PREVALENCE OF NONCOMMUNICABLE DISEASE RISK FACTORS IN THE REPUBLIC OF MOLDOVA

Transcription

1 PREVALENCE OF NONCOMMUNICABLE DISEASE RISK FACTORS IN THE REPUBLIC OF MOLDOVA STEPS 2013

2 PREVALENCE OF NONCOMMUNICABLE DISEASE RISK FACTORS IN THE REPUBLIC OF MOLDOVA STEPS MINISTERUL SĂNĂTĂȚII AL REPUBLICII MOLDOVA

3 KEYWORDS CHRONIC DISEASE - prevetio ad cotrol HEALTH POLICY HEALTH PROMOTION PHYSICAL ACTIVITY RISK FACTORS Address requests about publicatios of the WHO Regioal Office for Europe to: Publicatios WHO Regioal Office for Europe UN City, Marmorvej 51 DK-2100 Copehage Ø, Demark Tel.: ; Fax: Alteratively, complete a olie request form for documetatio, health iformatio, or for permissio to quote or traslate, o the Regioal Office web site ( pubrequest). World Health Orgaizatio 2014 All rights reserved. The Regioal Office for Europe of the World Health Orgaizatio welcomes requests for permissio to reproduce or traslate its publicatios, i part or i full. The desigatios employed ad the presetatio of the material i this publicatio do ot imply the expressio of ay opiio whatsoever o the part of the World Health Orgaizatio cocerig the legal status of ay coutry, territory, city or area or of its authorities, or cocerig the delimitatio of its frotiers or boudaries. Dotted lies o maps represet approximate border lies for which there may ot yet be full agreemet. The metio of specific compaies or of certai maufacturers products does ot imply that they are edorsed or recommeded by the World Health Orgaizatio i preferece to others of a similar ature that are ot metioed. Errors ad omissios excepted, the ames of proprietary products are distiguished by iitial capital letters. All reasoable precautios have bee take by the World Health Orgaizatio to verify the iformatio cotaied i this publicatio. However, the published material is beig distributed without warraty of ay kid, either express or implied. The resposibility for the iterpretatio ad use of the material lies with the reader. I o evet shall the World Health Orgaizatio be liable for damages arisig from its use. The views expressed by authors, editors, or expert s do ot ecessarily represet the decisios or the stated policy of the World Health Orgaizatio. 2

4 CONTENTS GLOSSARY... 5 FOREWORD... 6 ACKNOWLEDGEMENTS... 8 LIST OF CONTRIBUTORS... 9 EXECUTIVE SUMMARY BACKGROUND NONCOMMUNICABLE DISEASE (NCDS) WORLDWIDE NCDS IN THE REPUBLIC OF MOLDOVA PREVALENCE OF NCD RISK FACTORS IN THE REPUBLIC OF MOLDOVA SURVEY GOAL AND OBJECTIVES SURVEY GOAL SURVEY OBJECTIVES RATIONALE FOR THE SURVEY SURVEY METHODOLOGY SURVEY DESIGN SURVEY POPULATION AND SAMPLING ETHICAL CONSIDERATION DATA COLLECTION PROCESS SURVEY RESULTS DEMOGRAPHIC INDICATORS TOBACCO USE ALCOHOL CONSUMPTION DIET

5 PHYSICAL ACTIVITY HISTORY OF RAISED BLOOD PRESSURE HISTORY OF DIABETES HISTORY OF RAISED CHOLESTEROL CVD HISTORY LIFESTYLE ADVICE CERVICAL CANCER SCREENING PHYSICAL MEASUREMENTS BIOCHEMICAL MEASUREMENTS CVD RISK SUMMARY OF COMBINED RISK FACTORS HEALTH CARE RECAP AND CONCLUSIONS REFERENCES ANNEX 1 WHO STEPS SURVEY 2013 FACT SHEET ANNEX 2 WHO STEPS INSTRUMENT FOR CHRONIC DISEASE RISK FACTOR SURVEILLANCE (SURVEY INFORMATION QUESTIONNAIRE) ANNEX 3 WHO STEPS SURVEY 2013 DATA BOOK

