Non-communicable Disease Surveillance Research Articles

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

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

Assessing data availability of NCD prevention and control in six ASEAN countries based on WHO global monitoring framework and the progress monitor indicators

BackgroundTo tackle noncommunicable disease (NCD) burden globally, two sets of NCD surveillance indicators were established by the World Health Organization: 25 Global Monitoring Framework (GMF) indicators and 10 Progress Monitoring Indicators (PMI). This study aims to assess the data availability of these two sets of indicators in six ASEAN countries: Cambodia, Lao PDR, Malaysia, Myanmar, Thailand, and Vietnam.MethodsAs data on policy indicators were straightforward and fully available, we focused on studying 25 non-policy indicators: 23 GMFs and 2 PMIs. Gathering data availability of the target indicators was conducted among NCD surveillance experts from the six selected countries during May-June 2020. Our research team found information regarding whether the country had no data at all, was using WHO estimates, was providing ‘expert judgement’ for the data, or had actual data available for each target indicator. We triangulated their answers with several WHO data sources, including the WHO Health Observatory Database and various WHO Global Reports on health behaviours (tobacco, alcohol, diet, and physical activity) and NCDs. We calculated the percentages of the indicators that need improvement by both indicator category and country.ResultsFor all six studied countries, the health-service indicators, based on responses to the facility survey, are the most lacking in data availability (100% of this category’s indicators), followed by the health-service indicators, based on the population survey responses (57%), the mortality and morbidity indicators (50%), the behavioural risk indicators (30%), and the biological risk indicators (7%). The countries that need to improve their NCD surveillance data availability the most are Cambodia (56% of all indicators) and Lao PDR (56%), followed by Malaysia (36%), Vietnam (36%), Myanmar (32%), and Thailand (28%).ConclusionSome of the non-policy GMF and PMI indicators lacked data among the six studied countries. To achieve the global NCDs targets, in the long run, the six countries should collect their own data for all indicators and begin to invest in and implement the facility survey and the population survey to track NCDs-related health services improvements once they have implemented the behavioural and biological Health Risks Population Survey in their countries.

Prevalence of Hypertension among Children Based on the New American Academy of Pediatrics Clinical Practice Guidelines.

In 2017, the American Academy of Pediatrics (AAP) updated clinical practice guidelines for the diagnosis and management of hypertension in children. The present study aimed to assess the prevalence of hypertension in Iranian children based on the latest guidelines. Data on 7301 student participants (3589 boys and 3712 girls) aged between 7-12 yr were assessed. The data were extracted from the fifth Childhood and Adolescence Surveillance and Prevention of Adult Non-communicable Disease (CASPIAN V) school-based study conducted in the 30 provinces of Iran in 2015. Blood pressure (BP) was classified as normal, elevated BP, and stage 1 and 2 hypertension using weighted analysis and the 2017 AAP guidelines. All analyses were performed in STATA 14.0 statistical software, with findings presented in terms of prevalence. The overall prevalence of high BP in Iranian children was 14.7%. In addition, 15.1% of boys had high BP, with 9.4% and 1.7% of them with stage 1 and 2 hypertension, respectively. Moreover, 14.3% of girls had high BP, of which 10% had stage 1 and 1.3% with stage 2 hypertension. For elevated hypertension, it was observed in 4% of boys and 3% of girls. Using the 2017 AAP guidelines demonstrated a higher prevalence of hypertension in children (14.7%) in Iran. The prevalence of hypertension in boys was slightly higher compared to girls.

Analysis on the allocation of human resources for chronic disease prevention and control in 664 district/county-level centers for disease control and prevention in China in 2020

