Vanuatu NCD Risk Factors

Transcription

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2 Vauatu NCD Risk Factors STEPS REPORT May

3 Ackowledgemets This publicatio is the outcome of collaboratio betwee the Vauatu Miistry of Health ad the World Health Orgaizatio, with expert cotributios from a umber of idividuals. The authors of the report were: Graham Roberts (Uiversity of New South Wales); Le Tarivoda (Vauatu Miistry of Health); Coli Bell (WHO Office for the South Pacific); Shalvidra Raj (WHO Office for the South Pacific); Rufia Latu (WHO Vauatu Office). The authors wish to thak the followig for their cotributios, commets, suggestios ad statistical support: Ruth Boita (Uiversity of Aucklad); Melaie Cowa (Surveillace ad Populatio Based Prevetio, WHO Geeva); Regia Guthold (Surveillace ad Populatio Based Prevetio, WHO Geeva); Philayath Phogsava (Uiversity of Sydey); Leae Riley (Surveillace ad Populatio Based Prevetio, WHO Geeva); Cheria Varghese (WHO Regioal Office for the Wester Pacific); Temo Waqaivalu (WHO Office for the South Pacific). Appreciatio is exteded to the Miister for Health, Hoourable Serge Vohor; Director Geeral of Health, Howard Aru; WHO Represetative for Vauatu, Jacob Kool; ad WHO Represetative for the South Pacific ad Director of the Divisio of Pacific Techical Support, Dog-Il Ah for their support of this importat publicatio. Fiacial support was received from the Australia cy for Iteratioal Developmet (AusAID), the New Zealad Aid Programme ad the World Health Orgaizatio. I-kid support was provided by the Vauatu Miistry of Health. 2

4 CONTENTS Foreword Miistry of Health... 7 Foreword World Health Orgaizatio... 9 Executive Summary INTRODUCTION Backgroud ad Ratioale Geography Populatio ad Livig Eviromet Govermet, Culture ad the Ecoomy Nocommuicable Disease, Health Status ad Health Ifrastructure Developig WHO STEPS Survey i Vauatu OBJECTIVES METHODOLOGY Survey Structure Survey Samplig Methodology Provicial ad Household Level Samplig Sample Size Calculatio ad Respose Rates Data Collectio Procedures Registratio of Participats Step 1 - Behavioural Risk Factors Iterviews Step 2 - Physical Measuremets Step 3 - Biochemical Measuremets Check-out Statio ad Referral Data Maagemet ad Aalyses Data Etry Data Weightig ad Aalysis Statistical Sigificace RESULTS Characteristics of Survey Populatio Tobacco Use Alcohol Cosumptio Kava Cosumptio Itake of Fruit ad Vegetables Physical Activity Measuremets Aalysis Levels of Physical Activity History of raised blood pressure ad diabetes Overweight ad Obesity Height ad Weight Body Mass Idex (BMI) Categories Waist Circumferece Blood Pressure Fastig Blood Glucose Total Cholesterol Te year risk of a cardiovascular evet DISCUSSION AND CONCLUSIONS RECOMMENDATIONS Appedices Appedix 1 Betel Nut Use Appedix 2 Vauatu STEPS Survey Questioaire Appedix 3 Vauatu STEPS Survey Data Book Appedix 4 NCD STEP Survey Facilitators Appedix 5 Refereces Appedix 6 Key Cotacts

5 LIST OF FIGURES Figure 1 The WHO STEPwise approach to surveillace of NCDs 16 Figure 2 Vauatu NCD STEPS Survey provice ad household Samples 17 Figure 3 Sequece of data collectio ad statios at the survey base 17 LIST OF TABLES Table 1 ad geder of study populatio Table 2 Mea umber of years of educatio by geder ad age group Table 3 Percetage of curret smokers i the study populatio by geder ad age group Table 4 Curret smokig status amog me i the study populatio by age group Table 5 Curret smokig status amog wome i the study populatio by age group Table 6 Curret smokig status amog both sexes i the study populatio by age group Table 7 Mea age started smokig amog curret daily smokers Table 8 Mea umber of years of smokig amog curret daily smokers Table 9 Percetage of curret daily smokers who smoke maufactured cigarettes Table 10 Percetage of alcohol cosumptio amog me durig the past 12 moths by age group Table 11 Percetage of alcohol cosumptio amog wome durig the past 12 moths by age group.. 24 Table 12 Percetage of alcohol cosumptio amog both sexes durig the past 12 moths by age group Table 13 Frequecy ad quatity of driks cosumed by male drikers i the last 7 days Table 14 Frequecy ad quatity of driks cosumed by female drikers i the last 7 days Table 15 Number of driks per drikig day amog male drikers by age group Table 16 Number of driks per drikig day amog female drikers by age group Table 17 Number of driks per drikig day amog both sexes of curret drikers by age group Table 18 Percetage of kava drikers i the study populatio Table 19 Percetage smokig while drikig kava i the study populatio Table 20 Mea umber of occasio s kava was cosumed over the past 30 days Table 21 Mea umber of bowls of kava cosumed o each occasio Table 22 Mea umber of days i a week fruits cosumed by sex ad age group Table 23 Mea umber of days i a week vegetables cosumed by geder ad age group Table 24 Mea umber of servigs of fruits cosumed o a day whe fruits were eate Table 25 Mea umber of servigs of vegetables cosumed o a day whe vegetables were eate Table 26 Mea umber of combied servigs of fruit ad vegetables cosumed per average day Table 27 Percetage who cosumed less tha five combied servigs of fruit ad vegetables per average day Table 28 Categories of total physical activity amog me by age group Table 29 Categories of total physical activity amog wome by age group Table 30 Categories of total physical activity amog both sexes by age group Table 31 Level of total physical activity (mea miutes per day) by geder ad age group Table 32 Level of work-related physical activity (mea miutes per day) by geder ad age group Table 33 Level of trasport-related physical activity (mea miutes per day) by geder ad age group.. 32 Table 34 Level of recreatio-related physical activity (mea miutes per day) by geder ad age group 32 Table 35 Table 36 Proportio of participats reportig beig diagosed by a doctor or health worker as havig raised blood pressure i the last 12 moths Proportio of participats reportig beig diagosed by a doctor or health worker as havig diabetes i the last 12 moths Table 37 Mea height (cm) by geder ad age group Table 38 Mea weight (kg) by geder ad age group Table 39 Mea body mass idex (kg/m 2 ) by geder ad age group Table 40 BMI classificatios amog me by age group Table 41 BMI classificatios amog wome by age group Table 42 BMI classificatios amog both geders by age group Table 43 Percetage of obesity (BMI 30) by geder ad age group Table 44 Mea waist circumferece (cm) by geder ad age group Table 45 Mea restig systolic blood pressure (mmhg) by geder ad age group Table 46 Mea restig diastolic blood pressure (mmhg) by geder ad age group Table 47 Percetage with raised blood pressure (SBP 140 ad/or DBP 90 or curretly o medicatio for raised blood pressure) Table 48 Mea fastig blood glucose i mmol/l by geder ad age group

6 Table 54 Table 49 Prevalece of raised blood glucose by geder ad age group Table 50 Mea total cholesterol (mmol/l) by geder ad age group Table 51 Percetage with raised cholesterol ( 5.0 mmol/l or 190 mg/dl) Table 52 Percetage of me with <10, 10-<20, 20-<30, 30-<40 ad 40 risk of a fatal or ofatal cardiovascular evet i the ext 10 years Table 53 Percetage of wome with <10, 10-<20, 20-<30, 30-<40 ad 40 risk of a fatal or ofatal cardiovascular evet i the ext 10 years Percetage of me ad wome with <10, 10-<20, 20-<30, 30-<40 ad 40 risk of a fatal or o-fatal cardiovascular evet i the ext 10 years Table A1 Percetage of curret betel ut chewers amog me by age group Table A2 Percetage of curret betel ut chewers amog wome by age group Table A3 Percetage of curret betel ut chewers amog both sexes by age group

7 LIST OF ABBREVIATIONS BMI BP CI DBP EA FCTC ISH MET mg/dl mmhg mmol/l MOH NCD NIDM NSHP PDA PICs PHC STEPS WHO SBP SPC UN WHO Body Mass Idex Blood Pressure Cofidece Iterval Diastolic Blood Pressure Erolmet Area Framework Covetio o Tobacco Cotrol Iteratioal Society for Hypertesio Metabolic equivalet Milligrams per decilitre (uit of blood chemistry values) Millimetres of mercury (uit of blood pressure measuremet) Millimoles per litre (uit for blood chemistry values) Miistry of Health Nocommuicable diseases No Isuli Diabetes Mellitus Natioal Strategic Health Pla Persoal Digital Assistat Pacific islad coutries ad areas Primary Health Care Stepwise approach to NCD surveillace Systolic Blood Pressure Secretariat of the Pacific Commuity Uited Natios World Health Orgaizatio 6

8 Foreword Miistry of Health Vauatu has reached a health crisis from poor health, disability, sufferig, poverty ad early deaths brought about by a overwhelmig NCD epidemic. NCDs, pricipally cardiovascular diseases, diabetes, cacer ad chroic respiratory diseases impose a major ad growig burde o health ad developmet i Vauatu. NCDs are the leadig causes of death ad disability, ad resposible for 70 of deaths. However, our people are illiformed of the risk factors, the disease process ad debilitatig complicatios of NCDs. The atioal NCD STEPS survey coducted durig was a major udertakig by govermet, i particular Miistry of Health ad Natioal Statistics Office to measure the prevalece of risk factors for NCDs. I this study, more tha 4,000 idividuals participated, icludig male ad female aged years from all six provices i Vauatu. They were asked about their lifestyles i order to elicit behavioural risk factors related to tobacco use, alcohol cosumptio, eatig habits ad physical iactivity. They also uderwet body measuremets for overweight ad obesity; measuremets of blood pressure; ad blood tests for glucose ad cholesterol. This report outlies the results of the survey. It reveals eye-opeig facts o high prevalece of NCD risk factors ad high rates raised blood pressure, blood sugar ad cholesterol. The fidigs also ote that the presece of multiple risk factors i the same idividuals was high. The fidigs of the survey cofirm that Vauatu has sigificat disease burde attributed to NCDs. It provides the evidece as grouds to step up actio to prevet ad cotrol NCDs i our coutry. The actios are eeded to: Couteract premature death ad disability due to NCDs; Prevet the emergece of NCDs i childre ad i future geeratios; Reduce the ecoomic impact of NCDs o idividuals, families ad atioal ecoomies; Improve the overall health ad well-beig of all our people. Because of the multi-factorial ature of NCDs, prevetio ad cotrol strategies eed the partership ad egagemet of multi-sectoral stakeholders outside the health sector, icludig relevat govermet miistries, NGOs, food idustries, private sector ad the commuity themselves. The actios poit to political commitmet o the part of govermet mobilize resources for NCD programmes; developmet of a atioal NCD policy as a overarchig framework for actio; implemetig a multi-sectoral NCD prevetio ad cotrol strategy; ad establishig a moitorig pla to track chages. The govermet of Vauatu is grateful to WHO for its utirig assistace ad guidace throughout the coduct of the survey ad to arrive at cocrete fidigs. The Miistry of Health is also grateful to 7

9 other developmet parters, i particular AusAid, whose cotributio to the survey has greatly assisted i its completio. Lastly, we commed the efforts of our ow atioal statistics office for its techical iputs, the samplig frame ad data maagemet; ad to the survey field teams without whom this study would ot have bee made possible. 8

10 Foreword World Health Orgaizatio NCDs i Pacific islad coutries ad areas (PICs) accout for 75 of all deaths ad cotribute to sigificat log term illess ad disability, hamperig social ad ecoomic developmet. Miisters at the 9th Pacific Health Miisters' Meetig held i Jue, 2011 declared a NCD crisis i the Pacific requirig urget attetio ad Pacific Islads Forum Leaders echoed this call. As part of the global respose, the September 2011 political declaratio of the High-level Meetig of the UN Geeral Assembly o the Prevetio ad Cotrol of No-commuicable Diseases called for a comprehesive global moitorig framework icludig a set of idicators ad volutary global targets. I light of the size of the NCD problem ad the growig political support for actio atioally, regioally ad globally, this atioal NCD risk factors report for Vauatu is timely as it coicides with fial agreemet at the World Health Assembly i May 2013 o what the global NCD targets ad idicators will be. This puts Vauatu i a excellet positio to develop atioal NCD targets, to report o the status of NCD risk factors globally ad to develop atioal ad local policy ad programs to address NCDs. Data cotaied i the report were collected usig the WHO STEPwise Approach to Surveillace of NCD Risk Factors (STEPS). To date, more tha 148 coutries ad areas throughout the world have used this approach to coduct atioal surveys o risk factors ad prevalece of NCDs. Some of the key results of the Vauatu STEPS survey were: 45.8 of me ad 4 of wome were curret smokers ad the mea age of startig smokig was 20.2 years; Kava was commoly cosumed with over 40 of participats reportig cosumig kava; 68 of me ad 18 of wome. Furthermore kava cosumptio was associated with tobacco use; Over 70 of wome ad 23 of me reported beig lifetime abstaiers from alcohol; The overall prevalece of obesity was 18.8 ad obesity was more prevalet amog wome (23.3) tha amog me (13.9); Overall 58.2 of me ad 65.0 of wome were eatig less tha the recommeded 5 servigs of fruit ad vegetables per average day; Overall, 73.9 of participats reported high levels of physical activity. Me (81.7 reportig high levels) were more active tha wome (66.9 reportig high levels); 28.6 of the sample were hypertesive (30.8 of me ad 26.7 of wome); 21.2 of participats had raised blood glucose, 21.4 i me ad 21.0 i wome; 9

11 Over a third of participats (36.5) had raised total cholesterol levels exceedig 5.0 mmol/l ( 190 mg/dl), a greater proportio of me tha wome (38.4 ad 34.7 respectively; Overall 3.6 of participats had a >30 risk of a fatal or o-fatal cardiovascular evet i the ext 10 years. Compared to other coutries i the Pacific, the NCD profile for Vauatu does ot look too bad ad the low rates of smokig amog wome, the high proportio of lifelog abstaiers from alcohol amog wome, the relatively low prevalecee of obesity, sufficiet fruit ad vegetable itakes for at least 40 of the populatio, ad high levels of physical activity should be ackowledged ad celebrated. However, tobacco use amog me, hypertesio, blood glucose ad cholesterol levels are of cocer ad the challege for Vauatuu is to prevet the NCD epidemic from stregtheig its grip. To do this, priority eeds to be give to both primary ad secodary prevetio activities ad we commed the Miistry of Health for the priority actios they have idetified for reducig modifiable risk factors ad for maagig existig disease. WHO is hooured to have bee a part of the collaboratio that led to the publicatio of this report ad will cotiue to work with the Miistry of Health ad other key stakeholder rs to address the NCD burde i Vauatu. 10