6 GLOSSARY BMI CI CVD DALY DBP GPAQ IFG HDL HPV MET MICS NCD PDA PSU SSU SBP STEPS VIA WHR body mass idex cofidece iterval cardiovascular disease disability-adjusted life year diastolic blood pressure Geeral Physical Activity Questioaire impaired fastig glycaemia high-desity lipoprotei huma papillomavirus metabolic equivalet Multiple Idicator Cluster Surveys umber of respodets ocommuicable disease persoal digital assistat primary samplig uit secodary samplig uit systolic blood pressure WHO STEP-wise approach to surveillace visual ispectio with acetic acid waist hip ratio 5

7 FOREWORD Nocommuicable diseases are the leadig cause of death at global, regioal ad atioal levels. Six out of 10 deaths at global level ad eight out of 10 deaths i the WHO Europea Regio are caused by ocommuicable diseases. The ocommuicable disease death rates i the Republic of Moldova are similar to those of the WHO Europea Regio. Prevalece of this of diseases i the coutry is also very high; more tha half of the populatio suffer from ocommuicable diseases, icludig cardiovascular diseases, cacer, chroic respiratory diseases, digestive diseases ad diabetes. The burde of ocommuicable disease is udermiig the social ad ecoomic developmet of the coutry. The health ad fiacial costs of ocommuicable diseases to the idividuals, families, health system, ad ecoomy are sigificat ad growig. Without adequate prevetio of the commo risk factors ad early idetificatio of ocommuicable diseases, these costs will icrease for Moldova society. To respod to the growig burde of ocommuicable disease, the Uited Natios Political Declaratio of the High-level Meetig of the Geeral Assembly o the Prevetio ad Cotrol of No-commuicable Diseases was edorsed by the heads of state ad govermet i May 2011, followed by the edorsemet of the WHO Global Actio Pla for the Prevetio ad Cotrol of NCDs by the World Health Assembly. The Govermet of the Republic of Moldova recogized the impact of ocommuicable diseases ad reaffirmed its commitmet to tackle them ad their risk factors. To realize these commitmets, Moldova s Parliamet adopted i 2012 the Natioal Strategy for the Prevetio ad Cotrol of NCDs, ad a umber of targeted programmes were edorsed by the Govermet, such as the Natioal Programme o Diabetes Prevetio ad Cotrol (2011), the Natioal Programme o Tobacco Cotrol (2012), the Natioal Programme o Alcohol Cotrol (2012), ad the Natioal Programme o Cardiovascular Disease Prevetio ad Cotrol (2014). Two additioal programmes are uder way a Natioal Food ad Nutritio Programme ad a Natioal Cacer Cotrol Programme. All atioal strategies ad programmes aim to implemet specific actios at atioal ad local levels, ad provide a comprehesive, whole-of-govermet approach as well as promotig whole-of-society ivolvemet through the collaboratio of academics, ogovermetal orgaizatios, service providers, commuities ad idividuals. Developmet ad implemetatio of health policies require high-quality ad disaggregated data at atioal level to uderstad the problems, to iform the eed for itervetios, ad to develop appropriate itervetios aimig to reduce the burde of disease ad address health iequalities, as well as to moitor progress i achievig established targets. 6

8 The primary objective of the STEPS survey i Moldova was to evaluate the baselie situatio related to the mai risk factors for ocommuicable diseases both behavioural ad metabolic/ physiological ad to iform all atioal ad iteratioal stakeholders of the curret situatio. The survey data will serve as baselie iformatio for ew ocommuicable disease policies ad a startig poit for moitorig the prevalece of risk factors for ocommuicable disease. The effectiveess of itervetios aimig to reduce the burde of ocommuicable diseases ad their risk factors will also be aalysed. Results of the survey will eable compariso of the prevalece ad distributio of risk factors for ocommuicable disease over time ad across coutries. WHO provides cotiuous policy advice, techical assistace ad capacity buildig to the Govermet of the Republic of Moldova, aimig to improve adequately populatio health ad to reduce health iequalities through whole-of-govermet ad whole-of-society approaches. I this way WHO offers support to the coutry to esure its egagemet i the implemetatio at atioal level of the Europea Health 2020 policy ad the WHO global ad Europea actio plas for prevetio ad cotrol of ocommuicable disease. We are very grateful to our parters the Europea Uio ad the Swiss cy for Developmet ad Cooperatio for providig fiacial support to implemet the first STEPS survey i Moldova, as well as to other collaborators at iteratioal ad atioal levels who provided techical assistace i carryig out the survey. Adrei Usatii Miister of Health Jaro Habicht WHO Represetative 7