Objective: To analyze the allocation of human resources for chronic disease prevention and control of district/county-level centers for disease control and prevention(CDC) in China in 2020. Methods: Survey subjects were from National Chronic Noncommunicable Disease and Risk Factor Surveillance Sites and National Demonstration Areas for Chronic Noncommunicable Disease Prevention and Control (demonstration areas). A survey examining the allocation of human resources for chronic disease prevention and control at district/county-level CDC was conducted in December 2021 through the National Demonstration Areas Management Information System. The number and rate of allocation of human resources for chronic disease prevention and control in district/county-level CDC were analyzed and the Wilcoxon rank sum test was used to compare the difference between demonstration and non-demonstration areas and between urban and rural areas. The Kruskal-Wallis H test was used to compare the difference in east, central and west regions. The Gini coefficient and Theil index were used to evaluate the balance of human resource for chronic disease prevention and control. Results: A total of 678 districts/counties were investigated, and 664 districts/counties responded effectively, with an effective response rate of 97.9%. The establishment rate of district/county-level CDC was 98.34% (653/664), and the establishment rate of chronic disease prevention and control departments of district/county-level CDC was 96.02% (627/653). In 627 district/county-level CDC with departments for chronic disease prevention and control, the median number of full-time technical personnel for chronic disease prevention and control was 4, the median number of full-time technical personnel in demonstration areas (4 persons) was higher than in non-demonstration areas (3 persons), highest in the east region (5 persons) than in the middle region (4 persons) and the west region (4 persons), higher in urban areas (4 persons) than in rural areas (4 persons) (all P values<0.05). The allocation rate was 0.71 people/100 000, which was higher in demonstration areas (0.73 people/100 000) than in non-demonstration areas (0.67 people/100 000), highest in the west region (0.82 people/100 000) than in the middle region (0.71 people/100 000) and east region (0.67 people/100 000), higher in rural areas (0.77 people/100 000) than in urban areas (0.68 people/100 000) (all P values<0.05). The Gini coefficient for the allocation by population size was 0.352 9. The total Theil index for demonstration and non-demonstration areas, different regions, and urban-rural areas were 0.067 8, 0.076 3, and 0.000 2, with the intra-group contribution of 97.35%, 99.52%, and 98.80%, respectively. Conclusion: In 2020, the allocation of human resources for chronic disease prevention and control in district/county-level CDC is relatively balanced. The variation in the allocation of human resources for chronic disease prevention and control exist between demonstration and non-demonstration areas, urban and rural areas, and across regions.

Practical Strategies for Improving Sustainability and Scale-up of Noncommunicable Disease-related Public Health Interventions: Lessons from the Better Health Program in Southeast Asia.

The Better Health Program has been addressing key health system issues in the prevention and control of noncommunicable diseases (NCDs) in Malaysia, Thailand, Vietnam, and the Philippines. As the program comes to an end, the sustainability and scaling-up of issues have assumed importance. The objective is to assess how well sustainability and scale-up strategies have been integrated into the design and implementation of a 3-year multicountry technical program; to explore enablers and barriers of sustainability and scaling up; and to identify practical strategies that can improve sustainability and scale-up of Better Health Program interventions. We applied a staged approach to explore barriers and enablers and to identify practical strategies to improve sustainability and scale-up of four NCD interventions: community-based obesity prevention, front-of-pack labeling, local learning networks (LLNs), and NCD surveillance. We extracted evidence from peer-reviewed literature and local documents. We also conducted in-depth interviews with the implementation teams and key stakeholders. We conducted a thematic synthesis of the resulting information to identify practical strategies that improve sustainability and scale-up of the four interventions. Strong engagement of stakeholders at higher levels of the health system was identified as the main enabler, while limited funding and commitment from local governments were identified as a key barrier to sustainability and scale-up. Strengthening the social and institutional anchors of community health volunteers, enhancing evidence-based advocacy for front-of-pack labeling, trailblazing the LLN innovation, and securing the commitment of local governments in the implementation of NCD surveillance were among the key strategies for improving sustainability and scale-up of Better Health Program interventions in Malaysia, Thailand, Philippines, and Vietnam, respectively. This study identified practical strategies for improving sustainability and scale-up of NCD-related interventions. Implementation of the strategies that had high priority and feasibility will improve the sustainability of critical elements of the program in the respective countries.

National health surveys: overview of sampling techniques and data collected using complex designs.

This article aimed to present an overview of national health surveys, sampling techniques, and components of statistical analysis of data collected using complex sampling designs. Briefly, surveys aimed at assessing the nutritional status of Brazilians and maternal and child health care were described. Surveys aimed at investigating access to and use of health services and funding, those aimed at surveillance of chronic noncommunicable diseases and associated behaviors, and those focused on risk practices regarding sexually transmitted infections were also addressed. Health surveys through social networks, including online networks, deserved specific attention in the study. The conclusion is that the development of health surveys in Brazil, in different areas and using different sampling methodologies, has contributed enormously to the advancement of knowledge and to the formulation of public policies aimed at the health and well-being of the Brazilian population.