12 Executive Summary The Vauatu atioal NCD STEPS survey provides the baselie assessmet of the risk factors of o-commuicable diseases (NCDs) ad their associated risk factors amog i-vauatu adults. The survey was coducted betwee August ad October The key objectives of the NCD STEPS survey were: To determie the prevalece ad magitude of major modifiable risk factors for NCDs icludig tobacco ad betel ut use, kava ad alcohol cosumptio, poor eatig patters, physical iactivity, obesity, raised blood pressure, raised blood glucose ad cholesterol levels; To compare the prevalece of NCD risk factors across differet age groups ad betwee me ad wome; To use data from the NCD Steps Survey to measure potetial future disease burde ad to propose itervetio strategies. A total of 4,649 idividuals (respose rate 94) aged participated i the survey. This report presets data ad commetary o the sample followig the stadard 10-year age group reportig for WHO STEPS surveys. Step 1: Behavioural risk factors The report shows that i-vauatu start smokig youg. The mea age of startig smokig was 20.2 years ad youger (18.8 years) i the age group suggestig that it is droppig. Me were much more likely to smoke tha wome. There was a tefold differece i curret smokig prevalece betwee me ad wome with 45.8 of me ad oly 4 of wome beig curret smokers. Maufactured cigarettes were the most commo cigarettes smoked, particularly by wome. Kava was commoly cosumed with over 40 of participats reportig cosumig kava; 68.1 of me ad 18.3 of wome. O average, me also cosumed twice the amout of kava as wome. Kava cosumptio was associated with smokig cigarettes i all age groups, but particularly amog people aged years, where almost three quarters of me (73.7) ad over a quarter (28.2) of wome smoked while drikig kava. Alcohol cosumptio i Vauatu was ot widespread with just 12.0 of me ad less tha 3 of wome classified as curret drikers ad over 70 of wome ad 23 of me reported beig lifetime abstaiers from alcohol. Amog those who drak alcohol, 21.9 of me ad 15.2 of wome exhibited bige drikig behaviour o at least oe drikig occasio. Fruit was cosumed o average o 3.9 days a week ad vegetables o 5.5 days a week. Me reported margially higher mea days of fruit cosumed i a typical week tha wome, overall ad across all age groups, but a similar rate of vegetable cosumptio. Overall 58.2 of me ad 65.0 of wome were eatig less tha the recommeded 5 servigs of fruit ad vegetables per average day. Overall, 73.9 of participats reported high levels of physical activity, 14.4 moderate levels ad 11.7 low levels. Me were more active tha wome with 81.7 of me reportig high levels of physical activity compared to 66.9 of wome. Also, me egaged i physical activity for a mea of miutes per day compared to a mea of miutes per day for wome. Across all age groups, me reported egagig i more miutes of work, trasport ad recreatio activity tha wome. 11

13 Step 2: Physical risk factors Me were o average sigificatly taller ad heavier (167.8cm ad 72.2kg) tha wome (158.7cm ad 67.6kg). I both sexes, height varied little across age groups. Average weight amog both me ad wome peaked i the year age group (75.5kg ad 70.6kg respectively). Body Mass Idex (BMI) scores placed wome with higher mea BMI (26.7kg/m 2 ) tha me (25.5 kg/m 2 ) i all age groups. The mea BMI for both me ad wome was highest i the age group. The proportio of the total sample classified as beig overweight was 50.9 (males 45.5 ad females 55.9), while 47.3 were classified as ormal ad 1.8 as uderweight. The overall prevalece of obesity was The obesity rate was sigificatly higher amog wome (23.3) tha amog me (13.9). The highest prevalece of obese wome (32.4) ad me (23.1) was i the age group. Waist circumferece was assessed as a measure of cetral obesity. Wome had a higher mea waist circumferece (79.7cm) tha me (75.0cm). Mea waist circumferece varied more with age i me tha i wome ad was highest i both sexes i age group ad i females aged Raised blood pressure (defied as havig SBP 140 mmhg ad/or DBP 90 mmhg or o medicatio for raised blood pressure) was foud i 28.6 of the sample (30.8 of me ad 26.7 of wome), icreasig with age i both sexes. From the age group to the age group, the rate of hypertesio amog me more tha doubled (22.4 to 52.6) ad the rate amog wome icreased almost fivefold (12.0 to 57.8). Step 3. Biochemical risk factors The mea fastig blood glucose level was 5.7 mmol/l for both me ad wome ad icreased with age. Based o measures of fastig capillary whole blood, the overall prevalece of raised blood glucose (fastig glucose level 6.1 mmol/l or o medicatio for raised blood glucose) was 21.2 ad similar i both me (21.4) ad wome (21.0). More tha oe fifth of the sample from age had raised blood glucose; icreasig to a quarter of both me ad wome aged 45-54, ad to a third of wome aged The oset of adult diabetes is evidet from the icrease i raised blood glucose amog age group Over a third of the sample (36.5) had raised total cholesterol levels exceedig 5.0 mmol/l ( 190 mg/dl), a greater proportio of me tha wome (38.4 ad 34.7 respectively). I the age group 45-54, almost half of both me ad wome (46.2 ad 49.1 respectively) had raised blood cholesterol. Risk of a fatal or o-fatal cardiovascular evet i the ext 10-years The risk of developig a NCD accumulates with the umber of risk factors a idividual has. The absolute risk of a fatal or o-fatal cardiovascular evet i the ext 10-years was assessed for all idividuals surveyed based o age, raised blood glucose, smokig status, blood pressure ad total cholesterol. Overall, 3.6 of participats had a >30 risk of a fatal or o-fatal cardiovascular evet i the ext 10 years. The proportio of participats above a 30 level of risk icreased i a stepwise fashio across the three age groups. Coclusios & Recommedatios The Vauatu NCD STEPS survey showed some positive fidigs with respect to the modifiable risk factors of tobacco use, alcohol cosumptio, physical activity ad fruit ad vegetable itake. However, levels of raised blood pressure, raised blood glucose ad total cholesterol were of cocer. Moreover, i the oldest age group (55-64 years), 11.4 of me ad 4.9 of wome had a 30 or greater absolute risk of a fatal or o-fatal cardiovascular evet i the ext 10 years. NCDs are clearly a public health cocer ad these diseases are already impactig o the health system. 12

14 The survey has produced evidece for developig relevat policy ad strategy towards prevetig ad maagig o-commuicable diseases i Vauatu - particularly whe we kow that risk ca be modified by effective policy ad prevetative itervetios. The survey cofirms that raised blood glucose ad high blood pressure are prevalet but at the same time, also provides ecouragig evidece that certai risk factors are ot as prevalet as observed i other Pacific Islads coutries, such as tobacco smokig ad the use of alcohol. The fidigs suggest existig prevetio strategies should be maitaied ad further expaded while policy actios are developed to facilitate a multisectoral whole-of-coutry respose i scalig up a core set of itervetios to tackle NCDs. Of cocer was the fidig that smokig was already preset before the age of survey iclusio, highlightig the eed for effective health promotio ad disease prevetio activities amog youger people. Whe compared to the 1998 Vauatu NCD Survey Report the obvious chage is i the icreased prevalece of diabetes, although the authors of the 1998 NCD Survey raised the potetial of samplig error. Usig the same defiitios, the prevalece of diabetes appears to have icreased from 2.8 i 1998 to 21.2 i Obesity icreased from 15.9 to 18.8 ad was particularly oticeable for wome, icreasig from19.6 to The followig recommedatios are outlied as priority actios for Vauatu: Based o the fidigs of this NCD risk factor survey, a umber of recommedatios have bee idetified for govermet, the Miistry of Health ad stakeholders. They are outlied i detail i the discussio ad coclusios sectio of the report ad summarized here. It is recommeded that the govermet develop a atioal NCD policy respose that positios NCD itervetios at the highest level of the developmet ageda ad that support is give to the implemetatio of the policy actios through political commitmet ad resource mobilizatio. The Miistry of Health is called o to take a lead role i the coordiatio of a multi-sectoral NCD prevetio ad cotrol strategy that egages relevat stakeholders ad icludes efforts to expad screeig, iitiate early diagosis ad treatmet, ad stregthe NCD maagemet to prevet major complicatios, disability ad premature deaths. Close collaboratio betwee staff withi the Miister of Health is eeded to achieve this ad to esure system support for NCD itervetios at all levels of health care ad especially at primary level. Also eeded is adequate staffig withi the Miistry, essetial techology ad medicies, health fiacig, health facility capacity, referrals ad support for health iformatio. Reciprocally, improved delivery of essetial NCD itervetios will stregthe the delivery of health services i all areas. It is also recommeded that the Miistry of Health establish, lead ad maitai a fuctioal surveillace system to moitor essetial NCD data i a ogoig ad systematic way so that Vauatu is able to measure chages i the NCD disease burde over time. The system should iclude the collectio of relevat mortality ad morbidity data so that Vauatu is able to measure progress agaist the global goal of reducig premature (betwee ages 30 ad 70 years) deaths by 25 by As part of the surveillace system, ogoig atioal NCD STEPS surveys are recommeded every five to seve years, supplemeted by mii STEPS surveys every two years to determie the effectiveess, or otherwise, of NCD prevetio ad cotrol measures. Fially, Vauatu is ecouraged to make this data available for coutry comparisos ad to participate i reviewig iter-coutry itervetios so that best-practice approaches for NCD prevetio ad cotrol ca be adopted. 13

15 1. INTRODUCTION 1.1 Backgroud ad Ratioale I all coutries across the globe, regardless of size or stage of ecoomic developmet, ocommuicable diseases (NCDs) are resposible for a high proportio of death ad disability. I developig coutries, the burde of disease caused by NCDs is icreasig rapidly ad there are sigificat social, ecoomic, ad health cosequeces for these coutries. The 2004 Global Burde of Disease study cocluded for the world that cardiovascular diseases were resposible for the largest proportio of NCD deaths uder the age of 70 (39), followed by cacers (27). Chroic respiratory diseases, digestive diseases ad other NCDs were together resposible for approximately 30 of deaths, ad diabetes was resposible for 4 (WHO 2008). WHO (2004) have stated that behavioural risk factors, icludig tobacco use, physical iactivity, ad uhealthy diet, are resposible for about 80 of coroary heart disease ad cerebrovascular disease. The 2010 Global status report o ocommuicable diseases (WHO 2011) stated that i low- ad middle-icome coutries, 29 of NCD deaths occur amog people uder the age of 60, compared to 13 i high-icome coutries. Based o curret treds, by the year 2020 these diseases are predicted to accout for 73 of deaths ad 60 of the world s disease burde (WHO NCD Surveillace Strategy 2012). These icreases are cosistet with the epidemiological trasitio from predomiatly commuicable to ocommuicable causes of death ad disease. Uless the rise i NCD morbidity ad mortality ca be reversed the disability ad depedecy that accompaies NCDs will cotiue to be a major burde o families, health facilities ad atios. STEPS surveys are iteded to be repeated periodically with the same methodology. This 2011 survey provides a baselie to assist i determiig the directios of risk factor behaviour chages ad the effectiveess, or otherwise, of NCD prevetio ad cotrol measures over time. I the immediate term, this STEPS report provides iformatio to iform people about the risks of their cosumptio of tobacco, alcohol ad uhealthy foods ad levels of physical activity. It also provides evidece for atioal policy developmet i areas where populatio health gais ca be made by actio both withi ad outside the health sector: by improvig food productio ad availability; regulatig trade ad advertisig; ad providig educatio ad ifrastructure to support healthier choices by groups ad idividuals. 1.2 The Natioal Cotext Vauatu has bee ihabited for over 4000 years ad first came ito brief cotact with Europeas i 1606, followed by James Cook i 1774 ad the Frech ad Eglish missioaries, traders, ad black birders who took local people as slaves to work i the sugar cae platatios i Australia. After some 74 years of joit "Codomiium" rule betwee Britai ad Frace, Vauatu received idepedece o the 30th July Geography The Vauatu govermet web site describes Vauatu as a archipelago of approximately 83 islads situated i the South-wester Pacific Ocea, about 1,750 kilometres east of Australia ad 500 kilometres ortheast of New Caledoia. The Republic of Vauatu lies betwee latitude 130 south ad 230 south ad logitude 1660 east ad 1720 east. The total lad area is approximately 12,200 square kilometres ad the territorial waters cover 450,000 square kilometres Populatio ad Livig Eviromet The 2009 Cesus of Populatio ad Housig reported the total populatio of Vauatu as 234,023 i November 2009, 75 of whom lived i rural areas. The populatio has grow from 187,000 i 1999 with a growth rate of 2.3 per aum. I 1999, 39 of the populatio were aged less tha 15 14

16 years, 19 were aged years, years ad 6 >60 years. The majority populatio is Melaesia (95). The livig eviromet of Vauatu is a tropical seasoally wet ad dry climate where subsistece farmig ad fishig have sustaied Ni-Vauatu 1 for geeratios Govermet, Culture ad the Ecoomy The Republic of Vauatu is a parliametary republic formerly kow as the New Hebrides. O December 1994, the 11 Local Govermet Coucils were coverted ito 6 semi-autoomous provices (Malampa, Peama, Sama, Shefa, Tafea, Torba) uder the cotrol of the atioal Govermet. The capital is located at Port Vila o Efate Islad. The atioal govermet admiisters the atio s 13 govermet miistries. The Vauatu Miistry of Health (MOH) web pages states the MoH is guided by the Health Sector strategy (HSS) ( ) which defies our visio for the developmet of the health sector i the coutry. It provides broad objectives ad the strategies to be employed i meetig them. The culture of Vauatu is predomiatly Melaesia ad aimist with strog traditios of acestral likages betwee the lad ad people. Cla allegiaces are strog ad social structure patrilieal or matrilieal depedig o your locatio i the archipelago. There are over 100 laguages spoke. Christiaity has provided a more recet overlay of moder religio but is iterpreted through similarities to aciet cultural beliefs. The ecoomy of Vauatu is based o rural small-scale agriculture, which provides a livig for the bulk of the rural populatio. Fishig, tourism ad offshore fiacial services are importat compoets of the ecoomy. Mieral deposits are thought to be egligible. Tax reveues come maily from import duties. Ecoomic developmet is limited by exports depedet o fluctuatig world prices (copra, beef, cocoa, timber, kava ad coffee) ad the log distaces from markets Nocommuicable Disease, Health Status ad Health Ifrastructure I 2000 the Secretariat of the Pacific Commuity (SPC) published the 1998 No-Commuicable Disease Survey Report (Carlot-Tary et al 2000) coducted with the Vauatu Miistry of Health. The sample of 1620 participats was selected from 100 households i each of three radomly selected villages i each provice. While ot directly comparable to the NCD STEPS survey s sample size ad selectio process, the report foud that oe third of all respodets were classified as beig overweight ad a further 15.9 as obese, with obesity more commo amog wome (19.6 as to 12.2 for me). More tha half (51.9) of all wome ad almost a half (45.9) of me were overweight. Thirtee percet of the sample was hypertesive icreasig with age i both males ad females. The prevalece of diabetes was foud to be low at 2.8 of the sample. Males cosumed more alcohol, tobacco ad kava tha wome. The Report stated that i geeral, rates of obese ad overweight coditios, ad hypertesio ad borderlie hypertesio, have icreased sice 1985 by as much as however the rates of diabetes ad impaired glucose tolerace have remaied steady. The World Health Orgaizatio - NCD Coutry Profiles, 2011 states that NCDs are estimated to accout for 70 of all deaths i Vauatu, 36 of which are due to cardiovascular diseases, 13 to other NCDs, 12 to cacers, 6 to respiratory diseases ad 4 to diabetes. NCD services i Vauatu are provided at the primary ad secodary care levels. Ipatiet services are available at all provicial hospitals with specialised care at the 2 referral hospitals i Port Vila ad Lugaville ad specialist Outpatiet Departmet care for follow-up ad the prevetio of disability ad disease progressio. Although the follow-up of these patiets ca be made at the primary level, the health system has ot built sufficiet capacity to provide the essetial care required. However, with the recet itroductio of the cocept of the Package of Essetial NCD itervetios (PEN) at the primary care level, the Miistry is optimistic that better care ad referrals for NCD patiets at Health Cetre ad Dispesary levels ca be provided. The impetus for the 1 This term deotes atioals or citizes of Vauatu, particularly those of Melaesia origi. 15

