Professional Documents
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seminar21-190401171255_edited
seminar21-190401171255_edited
seminar21-190401171255_edited
FOR
NON COMMUNICABLE
DISEASES
INTRODUCTION
CONCLUSION
CONTENTS
PROLOGUE
Non Communicable Diseases
• CHD
• Cancer
• Peptic Ulcer
• Mental illness
Hypothesis-testing Hypothesis-generating
geographic areas
TERMINOLOGIES
Survey: Making a single observation to measure and record something.
Surveillance: Making repeated standardised surveys in order that change can be detected. This is quite different to,
but often confused with, monitoring. Surveillance lacks the ‘formulated standards’ that are so important in monitoring.
Surveillance is used to detect change but does not differentiate between acceptable and unacceptable change.
Monitoring: Surveillance undertaken to ensure that formulated standards are being maintained.
SURVEILLANCE DEFINITION
On-going, systematic collection, analysis,
interpretation and dissemination of data essential
for health promotion and disease prevention
(CDC 2004)
Why is surveillance important ?
• Sizes the problem
• Informs interventions
• Stimulates research
TYPES OF SURVEILLANCE – based on data collection
PASSIVE SURVEILLANCE
Laboratories, physicians, or others regularly report cases of disease or death to the local or state health
department.
Examples:
• A doctor’s office reports 2 cases of measles
• A nursing home reports an unusual number of older patients with unexplained rashes
ACTIVE SURVEILLANCE
Local or state health departments initiate the collection of information from laboratories, physicians, health
• Selected reporting units, with a high probability of seeing cases of the disease in
question, good laboratory facilities and experienced well-qualified staff, identify and
• Whereas most passive surveillance systems receive data from as many health
• STEPS (adults)
• GSHS (adolescents)
monitoring framework (GMF) for the prevention and control of non communicable
diseases.
application across regions and country settings to monitor trends and assess
• NCD infrastructure, policy response, surveillance and health systems response and partnerships and health
promotion.
• 5th wave of surveillance conducted in – previous surveys in 2000, 2005, 2013 and 2015.
• It is sufficiently flexible to allow each country to expand on the core variables and risk
• PURPOSE: Designed to help countries build and strengthen their surveillance capacity.
STEPS- Adult Risk Factor Surveillance
• The STEPS approach focuses on obtaining core data on the established risk factors that
• It is sufficiently flexible to allow each country to expand on the core variables and risk
• PURPOSE: Designed to help countries build and strengthen their surveillance capacity.
STEPS DESIGN
The STEPS Instrument covers three different levels of "steps" of risk factor assessment.
These steps are:
• Questionnaire
• Physical measurements
• Biochemical measurements
• Core
• Expanded
• Optional
BASIS OF STEPS
STEPS emphasizes that small amounts of good quality data are more valuable than large amounts of
poor data.
POPULATION: The STEPS approach uses a representative sample of the study population. This
• Repeat surveys are essential to identify trends in the prevalence of risk factors
Current Status of STEPS
# with
# in field / data entry # reporting # trained but
# planning Total # active 1 or more
or analysis work completed inactive
repeats
AFRO 10 18 15 43 (3) 7
AMRO 13 8 1 22 (3) 1
EMRO 2 7 9 18 (1) 7
EURO 1 1 0 2 (0) 0
SEARO 0 2 8 10 (0) 9
WPRO 3 11 11 25 (1) 7
120
STEPS Current Status
Global School Based Student Health Survey (GSHS)
Overview & Objectives
• System for surveillance of behavioural risk factors and protective factors in school-aged
children
• Help countries develop priorities, establish programmes, and advocate for resources
• Establish trends in the prevalence of health behaviors and protective factors by country
• 10 Question Modules are available, from which countries can select a minimum of 6:
Alcohol, diet, drugs, hygiene, mental health, physical activity, protective factors, sexual
behaviours, tobacco, violence & injury
106 countries across all six WHO regions have been trained
and 96 have finished GSHS data collection
(including 17 countries with repeat surveys).
• The 2007 India (CBSE) GSHS was a school-based survey of students in classes 8, 9,
and 10.
• Measured hygiene; dietary behaviours and overweight; physical activity; tobacco use;
• For comparison purposes, only students aged 13-15 years are included in the analyses
for this fact sheet.
Service Availability and Readiness
Assessment (SARA)
A health facility assessment tool designed to assess and monitor service availability and readiness
of the health sector and generate evidence to support planning and managing a health system.
Designed as a systematic survey to generate a set of tracer indicators of service availability and
readiness, including:
availability of basic equipment, basic amenities, essential medicines, and diagnostic capacities; and
readiness of health facilities to provide basic health-care interventions relating to family planning, child health
services, basic and comprehensive emergency obstetric care, HIV, TB, malaria, and non-communicable
diseases.