Planning and setting up of a patient health record system for patients with non-communicable diseases in a primary healthcare setting

India has a high burden of non-communicable diseases (NCDs). For NCD surveillance, there are national and international targets. However, India lacks good quality data for NCD surveillance. Maintenance of the NCD record improves the quality of care and helps a treating physician in making a clinical decision. Most of the patients with NCDs seek care at the primary level and these facilities lack NCD record management. Through this paper, we share our experience of planning and setting up of a paper-based NCD health record system at a primary health care setting. We developed a system to generate and maintain patient health records which consisted of unique ID generation, index register, NCD record file and NCD passbook (Dhirghayu card) for each patient. We reorientated the process and devised a mechanism for record-keeping and data management. We faced several challenges during its implementation and overcame those with the mentioned solutions. Findings from this paper can be used to develop a similar system for patient health records at primary health care facilities, which can be used for NCD surveillance and patient monitoring purposes.

Alcohol consumption and related disorders in Iran: Results from the National Surveillance of Non-Communicable Diseases' Survey (STEPs) 2016.

Alcohol consumption is a public health concern which is illegal in Iran. Moreover, due to cultural and religious beliefs, the available population-based research findings on alcohol consumption are inadequate. We aimed to provide an estimate on alcohol consumption using a large-scale population-based survey in Iran. The National Surveillance of Non-Communicable Risk Factors in Iran was a population-based survey conducted in 2016. The epidemiologic distribution of alcohol consumption and its related disorders were assessed using weighted survey methods and multiple logistic regression models. Age standardized rates were calculated using Iran's national population census in 2016. At the national level, the prevalence rates of lifetime and current alcohol consumption were 8.00% (95% CI: 7.67-8.32) and 4.04% (95% CI: 3.81-4.27), respectively. The highest prevalence was reported among 25 to 34 year-olds. Individuals of higher socioeconomic status consumed significantly greater levels of alcohol. At provincial level, the highest and lowest percentages of the current alcohol drinking rates in Iran's provinces were, 23.92% (95% CI: 17.56-30.28) and 0.4% (95% CI: 0-1.18) in males, 1.58% (95% CI: 0.22-2.94) and 0% in females, respectively. In urban regions, the highest alcohol consumption rate was more than 22 times greater than the lowest alcohol consumption rate. Current alcohol drinkers were 2 times more prone to injury as compared to nondrinkers (ORadj: 2.0, 95%CI: 1.7, 2.3). In Iran, the prevalence of alcohol consumption is low, although there is a considerable variation of alcohol consumption at provincial level as well as in different gender groups. Therefore, preventive WHO-recommended measures should be adopted more seriously by vulnerable groups.

Outdoor light at night in relation to glucose homoeostasis and diabetes in Chinese adults: a national and cross-sectional study of 98,658 participants from 162 study sites.

Exposure to artificial light at night (LAN) disrupts the circadian timing system and might be a risk factor for diabetes. Our aim was to estimate the associations of chronic exposure to outdoor LAN with glucose homoeostasis markers and diabetes prevalence based on a national and cross-sectional survey of the general population in China. The China Noncommunicable Disease Surveillance Study was a nationally representative study of 98,658 participants aged ≥18 years who had been living in their current residence for at least 6 months recruited from 162 study sites across mainland China in 2010. Diabetes was defined according to ADA criteria. Outdoor LAN exposure in 2010 was estimated from satellite data and the participants attending each study site were assigned the same mean radiance of the outdoor LAN at the study site. The linear regression incorporating a restricted cubic spline function was used to explore the relationships between LAN exposure and markers of glucose homoeostasis. Cox regression with a constant for the time variable assigned to all individuals and with robust variance estimates was used to assess the associations between the levels of outdoor LAN exposure and the presence of diabetes by calculating the prevalence ratios (PRs) with adjustment for age, sex, education, smoking status, drinking status, physical activity, family history of diabetes, household income, urban/rural areas, taking antihypertensive medications, taking lipid-lowering medications, and BMI. The mean age of the study population was 42.7 years and 53,515 (weighted proportion 49.2%) participants were women. Outdoor LAN exposure levels were positively associated with HbA1c, fasting and 2 h glucose concentrations and HOMA-IR and negatively associated with HOMA-B. Diabetes prevalence was significantly associated with per-quintile LAN exposure (PR 1.07 [95% CI 1.02, 1.12]). The highest quintile of LAN exposure (median 69.1 nW cm-2 sr-1) was significantly associated with an increased prevalence of diabetes (PR 1.28 [95% CI 1.03, 1.60]) compared with the lowest quintile of exposure (median 1.0 nW cm-2 sr-1). There were significant associations between chronic exposure to higher intensity of outdoor LAN with increased risk of impaired glucose homoeostasis and diabetes prevalence. Our findings contribute to the growing evidence that LAN is detrimental to health and point to outdoor LAN as a potential novel risk factor for diabetes.