17 Miistries work i these areas comes from commitme ts made at the Pacific Miisters for Health meetig 1995 as part of the Yauca Isladss Declaratio to revitalise of Primary Health Care ad uphold the visio of Healthy Islads. 1.3 Developig WHO STEPS Survey i Vauatu The survey was coducted by the Vauatu Miistry of Health betwee August ad October 2011, with techical support provided by Vauatu Natioal Statisticss Office ad the World Health Orgaizatio. 2. OBJECTIVES The overall aim of the NCD STEPS risk factor survey was to ivestigate the prevalece of key NCDs ad their associated risk factors. Specifically, the STEPS survey: Documets the prevalece ad magitude of major modifiable risk factors for NCDs icludig smokig, alcohol cosumptio, poor eatig patters, physical iactivity, obesity, highh blood pressure, raised blood glucose ad cholesterol; ad Compares NCDs ad their risk factors by age ad geder groups. 3. METHODOLOGY 3.1 Survey Structure Vauatu STEPS survey followed a sequetial three-step process as follows (Figure 1): Step 1: A questioaire-based (iterview) survey o tobacco use, alcohol drikig, kava drikig, betel ut use 2, fruit ad vegetable cosumptio, physical activity ad history of raised blood pressure ad diabetes. Step 2: Physical measures of blood pressure, height, weight, ad waist circumferece. Step 3: Biochemical measuress of fastig blood glucose ad total cholesterol. Similar to other STEPSS surveys coducted i the Pacific regio, the Vauatu survey collected core iformatio across the three steps. STEPS stadardized survey methodology was followed (see t/chp/steps/e/). This approach esures thatt Vauatu has available populatio-wide ad represetati ive data for betwee-coutry could add more questios or measuremets to the core questios, comparisos as well as withi-coutry comparisos. I future surveys, Vauatu depedig o local eeds. Figure 1. The WHO STEPwise approach to surveillace of NCDs 2 Due to the low prevalece of betel ut use, data o this behaviour are ot preseted i the mai report but summarized i the Appedix. 16

18 3.2 Survey Samplig Methodology Provicial ad Household Level Samplig The survey used a cluster samplig desig where the primary samplig uit was eumeratio area (EA) ad the secodary samplig uit was households. All 6 provices i Vauatu were icluded i the survey. Oe hudred ad thirtee (113) EAs were radomly selected proportio to the size of the EA from a total of 411 EAs. Forty four (44) households were the radomly selected i each EA proportioal to the umber of households i each EA. The selectio of participats withi each household was doe usig the Kish method. The total umber of households selected by combied Erolmet Areas was 4,972. Figure 2 Vauatu NCD STEPS Survey provice ad household Samples PROVINCE TOTAL HOUSEHOLDS HOUSEHOLDS SELECTED TORBA SANMA 2, PENAMA 1, SHEFA 4,391 1,672 MALAMPA 2, TAFEA 1, TOTAL 13,511 4, Sample Size Calculatio ad Respose Rates The required sample size was calculated as 4972 households o a margi of error of 0.05, a aticipated respose rate of 89 ad with 80 power to detect statistically sigificat differeces betwee six age/sex groups. Accordigly, from the 4,972 selected households 4,649 idividuals aged years participated i STEP 1 ad STEP 2 givig a overall respose rate of 94. The respose rate dropped to 85 for STEP 3 with 4,224 people participatig. 3.4 Data Collectio Procedures The survey was coducted betwee August ad October Survey persoel (see appedix 4) obtaied iformed coset from survey participats ad gave them fastig istructios. I all study areas the same procedure for selectig eligible participats were followed (figure 3). Figure 3: Sequece of data collectio ad statios at the survey base Registratio Statio Iformed Coset obtaied Iterview Statio Waist Circumferece Measuremets Weight Measuremets Height Measuremets Blood pressure Statio Blood Testig Statio Check out ad/or Referral Statio Registratio of Participats Idividual household summary forms ad a household trackig form were used to keep track of the umber of participats. At the registratio statio, survey staff assiged participat ID umbers, cofirmed iformed coset, participats date of birth, fastig status, ad explaied to participats all the steps ivolved i the survey. 17

19 A Survey Team loads a speedboat to get to the islads A truck goes with the survey Step 1 - Behavioural Risk Factors Iterviews All participats completed a face-to-face iterview i which questios were asked o smokig, alcohol cosumptio, betel ut use, fruit ad vegetable cosumptio, physical activity ad history of chroic coditios ad medicatios. Participats were also asked about the umber of years of formal educatio. Resposes were recorded o a paper questioaire. Iterviews take place uder trees Step 2 - Physical Measuremets Traied survey staff coducted the physical measuremets followig the recommeded STEPwise protocols. The OMRON M4 Digital Automatic Blood Pressure Moitor was used to measure restig blood pressure. Blood pressure was measured three times; the first readig followed by two more measuremets take with 2-3 miute itervals i betwee. The three readigs of the blood pressure were recorded, ad the average of the secod ad third readigs was used i the aalysis. LEFT: A commuity school provides a classroom to facilitate field work. RIGHT: Data collectio i progress 18

20 Height ad weight were measured oce usig the Seca Leicester Height Measure to the earest 0.1 cm ad the Siltec PS500L to the earest 0.1 kg, respectively. Participats were measured without shoes ad wearig oly light clothig. Waist circumferece was measured oce usig the Figure Fider costat tesio tape ad recorded to the earest 0.1 cm. Waist circumferece was ot measured for pregat wome Step 3 - Biochemical Measuremets The survey icluded assessmets of fastig blood glucose ad fastig total cholesterol. Participats fasted from 10:00pm the previous ight. Testig commeced at 6.00am the followig morig, whe capillary blood samples were draw usig the method of figer prick. Skilled urse checks fastig blood glucose ad cholesterol behid truck i the middle of bush Check-out Statio ad Referral Participats who were idetified as beig at high risk of developig, or with, advaced chroic coditios were referred for a follow-up cliical examiatio. 3.5 Data Maagemet ad Aalyses Data Etry Submitted questioaires were checked radomly by Team Leaders ad Supervisors to assess overall quality of data collectio ad completeess. Data etry was coducted by the data etry team at the Miistry of Health office usig EpiData software cofigured for double data etry Data Weightig ad Aalysis Post-stratificatio weights were calculated usig populatio projectios based o Vauatu 2009 cesus of the populatio aged years i 10 year age groups followig the stadard age group reportig for WHO STEPS surveys. This weightig adjusted for certai age/sex stratum beig either over-represeted or uder-represeted i the survey data. Weighted sample meas were computed for cotiuous variables. Frequecy distributios were calculated usig weighted frequecies for categorical variables. For both weighted frequecy estimates ad weighted meas, 95 cofidece itervals were reported by 10-year age groups ad geder. With support from the WHO Office i Suva, the WHO Office i Geeva performed fial data cleaig, data weightig, ad aalysis. Data aalyses were coducted usig the EpiIfo 2002 Versio The WHO Office i Suva compiled the Data Book a comprehesive summary of all data collected as part of the survey (see appedix) Statistical Sigificace The data are reported alogside their cofidece itervals. A statistically sigificat differece is achieved whe the mea value of oe measure is ot icluded withi the cofidece itervals of the measure to which it is compared. 19

21 4. RESULTS 4.1 Characteristics of Survey Populatio The study icluded 4,649 (94 respose rate) Ni-Vauatu aged years. Te year age groups follow the stadard age group reportig for WHO STEPS surveys. A smaller umber of 4,272 participated i STEP 3. Table 1 presets the age ad geder distributio of the survey sample. A similar umber of me ad wome were surveyed i all age groups except for the oldest age group, where wome were fewer tha me. Table 1 ad geder of study populatio group ad sex of respodets Me Wome Both Sexes N N Table 2 presets the mea years of educatio of the survey respodets. Me reported a margially higher mea umber of years of educatio tha wome: 6.9 years ad 6.4 years respectively. For both geders, the yougest age group (25-34 years) reported the highest mea years of educatio (7.5), while the oldest age group (55-64 years) reported the lowest ad a year loger for me (5.5 years) tha for wome (4.4 years). Table 2 Mea umber of years of educatio by geder ad age group Mea umber of years of educatio Me Wome Both Sexes N Mea N Mea Mea Tobacco Use Tobacco use was measured by askig participats if they curretly smoke tobacco products. Respodets were categorized ito the followig smokig status categories: Curret smokers those who had smoked ay tobacco product (such as cigarettes, cigars or rolled tobacco) i the past 12 moths; o o Daily smokers those who smoke ay tobacco product every day; No-daily smokers those curret smokers who do ot smoke o a daily basis; No-smokers those who had ever smoked. Table 3 shows that 23.7 of all respodets were curret smokers, 45.8 of me ad 4.0 of wome. This major differece betwee the sexes i smokig behaviour exceeded te-fold i all age groups except the group, which had the highest proportio of curret smokers amog wome (6.2). 20

22 Table 3 Percetage of curret smokers i the study populatio by geder ad age group Percetage of curret smokers Me Wome Both Sexes N Curret Curret smoker smoker Curret smoker Table 4 shows that 26.5 of male respodets had ever smoked ad a further 27.7 had smoked i the past (past smokers). Oe-quarter (24.6) of male participats smoked o a daily basis ad almost oe third (32.6) of me aged years were daily smokers. The proportio of daily smokers was lower i the age group but the proportio of o-daily smokers was the same as me aged years suggestig that a reasoable umber of me i this age group quit (see correspodigly higher proportio of past smokers). Table 4 Curret smokig status amog me i the study populatio by age group Smokig status Me Curret smoker No-smokers N Nodaily smoker smoker Past Never Daily Table 5 shows that 80.2 of wome respodets had ever smoked ad a further 15.8 were past smokers. Curret smokers (4.1) comprised the balace, of whom, 1.6 smoked o a daily basis. The highest proportio of both daily (2.1) ad o-daily smokers (4.2) were i the yougest age group, decreasig i age groups ad decreasig further i age group I the yougest age group (25-34) the combied proportios of past smokers (21.2) ad curret smokers (6.3) idicates that a quarter of the group had tried smokig at a youg age. Table 5 Curret smokig status amog wome i the study populatio by age group Smokig status Wome Curret smoker No-smokers N Nodaily smoker smoker Past Never Daily Table 6 presets the prevalece of daily smokers, o-daily smokers ad o-smokers for me ad wome combied. Overall, 23.7 of respodets were smokers (12.4 daily ad 11.3 o-daily) ad 76.3 were o-smokers (54.9 ever smoked ad 21.4 were past smokers). The highest proportio of daily smokers i both sexes was i age group

23 Table 6 Curret smokig status amog both sexes i the study populatio by age group Smokig status Both Sexes Curret smoker No-smokers N Nodaily smoker Past Never Daily smoker Table 7 shows that, amog curret daily smokers, the mea age of startig smokig was 20.2 years for me ad 21.0 years for wome. That the age of smokig uptake has falle is suggested by the lowest reported mea age of started smokig (18.8 years) occurrig i me i the yougest age group, comprisig 46 of the sample of curret smokers. Table 7 Mea age started smokig amog curret daily smokers Mea age started smokig Me Wome Both Sexes N Mea age N Mea age Mea age N to small to report figures Table 8 shows that amog curret daily smokers overall, the mea umber of years of smokig was 15.6 years. Me ad wome reported similar mea duratios of smokig (15.6 to 15.7 years). The mea umber of years (9.8) of smokig amog the yougest age group (25-34) of me idicates that may curret smokers had commeced smokig i teeage years. Table 8 Mea umber of years of smokig amog curret daily smokers Mea duratio of smokig Me Wome Both Sexes Mea Mea 95 Mea N N duratio duratio CI duratio N to small to report figures Table 9 shows that maufactured cigarettes 52.2 were the most commo cigarettes smoked by curret daily smokers, particularly by wome (50.2 of me ad 80.7 of wome) ad that age had little impact o choice util the oldest age group. Almost half of me curret smokers i all age groups, ad over two thirds i the oldest age group, smoked alteratives to maufactured cigarettes ad these were predomiatly had-rolled cigarettes ad pipes. 22

24 Table 9 Percetage of curret daily smokers who smoke maufactured cigarettes Maufactured cigarette smokers amog daily smokers Me Wome Both Sexes Maufactured cigarette smoker Maufactured cigarette smoker Maufactured cigarette smoker N to small to report figures 4.3 Alcohol Cosumptio This sectio describes patters of alcohol cosumptio. Respodets were asked if they ever cosumed alcohol ad, if so, the frequecy ad quatity of alcohol cosumed. Those who had cosumed a alcoholic drik i the past 30 days were classified as curret drikers. Tables summarise the prevalece of alcohol cosumptio amog me, wome ad both geders combied. Table 10 shows a quarter (22.3) of males reported beig lifetime abstaiers from alcohol while oly 11.9 were classified as curret drikers; with the highest proportio of curret drikers beig amog me aged years (17.3). Table 10 Percetage of alcohol cosumptio amog me durig the past 12 moths by age group Lifetime Abstaier Alcohol cosumptio status Past 12 moths abstaier Me (drak i past 12 moths but ot curret driker) Curret driker (drak i past 30 days) I compariso, Table 11 shows sigificatly lower alcohol cosumptio by wome, as 71.9 of wome reportig beig lifetime abstaiers ad oly 2.4 of wome were classified as curret drikers. 23

25 Table 11 Percetage of alcohol cosumptio amog wome durig the past 12 moths by age group N Lifetime Abstaier Alcohol cosumptio status Past 12 moths abstaier Wome (drak i past 12 moths but ot curret driker) Curret driker (drak i past 30 days) CI Table 12 shows that almost half (48.8) of the combied sample reported beig lifetime abstaiers, aother 31.2 had abstaied for the past 12 moths ad oly 6.8 were classified as curret drikers. Table 12 Percetage of alcohol cosumptio amog both sexes durig the past 12 moths by age group N Lifetime Abstaier Alcohol cosumptio status Both Sexes Past 12 moths abstaier (drak i past 12 moths but ot curret driker) Curret driker (drak i past 30 days) Table 13 ad 14 preset iformatio o curret drikers by the frequecy (umber of drikig days) of alcohol cosumptio, quatity of driks cosumed (umber of driks o ay drikig day) ad the proportio that drak more tha 20 alcohol driks i the past 7 days. Table 13 shows that over a fifth (21.9) of male drikers cosumed 5 or more driks o ay drikig day ad 4.9 drak 20 or more driks over the 7 day period. The highest proportio that drak 5 or more stadard driks (i.e. bige drikig for males) o ay day was i the years age group (32.2). 24

26 Table 13 Frequecy ad quatity of driks cosumed by male drikers i the last 7 days Frequecy ad quatity of driks cosumed i the last 7 days Me Drak o 4+ driks o driks i 7 days ay day days Table 14 shows that amog female drikers 15.2 cosumed 4 or more driks, ( bige drikig for females) o ay drikig day ad 5.7 drak 15 or more driks over the 7 day period. The highest proportio that drak 4 or more stadard driks o ay day was i the years age group (18.0). Table 14 Frequecy ad quatity of driks cosumed by female drikers i the last 7 days Frequecy ad quatity of driks cosumed i the last 7 days Wome Drak o 4+ driks o driks i 7 days ay day days Note small sample size for older age groups Tables 15 ad 16 preset iformatio o the umber of stadard driks cosumed per drikig day by curret drikers ad show that heavy drikig is more commo amog me tha wome across all age groups with 27.1 of the me cosumig more tha 6 stadard driks o a drikig day compared to 14.2 of the wome; ad a average of 5.5 stadard driks o a drikig day, compared to 3.8 for wome. The largest percetage of those drikig 6+ stadard driks o a drikig day was by 29.9 of male curret drikers i the age group followed by 26.4 i the age group. Table 15 Number of driks per drikig day amog male drikers by age group 1 drik Number of stadard driks cosumed o a drikig day 2-3 drik s 4-5 drik s Me 6+ driks Mea # of stadard driks

