A Synthesis from INDEPTH Asian NCD Working Group

1. Risk Factors for Chronic Non-Communicable Disease: the burden in Asian INDEPTH Health and Demographic Surveillance Sites A Synthesis from INDEPTH Asian NCD Working Group Funded by INDEPTH Secretariat with the support from Wellcome Trust, Sida/GLOBFORSK, Rockefeller Foundation, Gates Foundation and Hewlett Foundation.

2. Chronic NCD – a neglected epidemic • Increasing burden of NCDs, especially heart disease, stroke, hypertension, diabetes, cancer and chronic respiratory disease, in low and middle-income countries, particularly in Asia (WHO, 2005) • Prevention programmes and policies are in their infancy in this region (Reddy, 2002)

3. Projected NCD burden in men in SEAR and WPR in 2005 and 2030

4. Projected NCD burden in women in SEAR and WPR in 2005 and 2030

5. INDEPTH and DSS WHO STEPS Risk factors surveillance in INDEPTH sites Potential #1 Potential #2 • Data on births, deaths, migration, socio-economy • Population dynamics • Sampling frames • Intervention and evaluation • Evidence-based policy • Simple and standardized questions and protocols • Add-on modules • Simplicity and adaptability • Within-country trends • Between-country comparisons INDEPTH Network

6. Overall aim To strengthen the capacity of INDEPTH Asia sites for NCD risk factors surveillance. Objectives • To collect information on NCD risk factors using the WHO STEP approach for risk factors surveillance • To compare NCD risk factors across INDEPTH Asia sites • To build capacity across sites in NCD risk factors surveillance INDEPTH Network

7. The timeline • Project preparation: • August 2004, Indonesia – proposal development • February 2005, India and April 2005, South Africa – instrument development • Project implementation: • July – October 2005: data collection in 8 Asian sites • November – December 2005: data analysis and report writing • 2006 – 2009: planning for further data analysis and publication INDEPTH Network

8. Methods Study design: A cross sectional study on 2000 individuals aged 25-64 years old Instruments: WHO STEP 1 + STEP 2, and adult health modules Data collected: • Age, sex, education, occupation, household socio-economic status • Smoking, alcohol, fruit and vegetable intake, physical activity • Blood pressure, weight, height, waist circumference • Self-reported health, health seeking behavior, history of NCD and treatment INDEPTH Network

11. Framework for translating research to action for NCDs at INDEPTH sites. (Krishnan et al., 2009)

12. Risk Factors for Chronic NCD: the burden in Asian INDEPTH HDSS • Using the INDEPTH HDSS to build capacity for chronic non-communicable disease risk factor surveillance in low and middle-income countries • Self-reported use of tobacco products in nine rural INDEPTH Health and Demographic Surveillance Systems in Asia • Patterns of alcohol consumption in diverse rural populations in the Asian region • Fruit and vegetable consumption in rural adults population in INDEPTH HDSS sites in Asia

13. Prevalence of physical inactivity in nine rural INDEPTH Health and Demographic Surveillance Systems in five Asian countries • Social factors and overweight: evidence from nine Asian INDEPTH Network sites • Blood pressure in adult rural INDEPTH population in Asia • Clustering of chronic non-communicable disease risk factors among selected Asian populations: levels and determinants • A role for INDEPTH Asian sites in translating research to action for non-communicable disease prevention and control: a case study from Ballabgarh, India

14. The visibility of the INDEPTH product During Sept 28 – Oct 26, the GHA journal has received 2 171 visits from 105 countries.

15. It is critically needed and important… “The results of this surveillance work come at a critical point. In May 2008, the World Health Assembly endorsed the Action Plan for the Global Strategy for the Prevention and Control of Non-communicable Diseases. This INDEPTH series also demonstrates the feasibility of incorporating the WHO STEPS approach into other surveillance systems.” (Dr. Ala Alwan, Assistant Director-General, Non-Communicable Disease and Mental Health, WHO Geneva)

16. and it is feasible to build the capacity to do it • “This series of papers has demonstrated that collaboration between surveillance sites in very different populations is possible ...”. “Building the capacity to turn the information into policy and programmes is the next critical step. Failure to do so would be a lost opportunity ...” • “The information from this multi-site study should stimulate the INDEPTH Network to assume a stronger leadership role in using its unique status to promote policies for the prevention of chronic NCD in low-and middle income countries.” Ruth Bonita (Guest Editor and Mentor for NCD Supplement)

17. and let’s continue to support this to grow…. “With modest INDEPTH support to our colleagues in Asia, they have worked relentlessly to show it can be done; scientists from different countries and institutions have worked together and have looked at a topical research issue chronic non-communicable disease surveillance in Asia. I sincerely hope that the findings of these studies will generate future work or programmes in NCD risk factor surveillance in Asia.” (Osman Sankoh, Executive Director of INDEPTH Network)