Age-specific prevalence, subtypes and risk factors of metabolic diseases in Chinese adults and the different patterns from other racial/ethnic populations

BackgroundAge has substantial influence on metabolic diseases patterns. Ethnic disparities of metabolic characteristics between Chinese and other populations also exist. Large-scale investigations of age-specific prevalence, subtypes and modifiable risk factors of metabolic disorders are essential to promote individualized strategies for the control and prevention of metabolic diseases in multi-ethnic populations. The study aims to address the age-specific prevalence, subtype characteristics and risk factor profiles of metabolic diseases among different races/ethnicities.MethodsWe analyzed data from the China Noncommunicable Disease Surveillance 2010 and the National Health and Nutrition Evaluation Survey (NHANES). We examined the prevalence and subtypes of hypertension, diabetes and hyperlipidemia across age groups in four ethnic populations. We also investigated the odds ratios (ORs) of metabolic diseases associated with 11 classical risk factors in the young and the elder Mainland Chinese.ResultsThe sex and BMI standardized prevalence of hypertension in Chinese aged 18–40 years was 18.5% and was the highest among the four populations. The main pathophysiologic subtype of diabetes was characterized by insulin resistance, instead of β-cell dysfunction in Mainland Chinese, and this pattern was more evident in obese subjects. The major subtype of hyperlipidemia in Mainland Chinese was hypertriglyceridemia, while Non-Hispanic Whites and Blacks were more prone to high low-density lipoprotein cholesterol. For risk of hypertension, diabetes and hyperlipidemia, young Chinese adults were more prone to general and central obesity than older ones. The other factors showed similar effects on the young and the old.ConclusionsThe age-specific prevalence, subtypes and risk factors of metabolic diseases were substantially different in Chinese and other ethnic/racial populations.

Association of single child family with subjective health complaints in children and adolescents

The number of single-child families has been increasing across developing countries during the last decades. We aimed to examine the association between being a single child (SC) and subjective health complaints (SHCs) in Iranian children and adolescents. This study was conducted as a part of the fifth survey of a national surveillance program entitled Childhood and Adolescence Surveillance and Prevention of Adult Non-communicable disease (CASPIAN-V). This national survey included a total of 14,400 students 7–18 years and their parents from rural and urban areas in 30 provinces of Iran. Data on demographic characteristics, lifestyle variables, and SHCs were measured using the questionnaire of the World Health Organization on Global School-based Health Survey (WHO-GSHS). Multivariate logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (95%CI) for the association of being an SC with SHCs. Data on 14,151 participants were available for this study, of whom 7.7% (1092) were SCs. The most frequent SHCs were irritability (37.1%, 95%CI: 36.3–37.9%), feeling nervous 32.5%, 95% CI: (31.7–33.3%), and headache 24.3%, 95%CI: (23.6–25.0% ). In the multivariate model, being an SC significantly increased the odds of dizziness [adjusted OR (95% CI): 1.37(1.08–1.72)] and backache complaint [1.22(1.01–1.47)]. The association of being an SC with other SHCs (feeling low, irritability, feeling nervous, difficulty in getting to sleep, headache, stomachache) was not statistically significant (p value > 0.05). Our results suggest that being an SC may be associated with higher odds of dizziness and backache complaints.