27 Table 16 shows that almost oe third (31.2) of female curret drikers cosumed 4 or more driks o a drikig day, while female drikers i all age groups averaged 3.8 stadard driks o a drikig day. The heaviest alcohol cosumptio amog wome was i the years age group. Table 16 Number of driks per drikig day amog female drikers by age group 1 drik Number of stadard driks cosumed o a drikig day 2-3 driks Wome 4-5 driks 6+ driks Mea # of stadard driks Note small sample size for older age groups Table 17 shows that curret drikers, of both sexes ad all ages, drik a average of 5.1 stadard driks o a drikig day; ad that the percetage drikig 6+ driks was 27.1 of the age group years, followed by 24.8 of those i age group years. Table 17 Number of driks per drikig day amog both sexes of curret drikers by age group 1 drik Number of stadard driks cosumed o a drikig day Both Sexes driks driks drik s Mea # of stadar d driks Kava Cosumptio Table 18 shows the percetage of kava drikers i the study populatio. Kava is the crushed root of the Piper Methysticum plat traditioally druk ceremoially but icreasigly cosumed as a social drik i Kava Bars ad homes. Table 18 shows that 41.8 of both sexes cosumed kava; more amog me (68.1) tha wome (18.3). Table 18 Percetage of kava drikers i the study populatio Percetage of kava drikers Me Wome Both Sexes 95 Drik 95 Drik Drik CI Kava CI Kava Kava ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± CI 26

28 Table 19 shows the relatioship betwee smokig ad drikig kava amog kava drikers, ad idicates that 53.1 of kava drikers of both sexes also smoke while drikig, more so amog me (63.7) tha wome (17.9). Table 19 also shows that it is amog the yougest age group, for both me ad wome, that smokig while drikig kava is most likely to occur. Table 19 Percetage smokig while drikig kava i the study populatio Percetage smokig while drikig kava Me Wome Both Sexes N Smoker CI Smoker CI Smoker CI ± ± ± ± ± ± ± ± ± ± ± ± ± ± ±3.2 Table 20 shows that me o average cosumed kava o twice as may occasios over the past 30 days tha wome (15.8 occasios for me compared to 7.6 occasios for wome). Table 20 Mea umber of occasio s kava was cosumed over the past 30 days Mea umber of occasios cosumed kava Me Wome Both Sexes Mea N Mea Mea ± ± ± ± ± ± ± ± ± ± ± ± ± ± ±0.8 Table 21 shows that o average me cosumed early twice the umber of bowls of kava o a drikig occasio (5.4 bowls) tha wome (3.2 bowls) i all age groups. Table 21 Mea umber of bowls of kava cosumed o each occasio Mea umber of bowls of kava cosumed Me Wome Both Sexes Mea N Mea N Mea ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± Itake of Fruit ad Vegetables Respodets fruit ad vegetable itake was assessed by askig how may days they cosumed fruit ad vegetables i a typical week, ad how may servigs of each they cosumed o oe of those days. Table 22 shows that me reported margially higher mea days of fruit cosumed i a typical week (4.0 days) tha wome (3.7 days) overall ad across all age groups. 27

29 Table 22 Mea umber of days i a week fruits cosumed by sex ad age group N Mea umber of days fruit cosumed i a typical week Me Wome Both Sexes Mea Mea Mea umber N umber umber of days of days of days Table 23 shows that me reported margially higher mea days of vegetable cosumptio i a typical week (5.6 days) tha wome (5.5 days) overall although the differece is ot sigificat i ay age group. Table 23 Mea umber of days i a week vegetables cosumed by geder ad age group Mea umber of days vegetables cosumed i a typical week Me Wome Both Sexes Mea Mea Mea umber N umber umber of days of days of days Tables 24 ad 25 show the mea umber of servigs of fruit ad vegetables per day durig a typical week. Table 24 shows that, overall, respodets reported a average of 1.9 to 2 servigs of fruit per day fairly cosistetly across all age groups. Table 24 Mea umber of servigs of fruits cosumed o a day whe fruits were eate Mea umber of servigs of fruit o average per day Me Wome Both Sexes Mea Mea Mea umber umber umber of of of servigs servigs servigs Table 25 shows that respodets reported a average of just over 3 servigs of vegetables per day relatively cosistetly across all age groups, although margially less amog females aged years. 28

30 Table 25 Mea umber of servigs of vegetables cosumed o a day whe vegetables were eate Mea umber of servigs of vegetables o average per day Me Wome Both Sexes Mea Mea Mea umber umber umber of of of servigs servigs servigs Table 26 shows the mea umber of servigs of fruit ad vegetables o a average day. Overall, respodets reported a average daily cosumptio of 4.9 servigs of fruit ad vegetables relatively cosistetly across all age groups. Table 26 Mea umber of combied servigs of fruit ad vegetables cosumed per average day Mea umber of servigs of fruit ad/or vegetables o average per day Me Wome Both Sexes Mea Mea Mea umber umber umber of of of servigs servigs servigs Table 27 shows that 61.8 of respodets of both geders ad all age groups cosumed less tha five servigs of fruit ad vegetables o a average day, higher amog wome (65) tha me (58.2) ad with wome i age group presetig the highest proportio (67) of those eatig less tha 5 servigs of fruit ad vegetables per average day. Table 27 Percetage who cosumed less tha five combied servigs of fruit ad vegetables per average day Less tha five servigs of fruit ad vegetables o average per day Me Wome Both Sexes < five < five < five servigs servigs servigs per day per day per day

31 4.6 Physical Activity Measuremets Respodets were asked how ofte (frequecy) ad how log (duratio) they egaged i three domais of physical activity i a typical week: work-related, trasport-related ad leisure-related. I the work ad leisure domais, respodets were asked how may days per week ad how may hours/miutes per day they participate i moderate ad vigorous itesity activities. I the trasport domai, respodets were asked how ofte ad how log they either walk ad/or cycle to ad from places Aalysis The three physical activity domais were first examied separately to determie the mea miutes of activity per day udertake i each domai. Furthermore, takig all domais ito accout, mea miutes of total activity were computed, as well as three overall levels of activity: low, moderate, ad high. Below, we first preset overall levels of activity, the mea miutes of total activity per day, ad fially mea miutes of activity per day for each domai separately. To accout for the differet levels of eergy expediture required for the activities (i.e. moderate ad vigorous), the daily duratio of activity was coverted ito METmiutes per day. The term MET (metabolic equivalet) is used as a idicatio of the itesity of physical activity. A MET is the ratio of the associated metabolic rate for a specific activity divided by the restig metabolic rate. The eergy cost of sittig is equivalet to a restig metabolic rate of 1 MET. I this report, as i all STEPS Reports, the followig MET values were allocated to the three physical activity domais: Moderate physical activity (work ad leisure domai) = 4.0 METS Vigorous physical activity (work ad leisure domai) = 8.0 METS Travel related walkig/cyclig = 4.0 METS The followig levels of activity i terms of METmiutes were defied as: Low activity: Moderate activity: High activity: <600 METmiutes per week METmiutes per week >1500 METmiutes per week Levels of Physical Activity Table 28 shows that whe physical activity, doe as part of work, trasport ad leisure time are combied, 10.1 of me reported a low level of total physical activity. Just over 8 (8.3) of me were moderately active, ad a high level of physical was reported by The proportios of low ad moderate total physical activity icreased i age group as the high level of total physical activity decreased ad further decreased i age group Table 28 Categories of total physical activity amog me by age group Level of total physical activity Me Low High Moderate

32 Table 29 shows that whe physical activity, doe as part of work, trasport ad leisure time are combied, 13.2 of wome reported a low level of total physical activity. Moderate physical activity was reported by 19.9 of wome ad a high level of physical was reported by The proportio of low total physical activity decreased i age group as the level of high activity icreased, while the proportios reportig a moderate level of physical activity varied little. A high level of total physical activity decreased i the age group Table 29 Categories of total physical activity amog wome by age group Level of total physical activity Wome Low High Moderate Table 30 shows that whe physical activity, doe as part of work, trasport ad leisure time are combied, 11.7 of the sample reported a low level of total physical activity. Moderate physical activity was reported by 14.4 ad a high level of physical was reported by The proportios reportig a moderate level of physical activity icreased i age group ad icreased further i age group A high level of total physical activity decreased margially i the age group ad further decreased i age group Table 30 Categories of total physical activity amog both sexes by age group Level of total physical activity Both Sexes Low High Moderate Table 31 presets the mea miutes of total physical activity across all three domais i miutes per day by sex ad age. Overall, respodets reported a average of miutes per day spet i total physical activity. There was a statistically sigificat geder differece with me egaged i physical activity for a mea of miutes per day, ad wome for a mea of miutes per day. Table 31 Level of total physical activity (mea miutes per day) by geder ad age group Mea miutes of total physical activity o average per day Me Wome Both Sexes Mea Mea Mea N miutes miutes miutes Tables preset results o mea miutes per day egaged i work-related, trasport- related ad recreatio-related physical activity separately. 31

33 Table 32 shows that work-related physical activities comprised miutes/day for me ad miutes/day for wome. Across age groups me reported egagig i sigificatly more miutes of work-related physical activity tha wome except for the age group. Table 32 Level of work-related physical activity (mea miutes per day) by geder ad age group Mea miutes of work-related physical activity o average per day Me Wome Both Sexes Mea Mea Mea miutes miutes miutes Table 33 shows that trasport-related physical activities comprised 57.5 miutes/day for me ad 39.8 miutes/day for wome. Across all age groups me reported egagig i more miutes/day of trasport related physical activity tha wome. Table 33 Level of trasport-related physical activity (mea miutes per day) by geder ad age group Mea miutes of trasport-related physical activity o average per day Me Wome Both Sexes Mea Mea Mea miutes miutes miutes Table 34 shows that recreatio-related physical activities comprised 40.6 miutes/day for me, sigificatly more tha the 21.9 miutes/day for wome. I all age groups me reported egagig i more miutes/day of recreatio related physical activity tha wome. Table 34 Level of recreatio-related physical activity (mea miutes per day) by geder ad age group Mea miutes of recreatio-related physical activity o average per day Me Wome Both Sexes Mea Mea Mea N miutes miutes miutes History of raised blood pressure ad diabetes Participats were asked if a doctor or health worker had diagosed them with raised blood pressure i the last 12 moths (table 35). Overall, 3.7 of participats reported that they had bee diagosed as havig raised blood pressure, higher amogst wome (4.5) tha me (2.8). Of this group, 33.6 reported curretly takig blood pressure drugs prescribed by a doctor or health worker ad 11.3 reported curretly takig a herbal or traditioal remedy for high blood pressure (see data 32

34 book). The most commoly received lifestyle advice received from a doctor or health worker was to reduce salt (82.7 of participats reported receivig this advice). Table 35 Proportio of participats reportig beig diagosed by a doctor or health worker as havig raised blood pressure i the last 12 moths Raised blood pressure diagosed by doctor or health worker i last 12 moths Me Wome Both Sexes diagosed diagosed diagosed Participats were also asked if a doctor or health worker had diagosed them with diabetes i the last 12 moths (table 36) ad what treatmets they were takig. Overall 1.9 of participats reported beig diagosed by a doctor or health worker as diabetic i the last 12 moths ad of those, 34.4 reported curretly takig isuli, 46.2 reported curretly takig oral drugs, ad 6.2 reported curretly takig herbal or traditioal treatmets (see data book). The most commo advice received from doctors or health workers was to start or do more exercise (81.1) ad to have a special prescribed diet (80.8). Table 36 Proportio of participats reportig beig diagosed by a doctor or health worker as havig diabetes i the last 12 moths Diabetes diagosed by doctor or health worker i last 12 moths Me Wome Both Sexes diagosed diagosed diagosed Overweight ad Obesity Height ad Weight The height ad weight of each participat was measured followig the stadardized STEPS protocol. The body mass idex (BMI) of each participat was computed by dividig the weight (kilograms) by the square of the height (metres 2 ). BMI risk categories are defied as follows: Uderweight BMI < 18.5 kg/m 2 Normal weight 18.5 BMI 24.9 kg/m 2 Overweight BMI 25.0 kg/m 2 Obese BMI 30.0 kg/m 2 Tables 37 ad 38 show that me, o average, were sigificatly taller ad heavier (167.8 cm ad 72.2kg) tha wome (158.7cm ad 67.6kg). I both geders, height varied little across age groups. Amog both me ad wome, weight peaked i the year group (75.5kg ad 70.6kg) respectively. 33

35 Table 37 Mea height (cm) by geder ad age group Mea height (cm) Me Wome Mea Mea Table 38 Mea weight (kg) by geder ad age group Mea weight (kg) Me Wome Mea Mea Body Mass Idex (BMI) Categories Table 39 presets the mea BMI scores for both sexes, idividually ad combied. The overall mea BMI was 26.1kg/m 2. Wome had a higher mea BMI (26.7kg/m 2 ) tha me (25.5 kg/m 2 ) ad i all age groups. The mea BMI for both me ad wome was highest i the years age group. Table 39 Mea body mass idex (kg/m 2 ) by geder ad age group Mea BMI (kg/m 2 ) Me Wome Both Sexes N Mea Mea Mea Tables 40, 41 ad 42 preset the proportio of the sample populatio i three BMI classificatios - uderweight, ormal ad overweight (icludes obese) for me, wome ad both geders combied. Table 40 shows that 45.5 of me are classified as overweight, 53.6 as ormal ad 0.8 as uderweight. Table 40 BMI classificatios amog me by age group BMI classificatios Uderweight <18.5 Normal weight Me Overweight

36 Table 41 shows that 55.9 of wome are classified as overweight, 41.5 as ormal ad 2.7 as uderweight. Table 41 BMI classificatios amog wome by age group Uderweight <18.5 BMI classificatios Wome Normal weight Overweight Table 42 shows that the proportio of males ad females combied classified as beig overweight was 50.9, as ormal 47.3 ad 1.8 as uderweight. Table 42 BMI classificatios amog both geders by age group BMI classificatios Both Sexes Uderweight weight weight Normal Over- < Table 43 presets the rates of obesity (BMI 30 kg/m 2 ) for both sexes, idividually ad combied. The overall prevalece of obesity was The obesity rate was sigificatly higher amog wome (23.3) tha amog me (13.9). The highest prevalece of obese wome (32.4) ad me (23.1) was i the years age group. Table 43 Percetage of obesity (BMI 30) by geder ad age group Me Wome Both Sexes N Obese Obese Obese Waist Circumferece Waist circumferece was assessed as a measure of cetral obesity. Table 44 shows the mea waist circumferece for both me ad wome, that wome had a margially higher mea waist circumferece (79.7cm) tha me (75cm), that mea waist circumferece i me varied more tha i wome ad was highest i age group i both sexes ad i females aged Waist circumfereces of greater tha 88 cm i wome ad 102cm i me are geerally idicative of cetral adiposity ad greater cardiovascular disease risk. 35

37 Table 44 Mea waist circumferece (cm) by geder ad age group Waist circumferece (cm) Me Wome Mea N Mea Blood Pressure As part of the STEP 2 protocol, all survey participats had their blood pressure measured. Participats were also asked if they had had their blood pressure measured i the last 12 moths, withi the last 1-5 years or loger, whether they had ever bee told i the last 12 moths by a health worker that they had high blood pressure, ad if they were curretly receivig ay medical treatmet for raised blood pressure. The STEPs protocol reports the presece of raised blood pressure to iclude people with: a systolic pressure of 140 mmhg, whether or ot they had previously bee told by a health worker that they had high blood pressure, OR a diastolic pressure of 90 mmhg, whether or ot they had previously bee told by a health worker that they had high blood pressure, OR ormal systolic ad diastolic pressures (i.e. ormotesive) AND who were curretly receivig ati-hypertesive medicatio, whether or ot they had previously bee told by a health worker that they had raised blood pressure. Those participats who reported havig bee previously told by a health worker that they had raised blood pressure, but who were ormotesive ad NOT o ati-hypertesive medicatio, were NOT icluded amog those cosidered to have raised blood pressure. Table 45 presets mea restig systolic ad Table 46 mea restig diastolic blood pressures for both geders, idividually ad combied. Table 45 shows a higher mea systolic blood pressure i males tha i females (131.7 mmhg ad mmhg respectively), icreasig with age i both sexes, particularly i females, where the mea i age group years margially exceeded that of males. Table 45 Mea restig systolic blood pressure (mmhg) by geder ad age group Mea systolic blood pressure (mmhg) Me Wome Both Sexes Mea N Mea Mea Table 46 shows o sigificat differece i mea diastolic blood pressure betwee males ad i females (79.8 mmhg ad 79.2 mmhg respectively), icreasig with age i both geders util age years where it decreased margially i males ad icreased i females, both remaiig above the sample mea. 36

