Using the INDEPTH HDSS to build capacity for chronic non-communicable disease risk factor surveillance in low and middle-income countries

Abstract

BackgroundChronic non-communicable diseases (NCDs) are the leading cause of morbidity, mortality, and disability worldwide. More than 80% of chronic disease deaths occur in low-income and middle-income countries. Epidemiological data on the burden of chronic NCD and the risk factors which predict them are lacking in most low-income countries. The INDEPTH Network (http://www.indepth-network.org) which includes the Health and Demographic Surveillance System (HDSS) with many surveillance sites in low-middle income countries provided an opportunity to establish surveillance of the major chronic NCD risk factors in 2005 using a standardised approach.ObjectiveThis paper presents the conceptual framework and research design of the chronic NCD risk factor surveillance within nine rural INDEPTH HDSS settings in Asia.MethodsThis multi-site study was designed as a baseline cross-sectional survey with sufficient sample size to measure trends over time. In each of nine HDSS sites in five Asian countries, a sample of 2,000 men and women aged 25–64 years, using the WHO STEPwise approach to Surveillance (http://who.int/chp/steps), was selected using stratified random sampling (in each 10-year interval) from the HDSS sampling frame.ResultsA total of 18,494 men and women from the nine sites were interviewed with an overall response rate of 98%. The major NCDs risk factors included self-reported information on tobacco and alcohol consumption, fruit and vegetable intake, physical activity patterns, and measured body weight, height, waist circumference, and blood pressure. A series of training sessions were conducted for research scientists, supervisors, and surveyors in each site. Data quality was ensured through spot check, re-check, and data validation procedures, including accuracy and completeness of data obtained. Standardised data entry programme, created using the EPIDATA software, was used to ensure uniform database structure across sites. The data merging and analysis were done using STATA Version 10.ConclusionThis multi-site study confirmed the feasibility of conducting chronic NCD risk factor surveillance in the low and middle-income settings by integrating the chronic NCDs risk factor surveillance into an existing HDSS data collection and management setting. This collaborative work has provided reliable epidemiological data as a basis for developing chronic NCD prevention and control activities.

Measuring population health: costs of alternative survey approaches in the Nouna Health and Demographic Surveillance System in rural Burkina Faso

“…The few available studies, where health modules were added to HDSS surveillance rounds, focused on the quality of the collected health data, but not on the technical or economic aspects of survey integration (10, 13). …”

“…The HDSS provides a platform for population-based health research and evaluation of health tools and interventions relevant to local health priorities and needs (10). Preceded by a baseline household census, vital events (e.g.…”

“…This tool is, therefore, of particular importance in collecting mortality data. HDSS sites also provide a platform to other longitudinal data collection efforts, such as the World Health Organization (WHO) Study on Global AGEing and Adult Health (SAGE) and surveillance systems for chronic non-communicable disease risk factors (10, 13). Many HDSS sites also undertake morbidity research studies (14–16).…”

Undiagnosed and uncontrolled hypertension among the adults in rural Bangladesh

“…The details of the method have been described elsewhere [21][22][23]. Briefly, three different phases constitute the STEPS approach.…”

Multiple cardiovascular risk factors in Kenya: evidence from a health and demographic surveillance system using the WHO STEPwise approach to chronic disease risk factor surveillance

“…An HDSS collects longitudinal, population based health and vital event information and monitors demographic and health events in a geographically defined population. Many HDSS sites have demonstrated utility in describing cardiovascular risk factor patterns in many lower and middle income countries (LMICs) 9 10. By using standardised instruments, population level data obtained from HDSS activities can inform local policy and be compared across regions.…”