Association between abdominal obesity and some selected non-communicable diseases among adults in Calabar metropolis, Cross River State, Nigeria

Background: Fat accumulation around the abdomen is an important consideration in obesity studies and management. Generalized obesity indices alone without considering abdominal obesity are not sufficient in the study and treatment of obesity and the related escalating cases of preventable non-communicable diseases globally.&#x0D; Objective: This study assessed the relationship between abdominal obesity and some selected non-communicable diseases such as generalized obesity, hypertension, and type 2 diabetes among adults in Calabar Metropolis.&#x0D; Materials and methods: A multistage sampling technique was used to select 500 participants (20-70 years). The cross-sectional descriptive study adapted the WHO STEPwise questionnaire for surveillance of non-communicable diseases. Data were analyzed using descriptive and inferential statistics including frequency, percentages, chi-square, correlation, and logistic regression; significant differences were established at p&lt;0.05.&#x0D; Results: 51% of the participants were single while 44.8% were married. It was found that 27.8% and 56.9% of males, as well as 31.1% and 41.1% of females who were diagnosed with hypertension, had high and very high waist circumferences respectively compared to fewer males and females who were undiagnosed with hypertension. There was a correlation between waist circumference and diastolic blood pressure (r= -0.102, p=0.022) as well as with random blood glucose (r=0.123, p=0.006). The males had higher odds to develop hypertension (OR=2.754; CI=1.776-4.270) and fewer odds to develop abdominal obesity compared to the females.&#x0D; Conclusion: There were strong associations between hypertension, type 2 diabetes, generalized obesity, and waist circumference of the participants. More individuals with high waist circumferences had hypertension. Men were less likely to have abdominal obesity in relation to high blood pressure compared to women. There should be appropriate interventions for the individuals who were already diagnosed with the various NCDs while those at risk of developing the disorders should be identified within the population for proper counseling.

Sleeping duration, physical activity, alcohol drinking and other risk factors as potential attributes of metabolic syndrome in adults in Ethiopia: A hospital-based cross-sectional study.

Available evidence showed that metabolic syndrome in the adult population is persistently elevated due to nutrition transition, genetic predisposition, individual-related lifestyle factors, and other environmental risks. However, in developing nations, the burden and scientific evidence on the pattern, and risk exposures for the development of the metabolic syndrome were not adequately investigated. Thus, the study aimed to measure the prevalence of metabolic syndrome and to identify specific risk factors among adult populations who visited Dessie Comprehensive Specialized Hospital, Ethiopia. A hospital-based cross-sectional study was conducted among randomly selected 419 adults attending Dessie Comprehensive Specialized Hospital from January 25 to February 29, 2020. We used the WHO STEP-wise approach for non-communicable disease surveillance to assess participants' disease condition. Metabolic syndrome was measured using the harmonized criteria recommended by the International Diabetes Federation Task Force in 2009. Data were explored for missing values, outliers and multicollinearity before presenting the summary statistics and regression results. Multivariable logistic regression was used to disentangle statistically significant predictors of metabolic syndrome expressed using an odds ratio with a 95% of uncertainty interval. All statistical tests were managed using SPSS version 26. A non-linear dose-response analysis was performed to show the relationships between metabolic syndromes with potential risk factors. The overall prevalence of metabolic syndrome among adults was 35.0% (95% CI, (30.5, 39.8)). Women were more affected than men (i.e. 40.3% vs 29.4%). After adjusting for other variables, being female [OR = 1.85; 95% CI (1.01, 3.38)], urban residence [OR = 1.94; 95% CI (1.08, 3.24)], increased age [OR = 18.23; 95% CI (6.66, 49.84)], shorter sleeping durations [OR = 4.62; 95% CI (1.02, 20.98)], sedentary behaviour [OR = 4.05; 95% CI (1.80, 9.11)], obesity [OR = 3.14; 95% CI (1.20, 8.18)] and alcohol drinking [OR = 2.85; 95% CI (1.27,6.39)] were positively associated with the adult metabolic syndrome. Whilst have no formal education [OR = 0.30; 95% CI (0.12, 0.74)] was negatively associated with metabolic syndrome. The prevalence of adult metabolic syndrome is found to be high. Metabolic syndrome has linear relationships with BMI, physical activity, sleep duration, and level of education. The demographic and behavioural factors are strongly related with the risk of metabolic syndrome. Since most of the factors are modifiable, there should be urgent large-scale community intervention programs focusing on increased physical activity, healthy sleep, weight management, minimize behavioural risk factors, and healthier food interventions targeting a lifecycle approach. The existing policy should be evaluated whether due attention has given to prevention strategies of NCDs.

