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Noncommunicable Diseases Global Monitoring

Framework: Indicator Definitions and Specifications

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NCD Global Monitoring Framework: Indicator Definitions and Specifications

Table of contents

Introduction

Global monitoring framework

Global targets for NCDs

Setting national targets

Reporting on the global NCD indicators

Indicators by Categorization

Mortality and morbidity:

1. Premature NCD Mortality

2. Cancer incidence

Behavioural Risk Factors:

3. Harmful use of alcohol: Adult Per Capita Consumption

4. Harmful use of alcohol: heavy episodic drinking

5. Harmful use of alcohol: alcohol-related morbidity and mortality

6. Physical inactivity in adolescents

7. Physical inactivity in adults

8. Salt intake

9. Tobacco use in adolescents

10. Tobacco use in adults

Biological Risk Factors:

11. a) Blood pressure: raised blood pressure

11.b) Blood pressure: mean blood pressure

12. Raised blood glucose/diabetes

13. Overweight and obesity in adolescents

14. Overweight and obesity in adults

15. Saturated fat

16. Low fruit and vegetable consumption

17. a) Total Cholesterol: raised

17.b) Total Cholesterol: mean

National Systems Response:

18. Drug therapy and counselling to prevent heart attacks and stroke

19. Essential medicines and technologies for NCD

20. Palliative care

21. Elimination of trans-fats

22. Vaccination for HPV

23. Marketing to children

24. Vaccination for Hepatitis B

25. Cervical cancer screening

Frequently asked questions

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Introduction:

In May 2013 the 66th World Health Assembly adopted the comprehensive global monitoring framework (GMF) for the

prevention and control of noncommunicable diseases. The Global Monitoring Framework included a set of indicators

capable of application across regions and country settings to monitor trends and assess progress made in the

implementation of national strategies and plans on noncommunicable diseases.

The purpose of this document is to provide detailed guidance to Member States so they can correctly measure each of

the 25 indicators and monitor their progress over time. For each indicator, a complete definition is provided,

appropriate data sources are identified and a detailed calculation, where applicable, is provided.

Global Monitoring Framework:

Member States have agreed 25 indicators across three areas which focus on the key outcomes, risk factors and national

systems response needed to prevent and control NCDs. (see figure 1).

Figure 1. Global Monitoring Framework

Framework Element

Target Indicator

OUTCOMES

Premature mortality from noncommunicable disease

1. A 25% relative reduction in the overall mortality from cardiovascular diseases, cancer, diabetes, or chronic respiratory diseases

1. Unconditional probability of dying between ages of 30 and 70 from cardiovascular diseases, cancer, diabetes or chronic respiratory diseases

Additional indicator 2. Cancer incidence, by type of cancer, per 100 000 population

BEHAVIOURAL RISK FACTORS

Harmful use of alcohol

2. At least 10% relative reduction in the harmful use of alcohol, as appropriate, within the national context

3. Total (recorded and unrecorded) alcohol per capita (aged 15+ years old) consumption within a calendar year in litres of pure alcohol, as appropriate, within the national context 4. Age-standardized prevalence of heavy episodic drinking among adolescents and adults, as appropriate, within the national context 5. Alcohol-related morbidity and mortality among adolescents and adults, as appropriate, within the national context

Physical inactivity 3. A 10% relative reduction in prevalence of insufficient physical activity

6. Prevalence of insufficiently physically active adolescents, defined as less than 60 minutes of moderate to vigorous intensity activity daily 7. Age-standardized prevalence of insufficiently physically active persons aged 18+ years (defined as less than 150 minutes of moderate-intensity activity per week, or equivalent)

Salt/sodium intake 4. A 30% relative reduction in mean population intake of salt/sodium

8. Age-standardized mean population intake of salt (sodium chloride) per day in grams in persons aged 18+ years

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Tobacco use 5. A 30% relative reduction in prevalence of current tobacco use

9. Prevalence of current tobacco use among adolescents 10. Age-standardized prevalence of current tobacco use among persons aged 18+ years

BIOLOGICAL RISK FACTORS

Raised blood pressure

6. A 25% relative reduction in the prevalence of raised blood pressure or contain the prevalence of raised blood pressure, according to national circumstances

11. Age-standardized prevalence of raised blood pressure among persons aged 18+ years (defined as systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg) and mean systolic blood pressure

Diabetes and obesity 7. Halt the rise in diabetes & obesity 12. Age-standardized prevalence of raised blood glucose/diabetes among persons aged 18+ years (defined as fasting plasma glucose concentration ≥ 7.0 mmol/l (126 mg/dl) or on medication for raised blood glucose) 13. Prevalence of overweight and obesity in adolescents (defined according to the WHO growth reference for school-aged children and adolescents, overweight – one standard deviation body mass index for age and sex, and obese – two standard deviations body mass index for age and sex) 14. Age-standardized prevalence of overweight and obesity in persons aged 18+ years (defined as body mass index ≥ 25 kg/m² for overweight and body mass index ≥ 30 kg/m² for obesity)

Additional indicators 15. Age-standardized mean proportion of total energy intake from saturated fatty acids in persons aged 18+ years 16. Age-standardized prevalence of persons (aged 18+ years) consuming less than five total servings (400 grams) of fruit and vegetables per day 17. Age-standardized prevalence of raised total cholesterol among persons aged 18+ years (defined as total cholesterol ≥5.0 mmol/l or 190 mg/dl); and mean total cholesterol concentration

NATIONAL SYSTEMS RESPONSE

Drug therapy to prevent heart attacks and strokes

8. At least 50% of eligible people receive drug therapy and counselling (including glycaemic control) to prevent heart attacks and strokes

18. Proportion of eligible persons (defined as aged 40 years and older with a 10-year cardiovascular risk ≥30%, including those with existing cardiovascular disease) receiving drug therapy and counselling (including glycaemic control) to prevent heart attacks and strokes

Essential noncommunicable disease medicines and basic technologies to treat major noncommunicable diseases

