dr. glennis andall-brereton...
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Adult Risk Factor Adult Risk Factor SurveillanceSurveillance
International Success Stories and Lessons LearnedInternational Success Stories and Lessons Learned
Dr. Glennis Andall-Brereton
Caribbean Epidemiology Centre (PAHO/WHO)
OutlineOutlineBackground and contextBackground and context
Growing epidemic of chronic diseasesGrowing epidemic of chronic diseasesResponding to the problemResponding to the problem
Global strategyGlobal strategyPolitical commitment in the CaribbeanPolitical commitment in the Caribbean
International approaches to Surveillance of Chronic Disease RiskInternational approaches to Surveillance of Chronic Disease Risk Factors in AdultsFactors in AdultsPopulation basedPopulation based--surveys surveys
WHO/Pan Am STEPS MethodologyWHO/Pan Am STEPS MethodologyFace to FaceFace to Face
Telephone SurveysTelephone SurveysPASSIPASSIVIGITELVIGITEL
Based on the CDC Based on the CDC BehaviouralBehavioural Risk Factor Surveillance System (BRFSS) Risk Factor Surveillance System (BRFSS)
Results from Risk Factor SurveillanceResults from Risk Factor SurveillanceLessons learned Lessons learned -- What works?What works?Using the InformationUsing the Information
Background and ContextBackground and ContextGrowing Epidemic of Chronic DiseasesGrowing Epidemic of Chronic Diseases
60% of the world60% of the world’’s annual deaths are due to nons annual deaths are due to non--communicable diseases (communicable diseases (NCDsNCDs))25% of deaths from 25% of deaths from NCDsNCDs are premature and could are premature and could be preventedbe preventedAgeAge--standardized death rates in developing countries standardized death rates in developing countries are more than 50% higher than in highare more than 50% higher than in high--income income countries countries Reducing mortality by 2% a year would save 24 Reducing mortality by 2% a year would save 24 million lives mostly among people <70 yearsmillion lives mostly among people <70 yearsPrevention strategies focusing on reducing known Prevention strategies focusing on reducing known modifiable risk factors is necessary for reducing the modifiable risk factors is necessary for reducing the human and economic toll of chronic diseasehuman and economic toll of chronic disease
2000
2003
2004
2008
WHO Global Strategy for the Prevention and Control of Noncommunicable Diseases
WHO Framework Convention on Tobacco Control
Global Strategy on Diet,Physical Activity
and Health
Action Plan on the Global Strategy for the Prevention and Control of Noncommunicable Diseases
Responding to the ProblemGlobal Strategy on NCDs
Key Components of the NCD Global StrategyKey Components of the NCD Global Strategy
Global Strategy for the Prevention and
Control of Noncommunicable
Diseases
Surveillance to quantify and track noncommunicable diseases and risk
factors
Primary prevention to reduce the level of exposure to risk
factors
Health care for people with
noncommunicable diseases
Regional Strategy and Plan of ActionRegional Strategy and Plan of Actionon Integrated Approach to the Prevention and Control of on Integrated Approach to the Prevention and Control of
Chronic Diseases (2006)Chronic Diseases (2006)
Goal:Goal: To prevent and reduce the burden of chronic diseases and To prevent and reduce the burden of chronic diseases and related risk factors in the Americasrelated risk factors in the Americas
Integrated ApproachIntegrated Approach
Health PromotionHealth Promotion
SurveillanceSurveillance
Integrated management of chronic disease and risk factorsIntegrated management of chronic disease and risk factors
Public Policy and AdvocacyPublic Policy and Advocacy
Crude Mortality Rates (per 100,000 population ) for Select Diseases: (2000-2004)CARICOM Member States
0
20
40
60
80
100
120
140
2000 2001 2002 2003 2004
Year
Rat
es p
er 1
00,0
00 p
op
ula
tio
n
Heart Disease
Cerebrovascular Diseases
Diabetes
Injuries
Hypertensive Diseases
Cancers
HIV Disease
Leading Causes of Death in CARICOM Countries Leading Causes of Death in CARICOM Countries by Sex, 2004by Sex, 2004
1.1. Heart DiseaseHeart Disease
2.2. CancersCancers
