Distribution and Prevalence of Major Risk Factors of Noncommunicable Diseases in Selected Countries: The WHO Inter-Health Programme
Berrios, X., Koponen, T., Huiguang, T., Khaltaev, N., Puska, P., Nissinen, A., Bulletin of the World Health Organization
Important demographic changes have taken place in recent decades in developing countries. These are highlighted by a decrease in fertility rates and an important and steady reduction in infant and maternal mortality, communicable diseases, and general mortality. These changes have resulted in an increase in life expectancy at birth as well as in the absolute number and percent of adult populations (1, 15). This process of ageing of the population, termed demographic transition, is in progress today, although the particular rate varies according to country (2).
In developing countries, health patterns have been strongly influenced by these changes: most of them exhibit a health profile characterized by a transition from a predominance of mortality from infectious and parasitic diseases that are more prevalent among younger age groups, to mortality from chronic noncommunicable diseases (CNCDs), more prevalent among the adult and elderly population, with persistence of trauma (3). This transition is producing a double burden of diseases in developing countries: the emergence of CNCDS when communicable infectious diseases have not yet disappeared.
CNCDS and injuries, also termed lifestyle diseases (4, 5), are a challenge for public health bodies, not only in industrialized countries, but also in developing countries all over the world. These diseases are, however, preventable, and premature deaths can be avoided if efficient interventions are made on the risk factors associated with them through the promotion of healthy lifestyles. Decades of research have provided the experience and the knowledge to reduce considerably their burden (6-10), and the role of serum total cholesterol, hypertension, and smoking in their development was established in the 1960s and 1970s (11, 12).
As a result, in 1986 WHO initiated a global project for developing countries based on an integrated programme approach (5, 13, 14), i.e. diseases with common risk factors should be approached using a common strategy of health promotion and provision of preventive health services. The outcome was the establishment of the WHO Inter-Health Programme, whose aim was to demonstrate how such integrated programmes could be implemented in populations in all regions of the world, at every stage of the demographic and epidemiological transition (15). The core of the programme consists of interventions aimed at modifying the levels of the major risk factors of CNCDS in the community through an integrated. community-oriented approach to health promotion and maintenance (5, 13, 14,. 16, 17).
Materials and methods
Based on the recommendations contained in the core protocol, a quasi-experimental design was used, selecting intervention and reference populations (16, 17). The effects of intervention activities were assessed by examining changes in the status of risk factors in these two populations before and after the intervention. For this purpose, baseline and terminal cross-sectional prevalence surveys were employed.
The study population consisted of people living in an intervention (experimental) and in a reference (control) area, both of which fulfilled specially defined characteristics 18). This article covers 10 of the 12 Inter-Health countries.
Local study populations were selected randomly from entire populations using the MONICA Project recommendations (18). The sampling frame consisted of individuals of both sexes aged 35-64 years, ensuring that at least 200 people were represented in each 10-year age group. The characteristics of the study populations in the various participating counties are shown in Table 1.
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Since this article primarily reports the status of risk factors in the Inter-health countries, but does not evaluate the intervention activities, samples from intervention and reference populations, when available, were combined for the analysis. …