9. An 80% availability of the affordable basic technologies and essential medicines, including generics required to treat major noncommunicable diseases in both public and private facilities

19. Availability and affordability of quality, safe and efficacious essential noncommunicable disease medicines, including generics, and basic technologies in both public and private facilities

Additional indicators 20. Access to palliative care assessed by morphine-equivalent 21. Adoption of national policies that limit saturated fatty acids and virtually eliminate partially hydrogenated vegetable oils in the food supply, as appropriate, within the national context and national programmes 22. Availability, as appropriate, if cost-effective and affordable, of vaccines against human papillomavirus, according to national programmes and policies 23. Policies to reduce the impact on children of marketing of foods and non-alcoholic beverages high in saturated fats, trans fatty acids, free sugars, or salt 24. Vaccination coverage against hepatitis B virus monitored by number of third doses of Hep-B vaccine (HepB3) administered to infants 25. Proportion of women between the ages of 30–49 screened for cervical cancer at least once, or more often, and for lower or higher age groups according to national programmes or policies

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Global Targets for NCDs:

Nine areas have been selected from the 25 indicators in the Global Monitoring Framework to be targets (see figure 2):

one mortality target (previously agreed at the WHA in May 2012); six risk factor targets (harmful use of alcohol, physical

inactivity, dietary sodium intake, tobacco use, raised blood pressure, and diabetes and obesity), and two national

systems targets (drug therapy to prevent heart attacks and strokes, and essential NCD medicines and technologies to

treat major NCDs). The targets are both attainable and significant, and when achieved will represent major

accomplishments in NCD and risk factors reductions. The global NCD targets are intended to focus global attention on

NCDs and would represent a major contribution to NCD prevention and control. Targets have been set for 2025, with a

baseline of 2010.

Figure 2. Global voluntary targets for NCDs

A 25% relative reduction in risk of premature mortality from cardiovascular diseases,

cancer, diabetes, or chronic respiratory diseases

At least 10% relative reduction in the harmful use of alcohol

A 10% relative reduction in prevalence of insufficient physical activity

A 30% relative reduction in mean population intake of salt/sodium

A 30% relative reduction in prevalence of current tobacco use

A 25% relative reduction in the prevalence of raised blood pressure or contain the

prevalence of raised blood pressure, according to national circumstances

Halt the rise in diabetes and obesity

At least 50% of eligible people receive drug therapy and counselling (including

glycaemic control) to prevent heart attacks and strokes

An 80% availability of the affordable basic technologies and essential medicines,

including generics, required to treat major noncommunicable diseases in both public

and private facilities

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Setting National Targets:

Member States are strongly encouraged to consider the development of national targets based on their own national

situations, which build on the nine global voluntary targets. Setting targets is a way to draw attention to NCDs and help

mobilize resources to address NCD priorities. National targets may need to be adapted from the global targets if a

country has already achieved a target or if the global target is too low given the progress already achieved within the

country.

As a starting point, Member States interested in setting national NCD targets are encouraged to consider the following:

• Are the targets and indicators included in the GMF all suitable in the national context?

• Are there additional targets and indicators needed for the country?

• Are the systems in place to track these 25 global indicators and report on nine global targets? And systems

which track any new proposed ones?

• What is the current level of exposure/mortality/service provision?

• Are the reductions or coverage proposed for global targets appropriate in the national context or should they be

more ambitious?

Reporting on the Global NCD Indicators:

WHO is mandated to prepare regular updates on the progress towards achieving the nine global NCD targets and the

status globally in relation to the 25 indicators included in the Global Monitoring Framework. To enable these reports to

be as comprehensive as possible, Member States are strongly encouraged to submit data to WHO on a regular basis to

enable analysis of the global status of NCD targets and indicators. For ease of data submission, WHO has prepared a

template for reporting against the NCD indicators. This template is available upon request from WHO by contacting:

[email protected].

Where multiple indicators exist for one target (i.e. for alcohol), Member States should endeavor to report against as

many indicators as possible. However they should also choose to report against the one most appropriate for their

national circumstances.

It is important to note that WHO will continue to produce figures for each country that are comparable across all

Member States. While these comparable figures will be based on the data submitted by Member States, they will also

take into consideration differences across countries in data availability, data type, population structure and other data

characteristics that reduce comparability across countries. Thus, the figures produced by WHO may differ from those

reported by each individual Member State.

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Name abbreviated Premature NCD Mortality

Indicator name Unconditional probability of dying between ages 30 and 70 years from cardiovascular

diseases, cancer, diabetes, or chronic respiratory diseases

Definition Probability of dying between the exact ages 30 and 70 years from cardiovascular diseases,

cancer, diabetes, or chronic respiratory diseases. Deaths from these four causes will be

based on the following ICD codes: I00-I99, C00-C97, E10-E14, and J30-J98.

Method of

estimation/calculation

��∗ � = �� ℎ�� + 5�� + 5

!�∗ � = ��∗ ∗ 51 + ��∗ � ∗ 2.5

!%&∗ '& = 1 − )*1 − !�∗ �+,�

�-'&

Age-specific death rates for the combined four cause categories (typically in terms of 5-

year age groups 30-34,…, 65-69). A life table method allows calculation of the risk of

death between exact ages 30 and 70 from any of these causes, in the absence of other

causes of death. The ICD codes to be included in the calculation are: cardiovascular

disease: I00-I99, Cancer: C00-C97, Diabetes: E10-E14, Chronic respiratory: J30-J98. To calculate age-specific mortality rate for each five-year age group and country, for each

5-year age range between 30 and 70:

Then translate the 5-year death rate to the probability of death in each 5-year age range:

The probability of death from age 30 to age 70, independent of other causes of death can

be calculated as:

Preferred data sources Vital registration systems which record deaths with sufficient completeness to allow

estimation of all-cause death rates.

Other possible data sources Sample registration systems; verbal autopsy.

