NCD Risk Factor Survey in Sri Lanka

Transcription

1 NCD Risk Factor Survey in Sri Lanka (STEP Survey) Dr. Lakshmi C. Somatunga Director/ Non Communicable Diseases 2004

2 CONTENTS 1. Introduction 03 Page 2. Survey Methods Study Results Demography Core behavioural measures Core Physical Measures Follow-up activities Conclusions 07 Annexure I. Training Schedule for interviewer training 08 II. Tables 09 III. Health Ministry Approval for the study 22 2

3 1. Introduction In Sri Lanka, Non Communicable Diseases (NCD) are on the increase due to a rapid transition in lifestyle. Cardiovascular Diseases being the leading cause of deaths, solely contribute 18% deaths at the government health institutions with compared to 8% deaths due to all communicable diseases. The trends in risk factors for major NCD are in upward direction in Sri Lanka. These include increased consumption of energy-densed, nutrient-poor foods that are high in fat, sugar and salt; reduced level of physical activity and tobacco use. It is realized that primary prevention becomes important and should devote more resources in order to have a healthy nation who will contribute productively for the development of the country. Because of the fact that in primary prevention identification of risk factors and magnitude of their existence play vital role, it was a necessity to conduct a survey, which comprehensively covers key risk factors for major NCD. At a national workshop conducted in 2001, WHO STEPwise approach was recognized as a good tool to be utilized for an initial risk factor survey, which will set a basis for an easy and inexpensive surveillance mechanism in Sri Lanka. 3

4 2. Survey Methods 2.1. Study Population The STEP survey was conducted in one Health Area in Western Province (Population 189,400). In Sri Lanka, one health area comprises several clusters/ PHM areas (Public Health Midwife areas). The average number of PHM areas per Health Area is around 20. Randomly selected 10 clusters were included to the study in order to have a representative sample from the health area. The sample was drawn to have a minimum of 250 numbers in each recommended age group and sex according to the guidelines for STEP surveys The Sample Selection Age Group Male Female Total Although the minimum sample should be 2000 and age groups from 25 to 64 (4 age groups) have to be included, it was decided to include age group due to the fact that average age at which people take up smoking might be in this age group for Sri Lanka and also the age group from was selected because the country s life expectancy is relatively long and it was important to include this particular age group Interviewing In all the clusters, the starting point was the most centrally located temple. The direction in which the location of the first household was selected randomly. In each cluster the interviewing was done house-to-house through the closest, until the expected number of respondents from relevant age and sex groups was interviewed. Each interviewer interviews an equal number of respondents, so that they have an equal workload and each interviewer was responsible for one cluster. 4

5 2.4. Study Instrument Report The survey was conducted adopting STEP I and II using the core data set. In order to assess the acceptance by the community, clarity of the instrument and also the feasibility of utilizing the primary health care staff, particularly the Public Health Midwife (PHM), the questionnaire was pre-tested. It was pre-tested in 5 PHM areas with altogether 110 questionnaires. The results of the pre testing were impressive as the participants had not complained about their time and very willingly responded to the survey. The views of the interviewers were evaluated. Except for that they have had a difficulty in assessing the nutrition section particularly the portion/ serving of the vegetables, the interviewing has been done smoothly. The results were impressive as the participants had not complained about their time and very willingly responded to the survey. The views of the interviewers were evaluated. Except for that they have had a difficulty in assessing the nutrition section particularly the portion/ serving of the vegetables, the interviewing has been done smoothly Training of Interviewers A 3-day training programme was conducted for interviewers. The training schedule was carefully designed for the interviewers to gain adequate knowledge and the skills for efficient data collection procedure (annexure I). The practical sessions and role-plays were included in the training schedule to facilitate better understanding the field situation. The lessons learnt from the previous pre-testing were considered thoroughly in the training process Data Collection The data collection has been commenced on July In addition to the supervision in the field, the Principal Investigator called a meeting of the study team in order to review the progress 2 weeks after the commencement of data collection. It was revealed that the interviewing the members in the youngest age group (15 24) is difficult than expected earlier, as most of them are engaged in the educational activities through out the week. Therefore, the process of data collection was little slower than the expected. Other than that, the survey was carried out as planned. Data collection ended in October