9 ACKNOWLEDGEMENTS The authors of the report are grateful to the WHO headquarters i Geeva (Leae Margaret Riley, Head of the Surveillace ad Populatio-based Prevetio Uit, Melaie Cowa ad Regia Guthold, Techical Officers for the uit), the WHO Regioal Office for Europe (Dr Gaude Galea, Director, Nocommuicable Diseases ad Life-Course ad Ms Frederiek Matigh, Techical Officer, Nocommuicable Diseases ad Health Promotio) ad the WHO Coutry Office of the Republic of Moldova (Dr Jaro Habicht, WHO Represetative ad Dr la Ciobau, Public Health Officer) for providig assistace ad guidace throughout the etire STEPS survey process. The authors wish to thak all idividuals ivolved i data collectio, field supervisors, the atioal STEPS coordiator, the STEPS coordiatig committee, cetres of public health, primary health care istitutios, ad the Natioal Bureau of Statistics for their support i coductig the survey. This report was produced through the Bieial Collaborative Agreemets (BCAs) of 2010/2012 ad 2013/2014 betwee the Miistry of Health of the Republic of Moldova ad WHO. It has bee prepared uder the guidace of Mr Adrei Usatii, Miister of Health of the Republic of Moldova, ad Jaro Habicht, WHO Represetative. The STEPS survey was coducted by the Natioal Ceter of Public Health of the Miistry of Health of the Republic of Moldova, uder the coordiatio of the STEPS Coordiatig Committee established withi the Miistry of Health, with the support of WHO. Fudig for the STEPS survey was provided by the Europea Uio, with additioal fudig provided by the Swiss cy for Developmet ad Cooperatio ad WHO. Disclaimer The authors views expressed i this report do ot ecessarily reflect the views of the World Health Orgaizatio, the Europea Uio, the Swiss cy for Developmet ad Cooperatio, the Miistry of Health of the Republic of Moldova, ad the Natioal Ceter of Public Health. 8

10 LIST OF CONTRIBUTORS Participatig orgaizatios Miistry of Health of the Republic of Moldova World Health Orgaizatio Natioal Ceter of Public Health Territorial Ceters of Public Health Primary Health Care Istitutios Natioal Bureau of Statistics Iteratioal cosultats Regia Guthold, Techical Officer, Surveillace ad Populatio-based Prevetio Uit, Departmet for Prevetio of Nocommuicable Diseases, Nocommuicable Diseases ad Metal Health Cluster, WHO Melaie Cowa, MPH, Techical Officer, Surveillace ad Populatio-based Prevetio Uit, Departmet for Prevetio of Nocommuicable Diseases, Nocommuicable Diseases ad Metal Health Cluster, WHO Pricipal ivestigator, site coordiator Galia Obreja, MD, MPH, Natioal Ceter of Public Health STEPS coordiatig committee at the Miistry of Health Svetlaa Cotelea, MD, MPH, Deputy Miister of Health, Miistry of Health Carolia Cericiuc, MD, MPH, Head of Divisio of Public Health, Miistry of Health Tatiaa Zatic, MD, Head of Divisio of Primary Health Care, Miistry of Health Io Salaru, MD, MPH, Deputy Director, Natioal Ceter of Public Health Galia Obreja, MD, MPH, Natioal Ceter of Public Health Petru Crudu, MD, Deputy Director, Natioal Cetre for Health Maagemet Gheadie Curocichi, MD, PhD, Professor, State Uiversity of Medicie ad Pharmacy Nicolae Testemitau Larisa Spiei, MD, PhD, Professor, State Uiversity of Medicie ad Pharmacy Nicolae Testemitau la Ciobau, MD, MPH, PhD, Public Health Officer, WHO Coutry Office of the Republic of Moldova Ala Negruta, Head of Social Services ad Livig Coditios Statistics Divisio, Natioal Bureau of Statistics Stela Bivol, MD, MPH, Policy ad Research Director, Ceter for Health Policies ad Studies Statistical aalysis team Melaie Cowa, MPH, Techical Officer, Surveillace ad Populatio-based Prevetio Uit, Departmet for Prevetio of Nocommuicable Diseases, Nocommuicable Diseases ad Metal Health Cluster, WHO Stefa Savi, MD, MPH, WHO expert Galia Obreja, MD, MPH, Natioal Ceter of Public Health la Ciobau, MD, MPH, PhD, Public Health Officer, WHO Coutry Office of the Republic of Moldova Report compiled by Galia Obreja, MD, MPH, Natioal Ceter of Public Health Ștefa Savi, MD, MPH, WHO expert la Ciobau, MD, MPH, PhD, Public Health Officer, WHO Coutry Office of the Republic of Moldova Copy-editor Nicole Russell 9