NCD Framework Outcome

Disaggregation Sex, other relevant socio-demographic stratifiers where available

Expected frequency of data

collection

Annual

Limitations Potential limitations include:

- incomplete or unusable death registration data

Data type Probability

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Related links http://www.who.int/gho/mortality_burden_disease/en/

http://www.who.int/healthinfo/statistics/LT_method.pdf

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Name abbreviated Cancer incidence

Indicator name Cancer incidence, by type of cancer

Definition Number of new cancers of a specific site/type occurring in the population per year,

usually expressed as the number of new cancers per 100,000 population.

Method of


�� . �At-ri�4�� ℎ�� . × 100,000

Numerator Number of new cancer cases diagnosed in a specific year. This may include multiple

primary cancers occurring in one patient. The primary site reported is the site of origin

and not the metastatic site. In general, the incidence rate would not include recurrences.

Denominator At-risk population for the given category of cancer. The population used depends on the

rate to be calculated. For cancer sites that occur in only one sex, the sex-specific

population (e.g., females for cervical cancer) is used.

Preferred data sources Population-based cancer registries, which collect and classify information on all new cases

of cancer in a defined population

Other possible data sources

NCD Framework Outcome

Disaggregation Age, Sex, other relevant socio-demographic stratifiers where available


collection

Annual


- incomplete records

- inadequate coverage of registries

Data type Rate

Related links http://globocan.iarc.fr/

http://www.iacr.com.fr/canreg5.htm

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Name abbreviated Harmful use of alcohol: Adult Per Capita Consumption

Indicator name Total (recorded and unrecorded) alcohol per capita (APC) (15+ years old) consumption

within a calendar year in litres of pure alcohol

Definition Consumption of pure alcohol (ethanol) in litres per person aged 15+ during one calendar

year.

Method of


8�� ℎ�� . �� . �� 15 + ��ℎ �� . �

Numerator Sum of recorded and unrecorded alcohol consumed in a population during a calendar

year, in litres.

Denominator Midyear resident population aged 15+ for the same calendar year.

Preferred data sources Administrative reporting systems for recorded APC and survey data for unrecorded APC.

The priority of data sources for recorded alcohol per capita consumption should be given

to government statistics on sales of alcoholic beverages during a calendar year or data on

production, export and import of alcohol in different beverage categories. For countries,

where the governmental sales or production data is not available, the preferred data

source would be country specific and publicly available data from the private sector,

including alcohol producers or country specific data from the Food and Agriculture

Organization of the United Nations statistical database (FAOSTAT), which may also

include the estimates of unrecorded alcohol consumption. For main categories of alcohol

beverages “Beer” includes malt beers, “Wine” includes wine made from grapes, “Spirits”

include all distilled beverages, and “Other” includes one or several other alcoholic

beverages, such as fermented beverages made from sorghum, maize, millet, rice, or cider,

fruit wine, fortified wine, etc. Data sources for unrecorded alcohol consumption include

survey data, FAOSTAT data, other data sources such as customs or police data, and expert

opinions.

Other possible data sources Data sets of FAO and UN Statistical office

NCD Framework Risk factor exposure



collection

Annual


- incomplete administrative records

- bias through self-report, including under-reporting of alcohol consumption

- misunderstanding/ -interpretation of questions and/ or size of a standard drink

- limited validity of survey instruments

Data type Volume

Related links http://apps.who.int/gho/data/view.main?showonly=GISAH

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Name abbreviated Harmful use of alcohol: heavy episodic drinking

Indicator name Age-standardized prevalence of heavy episodic drinking

Definition Heavy episodic drinking among adults is defined as those who report drinking 6 (60 grams) or

more standard drinks in a single drinking occasion

Method of


9:;<=>?@A:>B=C>=AD?EF=EGA>=D?>GHEIJ?EA:;HEI,&I>K;A?>;?>=?@D:>=KLJ?M?L?EKGL=KAG?E=?JJKAH?E;?EGMLC

9:;<=>?@A:>B=C>=AD?EF=EGA x100%

Numerator Number of persons reporting consuming 60 grams or more of pure alcohol on at least one

occasion monthly

Denominator All respondents of the survey

Preferred data sources Population-based (preferably nationally representative) survey

Other possible data

sources



Expected frequency of

data collection

At least every 5 years


- bias through self-report, including under-reporting of alcohol consumption

- misunderstanding/ -interpretation of questions and/ or size of a standard drink


Data type Prevalence


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Name abbreviated Harmful use of alcohol: alcohol-related morbidity and mortality

Indicator name Alcohol-related morbidity and mortality among adolescents and adults (monitored by

alcohol use disorders).

Definition Adults (15+ years) who suffer from disorders attributable to the consumption of alcohol

(according to ICD-10: F10.1 Harmful use of alcohol; F10.2 Alcohol dependence) during a

given calendar year.

Method of


9:;<=>?@A:>B=C>=AD?EF=EGA*P�QC=K>A+RHGMKFHKIE?AHA?@SP&.P?>SP&.TF:>HEIKJKL=EFK>C=K>

9:;<=>?@A:>B=C>=AD?EF=EGAKI=FP�QC=K>A x100%

Numerator Number of adults (15+ years) with a diagnosis of F10. or F10.2 during a calendar year.

Using the algorithms specified in the validated instruments, presence or absence of

harmful use of alcohol or alcohol dependence can be determined. AUD will be scored if

either disease category is present.

Denominator All respondents of the survey aged 15+ years.

Preferred data sources Population-based (preferably nationally representative) survey using validated

instruments

Other possible data sources Additional health services reporting systems may provide complementary or confirmatory

information regarding to the frequency and severity of alcohol use

Disorders.




collection



-bias through self-report, including under-reporting

- misunderstanding/ -interpretation of questions




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Name abbreviated Physical inactivity in adolescents

Indicator name Prevalence of insufficiently physically active adolescents

Definition Percentage of adolescents participating in less than 60 minutes of moderate to vigorous

intensity physical activity daily.

Adolescents are defined as 10 – 19 year olds or according to country definition.