Comparable estimates for selected NCD Risk
Factors
Compiling and storing NCD data
NCD SURVEILLANCE INDIA
The growing burden of NCDs represents a major challenge to health development in
India and accurate data are vital to curb the morbidity and mortality due to NCDs.
• The total sample size was 44,537 aged between 15 and 64 years stratified by sex
and 10-year age groups.
Key Findings
• Smoking: Smoking was most common among peri-urban/slum men (34.3%) compared to their rural (26.7%) and urban (26.5%) counterparts.
• Alcohol: Alcohol consumption was more prevalent among men. About 33% of urban men, 49.3% of peri-urban/slum men and 40.5% of rural men were
found to be current users of alcohol.
• Physical activity: More than 50% of the urban residents, 41.4% of peri-urban/slum residents and 35% of rural residents had a sedentary lifestyle while
25.4% of rural residents, 14.2% of peri-urban/slum residents and 7.4% of urban residents were involved in vigorous physical activity.
• Fruit consumption: The proportion of subjects who never consumed fruits (in the last week) were 24% in urban, 29% in peri-urban/slum and 41% in rural
area.
• Obesity: Obesity and abdominal obesity were more common in urban residents, followed by peri-urban/slum and lowest among rural residents.
Generalized obesity: Urban (men: 30.7%, women: 38.8%), peri-urban/slum: (men: 16.7%, women: 26.1%) and rural (men: 9.4%, women: 14.1%).
Abdominal obesity: Urban (men: 30.9%, women: 57.8%), peri-urban/slum: (men: 17.9%, women: 41.1%) and rural (men: 12.2%, women: 29.6%).
• Diabetes: Diabetes was diagnosed based on self-reported diabetes diagnosed by a physician. The lowest prevalence of self-reported diabetes was
recorded in rural (3.1%) followed by peri-urban/slum (3.2%) and the highest in urban areas (7.3%).
• Hypertension: The prevalence of hypertension was highest among urban residents (self-reported: 15.1%, newly-diagnosed: 19.3%), followed by peri-
urban/slum (self-reported: 9.9%, newly diagnosed: 20.8%) and rural residents (self-reported: 7.2%, newly diagnosed: 17.4%).
Integrated Disease Surveillance Project
NCD – Risk Factor Survey
• The Government of India through the Ministry of Health and Family Welfare (MOHFW) initiated a
decentralized, state based Integrated Disease Surveillance Project (IDSP) in the country with the
• The component of non communicable disease surveillance planned periodic community based surveys
of population aged 15-64 to provide data on the risk factors at state level enabling states to develop
• Assess the prevalence of NCD risk factors in different strata of population in the states.
• Establish a baseline database of NCD risk factors needed to monitor trends in population
health behavior and risk factors for chronic diseases over a period of time in the states; and
provide evidence for evolving strategies and interventions for identified risk factors in the
community to reduce the burden of Non-Communicable Diseases in the population.
• WHO STEPS methodology for NCD Risk Factor Surveillance has been
adopted for the survey.
The phase I (2007-08) of the survey covered seven states namely Andhra
KEY Pradesh, Kerala, Madhya Pradesh, Maharashtra, Mizoram, Tamil Nadu and
FINDINGS
Uttarakhand. • Current daily smokers
• Current smokeless tobacco users
• Respondents consumed alcohol in last 12 months
• Respondents consumed less than five servings of
fruits & vegetables (%) per day
• Type of oil consumption among the households for
cooking (%)
• Mean time spent on physical activity per day (minutes)
• Stage I & II hypertension (%)
• History of raised blood sugar (%)
• Overweight respondents
Overall, NCD risk factors were prevalent across all the socio-economic and demographic categories of
population in phase I states. The results generated through this survey would certainly focus on major
issues in bringing changes or initiate various programs related to control of non communicable diseases.
CONCLUSION
• Non-communicable diseases (NCDs) are reaching epidemic proportions worldwide
and in India.
• NCD risk factor surveillance is quite challenging, as the NCDs are chronic diseases
• Surveillance of NCD risk factors are therefore needed as they could help in policy
experience and challenge from India. Indian journal of community medicine : official publication of Indian Association of
• World Health Organization. Global school-based student health survey: India (CBSE) 2007 fact sheet.
• Anand K, Shah B, Yadav K, Singh R, Mathur P, Paul E, Kapoor SK. Are the urban poor vulnerable to non-communicable
diseases? A survey of risk factors for non-communicable diseases in urban slums of Faridabad. National Medical
• Riley, L., Guthold, R., Cowan, M., Savin, S., Bhatti, L., Armstrong, T. and Bonita, R., 2016. The World Health
Organization STEPwise approach to noncommunicable disease risk-factor surveillance: methods, challenges, and
.
• World Health Organization. Assessing national capacity for the prevention and control of
• Mishra US, Rajan SI, Joe W, Mehdi A. Surveillance of chronic diseases: challenges and strategies for
India.
• World Health Organization (WHO). Noncommunicable diseases global monitoring framework 2013.