3.3. Injuries and violenceInjuries and violence
4.4. StrokeStroke
5.5. DiabetesDiabetes
6.6. HIV/AIDSHIV/AIDS
7.7. HypertensionHypertension
8.8. Influenza/pneumoniaInfluenza/pneumonia
1.1. Heart DiseaseHeart Disease
2.2. CancersCancers
3.3. DiabetesDiabetes
4.4. StrokeStroke
5.5. HypertensionHypertension
6.6. HIV/AIDSHIV/AIDS
7.7. Influenza/pneumoniaInfluenza/pneumonia
8.8. Injuries and violenceInjuries and violence
MALES FEMALES
Political Commitment for Political Commitment for NCDsNCDs in the in the CaribbeanCaribbean
Declaration of Port of Spain, September Declaration of Port of Spain, September 20072007
““That we will establish, as a matter of urgency, the That we will establish, as a matter of urgency, the programmesprogrammesnecessary for research and surveillance of the risk factors for necessary for research and surveillance of the risk factors for NCDsNCDswith the support of our Universities and the Caribbean Epidemiolwith the support of our Universities and the Caribbean Epidemiology ogy Centre/Pan American Health Organization (CAREC/PAHO)Centre/Pan American Health Organization (CAREC/PAHO)””
International Approaches to Surveillance of International Approaches to Surveillance of Chronic Disease Risk Factors in AdultsChronic Disease Risk Factors in Adults
MethodologiesMethodologies
PopulationPopulation--based Surveysbased SurveysThe The STEPwiseSTEPwise Approach to Chronic Disease Risk Approach to Chronic Disease Risk Factor Surveillance (STEPS)Factor Surveillance (STEPS)
FaceFace--toto--face interviews at household level face interviews at household level
Telephone SurveysTelephone SurveysPASSI (Italy)PASSI (Italy)
VIGITEL (Brazil)VIGITEL (Brazil)Designed based on CDC Designed based on CDC BehaviouralBehavioural Risk Factor Risk Factor Surveillance System (US)Surveillance System (US)
PopulationPopulation--based Surveysbased Surveys
The The STEPwiseSTEPwise Approach to Chronic Disease Approach to Chronic Disease Risk Factor Surveillance (STEPS)Risk Factor Surveillance (STEPS)
Purpose of STEPSPurpose of STEPSPurpose of STEPS
"The WHO STEPwise approach to chronic disease risk "The WHO STEPwise approach to chronic disease risk factor surveillance provides an factor surveillance provides an entry pointentry point for low and for low and middle income countries to get started on chronic disease middle income countries to get started on chronic disease surveillance activities. It is also designed to help countries surveillance activities. It is also designed to help countries build and strengthen their capacitybuild and strengthen their capacity to conduct to conduct surveillance."surveillance."
Objectives of the STEPS MethodologyObjectives of the STEPS MethodologyObjectives of the STEPS Methodology
Empower countries to Empower countries to gather informationgather information on chronic disease on chronic disease risk factors risk factors for use in planningfor use in planning health programmes and health programmes and interventions.interventions.
Provide Provide standardizedstandardized questionnaire that allows for questionnaire that allows for comparisons, but is flexible to meet country needs.comparisons, but is flexible to meet country needs.
Build country capacityBuild country capacity in all aspects of national survey in all aspects of national survey implementation; in particular, develop skills in sample design, implementation; in particular, develop skills in sample design, data collection and data analysis.data collection and data analysis.
Targets a nationally representative sample of adults aged 25 Targets a nationally representative sample of adults aged 25 ––64.64.
STEP 1 (questionnaire) and STEP 2 (physical measures) are STEP 1 (questionnaire) and STEP 2 (physical measures) are conducted in the conducted in the householdhousehold by trained interviewers.by trained interviewers.
STEP 3 (biochemical measures) can be done using capillary STEP 3 (biochemical measures) can be done using capillary or venous bloodor venous blood
Pocket PCs (Pocket PCs (PDAsPDAs*) are used for data collection: "*) are used for data collection: "eSTEPSeSTEPS""
Repeat survey recommended every 3 Repeat survey recommended every 3 -- 5 years.5 years.
