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

Risk Factor SurveillanceRisk Factor SurveillanceSome results from LACSome results from LAC

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

andallgl@carec.paho.org