Method of


�� ℎ��ℎ �� .�� 4� �ℎ < 60� ��

�� W �� .�� W �. � < 7�.�� W .� �� x100%

Numerator Number of respondents for whom the number of days per week with <60 minutes of

moderate to vigorous intensity activity is <7 days

Denominator All adolescent respondents of the survey

Preferred data sources School-based or population-based (preferably nationally representative) survey

Other possible data

sources




data collection



- bias through self-report, including over-reporting of activity

- misunderstanding/ -interpretation of questions and/ or intensity of physical activity



Related links http://who.int/chp/gshs/en/

http://www.who.int/dietphysicalactivity/publications/9789241599979/en/index.html

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Name abbreviated Physical inactivity in adults

Indicator name Age-standardized prevalence of insufficiently physically active persons aged 18+ years

Definition Percentage of adults aged 18+ years not meeting any of the following criteria:

– 150 minutes of moderate-intensity physical activity per week

– 75 minutes of vigorous-intensity physical activity per week

– an equivalent combination of moderate- and vigorous-intensity physical activity

accumulating at least 600 MET-minutes* per week

Minutes of physical activity can be accumulated over the course of a week but must be of

a duration of at least 10 minutes.

*MET refers to metabolic equivalent. It is the ratio of a person's working metabolic rate

relative to the resting metabolic rate. One MET is defined as the energy cost of sitting

quietly, and is equivalent to a caloric consumption of 1 kcal/kg/hour. Physical activities

are frequently classified by their intensity, using the MET as a reference.

Method of


�� 18 + . �� ℎ �� ℎ.� �� W �.

�� W .� �� 18 + . �� x100%

Numerator Number of respondents where all 3 of the following criteria are true:

(1) Weekly minutes* of vigorous activity < 75 mins.

(2) Weekly minutes* of moderate activity < 150 mins.

(3) Weekly MET-minutes** < 600.

* Weekly minutes is calculated by multiplying the number of days on which

vigorous/moderate is done by the number of minutes of vigorous/moderate activity per

day.

** Weekly MET-minutes is calculated by multiplying the weekly minutes of vigorous

activity by 8 and the number of weekly minutes of moderate activity by 4 and then adding

these two results together.







collection



- bias through self-report, including over-reporting of activity

- misunderstanding/ -interpretation of questions and/ or intensity of physical activity


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Related links http://www.who.int/chp/steps/GPAQ/en/

http://www.who.int/chp/steps/en/index.html

http://www.who.int/dietphysicalactivity/publications/9789241599979/en/index.html

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Name abbreviated Salt intake

Indicator name Age-standardized mean population intake of salt (sodium chloride) per day in grams in

persons aged 18+ years

Definition Mean population intake of salt in grams

Method of


8�� 18 + . �� W .� �� 18 + . ��

Numerator Sum of sodium excretion in urine samples from all respondents aged 18+years. The gold-

standard for estimating salt intake is through 24-hour urine collection, however other

methods such as spot urines and food frequency surveys may be more feasible to

administer at the population level.







collection



- measurement error

Data type Mean

Related links http://www.who.int/chp/steps/en/index.html

http://whqlibdoc.who.int/publications/2011/9789241501699_eng.pdf

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Name abbreviated Tobacco use in adolescents

Indicator name Prevalence of current tobacco use among adolescents

Definition Percentage of adolescents who currently use any tobacco product (smoked or

smokeless). “Smoked tobacco products” includes the consumption of cigarettes, bidis,

cigars, cheroots, pipes, shisha (water pipes), fine-cut smoking articles (roll-your-own),

krekets, and any other form of smoked tobacco.

"Smokeless tobacco" includes moist snuff, plug, creamy snuff, dissolvables, dry snuff, gul,

loose leaf, red tooth powder, snus, chimo, gutkha, khaini, gudakhu, zarda, quiwam,

dohra, tuibur, nasway, naas/naswar, shammah, betel quid, toombak, pan (betel quid),

iq’mik, mishri, tapkeer, tombol and any other tobacco product that is sniffed, held in the

mouth, or chewed.


Method of


�� ℎ�� *� .�� ℎ�� .+

�� W .� �� x100%

Numerator Number of current adolescent tobacco users. “Current users” includes both daily and

non-daily users of smoked or smokeless tobacco.

Denominator All adolescent respondents of the survey.

Preferred data sources School-based or population-based (preferably nationally representative) survey





collection



- bias through self-report, including under-reporting of tobacco use




Related links http://www.who.int/tobacco/surveillance/gyts/en/

http://who.int/chp/gshs/en/

Name abbreviated

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Name abbreviated Tobacco use in adults

Indicator name Age-standardized prevalence of current tobacco use among persons aged 18+ years

Definition “Smoked tobacco products” includes the consumption of cigarettes, bidis, cigars, cheroots,

pipes, shisha (water pipes), fine-cut smoking articles (roll-your-own), krekets, and any other

form of smoked tobacco.

"Smokeless tobacco" includes moist snuff, plug, creamy snuff, dissolvables, dry snuff, gul,

loose leaf, red tooth powder, snus, chimo, gutkha, khaini, gudakhu, zarda, quiwam, dohra,

tuibur, nasway, naas/naswar, shammah, betel quid, toombak, pan (betel quid), iq’mik, mishri,

tapkeer, tombol and any other tobacco product that is sniffed, held in the mouth, or chewed.

Method of


�� 18 + . �� .�� .��*��4 ��4 ��+

�� W .� �� 18 + . �� x100%

Numerator Number of current tobacco users aged 18+ years. “Current users” includes both daily and

non-daily users or smoked or smokeless tobacco.



Other possible data

sources




data collection



- bias through self-report, including under-reporting of tobacco use



- representativeness of the sample


Related links http://www.who.int/tobacco/surveillance/survey/gats/en/

http://www.who.int/chp/steps/en/index.html

Name abbreviated Tobacco use in adults

Definition

Indicator name Age-standardized prevalence of raised blood pressure among persons aged 18+ years

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Name abbreviated Raised blood pressure

Definition Systolic blood pressure ≥140 and/or diastolic blood pressure ≥90 among persons aged 18+

years.