STEPS MethodologySTEPS MethodologySTEPS Methodology
Risk Factors for Chronic DiseaseRisk Factors for Chronic Disease
Causative risk factorsCausative risk factors
Tobacco useTobacco use Unhealthy dietsUnhealthy diets Physical inactivityPhysical inactivityHarmful use of Harmful use of alcoholalcohol
Non
Non
-- comm
un
icable d
iseasescom
mu
nicab
le diseases
Heart disease and strokeHeart disease and stroke
DiabetesDiabetes
CancerCancer
Chronic lung diseaseChronic lung disease
Questionnaire OverviewQuestionnaire OverviewQuestionnaire Overview
Different levels of risk factor Different levels of risk factor assessment:assessment:STEP 1 STEP 1 –– questionnairequestionnaireSTEP 2 STEP 2 –– physical physical measurementsmeasurementsSTEP 3 STEP 3 –– biochemical biochemical measurements (blood measurements (blood samples)samples)
Three modulesThree modulesCoreCoreExpandedExpandedOptionalOptional
Questionnaire Overview Questionnaire Overview contdcontd……
Behavioural Risk FactorsBehavioural Risk FactorsTobacco useTobacco useHarmful alcohol consumptionHarmful alcohol consumptionUnhealthy diet (low fruit and vegetable consumption)Unhealthy diet (low fruit and vegetable consumption)Physical inactivityPhysical inactivity
Biological Risk FactorsBiological Risk FactorsOverweight and obesityOverweight and obesityRaised blood pressureRaised blood pressureRaised blood glucoseRaised blood glucoseAbnormal blood lipidsAbnormal blood lipids
Optional Modules on Injury and Violence, Oral Health, Sexual HeaOptional Modules on Injury and Violence, Oral Health, Sexual Healthlth
Pan American Version of the Questionnaire used in the Americas RPan American Version of the Questionnaire used in the Americas Regionegion
eSTEPS Features/BenefitseSTEPS Features/BenefitseSTEPS Features/Benefits
Improves quality of data collection with Improves quality of data collection with ……automated random selection of participant (Kish Method)automated random selection of participant (Kish Method)prepre--defined skips defined skips automatic range checksautomatic range checksimmediate error checkingimmediate error checking
Fewer materials for data collectors to carryFewer materials for data collectors to carryNo data entry neededNo data entry neededMultiple languages supportedMultiple languages supported
English, French, Spanish, Arabic, Khmer, Georgian, Russian English, French, Spanish, Arabic, Khmer, Georgian, Russian ……
PDAsPDAs can be charged where power is unreliable by AA battery (cheap) can be charged where power is unreliable by AA battery (cheap) or solaror solar--power (expensive).power (expensive).
SD (external memory) cards provide data security in the event ofSD (external memory) cards provide data security in the event of PDA malfunction.PDA malfunction.
Target Audience: Survey Planning and Coordinating Target Audience: Survey Planning and Coordinating Committee Committee
Scope of surveyScope of survey
Survey methodologySurvey methodology
Questionnaire designQuestionnaire design
Sample designSample design
Data collection Data collection
LogisticsLogistics
Identification of resources requiredIdentification of resources required
Begin Draft Survey ProposalBegin Draft Survey Proposal
Training: Survey Implementation3 Days
Training: Survey ImplementationTraining: Survey Implementation3 Days3 Days
Target Audience: Interviewers, Supervisors and Survey Target Audience: Interviewers, Supervisors and Survey Coordinating CommitteeCoordinating Committee
STEPS methodologySTEPS methodology
PDA BasicsPDA Basics
Locating and approaching householdsLocating and approaching households
Kish MethodKish Method
Informed consentInformed consent
Interviewing skillsInterviewing skills
Taking physical measurementsTaking physical measurements
Taking biochemical measurementsTaking biochemical measurements
Conduct of Pilot TestConduct of Pilot Test
Training: Data Collection5 Days
Training: Data CollectionTraining: Data Collection5 Days5 Days
