NCD Surveillance: Methodology and Instruments in the Americas lecture 3

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1 NCD Surveillance: Methodology and Instruments in the Americas lecture 3 Branka Legetic, MD, MPH, PhD PAHO-WHO Regional Adviser on Prevention and control of NCDs

2 What are we strengthening NCD surveillance in the Americas on? Situation analysis (country capacity, availability of data, integration of the national or local system etc) PAHO Inter programmatic working group products: Minimum, optimum and desired set of indicators; RF surveillance methodologies: version of STEPs; Global School Survey( GSHS); Global Youth Tobacco Survey (GYTS); Global Adult Tobacco Survey (GATS), Info Base : PAHO & CAREC mortality info base and future RF info base Quality, underreporting, timelines : part of PAHO program for quality improvement of vital statistics Disease registers: Cancer and Stroke Innovations& research: Telephone based RF surveillance (TRFS)

3 Available methodologies, instruments/ tools

4 Situation analysis TOOL: Country Profile of Capacity and Response to NCDs

5 Country capacity survey 2010 Summary Most countries with infrastructure Most countries reporting that policies, strategies and plans are still not operational NCD Surveillance weak in morbidity, analysis & dissemination systems in place, focus on acute care promotion and prevention weak (tobacco control most advanced)

Data organization tool: Minimum dataset for NCDs Purpose: to combine multiple data sources in one functional annual reporting system as a foundation for NCD surveillance.

6 Data organization tool: Minimum dataset for NCDs Purpose: to combine multiple data sources in one functional annual reporting system as a foundation for NCD surveillance. to remedy the fragmentation of traditional country surveillance systems to facilitate further analysis on a national, sub Regional, and Regional level and the generation of more complex indicators for NCDs.

7 Implementation of NCD Minimum Data Set v NCD Minimum Data Set began in 2009 in LA and the Caribbean ( standardized approach with common indicators for Mo, Mb, RF, Determinants,) Ø 5 Southern Cone countries ( Argentina, Chile, Brazil, Paraguay, Uruguay) Ø 14 countries in the Caribbean (Aruba, Barbados, Bahamas, Belize, Bermuda, BVI, Dominica, Grenada, Guyana, Jamaica, St. Lucia (partial), St. Kitts & Nevis, St. Vincent and the Grenadines, Suriname) Ø 5 Andean countries are working on application and harmonization of their NCD data ( Colombia, Peru, Ecuador, Venezuela y Bolivia)

8 UNHLM: PURPOSE: Situation regarding NCDs Baseline for 2010 for setting Targets Guide on minimum info necessary for monitoring Analysis per country, sub region, included some social and economic indicators and gender

9 RF surveillance TOOLS: TOOLS: Methodology for Risk Factor Surveillance Disease, risk and protective factors for NCDs in adults: Pan Am STEPS New fact sheet on Determinants & RF E STEPS Additional modules option=com_content&view=article&id=1923&itemid=1670& lang=en

10 Objectives of STEPS Methodology Empower countries to gather information on chronic disease risk factors for use in planning health programs and interventions. Provide standardized methodology that allows for comparisons, but is flexible to meet country needs. Build country capacity in all aspects of national survey implementation; in particular, develop skills in sample design, data collection and data analysis.

11 <Country> (Site) STEPS Survey <year> Demographics Fact Sheet The STEPS survey of chronic disease risk factors in [country/site name] was carried out from [insert month and year] to [insert month and year]. [country/site name] carried out Step 1, Step 2 [and Step 3 if applicable]. Socio demographic and behavioural information was collected in Step 1. Physical measurements such as height, weight and blood pressure were collected in Step 2. [If applicable, biochemical measurements were collected to assess blood glucose and cholesterol levels in Step 3.] The STEPS survey in [insert site, country] was a population-based survey of adults aged [adjust as necessary]. A [insert type of sampling design] sample design was used to produce representative data for that age range in [insert country/site name]. A total of [insert sample size] adults participated in the [country/site name] STEPS survey. The overall response rate was [insert response rate (x%)]. Percentage who currently smoke tobacco Both Sexes Males Females Primary school completed or less Level of Education Secondary or High School completed University or Post-graduate degree completed Ethnic Group Marital Status Work Status Income Category Group 1 Group 2 Group 3 Never Married Cohabitating / Married Separated / Divorced Widowed Paid Unpaid Not Working Q1 Q2 Q3 Q4 Q5 Additional modules: Violence Preventive services Quality of life & health seeking behavior Economic module

12 e-steps

13 Pan Am STEPS methodology in the Americas: Bahamas 2005; 2011 Aruba 2007 Uruguay 2007 Barbados Dominica St. Kitts British Virgin Islands (1st country to use E- steps) Paraguay 2010 Grenada Trinidad and Tobago 2011 Costa Rica (2011) Countries 2012/13 STEPS surveys: Uruguay, Cayman Islands, Mexico

CURRENT SITUATION OF RFS IN LAC (2012) TYPE OF SURVEY PAN AM STEPS NATIONAL ( Uruguay, Cuba, C Rica; Barbados, St Kitts, BVI; Dominica, Aruba, T&T, Grenada, Bahamas, St Lucia, Cayman islands NATIONAL

14 CURRENT SITUATION OF RFS IN LAC (2012) TYPE OF SURVEY PAN AM STEPS NATIONAL ( Uruguay, Cuba, C Rica; Barbados, St Kitts, BVI; Dominica, Aruba, T&T, Grenada, Bahamas, St Lucia, Cayman islands NATIONAL PREP FOR PAN AM STEPS: Bolivia, Guyana, St Vincent and the Grenadines, SURINAME BRFS ALLIGNED TO PAN AM STEPS: ARG, BRA,, CHI, JAM,BELIZE NATIONAL BRFS: Colombia, Panama, Ecuador, Bermuda SUB NATIONAL BRFS: GUA; HON; NIC; El Sal.

