Chronic Disease Risk Factors
As the epidemic of chronic diseases is progressing and becoming the public health threat worldwide, prevention and control of chronic diseases has become the main goal among public health practitioners (Strong et al., 2005). With the aim to reduce the chronic diseases burden worldwide by an additional 2% annually, prevention of chronic diseases based on population-wide program should be pushed forward by identifying and monitoring the major common risk factors. The surveillance of chronic diseases risk factor is aiming at determining public health priorities, predicting future burden of chronic diseases, as well as monitoring and evaluating population-wide interventions. The WHO Stepwise framework should be used in the planning and intervention of chronic diseases (Epping-Jordan et al., 2005).
Some DSS sites have been using the WHO STEPwise approach to chronic disease risk factor surveillance (STEPS).
The current instruments for STEPS covers tobacco use, alcohol consumption, diet, physical activity, blood pressure, and diabetes.
The WHO STEPwise approach to Surveillance (STEPS) of risk factors is a simple, standardized method for collecting, analysing and disseminating data for chronic disease risk factors in WHO member countries. By using the same standardized questions and protocols, all countries can use STEPS information not only for monitoring within-country trends, but also for making comparisons across countries. The approach encourages the collection of small amounts of useful information on a regular and continuing basis adopting a standard methodology to detect trends over time by age and sex. STEPS risk factors is a sequential process, starting with gathering information on key risk factors by:
  • using a questionnaire for self reported behaviours and life style risk factors (Step 1),
  • then moving to simple physical measurements of blood pressure and anthropometric status (Step 2),
  • and only then recommending the collection of blood samples for biochemical assessment (Step 3).
Within each step, different modules - core, expanded, and optional - are also available, to allow for collecting more complex risk factor data, depending on resource availability and information needs in different settings (World Health Organization, 2005).
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Combining INDEPTH and the WHO STEPS methodology can potentially address basic epidemiological questions on how risk factors are distributed in populations, who amongst the population are more affected, and whether established risk factors for NCDs have already reached the world™s poor. DSSs are uniquely positioned to elucidate these issues and to chart the potentially rapid shifts in population risk profiles. In turn, this will clarify the epidemiologic transition in poorer countries and better inform public policy(Ng et al., 2005).
EPPING-JORDAN, J. E., GALEA, G., TUKUITONGA, C. & BEAGLEHOLE, R. (2005) Preventing chronic diseases: taking stepwise action. Lancet, 366, 1667-71.
NG, N., MINH, H. V., TESFAYE, F., BONITA, R., BYASS, P., STENLUND, H., WEINEHALL, L. & WALL, S. (2005) Combining risk factor and demographic surveillance – potentials of WHO STEPS and DSS methodologies for assessing epidemiologic transition. Scand J Public Health, In press.
STRONG, K., MATHERS, C., LEEDER, S. & BEAGLEHOLE, R. (2005) Preventing chronic diseases: how many lives can we save? Lancet, 366, 1578-82.
WORLD HEALTH ORGANIZATION (2005) WHO STEPS surveillance manual: the WHO STEPwise approach to chronic disease risk factor surveillance, Geneva, Noncommunicable Diseases and Mental Health, World Health Organization.
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