Data merging and cleaningData merging and cleaning
Weighting of survey dataWeighting of survey data
Mapping data to generic STEPS Instrument (as needed)Mapping data to generic STEPS Instrument (as needed)
Epi Info Analysis trainingEpi Info Analysis training
HalfHalf--day handsday hands--on introductionon introduction
Running provided analysis code for descriptive Running provided analysis code for descriptive analysisanalysis
Creation of STEPS Fact Sheet and Data Book Creation of STEPS Fact Sheet and Data Book (standardized reporting documents)(standardized reporting documents)
Begin draft of report and discuss dissemination planBegin draft of report and discuss dissemination plan
Training: Data Analysis & Reporting5 Days
Training: Data Analysis & ReportingTraining: Data Analysis & Reporting5 Days5 Days
Using STEPS survey results:Using STEPS survey results:Propose development of new programmes / services or Propose development of new programmes / services or elaboration of existing ones to address key findings of surveyelaboration of existing ones to address key findings of survey
DPAS (Global Strategy on Diet and Physical Activity for DPAS (Global Strategy on Diet and Physical Activity for Health) documents provide guidelinesHealth) documents provide guidelines
InterInter--Ministry collaborationMinistry collaboration
Training: Data to ActionTraining: Data to ActionTraining: Data to Action
STEPS ManualSTEPS Manualsurvey implementation plan templatesurvey implementation plan templatesuggested timelinessuggested timelinestraining guides for data collection and data entry stafftraining guides for data collection and data entry staffdata collection forms (e.g. participant information sheets, intedata collection forms (e.g. participant information sheets, interview tracking rview tracking forms)forms)
STEPS InstrumentSTEPS Instrument
Sampling ToolsSampling Tools"STEPS Sampling Workbook""STEPS Sampling Workbook""STEPS sample size calculator""STEPS sample size calculator"
Support MaterialsSupport MaterialsSupport Materials
eSTEPS Manager
Create (edit) Questionnaire on PC and
transfer to PDA
Data entry
Import datafrom PDA to PC
eSTEPSQuestionnaire
Designer
eSTEPS Pocket PC (PDA)
Support Materials: eSTEPS SoftwareSupport Materials: Support Materials: eSTEPSeSTEPS SoftwareSoftware
Support Materials: eSTEPS GuidesSupport Materials: Support Materials: eSTEPSeSTEPS GuidesGuides
Installation GuideInstallation Guide
Reviews PDA requirementsReviews PDA requirements
Provides stepProvides step--byby--step installation instructions for:step installation instructions for:all prerequisite softwareall prerequisite software
the 3 eSTEPS componentsthe 3 eSTEPS components
User ManualUser Manual
Provides detailed instructions for:Provides detailed instructions for:how to use each eSTEPS componenthow to use each eSTEPS component
how to manage the survey data and create the final datasethow to manage the survey data and create the final dataset
PAHO/WHO/CAREC pPAHO/WHO/CAREC provides assistance with the creation of the questionnaire rovides assistance with the creation of the questionnaire for the PDA and provides ongoing support via phone and efor the PDA and provides ongoing support via phone and e--mail during data mail during data collection.collection.
Data Analysis & Reporting ToolsData Analysis & Reporting ToolsEpi Info and SPSS analysis programsEpi Info and SPSS analysis programs
standardized fact sheet and data bookstandardized fact sheet and data book
survey report templatesurvey report template
Support Materials, cont.Support Materials, cont.Support Materials, cont.
From generic STEPS
Questionnaire
Fact Sheet Analysis Guide
Support Materials: Analysis HelpSupport Materials: Support Materials: Analysis HelpAnalysis Help
Support Materials: Analysis Help, Cont.Support Materials: Support Materials: Analysis Help, Cont.Analysis Help, Cont.