38 Table 46 Mea restig diastolic blood pressure (mmhg) by geder ad age group Mea diastolic blood pressure (mmhg) Me Wome Both Sexes N Mea N Mea Mea Table 47 presets the prevalece of raised blood pressure i the sample, cosistet with the above defiitio. Raised blood pressure was foud i 30.8 of me ad 26.7 of wome ad 28.6 overall. The prevalece of raised blood pressure icreased with icreasig age i both me ad wome. From age group of to age group years, hypertesio amog me more tha doubled (22.4 to 52.6) ad hypertesio amog wome icreased almost five-fold (12.0 to 57.8). Table 47 Percetage with raised blood pressure (SBP 140 ad/or DBP 90 or curretly o medicatio for raised blood pressure) SBP 140 ad/or DBP 90 mmhg or curretly o medicatio for raised blood pressure Me Wome Both Sexes N N Fastig Blood Glucose Participats who took part i step 3 of the survey were asked if they had bee told by a health worker i the previous 12 moths that they had diabetes, withi 1-5 years or loger, ad whether they were curretly receivig medical treatmet for diabetes. To measure fastig blood sugar levels, capillary whole blood was draw usig the figer prick method. Estimates of raised blood glucose prevalece were computed based o the capillary whole blood glucose test results ad by followig the WHO guidelies for defiig ad classifyig diabetes mellitus. fastig capillary whole blood value of glucose greater tha or equal to 6.1 mmol/l ( 110 mg/dl) whether or ot they had previously bee told by a health worker that they had diabetes, OR ormal capillary whole blood value of glucose less tha 6.1 mmol/l (<110 mg/dl) AND who were curretly receivig ati-diabetes medicatio prescribed by a health worker. Those participats who had bee advised by a health worker that they had diabetes but who had ormal fastig blood glucose, ad who were NOT o ati-diabetes medicatio or o a special diet prescribed by a health worker, were NOT icluded amog those cosidered as havig raised blood glucose. Table 48 summarizes results o mea fastig blood glucose for both geders idividually ad combied. The overall mea fastig blood glucose was 5.7 mmol/l. Me ad wome retured similar mea fastig glucose levels (5.7 mmol/l). For both me ad wome, mea fastig blood glucose levels icreased with icreasig age ad peaked i the oldest age groups. 37

39 Table 48 Mea fastig blood glucose i mmol/l by geder ad age group Mea fastig blood glucose (mmol/l) Me Wome Both Sexes Mea Mea Mea Table 49 shows the prevalece of raised blood glucose for both sexes idividually ad combied. The overall prevalece was The prevalece of raised blood glucose was similar i both me ad wome. More tha oe fifth of the sample from age had raised blood glucose; icreasig to a quarter of both me ad wome aged ad to a third of wome aged years. Table 49 Prevalece of raised blood glucose by geder ad age group Raised blood glucose or curretly o medicatio for diabetes ** Me Wome Both Sexes ** capillary whole blood value: 6.1 mmol/l (110 mg/dl) 4.11 Total Cholesterol Cosistet with STEPs protocol, for elevated total cholesterol, a cut-off poit 5.0 mmol/l (or 190 mg/dl) was used to classify participats as beig i a high-risk group for coroary artery disease. Table 50 shows the overall mea cholesterol levels for both sexes idividually ad combied. The overall mea was 4.9 mmol/l, similar for me (5.0 mmol/l) ad wome (4.9 mmol/l) ad with little variace across age groups from age years. Table 50 Mea total cholesterol (mmol/l) by geder ad age group Mea total cholesterol (mmol/l) Me Wome Both Sexes Mea N Mea Mea Table 51 shows the proportio of the sample with raised blood cholesterol for both geders idividually ad combied. Over a third of the sample (36.5) had raised total cholesterol, a greater proportio of me tha wome (38.4 ad 34.7 respectively) ad particularly i age group where half of both me ad wome (46.2 ad 49.1 respectively) had raised total cholesterol. 38

40 Table 51 Percetage with raised cholesterol ( 5.0 mmol/l or 190 mg/dl) Total cholesterol 5.0 mmol/l or 190 mg/dl Me Wome Both Sexes N Te year risk of a cardiovascular evet Usig the WHO ad Iteratioal Society for Hypertesio (ISH) charts developed for the Wester Pacific Regio as part of the Package of Essetial NCD itervetios for low resource coutries, 3 absolute risk of a fatal or o-fatal cardiovascular evet was determied based o participats: geder; age (i the rage years); smokig status (curret smoker, yes or o); systolic blood pressure (SBP rage = mmhg); diabetes prevalece (raised blood glucose 6.1 mmol/l capillary whole blood value or curretly o medicatio for diabetes) ad; total blood cholesterol (with a rage of 2 12 mmol/l). Table 52 shows the 10-year risk of a fatal or o-fatal cardiovascular evet for me. Overall, 3.9 of me aged years had a 30 risk of a fatal or o-fatal cardiovascular evet i the ext 10 years. Those at highest risk were me aged years with 11.4 havig a 30 risk of a fatal or o-fatal cardiovascular evet i the ext 10 years. Table 52 Percetage of me with <10, 10-<20, 20-<30, 30-<40 ad 40 risk of a fatal or o-fatal cardiovascular evet i the ext 10 years 10-year risk of a fatal or o-fatal cardiovascular evet Me <10 <20 <30 <40 CI Table 53 shows the 10-year risk of a fatal or o-fatal cardiovascular evet for wome. Overall, ad similar to me, 3.6 of wome aged years had a 30 risk of a fatal or o-fatal cardiovascular evet i the ext 10 years. Ulike me however, the age group that had the highest proportio of wome with a 30 risk of a fatal or o-fatal cardiovascular evet i the ext 10 years was the year old decile (5.5). 3 World Health Orgaizatio. Package of Essetial Nocommuicable (PEN) Disease Itervetios for Primary Health Care i low-resource Settigs. World Health Orgaizatio

41 Table 53 Percetage of wome with <10, 10-<20, 20-<30, 30-<40 ad 40 risk of a fatal or o-fatal cardiovascular evet i the ext 10 years 10-year risk of a fatal or o-fatal cardiovascular evet Wome <10 40 <20 <30 < Table 54 shows the 10-year risk of a fatal or o-fatal cardiovascular evet for both sexes. Overall 3.6 of participats had a 30 risk of a fatal or o-fatal cardiovascular evet i the ext 10 years. The proportio of participats above this level of risk icreased i a step-wise fashio across the three age groups. Table 54 Percetage of me ad wome with <10, 10-<20, 20-<30, 30-<40 ad 40 risk of a fatal or o-fatal cardiovascular evet i the ext 10 years 10-year risk of a fatal or o-fatal cardiovascular evet Both Sexes <10 40 <20 <30 CI <40 CI DISCUSSION AND CONCLUSIONS Comparisos betwee early NCD risk factor surveys ad this oe idicate that NCDs are slowly takig hold i Vauatu. That said, NCD risk factors are ot as prevalet i Vauatu as they are i other Pacific coutries. For example, the 2010 Global Status Report o NCDs idicates the prevalece of obesity i the Cook Islads, Nauru, Samoa ad Toga is over 50 ad over 30 i Fiji ad the Solomo Islads. 4 This may idicate that Vauatu is at a earlier stage i the epidemiological trasitio tha other Pacific Islads Coutries. However, tobacco use amog me, hypertesio, high blood glucose ad cholesterol should be flagged as areas for priority actio. Vauatu ca be proud of a log history of moitorig NCDs. Moitorig is ow the key to maitaiig some cotrol over the chagig coditios cotributig to populatio health, icludig the availability of fruit ad vegetables, the licesig ad regulatio of products that impact adversely o health, health educatio campaigs o the outcomes of risky behaviours, particularly amog youg people who still have the potetial to avoid NCDs by chagig their behaviours. Such chage will eed to occur i a maer that is sesitive to the prevailig social, ecoomic ad cultural eviromets of Vauatu. The Vauatu STEPS survey presets fidigs relevat to progressig atioal policy ad activity towards prevetig o-commuicable diseases i Vauatu. The survey has provided strog evidece that NCDs are prevalet i Vauatu ad has idetified related risk factors to be modified by policy ad related prevetative actios. At the same time, the report also provides ecouragig evidece that Vauatu culture is resistig or rejectig some kow risk factors, such as tobacco smokig ad the use of alcohol. The data suggests a policy respose to support the abstaiers ad to celebrate those who have give-up. 4 World Health Orgaizatio. Global Status report o ocommuicable diseases Wolrd Health Orgaizatio

42 Yet the data also idicate that the behavioural risks to public health start at a youg age ad are already available ad tried before the age of survey, presetig a eed for effective health promotio ad disease prevetio activities amog youger people, particularly to prevet diabetes reachig higher levels as it has doe elsewhere i the Pacific regio. Cocurretly, the eed to respod to the prevetable aspects of NCDs requires a sigificat social ad health service respose. The key stregth of the survey is its size ad its represetativeess of the populatio as a whole. However, it should be oted whe iterpretig the fidigs that the behavioural risk factor data were collected from self-reports ad, as such, the prevalece of some risk factors may be over or uderestimated. It is possible for example that reportig of physical activity was over-estimated ad also, if fastig protocols were ot strictly adhered to, blood glucose levels may also be overestimated. Fially the assessmet of absolute CVD risk relies o estimates of several risk factors ad may uderestimate risk for the Vauatu populatio. 6. RECOMMENDATIONS The followig recommedatios are outlied as priority actios for Vauatu: Overarchig high level atioal policy directios That the govermet: 1.1 Develops a atioal NCD respose policy that positios NCD itervetios at the highest level of the atioal developmet ageda; 1.2 Supports the implemetatio of the NCD policy through political commitmet ad resource mobilizatio that applies a whole-of-govermet ad multi-sectoral approach i the fight agaist NCDs; 1.3 Establishes ad supports the ecessary legal frameworks to steer the implemetatio of atioal NCD policy ad plas; 1.4 Commuicates this policy to other govermet miistries, agecies ad stakeholders to leverage support ad resources for the implemetatio of operatioal plas ad strategies for NCD prevetio ad cotrol; 1.5 Aligs atioal NCD strategies with iteratioal frameworks ad covetios, such as the WHO Framework of Covetio o Tobacco Cotrol (FCTC), ad with the atioal priority actio ageda (PAA). Advocacy ad Dissemiatio of NCD STEPS Survey Fidigs That the Miistry of Health: 1.6 Values the fidigs of the 2011 NCD STEPS Survey ad uses the publicatio of this report as a tool to stregthe a atio-wide NCD cotrol programme with clear targets ad focus; 1.7 Uses survey fidigs to develop targeted NCD itervetios focused o risk factor reductios; 1.8 Takes lead role i the coordiatio of a multi-sectoral pla to egage relevat stakeholders i the fight agaist NCDs; 1.9 Collaborates with other govermet departmets, developmet parters, doors ad civil society orgaizatios to reder support for a multi-sectoral actio, ad to build o existig iter-agecy programmes for example health promotig schools i school settigs; 1.10 Collaborate with media orgaizatios to develop a multi-media commuicatio strategy aimed at creatig advocacy, awareess, educatio ad behaviour chage for NCD prevetio ad cotrol. 41

43 Actios for NCD Prevetio: addressig risk factors: That the govermet addresses smokig, alcohol ad kava cosumptio: 1.11 Eforces the legal frameworks ad regulatory mechaisms to reduce tobacco use ad smokig by reviewig the curret status of tobacco laws, legislatio ad law eforcemet; 1.12 Reviews taxes o the importatio ad sale of tobacco products; 1.13 Eforces existig regulatios o sale of tobacco to youg people; 1.14 Supports atioal ati-smokig campaigs ad cessatio programs targeted at both active ad passive smokers, with particular emphasis o teeagers; 1.15 Eforces the legal frameworks ad regulatory mechaisms to reduce alcohol cosumptio by reviewig the curret status of alcohol laws, legislatio ad law eforcemet; 1.16 Reviews taxes o the importatio ad sale of alcohol. Reviews the effect of kava cosumptio ad its impact o health, social, ad ecoomic well-beig of idividuals, families ad atio. That the govermet addresses healthy lifestyle related to healthy diet ad physical activity: 1.17 Develops a food security ad utritio policy that outlies regulatory frameworks, eforcemet ad compliace; ad which icorporates a review of food importatio to miimize a egative impact o NCD ad risk factors; 1.18 Supports local food productio ad marketig of local produce that icreases availability ad affordability of local foods which will i tur promote cosumptio of local foods, especially fruits ad vegetables; 1.19 Explores the itroductio of a food price idex for food products especially locally produced food items; 1.20 Supports the implemetatio of a salt reductio strategy to reduce salt itake ad its uwated effect o high blood pressure; 1.21 Promotes health educatio campaigs ad advocacy to icrease public awareess of healthy diet ad the adverse effects of excessive cosumptio of uhealthy food products; 1.22 Supports lifelog healthy eatig behaviours from exclusive breast feedig from birth ad healthy ifat feedig practices; 1.23 Establishes physical activity- ad health-eatig friedly eviromets usig healthy settigs approach ad egagig all age groups for example, healthy commuities, healthy workplaces, healthy schools. Actios for maagemet of patiets: screeig, early diagosis, treatmet ad prevetio of premature death That the Miistry of Health through its service delivery mechaisms: 1.24 Udertakes a well-developed pla for NCD screeig, early diagosis ad iitiatio of treatmet; 1.25 Stregthes the health care system to effectively respod to NCD maagemet through provisio of supplies ad medicies to sustai patiet treatmet ad referrals, both at hospital level ad through a effective primary health care system; 1.26 Stregthes commuity-based care of idividuals with diagosed NCDs by supportig primary care facilities to deliver the package of essetial NCD itervetios. This requires appropriately traied health workers, essetial techology ad medicies made available at all levels of the health care system; 42

44 1.27 Prevets NCD-related disability ad premature deaths due to NCDs by provisio of quality patiet care to prevet early complicatios. Actios for NCD Surveillace: That the Miistry of Health: 1.28 Establishes ad maitais a fuctioal surveillace system to moitor essetial NCD data i a ogoig ad systematic way as a essetial compoet of the Health Iformatio System, i order to measure NCD disease burde ad treds over time; 1.29 Establishes the curret baselie for NCDs mortality ad morbidity i lie with requiremets to report o the Pacific regioal goal to reduce NCD premature deaths by 25 by 2025; 1.30 Establishes strog leadership to maitai a systematic approach to STEPS data collectio, buildig o local capacity for implemetig the STEPS survey i order to create a ogoig ad robust surveillace system; 1.31 Coducts NCD STEPS surveys at 5 to 7 year itervals supplemeted by mii STEPS (ie surveys i workplaces ad/or with high risk groups) every 2 years to determie the effectiveess, or otherwise, of NCD prevetio ad cotrol measures; 1.32 Participates i the compariso of NCD STEPS survey fidigs across all Pacific islad coutries that have completed the NCD STEPS survey, ad review iter-coutry itervetios that are most ameable to modificatio; 43