15 TOOLS: Methodology for youth RF surveillance TOOLS: Focuses on grades with students TOOLS: Methodology for aged youth RF surveillance Methodology Two-stage scientific sample for design of schools and classes Self-administered questionnaire youth RF and generic answer sheet surveillance Completed by students during one classroom period Anonymous and confidential / W..H.O.

16 GSHS Core Questionnaire Modules Respondent demographics Alcohol and other drug use Dietary behaviors Hygiene Mental health Physical activity Protective factors Sexual behaviors that contribute to HIV infection, other STI, and unintended pregnancy Tobacco use Violence & unintentional injury

17 Countries with GSHS data in the Americas Argentina, Chile, Cuba, El Salvador, Guyana, Jamaica, Uruguay, Peru Belize, Costa Rica, Dominican Republic, Guatemala Honduras Mexico, Panama Suriname

18 Innovation and research :Telephone RF surveillance Incorporating a multi-mode design into a random-digit-dialing survey Coverage Sampling & Weighting BRFSS Non-response Measurement (self-reported data)

19 National RF surveillance by phone Brazilian Behavioral Risk Factor Surveillance System : VIGITEL - BRAZIL Developed based on the BRFSS in the US (CDC) 2006 Ministry of (MOH) of Brazil all the state capitals and Federal District (27 cities) Partnership signed with another MOH secretariat to carry out the telephone interviews Argentina pilot

20 National RF surveillance by phone Brazil Purpose Continuous monitoring of the frequency and distribution of risk and protective factors for NCD in all Brazilian state capitals and the Federal District Population under surveillance Adults ( 18 years old) living in households with landline telephones in the Brazilian state capitals Telephone interviews survey Random samples 2,000 interviews/state capital = 54,000/year Data collection: private telemarketing company Data analysis and reporting: the Surveillance Secretariat (SVS/MS) and the University of São Paulo

21 Use of Telephone for RF surveillance PAHO-CAREC-CDC Miami, Sept Countries participants: Aruba, Dominica, Jamaica, St Kitts, Brazil, Ecuador

22 Improving information on cancer: Cancer Incidence in CI5 IX Collaboration with IARC: Workshops for cancer registers: Port of Spain 2010

23 Improving information on incidence, prevalence and survival of diseases TOOLS: STEPS Stroke methodology

STEPS Stroke in LAC State and Perspectives www.paho.org/ecnt-vigilancia/stroke STROQUE: Stroke Register of Queretaro.

Accidente Vascular Cerebral Countries that have implemented STEPS stroke, 1,2, 3 step : Chile, Mexico, Brazil (Sao Paulo + 5 regions),

24 STEPS Stroke in LAC State and Perspectives STROQUE: Stroke Register of Queretaro. Municipio Queretaro Barbados, MI & Stroke register TAURUSs: Talca Urban & Rural Stroke Study EMMA: Estudio de Mortalidad e Morbilidad do Accidente Vascular Cerebral Countries that have implemented STEPS stroke, 1,2, 3 step : Chile, Mexico, Brazil (Sao Paulo + 5 regions), Barbados, Curacao Countries interested in implementing STEPS Stroke: Colombia, Uruguay, Argentina, Honduras, Workshop for the Caribbean on STEP Stoke: Curacao, 15,16 de Nov.2010

25 PAHO data Warehouse Data Integration of priority data base in the Data Warehouse Core Indicators 177 indicators organized by thematic areas, 48 countries, 13 years ( ) Mortality data reported by Countries ICD 10 data (dimensions: country, year, age groups, sex and groups of death causes) Population data, UN Population Division, years, single age and single sex population data of countries of The Americas World Development Indicators (World Bank, 2010) for internal use in health situation analysis

26 Products: Production of Analysis and Evidence Regional Situation Analysis dashboard Sub-Regional Situation Analysis dashboard Country Situation Profile dashboards Summary of Country Situation (printed version) Brochure of Indicators, 2012

27 Near Future: Sub regional INFO base-caribbean Connected with PAHO Data Warehouse Products: Caribbean Profiles: a internet -based semi open system Developed to provide easy access to health related data that is updated annually Started as a mainframe system that tracked individual health indicators, particularly vital statistics, disease reporting, BRFSS data, also as individual indicators.

28 Useful sources of info re NCDs and Americas: PAHO CAREC: WHO: CDC:

29 Thank You

Adult Risk Factor Surveillance

Adult Risk Factor Surveillance International Success Stories and Lessons Learned Dr. Glennis Andall-Brereton Caribbean Epidemiology Centre (PAHO/WHO) Background and context Growing epidemic of chronic