Method of


�� 18 + . �� ℎ�.�� ≥ 140��\�� ≥ 90��\�

�� W .� �� 18 + . �� x100%

Numerator Number of respondents with systolic blood pressure ≥140mmHg or diastolic blood pressure

≥90mmHg. Ideally three blood pressure measurements should be taken and the average

systolic and diastolic readings of the second and third measures should be used in this

calculation.


Preferred data sources Population-based (preferably nationally representative) survey in which blood pressure was

measured, not self-reported.

Other possible data

sources




data collection



- measurement error



Related links http://www.who.int/chp/steps/en/

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Name abbreviated Mean blood pressure

Indicator name Age-standardized mean systolic blood pressure in persons aged 18+ years

Definition Mean systolic blood pressure in persons aged 18+ years

Method of


8��.�� 18 + . �� W .� �� 18 + . ��

Numerator Sum of systolic blood pressure from all participants aged 18+ years. Ideally three blood

pressure measurements should be taken and the average systolic reading of the second

and third measures should be used in this calculation.


Preferred data sources Population-based (preferably nationally representative) survey in which blood pressure

was measured, not self-reported.





collection



- measurement error


Data type Mean


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Name abbreviated Raised blood glucose/diabetes

Indicator name Age-standardized prevalence of raised blood glucose/diabetes among persons aged 18+

years or on medication for raised blood glucose

Definition Fasting plasma glucose value ≥7.0 mmol/L (126 mg/dl) or on medication for raised blood

glucose among adults aged 18+ years.

Method of


�� 18 + . �� ℎ�� W� ≥ 7.0��/_*126mg/dl+or��

�� W .� �� 18 + . ��x100%

Numerator Number of respondents aged 18+ years with fasting plasma glucose value ≥7.0 mmol/L

(126 mg/dl) or on medication for raised blood glucose. Fasting blood glucose must be

measured, not self-reported, and measurements must be taken after the person has

fasted for at least eight hours.


Preferred data sources Population-based (preferably nationally representative) survey. There are two main

blood chemistry screening methods- dry and wet chemistry. Dry chemistry uses capillary

blood taken from a finger and used in a rapid diagnostic test. Wet chemistry uses a

venous blood sample with a laboratory based test. Either method is acceptable.





collection



- measurement error

- lack of fasting status

- limited validity of measurement instruments




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Name abbreviated Overweight and obesity in adolescents

Indicator name Prevalence of overweight and obesity in adolescents

Definition According to the WHO growth reference for school-aged children and adolescents,

overweight – one standard deviation body mass index for age and sex, and obese – two

standard deviations body mass index for age and sex.


Method of

estimation/calculation �� ℎ�� W �� ℎ�� W .� �� x100%

�� ℎ�� W .� �� x100%

Numerator Number of adolescent respondents who are overweight. Number of adolescent

respondents who are obese.

Body mass index (BMI) is calculated by dividing weight in kilograms by height in meters

squared. Overweight is ≥ 1SD BMI for age and sex (equivalent to BMI 25kg/m² at 19

years). Obese is ≥ 2SD BMI for age and sex (equivalent to BMI 30kg/m² at 19 years).

Denominator All adolescent respondents of the survey.

Preferred data sources School-based or population-based (preferably nationally representative) survey in which

height and weight were measured.





collection



- measurement error



Related links http://who.int/chp/gshs/en/

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Name abbreviated Overweight and obesity in adults

Indicator name Age-standardized prevalence of overweight and obesity in persons aged 18+ years

Definition Body mass index ≥25 kg/m² for overweight and body mass index ≥ 30 kg/m² for obesity in

adults aged 18+ years.

Method of


�� W .� �� 18 + . ��ℎ�� W �� ℎ�� W .� �� 18 + . �� x100%

�� W .� �� 18 + . ��ℎ�� W .� �� 18 + . �� x100%

Numerator Number of respondents aged 18+ years who are overweight. Number of respondents

aged 18+ years who are obese.

Body mass index (BMI) is calculated by dividing weight in kilograms by height in meters

squared. Overweight is defined as having a BMI ≥25 kg/m² and obesity is defined as

having a BMI ≥ 30 kg/m².


Preferred data sources Population-based (preferably nationally representative) survey in which height and

weight were measured.





collection



- measurement error




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Name abbreviated Saturated fat

Indicator name Age-standardized mean proportion of total energy intake from saturated fatty acids in persons

aged 18+ years

Definition Mean proportion of total energy intake from saturated fatty acids in persons aged 18+ years

Method of

estimation/calculatio

n

8�� 8ef�� . ��4 �� 18 + . �� W .� �� 18 + . �� 100%

X100%Numerator Sum of proportion of SFA of total energy intake from all participants aged 18+years. For each

participant, divide the saturated fatty acid intake by the total energy intake to get the

proportion of total energy from SFA.


Preferred data

sources

Population-based (preferably nationally representative) survey

Other possible data

sources

FAO National Food Balance Sheets




data collection



- bias through self-report, including under-reporting of consumption




Related links

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Name abbreviated Low fruit and vegetable consumption

Indicator name Age-standardized prevalence of persons aged 18+ years consuming less than five total servings

(400 grams) of fruit and vegetables per day

Definition Percentage of population aged 18+ years who eat less than five servings of fruit and/or

vegetables on average per day

Unit of measure A serving of fruit and vegetables is equivalent to 80 grams

Method of

measurement

Self-report

Method of


�� 18 + . �� ℎ�5� �W �� tand/orve� �� .

�� W .� �� 18 + . ��x100%

Numerator Number of respondents aged 18+ years eating less than 5 servings of fruit and/or vegetables

per day. The average number of servings of fruit and/or vegetables is calculated for each

participant as follows:

1) Calculate the average number of vegetable servings per week: total number of vegetable

servings per day multiplied by number of days per week vegetables are eaten divided by 7.