6 3. Study Results 3.1. Demography Sample Size and Response Proportions Number of Participants 3000 : Male : Female Demography Sex: Male 1500 (50)% Female 1500 (50) % Age Categories: % % % % % % Male Female Total Average Years of Schooling Years 3.2. Core Behavioural Measures Tobacco Use Male Female Total Total Daily Smokers Daily Smokers % Average age started smoking (years) Years Average years of smoking Number Smoking Manufactured Cigarettes Percentage Smoking Manufactured Cigarettes % Total Number of Cigarettes smoked daily Average Number of Cigarettes smoked/ day Alcohol Consumption Male Female Total Percentage who drank alcohol in the last year % Percentage who had 5 or more drinks on any day in last week % Percentage who drank alcohol on 5 or more days/ week % Fruit and Vegetable Consumption (in a typical week) Male Female Total Average days that fruit was consumed Average days that vegetables were consumed Percentage who eat <5 serves of fruit & vegetables/ day % Physical Activity Male Female Total Percentage of Inactivity % Average time spent sitting/ day (minutes) Average time spent in moderate activity/ day (minutes) Average time spent in vigorous activity/ day (minutes)

7 3.3. Core Physical Measures Report Male Female Total Average Weight kg Average body mass index (kg/ m 2 ) Percentage who are obese (body mass index 30 kg/ m 2 ) % Average waist girth (cm) Average systolic blood pressure (mmhg) Average diastolic pressure (mmhg) Percentage with high BP (SBP 140 and/or DBP 90 mmhg) % 4. Follow-up Activities Those who found to have blood pressure value 140/90 or more were referred to the nearest hospital. The medical officers attached to the out patient department of the nearest hospital to the survey site were given a brief about the survey. Post survey awareness was given to the health staff and the community leaders in the survey area. The arrangements have been made to conduct a demonstration project in the study area with the support of WHO/SEARO. In this project, the focus is to give guidance and technical expertise to the community leaders and professionals by empowering them to launch their own NCD prevention programme. The relevant policy makers were sensitized on the study results and following that there is a suggestion to continue to measure trends in key risk factors in stipulated intervals of time. 5. Conclusions The key results from this survey are par with the national level data. The national level statistics indicate the tobacco use among males in Sri Lanka is above 30 percent and below 1 percent for females. Similarly this study reveals the prevalence of the same as 32.6 and 0.67 percent respectively. The comprehensive data on physical activity and consumption of fruits and vegetables are very rare in Sri Lanka. This study revealed a relatively comprehensive data set for this information, which will be a good starting point to monitor these important aspects. Also, it is alarming that the percentage with high blood pressure was found to be 6.87 in this population, which needs attention at the national level. 7

8 Training Schedule Day I Time Session Facilitator/Resource Registration Opening Remarks Director/Non Communicable Diseases TEA BREAK Introduction to STEPWise approach Director/Medical Services Rationale for a risk factor Survey in Sri Lanka Introduction to the Step I Core data set Director/Non Communicable Diseases LUNCH BREAK Introduction to the Step II Core data set Director/Non Communicable Diseases Demonstration on physical Deputy Director General(Medical Services) Head/Nutrition Unit, Medical Research Institute Lecturer/Physiology Department, Faculty of Medicine measurements TEA BREAK Practical on physical measurements Head/Nutrition Unit, Medical Research Institute Lecturer/Physiology Department, Faculty of Medicine SUMMING UP Day II Time Session Facilitator/Resource Interview technique Interviewer administered questionnaires Director/Organization Development TEA BREAK Role-play on interviews Group I Director/Non Communicable Diseases LUNCH BREAK Role-play on interviews Group II Panel Feedback on the role-plays Panel TEA BREAK SUMMING UP Day III Time Session Facilitator/Resource Interviewing schedule in the field Medical Officer of Health TEA BREAK Coding system for questionnaires Director/Non Communicable Diseases Plan for clinic sites for physical measurements Director/Medical Services LUNCH BREAK Logistics review (consent forms, referral cards, arrangements at the clinic sites, etc.) Director/Non Communicable Diseases TEA BREAK SUMMING UP 8

9 Demographic Information Report Table 1.1 Years Spent in School: and Tobacco Use Table Current Smoking Status: Age N Daily Non-Daily Non-Smoker n (%) n (%) n (%) Table Current Smoking Status: Age N Daily Non-Daily Non-Smoker n (%) n (%) n (%)