45 Appedices Appedix 1 Betel Nut Use Table A1 shows that 98.2 of the male respodets were abstaiers from chewig betel ut with a egligible proportio of 0.2 beig daily chewers amog the age group. O these fidigs, rates of betel ut use i Vauatu are miimal. Aecdotal evidece suggests a small rise i Betel ut use i the far orth of Vauatu close to the Solomo Islads where Betel ut is i commo usage. Betel ut has bee show to have a harmful ad potetially carciogeic effect o the gums. Table A1 Percetage of curret betel ut chewers amog me by age group Chewig status Me Curret chewer Does N Nodaily Daily ot chew Table A2 shows that early all females do ot chew betel ut, with a small proportio of o-daily chewers i older age. Table A2 Percetage of curret betel ut chewers amog wome by age group Chewig status Wome Curret chewer Does N Nodaily Daily ot chew Table A3 shows that betel ut chewig was almost o-existet i both sexes of the sample populatio. Table A3 Percetage of curret betel ut chewers amog both sexes by age group Chewig status Both Sexes Curret chewer Does Nodaily Daily ot chew

46 Appedix 2 Vauatuu STEPS Survey Questioaire Natioal STEPSS Survey Questioaire for NCD Risk Factors Vauatu 2011 Miistry of Health Survey Iformatio Locatio ad Date Respose Code 1 EA No I1 2 Islad ame I2 3 Iterviewer ID I3 4 Date of completio of the questioaire dd mm year I4 Participat Id Number Coset, Iterview Laguage ad Name 5 Coset has bee read ad obtaied 6 Iterview Laguage Respose Yes No 1 2 If NO, END Bislama Eglish 1 2 Other 3 Code I5 I6 7 Time of iterview (24 hour clock) : hrs mis I7 8 9 Family Surame First Name I8 I9 10 Cotact phoe umber wheree possible I10 Record ad file idetificatio iformatio (I5 to I10) separately from the completed questioaire. 45

47 Demographic Iformatio Demographic Iformatio Questio Respose Code 11 Sex (Record Male / Female as observed) Male 1 Female 2 C1 12 What is your date of birth? Do't Kow How old are you? Years I total, how may years have you spet at school or i full-time study (excludig preschool)? What is the highest level of educatio you have completed? 16 What is your ethic backgroud? 17 What is your marital status? 18 Which of the followig best describes your mai work status over the past 12 moths? If kow, Go to C4 dd mm year Years No formal schoolig 1 Less tha primary school 2 Primary school completed 3 Secodary school completed 4 College/Uiversity completed 5 Post graduate degree 6 Refused 88 Ni-Vauatu 1 Part Ni-Vauatu 2 Other Pacific islad coutries ad areas 3 Other 4 Refused 88 Never married 1 Curretly married 2 Separated 3 Divorced 4 Widowed 5 Cohabitatig 6 Refused 88 Govermet employee 1 No-govermet employee 2 Farmer 3 Self-employed 4 No-paid 5 Studet 6 Homemaker 7 Retired 8 Uemployed (able to work) 9 Uemployed (uable to 10 work) Refused 88 C2 C3 C4 C5 C6 C7 C8 19 How may people older tha 18 years, icludig yourself, live i your household? Number of people C9 46

48 Demographic Iformatio, Cotiued Questio Respose Code Takig the past year, ca you tell me what the average earigs of the household have bee? (RECORD ONLY ONE, NOT ALL 3) If you do t kow the amout, ca you give a estimate of the mothly household icome if I read some optios to you? Is it (READ OPTIONS) Per week Go to T1 OR per moth Go to T1 C10a C10b OR per year Go to C10c T1 Refused 88 C10d 14,400vt 1 More tha 14,400vt 2 More tha 27,000vt t 3 More tha 41,300vt t t More tha 63,100vt 5 Do't Kow 77 Refused 88 C11 Step 1 Behavioural Measuremets Tobacco Use Now I am goig to ask you some questios about various health behaviours. This icludes thigs like smokig, drikig alcohol, eatig fruits ad vegetables ad physical activity. Let's start with tobacco. Questio Respose Code 22 Have you ever smoked tobacco products? 23 Do you curretly smoke ay tobacco products? Yes No 1 Yes 1 2 If No, go to X1 No 2 If No, go to T6 T1a T1 24 Do you curretly smoke tobacco products daily? Yes 1 No 2 If No, go to T6 T2 25 How old were you whe you first started smokig daily? Do t kow 77 If Kow, go to T5a T3 Do you remember how log ago it was? I Years If Kow, go to T4a 26 (RECORD ONLY 1, NOT ALL 3) OR i Moths If Kow, go to T4b Do t kow 77 OR i Weeks T4c 27 O average, how may of the followig do you smoke each day? (RECORD FOR EACH TYPE, USE SHOWCARD) Do t Kow 77 Maufactured cigarettes Had-rolled commercial cigarettes Had-rolled traditioal cigarettes Pipes full of tobacco Cigars, cheroots, cigarillos T5a T5b T5c T5d T5e 47

49 Other If Other, go to T5other, else go to T6 T5f 28 I the past, did you ever smoke daily? Other (please specify): Go to T9 Yes 1 No 2 If No, go to T9 T5other T6 29 How old were you whe you stopped smokig daily? Do t Kow 77 If Kow, go to T9 T7 How log ago did you stop smokig daily? Years ago If Kow, go to T9 T8a (RECORD ONLY 1, NOT ALL 3) Do t Kow 77 Durig the past 7 days, o how may days did someoe i your home smoke whe you were preset? Durig the past 7 days, o how may days did someoe smoke i closed areas i your workplace (i the buildig, i a work area or a specific office) whe you were preset? OR OR Moths ago Weeks ago Number of days Do't kow 77 Number of days Do't kow or do't work i a closed area 77 If Kow, go to T9 T8b T8c T9 T10 Betel Nut Use Questio Respose Code 33 Do you curretly chew betel ut? 34 If Yes, Do you curretly chew betel uts daily? 35 Whe you chew, how may uts o average do you chew at oe time? 36 O average, how may times each day do you chew? Betel Nut with Tobacco 48 Yes No Yes No Number of Betel Nuts Times per day 1 2 If No, go to A1a 1 2 Questio Respose Code Do you curretly chew betel ut with Tobacco? Do you curretly chew betel ut with Tobacco daily? Durig the past 30 days, how may occasios did you chew betel ut with Tobacco? Yes No Yes No Number of times Do't Kow If No, go to A1a 1 2 Alcohol Cosumptio The ext questios ask about the cosumptio of alcohol. Questio Respose Code 40 Have you ever cosumed a alcoholic drik such as beer, home brew, wie or spirits? Yes No 1 2 If No, go to X8 X1 X2 X3 X4 X5 X6 X7 A1a

50 Have you cosumed a alcoholic drik withi the past 12 moths? Durig the past 12 moths, how frequetly have you had at least oe alcoholic drik? (READ RESPONSES) Have you cosumed a alcoholic drik withi the past 30 days? Yes No 1 2 If No, go to X8 Daily days per week days per week days per moth 4 Less tha oce a moth 5 Yes 1 No 2 If No, go to X8 A1b A2 A Durig the past 30 days, how may occasios did you have at least oe alcoholic drik? Durig the past 30 days, whe you drak alcohol, o average, how may stadard alcoholic driks did you have durig oe drikig occasio? Durig the past 30 days, what was the largest umber of stadard alcoholic driks you had o a sigle occasio, coutig all types of alcoholic driks together? Durig the past 30 days, how may times did you have for me: five or more for wome: four or more stadard alcoholic driks i a sigle drikig occasio? Number Do't kow 77 Number Do't kow 77 Largest umber Do't Kow 77 Number of times Do't Kow 77 A4 A5 A6 A7 Moday A8a Durig each of the past 7 days, how may stadard alcoholic driks did you have each day? Tuesday Wedesday A8b A8c 48 Thursday A8d Do't Kow 77 Friday Saturday A8e A8f Suday A8g Kava Questio Respose Code 49 Have you cosumed kava i the past 30 days? Yes No 1 2 If No, go to D1 X8 50 Durig the past 30 days, how may occasios did you drik kava? Number of times Do't Kow 77 X9 51 O each occasio that you drak kava, how may bowls did you cosume? Number of bowls Do't Kow 77 X10 52 Do you smoke whe you drik kava? Yes No 1 2 If No, go to D1 X11 53 How may tobacco products do you usually smoke durig oe kava drikig occasio? Number of products X12 49

51 54 After drikig kava, do you cotiue with drikig alcohol? Yes No 1 2 X13 Diet The ext questios ask about the fruits ad vegetables that you usually eat. I have a utritio card here that shows you some examples of local fruits ad vegetables. Each picture represets the size of a servig. As you aswer these questios please thik of a typical week i the last year. Questio Respose Code 55 I a typical week, o how may days do you eat fruit? Number of days Do't Kow 77 go to D3 If Zero days, D1 56 How may servigs of fruit do you eat o oe of those days? Number of servigs Do't Kow 77 D2 57 I a typical week, o how may days do you eat vegetables Number of days Do't Kow 77 go to D5 If Zero days, D3 58 How may servigs of vegetables do you eat o oe of those days? Number of servigs Do t kow 77 D4 59 O average, how may meals per week do you eat that were ot prepared at a home? By meal, I mea breakfast, luch ad dier. Number Do t kow 77 D5 60 O average how log does it take to cosume 500g of salt? Number of days Do't Kow 77 If Zero days, go to P1 X Please choose a example that best represets what your biggest meal of the day is made of X Physical Activity Next I am goig to ask you about the time you sped doig differet types of physical activity i a typical week. Please aswer these questios eve if you do ot cosider yourself to be a physically active perso. Thik first about the time you sped doig work. Thik of work as the thigs that you have to do such as paid or upaid work, study/traiig, household chores, harvestig food/crops, fishig or hutig for food, seekig employmet. I aswerig the followig questios 'vigorous-itesity activities' are activities that require hard physical effort ad cause large icreases i breathig or heart rate, 'moderate-itesity activities' are activities that require moderate physical effort ad cause small icreases i breathig or heart rate. Questio Respose Code Work 62 Does your work ivolve vigorous-itesity activity that causes large icreases i breathig or heart rate like [carryig or liftig heavy loads, diggig or costructio work] for at least 10 miutes cotiuously? Yes 1 No 2 If No, go to P 4 P1 50

52 I a typical week, o how may days do you do vigorous-itesity activities as part of your work? How much time do you sped doig vigorous-itesity activities at work o a typical day? Does your work ivolve moderate-itesity activity, that causes small icreases i breathig or heart rate such as brisk walkig [or carryig light loads] for at least 10 miutes cotiuously? I a typical week, o how may days do you do moderate-itesity activities as part of your work? How much time do you sped doig moderate-itesity activities at work o a typical day? Number of days Hours : miutes Number of days Hours : miutes Yes 1 : hrs mis No 2 If No, go to P 7 : P2 P3 (a-b) P4 P5 P6 (a-b) hrs mis Travel to ad from places The ext questios exclude the physical activities at work that you have already metioed. Now I would like to ask you about the usual way you travel to ad from places. For example to work, for shoppig, to market, to place of worship. 68 Do you walk or use a bicycle (pedal cycle) for at least 10 miutes cotiuously to get to ad from places? Yes 1 No 2 If No, go to P 10 P7 69 I a typical week, o how may days do you walk or bicycle for at least 10 miutes cotiuously to get to ad from places? Number of days P8 70 How much time do you sped walkig or bicyclig for travel o a typical day? Physical Activity, Cotiued Hours : miutes : hrs mis P9 (a-b) Questio Respose Code Recreatioal activities The ext questios exclude the work ad trasport activities that you have already metioed. Now I would like to ask you about sports, fitess ad recreatioal activities (leisure). 71 Do you do ay vigorous-itesity sports, fitess or recreatioal (leisure) activities that cause large icreases i breathig or heart rate like [ruig or football] for at least 10 miutes cotiuously? Yes 1 No 2 If No, go to P 13 P10 72 I a typical week, o how may days do you do vigorous-itesity sports, fitess or recreatioal (leisure) activities? Number of days P11 73 How much time do you sped doig vigorous-itesity sports, fitess or recreatioal activities o a typical day? Hours : miutes : hrs mis P12 (a-b) 74 Do you do ay moderate-itesity sports, fitess or recreatioal (leisure) activities that cause a small icrease i breathig or heart rate such as brisk walkig, [cyclig, swimmig, volleyball] for at least 10 miutes cotiuously? Yes 1 No 2 If No, go to P16 P13 75 I a typical week, o how may days do you do moderate-itesity sports, fitess or recreatioal (leisure) activities? Number of days P14 51

53 76 How much time do you sped doig moderate-itesity sports, fitess or recreatioal (leisure) activities o a typical day? Hours : miutes : hrs mis P15 (a-b) Physical Activity Sedetary behaviour The followig questio is about sittig or recliig at work, at home, gettig to ad from places, or with frieds icludig time spet sittig at a desk, sittig with frieds, travelig i car, bus, readig, playig cards or watchig televisio, but do ot iclude time spet sleepig. 77 How much time do you usually sped sittig or recliig o a typical day? Hours : miutes : hrs mis P16 (a-b) History of Raised Blood Pressure Questio Respose Code Have you ever had your blood pressure measured by a doctor or other health worker? Have you ever bee told by a doctor or other health worker that you have raised blood pressure or hypertesio? 80 Have you bee told i the past 12 moths? Yes 1 No 2 If No, go to H6 Yes 1 No 2 If No, go to H6 Yes 1 No 2 Are you curretly receivig ay of the followig treatmets/advice for high blood pressure prescribed by a doctor or other health worker? Drugs (medicatio) that you have take i the past two weeks Yes 1 No 2 H1 H2a H2b H3a Advice to reduce salt itake Yes 1 No 2 H3b 81 Advice to lose weight Yes 1 No 2 H3c Advice or treatmet to stop smokig Yes 1 No 2 H3d Advice to start or do more exercise Yes 1 No 2 H3e 82 Have you ever see a traditioal healer for raised blood pressure or hypertesio? Yes 1 No 2 H4 83 Are you curretly takig ay herbal or traditioal remedy for your raised blood pressure? Yes 1 No 2 H5 History of Diabetes Questio Respose Code 84 Have you ever had your blood sugar measured by a doctor or other health worker? Yes 1 No 2 If No, go to M1 H6 52

54 85 Have you ever bee told by a doctor or other health worker that you have raised blood sugar or diabetes? Yes 1 No 2 If No, go to M1 H7a 86 Have you bee told i the past 12 moths? Yes 1 No 2 Are you curretly receivig ay of the followig treatmets/advice for diabetes prescribed by a doctor or other health worker? Isuli Yes 1 No 2 H7b H8a Drugs (medicatio) that you have take i the past two weeks Yes 1 No 2 H8b 87 Special prescribed diet Yes 1 No 2 H8c Advice to lose weight Yes 1 No 2 H8d Advice or treatmet to stop smokig Yes 1 No 2 H8e Advice to start or do more exercise Yes 1 No 2 H8f 88 Have you ever see a traditioal healer for diabetes or raised blood sugar? Yes 1 No 2 H9 89 Are you curretly takig ay herbal or traditioal remedy for your diabetes? Yes 1 No 2 H10 53