Socioeconomic inequality in violent behaviors, life dissatisfaction, and self-rated health in pediatric population: the CASPIAN-V study

BackgroundBullying, being a victim of violent behaviors, life satisfaction (LS) and self-rated health (SRH) in children and adolescents, all have consistently been recognized as vital factors in school performance and future individual life.MethodsThis cross-sectional data secondary study was a part of the fifth Childhood and Adolescence Surveillance and Prevention of Adult Non-communicable disease (CASPIAN-V) in 2015. A total of 14,400 students 7-18 years and their parents living in 30 provinces in Iran were studied. A validated questionnaire of the World Health Organization on Global School-based Health Survey (WHO-GSHS) was used to measure the outcomes and socioeconomic variables. Family’s socioeconomic status (SES) was determined using principal component analysis (PCA). The crude and adjusted odds ratios (95% confidence interval (CI)) were estimated using multiple logistic regressions for each outcome.ResultsA total of 14,274 students completed the study, of whom 50.6% were boys. Overall, the prevalence of bullying, being a victim, life dissatisfaction (LDS), and poor SRH among students was 35.6, 21.4, 21.1, and 19.0%, respectively. In multiple-logistic regression analysis (Adjusted OR, (95%CI), students with an illiterate father and mother (1.60, (1.25-2.04), 1.28, (1.03-1.61), unemployed father (1.58, (1.29-1.81)), and one-parent family (1.32, (1.05 – 1.64) had a higher odd of Poor-SRH. Besides, a family size larger than four members (1.14, (1.03-1.25), and low-SES (1.35, (1.15-1.56), and illiteracy of the mother (1.64, (1.30-2.08) had a direct association with LDS. Mother illiteracy also increased the odds of bullying (1.77, (1.45-2.16) and being a victim (1.58, (1.26-1.98).ConclusionsSome socioeconomic variables can be proposed as the statistically significant attribution of bullying and being a victim, LDS, and Poor-SRH in children and adolescents.

Prioritizing noncommunicable diseases in the Americas region in the era of COVID-19.

ABSTRACTThis article describes the situation of noncommunicable diseases (NCDs) in the Americas, implementation of NCD interventions according to key progress indicators, the impact of COVID-19 on NCD services, and ways to reprioritize NCDs following COVID-19. Information was retrieved from institutional data and through a supplementary scoping review of published articles related to NCDs and COVID-19 in the Americas published April 2020–November 2021. While NCDs account for 80.7% of all deaths in the Americas, implementation of a key set of NCD interventions has been limited, with only three countries reporting implementation of 12 or more of the 19 NCD indicators. By mid-May 2022, the Americas had reported about 29.9% of all COVID-19 cases in the world (154 million of 515 million) and 43.5% all COVID-19 deaths (2.7 million of 6.2 million). This pandemic has hampered progress on NCDs and significantly disrupted services for people who require ongoing care. Adaptive strategies, such as telehealth and mobile pharmacies, have been used to mitigate service disruptions. However, NCD prevention and management must be an integral part of recovering from the COVID-19 pandemic. This will require scaled up efforts to establish/re-establish and enforce policies on NCD risk factors, especially for tobacco control and obesity prevention, as well as greater investment in primary care and expansion of telemedicine and digital health solutions for continuous care for people with NCDs. Lastly, limited data are available on the impact of COVID-19 on NCDs, and hence NCD data and surveillance need to be strengthened.

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.

Assessment of association between smoking and all-cause mortality among Malaysian adult population: Findings from a retrospective cohort study.

INTRODUCTIONSmoking is a known risk factor for many chronic diseases. Illness and death due to smoking are a significant public health burden in many countries. This study aims to address the information gap in smoking-related mortality in Malaysia by estimating the risk of cardiovascular disease and all-cause mortalities due to smoking among Malaysian adults.METHODSWe analyzed data on 2525 respondents, aged 24–64 years, of the Malaysian Non-Communicable Disease Surveillance survey conducted September 2005 to February 2006. Mortality records from the Malaysian National Registration Department were linked to the MYNCDS-1 data to determine respondents’ mortality status over 12 years from 2006 to 2018. Associations between smoking and all-cause mortalities were assessed using Cox proportional hazards regression with adjustments for non-communicable disease and sociodemographic and lifestyle factors.RESULTSThe prevalence of daily smoking was 21.2% (95% CI: 19.0–23.7). During the 31668 person-years follow-up, 213 deaths from all causes occurred, where 68 deaths were among smokers (13.2%), and 452 were among non-smokers (6.3%). Smoking was associated with a significantly increased risk of all-cause mortality (adjusted hazard ration, AHR=1.79; 95% CI: 1.12– 2.97). These associations remained significant after excluding mortalities in the first two years of follow-up.CONCLUSIONSDaily smoking is associated with a significantly higher risk of all-cause death. Behavioral and pharmacological smoking cessation interventions should be intensified among smokers to reduce the risk of mortality.