Data Book Page
Recognize need for data on
chronic disease risk factors
Begin Begin STEPS STEPS
PlanningPlanning
STEPS Implementation
Training Workshop
Conduct Conduct STEPSSTEPS
Report Report ResultsResults
ImplementImplementInterventionsInterventions
STEPS Data Analysis & ReportingWorkshop
Data to Action Workshop
STEPS Data Collection
Training Workshop
STEPS MethodologyThe Surveillance Loop
STEPS MethodologySTEPS MethodologyThe Surveillance LoopThe Surveillance Loop
77(1)(1)1818997722EMROEMRO
(1)(1)
(0)(0)
(0)(0)
(3)(3)
(3)(3)
# trained # trained but inactivebut inactive
7725251111111133WPROWPRO
991010882200SEAROSEARO
0022001111EUROEURO
11222211881313AMROAMRO
774343151518181010AFROAFRO
# with # with 1 or more 1 or more
repeatsrepeats
Total # Total # activeactive
# reporting # reporting completedcompleted
# in field / data # in field / data entry or analysis entry or analysis
workwork# planning# planning
STEPS Activity InternationallyWHO Regions
STEPS Activity InternationallySTEPS Activity InternationallyWHO RegionsWHO Regions
Current Situation - Risk Factor Surveillance in Latin America and The Caribbean (2011)
PAN AM STEPS SURVEY ( NATIONAL): LA: Uruguay, Cuba, Costa Rica C: Aruba, Bahamas, Barbados, British Virgin Islands, Dominica, Grenada, St. Kitts
PREP FOR PAN AM STEPS SURVEY (NATIONAL) : LA:
Paraguay, Bolivia C: Anguilla, Guyana, Nevis, Suriname, Trinidad and Tobago, St. Lucia, St. Vincent and the Grenadines, ,Turks and Caicos islands
NATIONAL BRFS: LA: Colombia, Belize, Panama
C: Curacao, Jamaica
SUB-NATIONAL BRFS: LA: Guatemala; Honduras; Nicaragua; El Salvador.
SURVEY TYPE
BRFS ALLIGNED TO PAN AM STEPS: LA: Argentina, Brazil, Chile
CAREC Member CountriesCAREC Member CountriesCAREC provides epidemiological CAREC provides epidemiological support to 21 Member Countriessupport to 21 Member Countries
English and Dutch speaking English and Dutch speaking CaribbeanCaribbean
Bermuda to SurinameBermuda to Suriname
Varying population sizesVarying population sizesMontserrat, 4,681 Montserrat, 4,681 –– Jamaica, Jamaica, 2,600,7232,600,723
Countries have well developed Countries have well developed primary health care systems, primary health care systems, secondary care services and secondary care services and some tertiary care services some tertiary care services mainly in larger countriesmainly in larger countries
Trinidad and Tobago
Suriname
Jamaica
Guyana
>400,000
St. Vincent and the Grenadines
St. Lucia
Netherlands Antilles
Grenada
Belize
Barbados
Bahamas
Aruba
>=100,000 to <=400,000
Turks and Caicos Islands
St. Kitts and Nevis
Montserrat
Dominica
Cayman Islands
British Virgin Islands
Bermuda
Antigua and Barbuda
Anguilla
<100,000
CountryPopulation Grouping
National Risk Factor Surveillance National Risk Factor Surveillance Telephone InterviewingTelephone Interviewing
Italian Italian BehaviouralBehavioural Risk Factor Surveillance System Risk Factor Surveillance System PASSIPASSI (Progress by Local Health Units Towards a Healthier Italy)(Progress by Local Health Units Towards a Healthier Italy)
Developed based on the Developed based on the BehaviouralBehavioural Risk Factor Risk Factor Surveillance System (BRFSS) in the US (CDC)Surveillance System (BRFSS) in the US (CDC)System for the ongoing surveillance of risk factors and System for the ongoing surveillance of risk factors and preventive measures for preventive measures for NCDsNCDs
Feasibility study conducted (2005Feasibility study conducted (2005--2006)2006)Protocol developedProtocol developedRegional Coordinators identified and trained on all aspects of Regional Coordinators identified and trained on all aspects of systemsystemTraining provided by Regional Coordinators to PASSI supervisors Training provided by Regional Coordinators to PASSI supervisors and interviewers at Local Health Unit (LHU) leveland interviewers at Local Health Unit (LHU) level
PASSI (2007)PASSI (2007)System DescriptionSystem Description