55 Step 2 Physical Measuremets Height ad Weight Questio Respose Code 90 Iterviewer ID 91 Device IDs for height ad weight M1 Height M2a Weight M2b 92 Height i Cetimetres (cm). M3 93 Weight If too large for scale For wome: Are you pregat? Waist 95 Device ID for waist i Kilograms (kg). Yes 1 If Yes, go to M 8 No 2 M4 M5 M6 96 Waist circumferece i Cetimetres (cm) Blood Pressure. M7 97 Iterviewer ID 98 Device ID for blood pressure 99 Cuff size used 100 Readig Readig Readig Durig the past two weeks, have you bee treated for raised blood pressure with drugs (medicatio) prescribed by a doctor or other health worker? 54 Medium 1 Large 2 M8 M9 M10 Systolic ( mmhg) M11a Diastolic (mmhg) Systolic ( mmhg) Diastolic (mmhg) Systolic ( mmhg) Diastolic (mmhg) Yes 1 No Hip circumferece i Cetimeters (cm). M Heart Rate M11b M12a M12b M13a M13b Readig 1 Beats per miute M16a Readig 2 Beats per miute M16b Readig 3 Beats per miute M16c M14

56 Step 3 Biochemical Measuremets Blood Glucose Questio Respose Code 106 Durig the past 12 hours have you had aythig to eat or drik, other tha water? Yes 1 No 2 B1 107 Techicia ID 108 Device ID Time of day blood specime take (24 hour clock) Fastig blood glucose Today, have you take isuli or other drugs (medicatio) that have bee prescribed by a 111 doctor or other health worker for raised blood glucose? Blood Lipids 112 Device ID Total cholesterol Durig the past two weeks, have you bee treated for raised cholesterol with drugs (medicatio) prescribed by a doctor or other health worker? Hours : miutes mmol/l Yes 1 mmol/l No 2 Yes 1 No 2 : hrs mis.. B2 B3 B4 B5 B6 B7 B8 B9 55

57 Appedix 3 Vauatu STEPS Survey Data Book WHO STEPS Chroic Disease Risk Factor Surveillace DATA BOOK VANUATU 56

58 Table of Cotets Table of Cotets Demographic Iformatio Results Tobacco Use Betel Nut Use Alcohol Cosumptio Fruit ad Vegetable Cosumptio Physical Activity Blood Pressure ad Diabetes History Physical Measuremets Biochemical Measuremets Raised Risk

59 Demographic Iformatio Results group by sex Descriptio: Summary iformatio by age group ad sex of the respodets. Istrumet questio: Sex What is your date of birth? group ad sex of respodets Me Wome Both Sexes Ethicity Descriptio: Summary results for the ethicity of the respodets. Istrumet Questio: What is your [isert relevat ethic group/racial group/cultural subgroup/others] backgroud? Ethic group of respodets Both Sexes 3) Other Pacific 1) Ni-Vauatu 2) Part Ni-Va Islader 4) Other

60 Educatio Descriptio: Mea umber of years of educatio amog respodets Istrumet questio: I total, how may years have you spet at school or i full-time study (excludig pre-school)? Mea umber of years of educatio Me Wome Both Sexes Mea Mea Mea Highest level of educatio Descriptio: Highest level of educatio achieved by the survey respodets. Istrumet questio: What is the highest level of educatio you have completed? No formal schooli g Highest level of educatio Me Less tha Primary Primary school comp. Secodary School comp. Uiversity comp. Post graduate degree No formal schooli g Highest level of educatio Wome Less tha Primary Primary school comp. Secodary School comp. Uiversity comp. Post graduate degree

61 No formal schooli g Highest level of educatio Both Sexes Less tha Primary Primary school comp. Secodar y School comp. Uiversity comp. Post graduate degree Employmet status Descriptio: Proportio of respodets i paid employmet ad those who are upaid. Upaid icludes persos who are o-paid, studets, homemakers, retired, ad uemployed. Istrumet questio: Which of the followig best describes your mai work status over the last 12 moths? Employmet status Me Nogovermet Govermet employee employee Farmer Selfemploye d Upaid Employmet status Me Nogovermet Govermet employee employee Farmer Selfemploye d Upaid

62 Employmet status Me Nogovermet Govermet employee employee Farmer Selfemploye d Upaid Upaid work ad uemployed Descriptio: Proportio of respodets i upaid work. Istrumet questio: Which of the followig best describes your mai work status over the last 12 moths? Upaid work ad uemployed Me Uemployed Home- Nopaid Retired Studet Able to Not able maker work to work Upaid work ad uemployed Wome Uemployed Home- Nopaid Retired Studet Able to Not able maker work to work

63 Upaid work ad uemployed Both Sexes Uemployed Home- Nopaid Retired Studet Able to Not able maker work to work Per capita aual icome Descriptio: Mea reported per capita aual icome of respodets i local currecy. Istrumet questio: How may people older tha 18 years, icludig yourself, live i your household? Takig the past year, ca you tell me what the average earig of the household has bee? Mea aual per capita icome Mea Estimated household earigs Descriptio: summary of participat household earigs by quitile. Istrumet questio: If you do't kow the amout, ca you give a estimate of the aual household icome if I read some optios to you? Estimated household earigs Quitile 1: Quitile 2: Quitile 3: Quitile 4: Quitile 5: Uder $... $...-$... $...-$... $...-$... Over $

64 Tobacco Use Curret smokig Descriptio: Curret smokers amog all respodets. Istrumet questios: Do you curretly smoke ay tobacco products, such as cigarettes, cigars, or pipes? Percetage of curret smokers Me Wome Both Sexes 95 Curret Curret Curret CI smoker smoker smoker Smokig Status Descriptio: Smokig status of all respodets. Istrumet questios: Do you curretly smoke ay tobacco products, such as cigarettes, cigars, or pipes? Do you curretly smoke tobacco products daily? Smokig status Me Curret smoker No-smokers Neve Past Nodaily smok r Daily smoker er

65 Frequecy of smokig Descriptio: Percetage of curret daily smokers amog smokers. Istrumet questio: Do you curretly smoke ay tobacco products, such as cigarettes, cigars, or pipes? Do you curretly smoke tobacco products daily? Curret daily smokers amog smokers Me Wome Both Sexes Daily Daily Daily smokers smokers smokers Smokig status Wome Curret smoker No-smokers 95 Past Never Daily Nodaily CI smoker smoker Smokig status Both Sexes Curret smoker No-smokers Past Never Nodaily Daily smoker smoker

66 Maufactured cigarette smokers Descriptio: Percetage of smokers who use maufactured cigarettes amog daily smokers. Istrumet questio: O average, how may of the followig do you smoke each day? Maufactured cigarette smokers amog daily smokers Me Wome Both Sexes Maufactured Mau- Mau- factured factured cigarette cigarette cigarette smoker smoker smoker Amout of tobacco used amog smokers by type Descriptio: Mea amout of tobacco used by daily smokers per day, by type. Istrumet questio: O average, how may of the followig do you smoke each day? (years ) Mea # of mau - factur ed cig. Mea amout of tobacco used by daily smokers by type Mea #of ha d- rolle d cig. Me Mea # of pipe s of toba cco Mea # of other type of tobacco

67 Mea # of maufacture d cig. Mea amout of tobacco used by daily smokers by type Wome 95 CI Mea #of hadrolled cig. 95 CI Mea # of pipes of tobacco 95 CI Mea # of other type of tobacco Mea # of maufactured cig. Mea amout of tobacco used by daily smokers by type Both Sexes Mea #of hadrolled cig. 95 CI Mea # of pipes of tobacco Mea # of other type of tobacc o Iitiatio of smokig Descriptio: Mea age of iitiatio ad mea duratio of smokig, i years, amog daily smokers (o total age group for mea duratio of smokig as age iflueces these values). Istrumet questios: How old were you whe you first started smokig daily? How log ago did you stop smokig daily? Mea age started smokig Me Wome Both Sexes Mea age Mea age Mea age started started started smokig smokig smokig

68 Mea duratio of smokig Me Wome Both Sexes Mea yrs Mea Mea of yrs of yrs of smokig smokig smokig

69 Betel Nut Use Betel Nut Use Descriptio: Percetage of participats who chew betel ut. Betel Nut Use Me Curret User Does ot use Daily Nodaily Betel Nut Use Wome Curret User Does ot use Daily Nodaily Betel Nut Use Both Sexes Curret User Does ot use Daily Nodaily

70 Alcohol Cosumptio Alcohol cosumptio status Descriptio: Alcohol cosumptio status of all respodets. Istrumet questios: Have you ever cosumed alcohol? Have you cosumed alcohol (such as beer, wie, spirits, fermeted cider, or (add other local examples) withi the past 12 moths? Lifetime Abstaier Alcohol cosumptio status Me Past 12 mos. abstaier curret driker (drak i past 12 mos.) Curret driker (drak i past 30 days) Lifetime Abstaier Alcohol cosumptio status Me Past 12 mos. abstaier curret driker (drak i past 12 mos.) Curret driker (drak i past 30 days)

71 Lifetime Abstaier Alcohol cosumptio status Me Past 12 mos. abstaier curret driker (drak i past 12 mos.) Curret driker (drak i past 30 days) Frequecy of alcohol cosumptio Descriptio: Frequecy of alcohol cosumptio i the last year amog those respodets who have drak i the last 12 moths. Istrumet questio: I the past 12 moths, how frequetly have you had at least oe drik? less tha oce a moth Frequecy of alcohol cosumptio i the last 12 moths 1-3 days per moth Me 1-4 days per week 5-6 days per week Daily

72 less tha oce a moth Frequecy of alcohol cosumptio i the last 12 moths 1-3 days per moth Wome 1-4 days per week 5-6 days per week 95 CI Daily less tha oce a moth Frequecy of alcohol cosumptio i the last 12 moths 1-3 days per moth Both Sexes 1-4 days per week 5-6 days per week Daily CI Stadard driks per drikig day Descriptio: Number of stadard driks cosumed o a drikig day amog those respodets who have drak i the last 12 moths. Istrumet questio: Whe you drik alcohol, o average, how may driks do you have durig oe day? 1 drik Number of stadard driks cosumed o a drikig day 2-3 driks Me 4-5 driks 6+ drik s Mea # of stadard driks

73 1 drik Number of stadard driks cosumed o a drikig day 2-3 driks Wome 4-5 driks 6+ drik s Mea # of stadar d driks drik Number of stadard driks cosumed o a drikig day 2-3 driks Both Sexes 4-5 driks 6+ drik s Mea # of stadar d driks Heavy drikig Descriptio: Frequecy ad quatity of driks cosumed i the last 7 days by curret (last 30 days) driker, grouped ito three categories. Istrumet questio: Durig each of the past 7 days, how may stadard driks of ay alcoholic drik did you have each day? Frequecy ad quatity of driks cosumed i the last 7 days Me 20+ Drak 5+ driks o driks o 4+ ay day i 7 days days

74 Frequecy ad quatity of driks cosumed i the last 7 days Wome 15+ Drak 4+ driks driks o 4+ o ay day i 7 days days Frequecy ad quatity of driks cosumed i the last 7 days Both Sexes Drak o 4+ days Hazardous ad harmful drikig Descriptio: Percetage of curret (last 30 days) driker egagig i hazardous ad harmful drikig i the last 7 days. Harmful drikig is defied as 60g of pure alcohol o average per day for me ad 40 g for wome. Hazardous drikig is defied as g of pure alcohol o average per day for me ad g for wome. A stadard drik cotais approximately 10g of pure alcohol. Istrumet questio: Durig each of the past 7 days, how may stadard driks of ay alcoholic drik did you have each day? 73

75 Hazardous ad harmful drikig i the last 7 days Me harmful hazardous drikig drikig Hazardous ad harmful drikig i the last 7 days Wome harmful hazardous drikig drikig

76 Fruit ad Vegetable Cosumptio Mea umber of days of fruit ad vegetable cosumptio Descriptio: mea umber of days fruit ad vegetables cosumed. Istrumet questios: I a typical week, o how may days do you eat fruit? I a typical week, o how may days do you eat vegetables? Mea umber of days fruit cosumed i a typical week Me Wome Both Sexes Mea Mea Mea umber umber umber of days of days of days Mea umber of days vegetables cosumed i a typical week Me Wome Both Sexes Mea Mea Mea umber umber umber of days of days of days

77 Mea umber of servigs of fruit ad vegetable cosumptio Descriptio: mea umber of fruit, vegetable, ad combied fruit ad vegetable servigs o average per day. Istrumet questios: I a typical week, o how may days do you eat fruit? How may servigs of fruit do you eat o oe of those days? I a typical week, o how may days do you eat vegetables? How may servigs of vegetables do you eat o oe of those days? Mea umber of servigs of fruit o average per day Me Wome Both Sexes Mea Mea umber umber of of servigs servigs Mea umber of servigs CI Mea umber of servigs of vegetables o average per day Me Wome Both Sexes Mea Mea Mea umber 95 umber umber of CI of of servigs servigs servigs Mea umber of servigs of fruit ad/or vegetables o average per day Me Wome Both Sexes Mea Mea Mea umber 95 umber umber 95 of CI of of CI servigs servigs servigs

78 Fruit ad vegetable cosumptio per day Descriptio: Frequecy of fruit ad/or vegetable cosumptio. Istrumet questios: I a typical week, o how may days do you eat fruit? How may servigs of fruit do you eat o oe of those days? I a typical week, o how may days do you eat vegetables? How may servigs of vegetables do you eat o oe of those days? Number of servigs of fruit ad/or vegetables o average per day Me o fruit ad/or servig servigs servigs vegetables s Number of servigs of fruit ad/or vegetables o average per day Wome o fruit ad/or vegetables 1-2 servigs 3-4 servigs 5 servigs (years ) Number of servigs of fruit ad/or vegetables o average per day Both Sexes o fruit ad/or vegetable s 1-2 servig s 3-4 servig s 5 servigs

79 Fruit ad vegetable cosumptio per day Descriptio: Percetage of those eatig less tha five servigs of fruit ad/or vegetables o average per day. Istrumet questios: I a typical week, o how may days do you eat fruit? How may servigs of fruit do you eat o oe of those days? I a typical week, o how may days do you eat vegetables? How may servigs of vegetables do you eat o oe of those days? Less tha five servigs of fruit ad/or vegetables o average per day Me Wome Both Sexes < five < five < five servigs servigs servigs per day per day per day

80 Physical Activity Itroductio Aalysis physical activity data ca be very complicated ad the result cofusig. The followig guidelies will help clarify the results of the physical activity data ad will also provide valuable iformatio o the classificatios. Make sure you use some of these guidelies whe you report physical activity data. MET values are applied to vigorous ad moderate itesity variables i the work, trasport ad recreatio domais. These have bee calculated usig a average of the typical types of activity udertake. Differet types of activities have bee grouped together ad give a MET value based o the itesity of the activity. Applyig MET values to types of activities allows us to calculate total physical activity. For more iformatio regardig MET values go the STEPS website at The calculatios below use multiple questios i the physical activity sectio. To simplify this a bit the questios have bee clustered ito four groups (as they appear i the Istrumet). I the Istrumet questios sectio of the table, oly the group label appears. The specific questios for each group are preseted below. Activity at work: Does your work ivolve vigorous-itesity activity that causes large icreases i breathig or heart rate like [examples] for at least 10 miutes cotiuously? I a typical week, o how may days do you do vigorous-itesity activities as part of your work? How much time do you sped doig vigorous-itesity activities at work o a typical day? Does your work ivolve moderate-itesity activity, that causes small icreases i breathig or heart rate such as brisk walkig for at least 10 miutes cotiuously? I a typical week, o how may days do you do moderate-itesity activities as part of your work? How much time do you sped doig moderate-itesity activities at work o a typical day? Travel to ad from places: Do you walk or use a bicycle for at least 10 miutes cotiuously to get to ad from places? I a typical week, o how may days do you walk or bicycle for at least 10 miutes cotiuously to get to ad from places? Cotiued o ext page 79

