondary prevention was defined among individuals with a history of self-reported cardiovascular disease. At the country level, we estimated statin use by per-capita health spending, per-capita income, burden of cardiovascular diseases, and commitment to non-communicable disease policy. At the individual level, we used modified Poisson regression models to assess statin use alongside individual-level characteristics of age, sex, education, and rural versus urban residence. Countries were weighted in proportion to their population size in pooled analyses.FindingsThe final pooled sample included 116 449 non-pregnant individuals. 9229 individuals reported a previous history of cardiovascular disease (7.9% [95% CI 7.4–8.3] of the population-weighted sample). Among those without a previous history of cardiovascular disease, 8453 were eligible for a statin for primary prevention of cardiovascular disease (9.7% [95% CI 9.3–10.1] of the population-weighted sample). For primary prevention of cardiovascular disease, statin use was 8.0% (95% CI 6.9–9.3) and for secondary prevention statin use was 21.9% (20.0–24.0). The WHO target that at least 50% of eligible individuals receive statin therapy to prevent cardiovascular disease was achieved by no region or income group. Statin use was less common in countries with lower health spending. At the individual level, there was generally higher statin use among women (primary prevention only, risk ratio [RR] 1.83 [95% CI 1.22–2.76), and individuals who were older (primary prevention, 60–69 years, RR 1.86 [1.04–3.33]; secondary prevention, 50–59 years RR 1.71 [1.35–2.18]; and 60–69 years RR 2.09 [1.65–2.65]), more educated (primary prevention, RR 1.61 [1.09–2.37]; secondary prevention, RR 1.28 [0.97–1.69]), and lived in urban areas (secondary prevention only, RR 0.82 [0.66–1.00]).InterpretationIn a diverse sample of LMICs, statins are used by about one in ten eligible people for the primary prevention of cardiovascular diseases and one in five eligible people for secondary prevention. There is an urgent need to scale up statin use in LMICs to achieve WHO targets. Policies and programmes that facilitate implementation of statins into primary health systems in these settings should be investigated for the future.FundingNational Clinician Scholars Program at the University of Michigan Institute for Healthcare Policy and Innovation, and National Institute of Diabetes and Digestive and Kidney Diseases.

Hypertension screening, awareness, treatment, and control: a study of their prevalence and associated factors in a nationally representative sample from Nepal

ABSTRACT Background The growing burden of hypertension is emerging as one of the major healthcare challenges in low- and middle-income countries (LMICs), such as Nepal. Given that they are struggling to deliver adequate health services, some LMICs have significant gaps in the cascade of hypertension care (including screening, awareness, treatment, and control). This results in uncontrolled hypertension, placing a high burden on both patients and healthcare providers. Objective The objective of this study was to quantify the gaps in hypertension screening, awareness, treatment, and control in the Nepalese population. Methods We used the data from a pooled sample of 9682 participants collected through two consecutive STEPwise approach to Surveillance (STEPS) surveys conducted in Nepal in 2013 and 2019. A multistage cluster sampling method was applied in the surveys, to select nationally representative samples of 15- to 69-year-old Nepalese individuals. Prevalence ratios were calculated using multivariable Poisson regression. Results Among the hypertensive participants, the prevalence of hypertension screening was 65.9% (95% CI: 62.2, 69.5), the prevalence of hypertension awareness was 20% (95% CI: 18.1, 22.1), the prevalence of hypertension treatment was 10.3% (95% CI: 8.8, 12.0), and the prevalence of hypertension control was 3.8% (95% CI: 2.9, 4.9). The unmet need of hypertension treatment and control was highest amongst the poorest individuals, the participants from Lumbini and Sudurpaschim provinces, those who received treatment in public hospitals, the uninsured, and those under the age of 30 years. Conclusions The gaps in the cascade of hypertension care in Nepal are large. These gaps are particularly pronounced among the poor, persons living in Lumbini and Sudurpaschim provinces, those who sought treatment in public hospitals, those who did not have health insurance, and young people. National- and local-level public health interventions are needed to improve hypertension screening, awareness, treatment, and control in Nepal.