2) Calculate the average number of fruit servings per week: total number of fruit servings per

day multiplied by number of days per week fruit are eaten divided by 7.

3) Sum the average number of vegetable and fruit servings per week.

If this total is less than 5, then the participant is counted in the numerator of the equation as

eating less than 5 servings of fruit and/or vegetables per day.

A serving of fruit or vegetables is equivalent to 80 grams.



Other possible data

sources




data collection



- bias through self-report


Related links http://who.int/chp/steps/en/

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Name abbreviated Raised total cholesterol

Indicator name Age-standardized prevalence of raised total cholesterol among persons aged 18+ years

Definition Total cholesterol ≥5.0 mmol/L (190 mg/dl).

Method of


�� 18 + . �� ℎ��ℎ� �� W� ≥ 5.0��/_*190mg/dl+

�� W .� �� 18 + . ��x100%

Numerator Number of respondents aged 18+ years with total cholesterol value ≥ 5.0 mmol/L (190

mg/dl).


Preferred data sources Population-based (preferably nationally representative) survey in which cholesterol was

measured, not self-reported. There are two main blood chemistry screening methods-

dry and wet chemistry. Dry chemistry uses capillary blood taken from a finger and used in

a rapid diagnostic test. Wet chemistry uses a venous blood sample with a laboratory

based test. Either method is acceptable.





collection



- measurement error due to insufficient blood sample


representativeness of the sample



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Name abbreviated Mean total cholesterol

Indicator name Age-standardized mean total cholesterol among persons aged 18+ years

Definition Mean total cholesterol.

Method of


8��ℎ� �� 18 + . �� W .� �� 18 + . ��

Numerator Sum of total cholesterol (in mmol/L or mg/dl) from all participants aged 18+ years.


Preferred data sources Population-based (preferably nationally representative) survey in which cholesterol was

measured, not self-reported. There are two main blood chemistry screening methods-

dry and wet chemistry. Dry chemistry uses capillary blood taken from a finger and used in

a rapid diagnostic test. Wet chemistry uses a venous blood sample with a laboratory

based test. Either method is acceptable.





collection






Data type Mean


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Name abbreviated Drug therapy and counseling to prevent heart attacks and stroke

Indicator name Proportion of eligible persons receiving drug therapy and counseling (including glycaemic

control) to prevent heart attacks and strokes

Definition Percentage of eligible persons (defined as aged 40 years and older with a 10-year

cardiovascular disease (CVD) risk* ≥30%, including those with existing CVD) receiving drug

therapy** and counseling*** (including glycaemic control) to prevent heart attacks and

strokes.

*A 10-year CVD risk of ≥30% is defined according to Age, Sex, other relevant socio-

demographic stratifiers where available, blood pressure, smoking status (current smokers

OR those who quit smoking less than 1 year before the assessment), total cholesterol,

and diabetes (previously diagnosed OR a fasting plasma glucose concentration >7.0

mmol/l (126 mg/dl).

**Drug therapy is defined as taking medication for raised blood glucose/diabetes, raised

total cholesterol, or raised blood pressure, or taking aspirin or statins to prevent or treat

heart disease.

***Counseling is defined as receiving advice from a doctor or other health worker to quit

using tobacco or not start, reduce salt in diet, eat at least five servings of fruit and/or

vegetables per day, reduce fat in diet, start or do more physical activity, maintain a

healthy body weight or lose weight.

Method of


�� W .� �� ℎ�� W ��ℎ ��.��

�� W .�� x100%

Numerator Number of eligible survey participants who are receiving drug therapy and counseling.

See Denominator for definition of eligible people. Receiving drug therapy and counseling

is calculated by self-report from respondents reporting they are taking medication for

raised blood glucose/diabetes, raised total cholesterol, or raised blood pressure, or taking

aspirin or statins to prevent or treat heart disease; and receiving advice from a doctor or

other health worker to quit using tobacco or not start, reduce salt in diet, eat at least five

servings of fruit and/or vegetables per day, reduce fat in diet, start or do more physical

activity, maintain a healthy body weight or lose weight.

Denominator Total number of eligible survey participants. Eligible people are those people aged 40 and

older who either currently self-report that they have existing CVD or who have a 10 year

cardiovascular risk of 30 per cent or higher calculated by using the WHO/ISH Risk

prediction charts for 14 WHO epidemiological sub-regions which provide the approximate

estimates of cardiovascular disease (CVD) risk in people who do not have established

coronary heart disease, stroke or other atherosclerotic disease, based on responses to

the following: Age, gender, smoking status, SBP, TC and absence or presence of diabetes.






collection


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http://www.who.int/cardiovascular_diseases/publications/Chart_predictions/en/

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Name abbreviated Essential medicines and technologies for NCD

Indicator name Availability and affordability of quality, safe and efficacious essential noncommunicable

disease medicines, including generics, and basic technologies in both public and private

facilities

Definition Percentage of public and private primary health care facilities who have all of the

following available: Medicines - at least aspirin, a statin, an angiotensin converting

enzyme inhibitor, thiazide diuretic, a long acting calcium channel blocker, metformin,

insulin, a bronchodilator and a steroid inhalant. Technologies - at least a blood pressure

measurement device, a weighing scale, blood sugar and blood cholesterol measurement

devices with strips and urine strips for albumin assay.

Method of


�� ℎ�ℎW �� ℎ�� ℎ � � �� W �

�� W . �� x100%

Numerator Number of facilities that have available during assessment the minimum list of essential

medicines and basic technologies. The minimum list is: Medicines - at least aspirin, a

statin, an angiotensin converting enzyme inhibitor, thiazide diuretic, a long acting calcium

channel blocker, metformin, insulin, a bronchodilator and a steroid inhalant.

Technologies - at least a blood pressure measurement device, a weighing scale, height

measuring equipment, blood sugar and blood cholesterol measurement devices with

strips and urine strips for albumin assay.

Denominator Number of surveyed facilities.