Monitoring non-communicable diseases risk factors in national adult health surveys – a review of international experience

Introduction. Monitoring is an important tool for managing the epidemic of noncommunicable diseases. The insufficiency of the measures taken to create and strengthen national systems of epidemiological surveillance for noncommunicable diseases is recognized. In this regard, the search and development of rapid and cost-effective approaches to monitoring risk factors for noncommunicable diseases continues. Objective. To explore an approach to developing a national monitoring system for risk factors for noncommunicable diseases based on population health surveys in some countries of the world. Materials and methods. A content analysis of the documents of the World Health Organization, open data, scientific publications, regulations and reports of countries (India, USA, European countries, including Belgium and Finland) on the study of public health and risk factors for non-communicable diseases was carried out. Results. The possibility of incorporating elements of a monitoring study into population health surveillance systems that already exist at the national level is an important advantage for developing approaches to monitoring risk factors for noncommunicable diseases. In this regard, the World Health Organization's STEPS stepwise approach to risk factor surveillance has evolved. National population health surveys that include risk factor monitoring can be divided into health surveys and health surveys. There are also separate national studies (surveys and surveys) that focus on several behavioral risks or individual risk factors. Some monitoring systems that measure progress towards global noncommunicable disease targets also additionally cover late issues and emerging risk factors. Discussion. The studied international experience of national systems of research on public health and epidemiological surveillance of noncommunicable diseases indicates trends towards standardization and unification of tools for monitoring risk factors for noncommunicable diseases.

Quality of data from cancer registries in the Eastern Mediterranean region.

Population-based cancer registries are crucial for our understanding of cancer burden and to inform cancer policy. They provide data on cancer incidence in a country or region, which aid the setting of priorities for cancer control, the monitoring and evaluation of preventive interventions, and the prediction of the future burden of cancer. When information on vital status is available, registry data allow for the estimation of population-based cancer survival, which helps researchers evaluate progress in cancer control, including early diagnosis, prompt referral, and adequate treatment. Routinely collected variables such as age, sex, stage, geographical location, and treatment can help to answer a multitude of questions about the distribution of risk factors, success of early detection efforts, and disparities in cancer survival. 1 Piñeros M Znaor A Mery L Bray F A global cancer surveillance framework within noncommunicable disease surveillance: making the case for population-based cancer registries. Epidemiol Rev. 2017; 39: 161-169 Google Scholar

Trend of passive smoking and associated factors in Iranian children and adolescents: the CASPIAN studies

BackgroundIt is well documented that, similar to active smokers, passive smokers are also at an increased risk of developing non-communicable diseases, and it could impose high financial costs on the healthcare system. This study aimed to evaluate the trend of passive smoking and related determinants during the three phases of a school-based surveillance program.MethodsThis is a secondary study using the national data obtained from three phases of the surveillance program entitled The Childhood and Adolescence Surveillance and Prevention of Adult Noncommunicable Disease (CASPIAN) study, conducted from 2008 to 2014 on Iranian children and adolescents living in urban and rural areas of 30 provinces in Iran. Participants were selected by cluster multistage sampling method.ResultsOverall, the study participants consisted of 33,288 students (50.5% boys) with a mean (± SD) age of 12.8 ± 3.2 years. The passive smoking rate was significantly increased from 35.6% in 2008 to 43.2% in 2015 among children and adolescents. According to the multivariate logistic regression, father’s university education, mother’s employment, life satisfaction, and socioeconomic status had a protective role regarding second-hand smoke exposure. In contrast, the father’s self-employment had a positive role in increasing the rate of passive smoking.ConclusionConsidering the increasing trend of passive smoking and its considerable adverse health effects, it is necessary to implement large-scale public interventions to reduce the rate and hazards of exposure to tobacco smoke.