Random sample in each LHU extracted each month from enrollment Random sample in each LHU extracted each month from enrollment lists of residents 18lists of residents 18--69 years in the catchment area69 years in the catchment area
Letter sent to homes of selected individualsLetter sent to homes of selected individualsExplains purposeExplains purpose
Informs that they will be contactedInforms that they will be contacted
GPs of selected persons also informedGPs of selected persons also informed
Questionnaires administered via telephone interviews by trained Questionnaires administered via telephone interviews by trained personnelpersonnel
All data self reportedAll data self reported
Ongoing surveillance processOngoing surveillance processInterviews conducted every monthInterviews conducted every month
Flexible system allows items in questionnaire to be modified ovFlexible system allows items in questionnaire to be modified over timeer time
www.cdc.gov/pcd/issues/2011/jan/10_0030.htm
National Risk Factor Surveillance National Risk Factor Surveillance Telephone InterviewingTelephone Interviewing
Brazilian Brazilian BehaviouralBehavioural Risk Factor Surveillance System : Risk Factor Surveillance System : VIGITELVIGITEL -- BRAZILBRAZIL
Developed based on the BRFSS in the US (CDC)Developed based on the BRFSS in the US (CDC)
2003 – Pilot by State University – São Paulo, Brazil São Paulo + 4 state capitals
2006 – Ministry of Health (MOH) of Brazil – all the state capitals and Federal District (27 cities)
Partnership signed with another MOH secretariat to carry out the telephone interviews
System DescriptionVIGITEL
PurposeContinuous monitoring of the frequency and distribution of risk and protective factors for NCD in all Brazilian state capitals and the Federal District
Population under surveillanceAdults ( ≥ 18 years old) living in households with landline telephones in the Brazilian state capitals
Telephone interviews surveyRandom samples
2,000 interviews/state capital = 54,000/yearData collection: private telemarketing company
Data analysis and reporting: the Health Surveillance Secretariat (SVS/MS) and the University of São Paulo
Prevalence of Overweight Persons (BMI Prevalence of Overweight Persons (BMI ≥≥25 kg/m25 kg/m22) by Gender) by GenderEnglishEnglish--speaking Caribbean Countriesspeaking Caribbean Countries
Female Male
Co
un
try
1
Co
un
try
2
Co
un
try
3
Co
un
try
4
Co
un
try
1
Co
un
try
2
Co
un
try
3
Co
un
try
4
0
10
20
30
40
50
60
70
80
90
100
Pre
vale
nce
(%
)
Comparison of Physical Activity and Overweight Comparison of Physical Activity and Overweight EnglishEnglish--speaking Caribbean Countriesspeaking Caribbean Countries
Country 1
Country 2
Country 3
Country 4
Physical Activity
Physical activityHigh levels of physical activ ityLow levels of physical activ ityNo v igorous activ ity Country 1 Country 2 Country 3 Country 4
0
10
20
30
40
50
60
70
80
Pre
vale
nce
(%
)
78.6%
45.7%
74.9%
64.5%
Prevalence of Overweight Persons
GenderFemaleMale
Country 1 Country 2 Country 3 Country 4
Prevalence of Current Drinkers
GenderFemales (having = 4 drinks on any day in last week)Males (having = 5 drinks on any day in last week)
Country 1 Country 2 Country 3 Country 4
Prevalence of Binge Drinking
Comparison of the Prevalence of Current Drinkers and of Comparison of the Prevalence of Current Drinkers and of Binge DrinkingBinge Drinking
RF Studies RF Studies -- ArgentinaArgentina
20092005Indicators
42,5%42,5%
51,6%51,6%
8,4%8,4%
69,3%69,3%
27,9%27,9%
72,9%72,9%
34,5%34,5%
78,7%78,7%
54,2%54,2%Mammography ( over 40 years of age)
60,5%60,5%PAP in last 2 years ( women)
9,6%9,6%Diabetes (overall population)
75,7%75,7%Glucose Control
29,1%29,1%Elevated Cholesterol )
76,6%76,6%Cholesterol Control (once in a lifetime)
34,8%34,8%Prevalence of elevated blood pressure
81,4%81,4%BP Control in the last 2 years
Anxiety -depression (moderate or severe) 19,2%21,8%