81 Physical Activity, Cotiued Itroductio (cot.) How much time do you sped walkig or bicyclig for travel o a typical day? Recreatioal activities: Do you do ay ivolve vigorous-itesity sports, fitess or recreatioal activities that cause large icreases i breathig or heart rate like [examples] for at least 10 miutes cotiuously? I a typical week, o how may days do you do vigorous-itesity sports, fitess or recreatioal activities? How much time do you sped doig vigorous-itesity sports, fitess or recreatioal activities o a typical day? Do you do ay ivolve moderate-itesity sports, fitess or recreatioal activities that cause large icreases i breathig or heart rate like [examples] for at least 10 miutes cotiuously? I a typical week, o how may days do you do moderate--itesity sports, fitess or recreatioal activities? How much time do you sped doig moderate--itesity sports, fitess or recreatioal activities o a typical day? Sedetary behaviour : How much time do you usually sped sittig or recliig o a typical day? Levels of total physical activity Descriptio: Percetage of respodets classified ito three categories of total physical activity. Istrumet questios: activity at work travel to ad from places recreatioal activities Level of total physical activity Me Low Moderate High

82 Level of total physical activity Wome Low Moderate High Level of total physical activity Both Sexes Low Moderate High Total physical activitymea Descriptio: Mea miutes of total physical activity o average per day. Istrumet questios activity at work travel to ad from places recreatioal activities Mea miutes of total physical activity o average per day Me Wome Both Sexes Mea Mea Mea miutes miutes miutes

83 Total physical activitymedia Descriptio: Media miutes of total physical activity o average per day. Istrumet questios activity at work travel to ad from places recreatioal activities Media miutes Media miutes of total physical activity o average per day Me Wome Both Sexes Iter-quartile Iter-quartile Media Media rage (P25- rage (P25- miutes miutes P75) P75) Iter-quartile rage (P25- P75) Domaispecific physical activitymea Descriptio: Mea miutes spet i work-, trasport- ad recreatio-related physical activity o average per day. Istrumet questios: activity at work travel to ad from places recreatioal activities Mea miutes of work-related physical activity o average per day Me Wome Both Sexes Mea Mea Mea miutes miutes miutes

84 Mea miutes of trasport-related physical activity o average per day Me Wome Both Sexes Mea Mea Mea miutes miutes miutes Mea miutes of recreatio-related physical activity o average per day Me Wome Both Sexes Mea Mea Mea miutes miutes miutes Domaispecific physical activity - media Descriptio: Media miutes spet o average per day i work-, trasport- ad recreatio-related physical activity. Istrumet questios: activity at work travel to ad from places recreatioal activities Media miutes of work-related physical activity o average per day Me Wome Both Sexes Iterquartile Media quartile Media quartile Iter- Iter- Media miutes rage (P25- miutes rage miutes rage (P25- P75) (P25-P75) P75)

85 Media miutes of trasport-related physical activity o average per day Me Wome Both Sexes Iterquartile Media quartile Media quartile Iter- Iter- Media miutes rage miutes rage miutes rage (P25-P75) (P25-P75) (P25-P75) Media miutes of recreatio-related physical activity o average per day Me Wome Both Sexes Iterquartile Media quartile Media quartile Iter- Iter- Media miutes rage miutes rage miutes rage (P25-P75) (P25-P75) (P25-P75) No physical activity by domai Descriptio: Percetage of respodets classified as doig o work-, trasport- or recreatioal-related physical activity. Istrumet questios: activity at work travel to ad from places recreatioal activities No work-related physical activity Me Wome Both Sexes o o o activity activity activity at work at work at work

86 No trasport-related physical activity Me Wome Both Sexes o o o activity activity activity for for for trasport trasport trasport No recreatio-related physical activity Me Wome Both Sexes o o o activity at activity at activity at recreatio recreatio recreatio Compositio of total physical activity Descriptio: Percetage of work, trasport ad recreatioal activity cotributig to total activity. Istrumet questios: activity at work travel to ad from places recreatioal activities Compositio of total physical activity Me Activity from work Activity for trasport Activity durig leisure time

87 Compositio of total physical activity Wome Activity from work Activity for trasport Activity durig leisure time Compositio of total physical activity Both Sexes Activity from work Activity for trasport Activity durig leisure time No vigorous physical activity Descriptio: Percetage of respodets ot egagig i vigorous physical activity. Istrumet questios: activity at work recreatioal activities No vigorous physical activity Me Wome Both Sexes o o o vigorous vigorous vigorous activity activity activity

88 Sedetary Descriptio: Miutes spet i sedetary activities o a typical day. Istrumet questio: sedetary behaviour Miutes spet i sedetary activities o average per day Me Mea miutes Media miutes Iter-quartile rage (P25-P75) Miutes spet i sedetary activities o average per day Wome Mea miutes Media miutes Iter-quartile rage (P25-P75) Miutes spet i sedetary activities o average per day Both Sexes Mea miutes Media miutes Iter-quartile rage (P25-P75)

89 Blood Pressure ad Diabetes History Blood pressure diagosis ad treatmet Descriptio: Raised blood pressure diagosis ad treatmet results amog all respodets. Istrumet questios: Durig the past 12 moths have you bee told by a doctor or other health worker that you have elevated blood pressure or hypertesio? Are you curretly receivig ay of the followig treatmets/advice for high blood pressure prescribed by a doctor or other health worker? Drugs (medicatio) that you have take i the last 2 weeks? Raised blood pressure diagosed by doctor or health worker i last 12 moths Me Wome Both Sexes diagosed diagosed diagosed Curretly takig blood pressure drugs prescribed by doctor or health worker Me Wome Both Sexes takig takig takig meds meds meds

90 Blood pressure lifestyle advice Descriptio: Percetage of respodets who received lifestyle advice from a doctor or health worker to treat raised blood pressure. Istrumet questio: Are you curretly receivig ay of the followig treatmets/advice for high blood pressure prescribed by a doctor or other health worker? Advised by doctor or health worker to reduce salt itake Me Wome Both Sexes Advised by doctor or health worker to lose weight Me Wome Both Sexes Advised by doctor or health worker to stop smokig Me Wome Both Sexes

91 Advised by doctor or health worker to start or do more exercise Me Wome Both Sexes Blood pressure advice by a traditioal healer Descriptio: Percetage of respodets who have sought advice or received treatmet from traditioal healers for raised blood pressure. Istrumet questios: Durig the past 12 moths have you see a traditioal healer for raised blood pressure? Are you curretly takig ay herbal or traditioal remedy for your high blood pressure? See a traditioal healer i the last 12 moths Me Wome Both Sexes Curretly takig herbal or traditioal remedy for high blood pressure Me Wome Both Sexes

92 Diabetes diagosis ad treatmet Descriptio: Diabetes diagosis ad treatmet results amog all respodets. Istrumet questios: Durig the past 12 moths, have you ever bee told by a doctor or other health worker that you have diabetes? Are you curretly takig ay of the followig treatmets/advice for diabetes prescribed by a doctor or other health worker? Diabetes diagosed by doctor or health worker i last 12 moths Me Wome Both Sexes diagosed CI diagosed CI diagosed Curretly takig isuli prescribed for diabetes by doctor or health worker Me Wome Both Sexes takig takig takig isuli isuli isuli Curretly takig oral drugs prescribed for diabetes by doctor or health worker Me Wome Both Sexes takig takig takig meds meds meds

93 Diabetes lifestyle advice Descriptio: Percetage of respodets who received lifestyle advice from a doctor or health worker to diabetes. Istrumet questio: Are you curretly takig ay of the followig treatmets/advice for diabetes prescribed by a doctor or other health worker? Advised by doctor or health worker to have special prescribed diet Me Wome Both Sexes Advised by doctor or health worker to lose weight Me Wome Both Sexes Advised by doctor or health worker to stop smokig Me Wome Both Sexes Advised doctor or health worker to start or do more exercise Me Wome Both Sexes

94 Diabetes advice by traditioal healer Descriptio: Percetage of respodets who are have sought advice or treatmet from traditioal healers for diabetes. Istrumet questios: Durig the past 12 moths have you see a traditioal healer for diabetes? Are you curretly takig ay herbal or traditioal remedy for your diabetes? See a traditioal healer for diabetes i the last 12 moths Me Wome Both Sexes Curretly takig herbal or traditioal treatmet for diabetes Me Wome Both Sexes

95 Physical Measuremets Height, weight ad BMI Height Weight Descriptio: Mea height, weight, ad body mass idex amog all respodet (excludig pregat wome for weight ad BMI). Istrumet questios: Mea height (cm) Me Wome Mea Mea Mea weight (kg) Me Wome Mea Mea Mea BMI (kg/m 2 ) Me Wome Both Sexes Mea Mea Mea

96 BMI categories Height Weight Descriptio: Percetage of respodets (excludig pregat wome) i each BMI category. Istrumet questios: BMI classificatios Me Overweight Normal Uderweight weight Obese < BMI classificatios Wome Overweight Normal Uderweight weight Obese < Uderweight <18.5 BMI classificatios Both Sexes Normal weight Overweight Obese

97 Waist circumferece Descriptio: Mea waist circumferece amog all respodets (excludig pregat wome). Istrumet questio: Waist circumferece measuremet Waist circumferece (cm) Me Wome Mea Mea Blood pressure Descriptio: Mea blood pressure amog all respodets. Istrumet questio: Readig 1-3 systolic ad diastolic blood pressure Mea systolic blood pressure (mmhg) Me Wome Both Sexes Mea Mea Mea Mea diastolic blood pressure (mmhg) Me Wome Both Sexes Mea Mea Mea

98 Raised blood pressure Descriptio: Percetage of respodets with raised blood pressure. Istrumet questio: Readig 1-3 systolic ad diastolic blood pressure SBP 140 ad/or DBP 90 mmhg Me Wome Both Sexes SBP 160 ad/or DBP 100 mmhg Me Wome Both Sexes

99 Biochemical Measuremets Mea fastig blood glucose Descriptio: mea fastig blood glucose results excludig those curretly o medicatio for diabetes (No-fastig recipiets excluded). Istrumet questios: Are you curretly receivig ay of the followig treatmets for diabetes prescribed by a doctor or other health worker? Isuli? Oral drugs (medicatio) that you have take i the last 2 weeks? Durig the last 12 hours have you had aythig to eat or drik, other tha water? Blood glucose measuremet Mea fastig blood glucose (mmol/l) Me Wome Both Sexes Mea Mea Mea Mea fastig blood glucose (mg/dl) Me Wome Both Sexes Mea Mea Mea

100 Raised blood glucose Descriptio: Categorizatio of respodets ito blood glucose level categories ad percetage curretly o medicatio for raised blood glucose (o-fastig recipiets excluded). Istrumet questios: Are you curretly receivig ay of the followig treatmets for diabetes prescribed by a doctor or other health worker? Isuli? Oral drugs (medicatio) that you have take i the last 2 weeks? Durig the last 12 hours have you had aythig to eat or drik, other tha water? Blood glucose measuremet Impaired Fastig Glycaemia* Me Wome Both Sexes Raised blood glucose or curretly o medicatio for diabetes** Me Wome Both Sexes

101 Curretly o medicatio for diabetes Me Wome Both Sexes * Impaired fastig glycaemia is defied as either plasma veous value: 6.1mmol/L (110mg/dl) ad <7.0mmol/L (126mg/dl) capillary whole blood value: 5.6mmol/L (100mg/dl) ad <6.1mmol/L (110mg/dl) ** Raised blood glucose is defied as either plasma veous value: 7.0 mmol/l (126 mg/dl) capillary whole blood value: 6.1 mmol/l (110 mg/dl) Total cholesterol Descriptio: Mea total cholesterol amog all respodets ad percetage of respodets with raised total cholesterol. Istrumet questio: Total cholesterol measuremet Mea total cholesterol (mmol/l) Me Wome Both Sexes Mea Mea Mea Mea total cholesterol (mg/dl) Me Wome Both Sexes Mea Mea Mea

102 Total cholesterol 5.0 mmol/l or 190 mg/dl Me Wome Both Sexes Total cholesterol 6.2 mmol/l or 240 mg/dl Me Wome Both Sexes

103 Raised Risk Raised risk Descriptio: Percetage of respodets with 0, 1-2, or 3-5 of the followig risk factors: curret daily smoker less tha 5 servigs of fruits & vegetables per day low level of activity (<600 MET -miutes) overweight or obese (BMI 25 kg/m 2 ) raised BP (SBP 140 ad/or DBP 90 mmhg or curretly o medicatio for raised BP). Istrumet questios: combied from Step 1 ad Step 2 Raised Risk Me with 0 with 1-2 with 3-5 risk risk risk factors factors factors Raised Risk Wome with 0 with 1-2 with 3-5 risk risk risk factors factors factors Raised Risk Both Sexes with 0 with 1-2 with 3-5 risk risk risk factors factors factors

104 Appedix 4 NCD STEP Survey Facilitators Miistry of Health STEPS survey coordiatig team at atioal level 1. Le Tarivoda, Director of Public Health 2. Dr Willie Toko, Cliical Services Maager, Vila Cetral Hospital 3. Ady Calo, Statisticia, Natioal Statistics Office 4. Be Garae, STEP Survey Coordiator 5. Jea Jacques Rory, Health Promotio Maager 6. Be Taura, Provicial Health Maager, Shefa Provice 7. Jerry Iaruel, NCD Officer 8. Graham Tabi, Actig NCD Coordiator 9. Marie Woleg, Public health urse/imci 10. Eeth Ilaisa, Actig Nutritio Coordiator 11. Kalli Babcock, Nutritioist/Peace Corp WHO coutry office Support for survey coordiatig team 1. Dr Berard Fabre-Teste, Coutry Liaiso Officer 2. Dr Rufia Latu, Medical Officer, Health Systems Developmet 3. Ms Agria Willie, Secretary Miistry of Health STEPS survey field supervisors ad team leaders i six provices 1. Tafea provice: Saimo Saika, Provicial Health Maager, 2. Sama provice: Jivi Mele, Provicial Health Maager 3. Sama provice: Domiique Laissa, Public Health Nurse 4. Shefa provice: Bill Lacey, Public Health Officer/Peace Corp 5. Malampa provice: Gueola Lessies, NCD Nurse 6. Peama provice: Matheas Tabeva, Provicial Health Maager 7. Torba provice: Frackli Dih, Provicial Health Maager 103

105 Appedix 5 Refereces Carlot-Tary M, Hughes R, Hughes M.C., 1998 Vauatu o-commuicable disease survey report, Techical Paper/Secretariat of the Pacific Commuity 2000, ISBN World Health Orgaizatio, The global burde of disease: 2004 update. Geeva, World Health Orgaizatio, Comparative quatificatio of health risks: Global ad regioal burde of disease attributable to selected major risk factors. Geeva, World Health Orgaizatio, Editors: Global status report o ocommuicable diseases 2010: Descriptio of the global burde of NCDs, their risk factors ad determiats, April 2011, ISBN: NCD Surveillace Strategy 2012, Govermet of Vauatu, 2009 Natioal Cesus of Populatio ad Housig: Summary Release, Vauatu Natioal Statistics Office, Miistry of Fiace ad Ecoomic Maagemet, Port Vila, Vauatu, 31st August 2009 World Health Orgaizatio Nocommuicable disease coutry profiles 2011, ISBN: , Yauca Islads Declaratio o Health i the Pacific i the 21 st Miisters of Health of the Pacific Islad Coutries, 1995 Cetury, Meetig of 104

106 Appedix 6 Key Cotacts Miistry of Health: Le Tarivoda Director of Public Health Miistry of Health PO Box 009 Port Vila Vauatu Tel: (678) Fax: (678) ltarivoda@vauatu.gov.vu World Health Orgaizatio: Dr Coli Bell Techical Officer Nocommuicable Diseases Divisio of Pacific Techical Support/Office for the South Pacific World Health Orgaizatio Plaza Oe, Dowtow Boulevard PO Box 113 Suva, Fiji Islads Tel: (679) Fax: (679) bella@wpro.who.it 105

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