Preferred data sources Nationally-representative health facility assessment


NCD Framework National systems response

Disaggregation Public, Private


collection


Limitations


Related links http://www.who.int/healthinfo/systems/sara_introduction/en/

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Name abbreviated Palliative care

Indicator name Access to palliative care assessed by morphine-equivalent consumption of strong opioid

analgesics (excluding methadone) per death from cancer

Definition Consumption of morphine-equivalent strong opioid analgesics (excluding methadone) per

death from cancer. Morphine- equivalent is a method of standardizing and combining

volumes of opioids with differing potencies and is used as a measure of opioid

consumption, which is used as the indicator for access to pain and palliation.

Method of


k�� n-leW �� ℎ � -e!� W �� ℎ��W ��ℎ ��

Numerator Population-level consumption of morphine-equivalent strong opioid analgesics for a given

time period. Levels of consumption of opioid medicines in kilograms or grams (for

Fentanyl) are calculated by the INCB on the basis of statistics on manufacture and trade

provided by Governments. Consumed quantities include those distributed by wholesalers

or manufacturers to retailers (mainly pharmacies and hospitals) plus quantities imported

directly by retailers. In countries where the retailers obtain their supply from abroad,

quantities declared as imported are considered to be destined for consumption.

Therefore the average reported consumption for the previous three-year period in many

cases provides a more accurate estimate of actual consumption since volumes procured

in one year may be consumed in the following year.

Morphine-equivalent volumes are calculated as:

(1*morphine)+(83.3*fentanyl)+(5*hydromorphone)+(1.33*oxycodone)+

(0.25*pethidine)

Denominator Number of cancers deaths occurring in the population over the same time period.

Preferred data sources Consumption of opioids from International Narcotics Control Board annual reports for

narcotics consumption. Cancer deaths from vital registration systems which record

deaths with sufficient completeness to allow estimation of all-cause death rates.

Other possible data sources Opioid consumption data from national competent authorities


Disaggregation None


collection

Annual


- incomplete administrative records

- incomplete or unusable death registration data

Data type Ratio

Related links http://www.incb.org/documents/Publications/AnnualReports/AR2010/Supplement-

AR10_availability_English.pdf

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Name abbreviated Elimination of trans-fats

Indicator name Adoption of national policies that limit saturated fatty acids and virtually eliminate

partially hydrogenated vegetable oils in the food supply, as appropriate, within the

national context and national programmes

Definition Adoption of a policy to limit saturated fatty acids and virtually eliminate partially

hydrogenated vegetable oils in the food supply.

Method of


Country can respond "yes" to the question “Is your country implementing any national

policies that limit saturated fatty acids and virtually eliminate industrially produced trans-

fats (i.e. partially hydrogenated vegetable oils) in the food supply?”

Preferred data sources WHO NCD Country Capacity Survey



Disaggregation None


collection

Every 2 years






Related links http://www.who.int/chp/ncd_capacity/en/

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Name abbreviated Vaccination for Human Papillomavirus (HPV)

Indicator name Availability, as appropriate, if cost-effective and affordable, of vaccines against human

papillomavirus, according to national programmes and policies

Definition Availability of HPV vaccines as part of a national immunization schedule

Method of


Country can indicate that they have added HPV vaccine to their national immunization

programme, as reflected in their responses to the WHO-UNICEF Joint Reporting Form.

Preferred data sources WHO-UNICEF Joint Reporting Form (JRF)



Disaggregation None


collection

Annual




Data type Percentage

Related links http://www.who.int/nuvi/hpv/decision_implementation/en/index.html

http://www.who.int/immunization_monitoring/routine/joint_reporting/en/index.html

Name abbreviated

Indicator name

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Name abbreviated Marketing to children

Indicator name Policies to reduce the impact on children of marketing of foods and non-alcoholic

beverages high in saturated fats, trans-fatty acids, free sugars, or salt

Definition Existence of a policy to reduce the impact on children of marketing of foods and non-

alcoholic beverages high in saturated fats, trans-fatty acids, free sugars, or salt

Method of


Country can respond "yes" to the question “Is your country implementing any policies to

reduce the impact on children of marketing of foods and non-alcoholic beverages high in

saturated fats, trans-fatty acids, free sugars, or salt?”

Preferred data sources WHO NCD Country Capacity Survey



Disaggregation None


collection

Every 2 years






Related links http://www.who.int/chp/ncd_capacity/en/

http://www.who.int/dietphysicalactivity/publications/recsmarketing/en/

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Name abbreviated Vaccination for Hepatitis B

Indicator name Vaccination coverage against hepatitis B virus monitored by number of third doses of

Hep-B vaccine (HepB3) administered to infants

Definition Percentage of one-year-olds who have received three doses of hepatitis B vaccine in a

given year.

Unit of measure Doses of Hep-B vaccine (HepB3) administered to infants

Method of measurement Service/facility reporting system /administrative data: Reports of vaccinations performed

by service providers (e.g. district health centres, vaccination teams, physicians) are used

for estimates based on service/facility records. The estimate of immunization coverage is

derived by dividing the total number of vaccinations given by the number of children in

the target population, often based on census projections. Household surveys: Survey

items correspond to children’s history in coverage surveys. The principle types of surveys

are the Expanded Programme on Immunization (EPI) 30-cluster survey, the UNICEF

Multiple Indicator Cluster Survey (MICS), and the Demographic and Health Survey (DHS).

The indicator is estimated as the percentage of children ages 12–23 months who received

three doses of hepatitis B vaccine either any time before the survey.

Method of

estimation/calculation �� ℎ �� lW�� W ��ℎ ��

�� ℎ �� x100%

�� ℎ �� 12– 23��ℎ�� ℎ ��W .�ℎ�� W ��ℎ� �� ℎ �� lW�� .� � � �� ℎ ��W .

�� ℎ �� 12 − 23��ℎ��ℎ�� ℎ ��W . �100%

Service/facility reporting system /administrative data:

Household survey data:

Numerator Service/facility reporting system /administrative data:

Total number of hepatitis B vaccinations given to children taken from reports of

vaccinations performed by service providers (e.g. district health centres, vaccination

teams, physicians).


