Academic journal article Bulletin of the World Health Organization

Availability of Data for Monitoring Noncommunicable Disease Risk Factors in India/Disponibilite Des Donnees Pour la Surveillance Des Facteurs De Risque Des Maladies Non Transmissibles En Inde/Disponibilidad De Datos Para la Supervision De Los Factores De Riesgo De Enfermedades No Transmisibles En India

Academic journal article Bulletin of the World Health Organization

Availability of Data for Monitoring Noncommunicable Disease Risk Factors in India/Disponibilite Des Donnees Pour la Surveillance Des Facteurs De Risque Des Maladies Non Transmissibles En Inde/Disponibilidad De Datos Para la Supervision De Los Factores De Riesgo De Enfermedades No Transmisibles En India

Article excerpt

Introduction

Noncommunicable diseases (NCDs) were estimated to account for over 50% of the deaths and 43% of the disability-adjusted life years (DALYs) lost in India in 2004 (1) and they are prevalent across all socioeconomic strata in the country) (2,3) According to predictions, by 2030 NCDs will account for almost three quarters of all deaths in India (2) and the years of life lost due to coronary heart disease will be greater in that country than in China, the Russian Federation and the United States of America combined. (2) To address the growing burden of NCDs, the government of India has launched several programmes that aim to reduce the prevalence of modifiable NCD risk factors. (4,5) These risk factors, which include tobacco use, alcohol use, low fruit and vegetable intake, physical inactivity, overweight and obesity, high blood pressure, high blood glucose and high blood cholesterol, account for an estimated 61% of cardiovascular disease deaths in low- and middle-income countries. (6) Information on the prevalence of NCD risk factors in the population is crucial for NCD programme monitoring and planning, and can assist in predicting the future burden of disease. Ideally, this information should be collected periodically as part of NCD surveillance to allow comparisons over time both nationally and at appropriate levels of disaggregation.

The STEPwise approach to surveillance (STEPS) of the World Health Organization (WHO), based on conducting population surveys to collect information on the major modifiable NCD risk factors, has been used in many studies globally (7) and was designed for use in low- and middle-income countries. (8,9) In 2009, WHO proposed a set of core indicators derived from STEPS for monitoring NCD risk factors nationally and globally. These core indicators were deemed practical and easily obtainable by countries at all levels of technical capacity (Box 1). (10,11)

In the light of the rising burden of NCDs and of government efforts to control NCDs in India, NCD risk factor surveillance should be a priority for the national health information system. To assess the current status of NCD risk factor information in India, we studied the availability of data measuring the WHO core indicators and the STEPS indicators from household surveys conducted in India over the 10-year period from 2000 to 2009.

Methods

Survey selection criteria

Household surveys that collected information on at least one risk factor in the general adult population included in the WHO-recommended core indicators and STEPS indicators (tobacco use, alcohol use, physical inactivity, diet, body mass index [BMI], waist and/or hip circumference, blood pressure, fasting blood glucose, blood cholesterol), (8) with data collection completed in or after the year 2000 and with a minimum sample size of 5000 individuals, were included. This sample size would allow measurement of a risk factor with a prevalence of 15% and a 2% absolute margin of error in males and females at the 95% confidence level, taking into account survey design effect and response rate. (8)

Identification of household surveys

A previous study on the health information system in India identified household surveys that form part of the country's routine health information system. (12) The web sites of the organizations conducting these surveys were searched for additional, more recent household surveys. The WHO Global NCD Infobase data-base was also searched. (13) These initial searches were followed by a PubMed search conducted in October 2010. The search strategy is shown in Box 2.

Box 1. Core behavioural and biological noncommunicable
disease (NCD) risk factor indicators recommended by WHO
for NCD monitoring (10)

Behavioural risk factors

Tobacco use

* Prevalence of tobacco use--use reported in three status
categories: non-user, occasional user, daily user.

* Prevalence of cigarette smoking--smoking reported in
three status categories: non-smoker, occasional smoker,
daily smoker. … 
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