Comparing results 2005Comparing results 2005--20092009Physical InactivityPhysical Inactivity
AF Baja (%)
20-30%
30-40%
40-50%
Low PA (%)
>50%
2005 2009
Comparing results 2005Comparing results 2005--20092009Overweight & Obesity (BMI >25)Overweight & Obesity (BMI >25)
10-14%
>18%
Obesidad (%)
14-16%
16-18%
2005 2009
Risk factor distribution by sex, VIGITEL Brazil (2009)Risk factor distribution by sex, VIGITEL Brazil (2009)
46.6
33
15.6 15.5
51
43.2
1619
42.3
24.3
15.312.5
0
10
20
30
40
50
60
Overweight Meat with fat Phisically inactive Smokers
total men women
Results
Smoking indicators by schooling, VIGITEL Brazil (2009)Smoking indicators by schooling, VIGITEL Brazil (2009)
19.3
26.6
6.4
13.7 14.211.3
15.7
2.7
14.3 13.4
11.1
18.5
2.9
10.07.7
0
5
10
15
20
25
30
Smoker Ex‐smoker ≥ 20 cigarretes/day
Passive smoking at home
Passive smoking at work
%
0 a 8 9 a 11 12 e mais
ResultsObesity trends in Brazil Obesity trends in Brazil (BMI(BMI ≥≥ 30 kg/m30 kg/m22))
11.4 11.4 11.412.7
13.51213.1 13.1 13.113.9 13.7 14
0
2
4
6
8
10
12
14
16
18
20
Total Men Women
%
2006 2007 2008 2009
2003Argentina: 26,1%Chile: 26,8%;
2007Ecuador : 26.3%
Results
Report of flu symptoms and demands for services in adults from Report of flu symptoms and demands for services in adults from Southeast Brazil, JanSoutheast Brazil, Jan--Jul 2010Jul 2010
0
10
20
30
40
50
60
70
80
90
10/01 a 16/01
17/01 a 23/01
24/01 a 30/01
31/01 a 06/02
07/02 a 13/02
14/02 a 20/02
21/02 a 27/02
28/02 a 06/03
07/03 a 13/03
14/03 a 20/03
21/03 a 27/03
28/03 a 03/04
04/04 a 10/04
11/04 a 17/04
18/04 a 24/04
25/04 a 01/05
02/05 a 08/05
09/05 a 15/05
16/05 a 22/05
23/05 a 29/05
30/05 a 05/06
06/06 a 12/06
13/06 a 19/06
20/06 a 26/06
27/06 a 03/07
04/07 a 10/07
11/07 a 17/07
18/07 a 24/07
15/07 a 31/07
%
Epidemiological week
flu symptoms
health care assistance Flu vaccine
Lessons LearnedLessons LearnedWhat Works?What Works?
High level political commitmentHigh level political commitmentEstablishment of partnerships with local organizations and instiEstablishment of partnerships with local organizations and institutionstutionsInvolving all parties at planning phaseInvolving all parties at planning phaseUse of a standardized methodology Use of a standardized methodology
Facilitates comparisonsFacilitates comparisonsSome flexibility Some flexibility Support and training for survey planning, implementation data enSupport and training for survey planning, implementation data entry, try, analysis and report writinganalysis and report writingAssured fundingAssured funding
Ensures sustainabilityEnsures sustainabilityEnhanced accountabilityEnhanced accountability
Annual ReportingAnnual ReportingNCD Minimum Data SetNCD Minimum Data SetDeclaration of Port of Spain on Declaration of Port of Spain on NCDsNCDs
Using the InformationUsing the Information
Identification of at risk populationIdentification of at risk populationForecasting of needs for health servicesForecasting of needs for health servicesPolicy FormulationPolicy FormulationProgrammeProgramme development and implementationdevelopment and implementationProgrammeProgramme evaluation evaluation
Identifying whether interventions are workingIdentifying whether interventions are working
Monitoring trendsMonitoring trendsMaking comparisons (Making comparisons (gender,countriesgender,countries, counties), counties)ResearchResearch
Assessing population knowledge about specific health issues etc.Assessing population knowledge about specific health issues etc.
AcknowledgementsAcknowledgements
Dr. Dr. BrankaBranka LegeticLegetic (PAHO/WHO, WDC)(PAHO/WHO, WDC)
Ms. Melanie Cowan (WHO, Geneva)Ms. Melanie Cowan (WHO, Geneva)
Ms. Sarah Ms. Sarah QuesnelQuesnel (CAREC/PAHO/WHO)(CAREC/PAHO/WHO)
Thank You for ListeningThank You for Listening
Questions??Questions??
Dr. Glennis Andall-Brereton
Caribbean Epidemiology Centre (CAREC/PAHO/WHO)
16-18 Jamaica Boulevard, Federation Park
Port of Spain, Trinidad and Tobago