Total number of children aged 12-23 months who received three doses of hepatitis B

vaccine any time before the survey.

Denominator Service/facility reporting system /administrative data:

Number of children in target population covered by service/facility reporting

system/administrative data.


Total number of children aged 12-23 months participating in the survey.

Preferred data sources Annual WUENIC reports (which are derived from the administrative coverage and the

household survey data)

38 | P a g e




Disaggregation None


collection

Annual


- subjective methods due to choice of rules

- absence of any articulation of uncertainty


Related links http://www.who.int/immunization_monitoring/data/data_subject/en/index.html

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Name abbreviated Cervical cancer screening

Indicator name Proportion of women between the ages of 30–49 screened for cervical cancer at least

once, or more often, and for lower or higher age groups according to national

programmes or policies

Definition Proportion of women aged 30 - 49 who report they were screened for cervical cancer

using any of the following methods: Visual Inspection with Acetic Acid/vinegar (VIA), pap

smear and Human Papillomavirus (HPV) test.

Method of


�� 30-49�ℎ�� W �ℎW ��ℎ�� W ��

�� 30-49 x100%

Numerator Number of women aged 30-49 who report ever having had a screening test for cervical

cancer using any of these methods: Visual Inspection with Acetic Acid/vinegar (VIA), pap

smear and Human Papillomavirus (HPV) test.

Denominator All female respondents aged 30-49.


Other possible data sources Facility based data




collection



- bias through self-report, including mistakenly assuming any pelvic exam was a test for

cervical cancer




http://www.who.int/reproductivehealth/publications/cancers/9241547006/en/index.html

40 | P a g e


Frequently asked questions:

1. What is the comprehensive global monitoring framework?

The Global Monitoring Framework represents an agreement by Member States, adopted in the World Health Assembly

in 2013, on a range of indicators and a set of voluntary global targets to track global progress in the prevention and

control of noncommunicable diseases.

2. What are the components of the global monitoring framework?

The global monitoring framework has three components of assessment: mortality and morbidity, risk factor exposures,

and national systems response needed to prevent and control NCDs.

3. What are the global targets?

Nine areas have been selected by Member States from the 25 indicators to be targets: one mortality target (previously

agreed at the WHA in May 2012); six risk factor targets (harmful use of alcohol, physical inactivity, dietary sodium intake,

tobacco use, raised blood pressure, and diabetes and obesity), and two national systems targets (drug therapy to

prevent heart attacks and strokes, and essential NCD medicines and technologies to treat major NCDs). The targets are

both attainable and significant, and when achieved will represent major accomplishments in NCD and risk factors

reductions.

4. How should countries set national targets?

Member States are strongly encouraged consider the development of national targets based on their own national

situations, which build on the nine global voluntary targets. National targets may be more or less ambitious than the

global ones, and national adaptation should be guided by: current performance in prevention and management of NCDs,

current level of NCD-related mortality, risk factor exposure, and NCD oriented programmes, policies and interventions

both planned and in place.

As a starting point Member States interested in setting national NCD targets are encouraged to consider the following:

• Are the targets and indicators included in the GMF all suitable in the national context?

• Are there additional targets and indicators needed for the country?

• Are the systems in place to track these 25 global indicators and report on nine global targets? And systems

which track any new proposed ones?

• What is the current level of exposure/mortality/service provision?

• Are the reductions or coverage proposed for global targets appropriate in the national context or should they be

more or less?

5. What needs to be done when there are multiple indicators for one target? If countries, choose different indicators

how can the global reporting be made?

Where multiple indicators exist for one target (ie: for alcohol), Member States should endeavor to report against as

many indicators as possible. However they should also choose to report against the one most appropriate for their

national circumstances.

6. What is the baseline?

The baseline selected for all targets and indicators is 2010.

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7. What is the reporting cycle? When should countries report, to whom and how?

WHO is mandated to prepare regular updates on the progress towards achieving the nine global NCD targets and the

status globally in relation to the 25 indicators included in the Global Monitoring Framework. Interim reports against

target achievement are scheduled for 2015 and 2020, with these reports sent to the World Health Assembly in 2016 and

2021.

To enable these reports to be as comprehensive as possible, Member States are strongly encouraged to submit data to

WHO on a regular basis, as data becomes available, and ideally at least every 5 years, to enable analysis of the global

status of NCD targets and indicators. For ease of data submission, WHO has prepared a template for reporting against

the NCD indicators. This template is available upon request from WHO by contacting: [email protected].

8. What is the reporting mechanism? Is there a template for reporting?

For ease of data submission, WHO has prepared a template for reporting against the NCD indicators. This template is

available upon request from WHO by contacting: [email protected].

9. Should countries provide raw data or the summary estimate?

WHO would be pleased to receive either raw data to enable the age-standardized indicators to be calculated or

aggregate data for the relevant variables. Further guidance on this is provided in the reporting template available from

WHO.

10. Is it mandatory for all countries to report on all 25 indicators? Or only just for the 9 targets and the country

selected indicators?

It is not mandatory for all countries to report on all 25 indicators, but Member States are strongly encouraged to provide

information on the status of all relevant indicators they collect to enable a comprehensive reporting of global status.

11. Will WHO be using secondary data available from other databases and will generate global estimates?

In order to generate the global status of indicators and to facilitate reporting against the 9 global targets, WHO will

produce comparable estimates of selected indicators. As with the previous round of estimates, and following WHO's

quality standards for data publication, prior to the official release of these updated estimates, WHO will consult its

Member States to review, comment and provide advice on the comparable estimates for the selected risk factors and to

ensure that latest country data have been identified and used for production of the updated comparable estimates.

12. What is the approach for estimating global status if countries are not able to report?

If countries do not have recent data to report against specific indicators, country comparable estimates generated by

WHO will be used to inform global values.

noncommunicable diseases global monitoring framework ... · ncd global monitoring framework:...

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