10 Table 2.2 Age started smoking, for current smokers: and Table 2.3 Years of smoking, for current smokers: and Table Percentages smoking various types of cigarettes, for current smokers: Age N Manufactured Hand Rolled Pipe Cigars Others n % n % n % n % n %

11 Table Report Percentages smoking various types of cigarettes, for current smokers: Age N Manufactured Hand Rolled Pipe Cigars Others n % n % n % n % n % Alcohol Consumption Table 3.1. Alcohol consumption status: and Age N Ever Consumed Never Consumed N Ever Consumed Never Consumed n % n % N % n % Table 3.2 Consumers of alcohol during the past 12 months: and Age N Current Consumers N Current Consumers n % n %

12 Diet Table 4.1 Number of days fruit is consumed per week: and Report Table Servings of fruits consumed per day: Age N <1 serving per day 1 serving per day 2-4 servings per day 5 or more servings per day n % n % n % n % Table Servings of fruits consumed per day: Age N <1 serving per day 1 serving per day 2-4 servings per day 5 or more servings per day n % n % n % n %

13 Table 4.3 Number of days vegetables are consumed per week: and Table Servings of vegetables consumed per day: Age N <1 serving per day 1 serving per day 2-4 servings per day 5 or more servings per day n % n % n % n % Table Servings of vegetables consumed per day: Age N <1 serving per day 1 serving per day 2-4 servings per day 5 or more servings per day n % n % n % n %

14 Table 4.5 Servings of fruits & vegetables consumed per day: and Age N <5 serving per day >=5 serving per day N <5 serving per day >=5 serving per day n % n % N % n % Physical Activity Table 5.1 Physically inactive: and Age N n % N n % Table 5.2 Total physical activity (minutes/week): and

15 Table Level of physical activity at work: and Age N Inactive Moderate only Vigorous N Inactive Moderate only Vigorous n % n % n % n % n % n % Table Level of physical activity during leisure time: and Age N Inactive Moderate only Vigorous N Inactive Moderate only Vigorous n % n % n % n % n % n % Table Average time spent sitting, moderate activity and vigorous activity per week (minutes): Age N Sitting Moderate only Vigorous Mean SE Mean SE Mean SE

16 Table Report Average time spent sitting, moderate activity and vigorous activity per week (minutes): Physical Measures Age N Sitting Moderate only Vigorous Mean SE Mean SE Mean SE Table 6.1 Height (cm): and Table 6.2 Weight (kg): and

17 Table 6.3 Body mass index (kg/m 2 ): and Report Table Risk categories for body mass index (kg/m 2 ): Age N Underweight Normal Weight Grade I Grade II Grade III (<18.5) ( ) ( ) ( ) (>40) n % n % n % n % n % Table Risk categories for body mass index (kg/m 2 ): Age N Underweight Normal Weight Grade I Grade II Grade III (<18.5) ( ) ( ) ( ) (>40) n % n % n % n % n %

18 Table 6.5 Waist circumference (cm): and Table 6.6 Currently on anti-hypertensive treatment with drugs prescribed by a health professional: and Age N n % N n % Table Resting blood pressure (mmhg): includes persons taking medication for high blood pressure Systolic Diastolic

19 Table Resting blood pressure (mmhg): includes persons taking medication for high blood pressure Report Systolic Diastolic Table Resting blood pressure (mmhg): excludes persons taking medication for high blood pressure Systolic Diastolic Table Resting blood pressure (mmhg): excludes persons taking medication for high blood pressure Systolic Diastolic

20 Table Blood pressure risk categories: includes persons taking medication for high blood pressure Age N Optimal Normal High-Normal Grade I Grade II Grade III HTN HTN HTN n % n % n % n % n % n % Table Blood pressure risk categories: includes persons taking medication for high blood pressure Age N Optimal Normal High-Normal Grade I Grade II Grade III HTN HTN HTN n % n % n % n % n % n % Table Blood pressure risk categories: excludes persons taking medication for high blood pressure Age N Optimal Normal High-Normal Grade I Grade II Grade III HTN HTN HTN n % n % n % n % n % n %

21 Table Blood pressure risk categories: excludes persons taking medication for high blood pressure Report Age N Optimal Normal High-Normal Grade I Grade II Grade III HTN HTN HTN n % n % n % n % n % n %

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