11 Project team members Io Salaru, MD, MPH, Deputy Director, Natioal Ceter of Public Health Io Baharel, MD, MPH, PhD, First Deputy Director, Natioal Ceter of Public Health Mihail Pisla, MD, PhD, Geeral Director, Natioal Ceter of Public Health Oleg Loza, MD, PhD, Deputy Rector, State Uiversity of Medicie ad Pharmacy Nicolae Testemitau Vasile Odobescu, MD, Natioal Ceter of Public Health Aatolie Melic, MD, PhD, Head of imuoprophilaxis Ceter, Natioal Ceter of Public Health Alexadra Silic, Head of Legal Divisio, Natioal Ceter of Public Health Ala Halacu, MD, Head of Referece Laboratory i Microbiology, Natioal Ceter of Public Health Natalia Silitrari, MD, Head of Ceter for Health Promotio ad Commuicatio, Natioal Ceter of Public Health Io Soroceau, MD, Ceter of Public Health of Bricei District Gheorghe Timus, MD, Ceter of Public Health of Floresti District Vasile Moraru, MD, Ceter of Public Health of Balti muicipality Dumitru Carasic, MD, Ceter of Public Health of Cahul District Nicolae David, MD, Ceter of Public Health of Hacesti District Leoid Cimpoi, MD, Ceter of Public Health of Teleesti District Raisa Popovici, MD, Ceter of Public Health of Ughei District Iurie Pazaru, MD, MPH, PhD, Natioal Ceter of Public Health Natalia Catericiuc, MD, PhD, Natioal Ceter of Public Health Olga Volcovschi, MD, Ceter of Public Health of Chișiãu muicipality Nelea Tabucic, MD, Natioal Ceter of Public Health Io Furtua, maager, ArtCo & Co Valeri Bejeari, MD, Ceter of Public Health of Bricei District Eugeia Tomceac, MD, Ceter of Public Health of Dodusei District Io Belciug, medical assistat, Ceter of Public Health of Dodusei District Galia Cojuhari, medical assistat, Ceter of Public Health of Drochia District Elea Reveco, MD, Ceter of Public Health of Balti muicipality Iurie Bobu, MD, Ceter of Public Health of Falesti District Svetlaa Bruma, MD, Ceter of Public Health of Taraclia District Alexei Negru, MD, Ceter of Family Doctors of Cahul District Lilia Guri, medical assistat, Ceter of Public Health of Basarabeasca District Svetlaa Toderas, MD, Ceter of Public Health of Chișiău muicipality la Gustiuc, medical assistat, Ceter of Public Health of Orhei District la Bat, medical assistat, Ceter of Public Health of Sagerei District Boris Bobeica, medical assistat, Hospital of Strasei District Alexadru Morari, medical assistat, Hospital of Nisporei District Iulia Eftodi, MD, Natioal Ceter of Public Health Viorel Cazaceco, MD, Prevetive Medical Ceter of the Miistry of Defese Iurie Catericiuc, MD, Prevetive Medical Ceter of the Miistry of Defese Victoria Burlacu, MD, Natioal Ceter of Public Health Mariaa Gacu, medical assistat, Natioal Ceter of Public Health Diaa Cebotari, MD, Vadul-lui-Voda health cetre Svetlaa Chirau, medical assistat, Natioal Ceter of Public Health Ecateria Salaru, MD, Prevetorium of the Academy of Scieces of Moldova Iurie Popescul, MD, Natioal Scietific Practical Cetre for Emergecy Medicie Rodica Solca, medical assistat, Natioal Ceter of Public Health Ostafiev Lilia, medical assistat, Ceter of Public Health of Bricei District Liuba Ciobau, medical laboratory techicia, Ceter of Public Health of Floresti District la Gadei, medical laboratory techicia, Ceter of Public Health of Glodei District Alexadra Grecu, medical laboratory techicia, Ceter of Family Doctors of Cahul District Vera Gorceco, MD, Ceter of Public Health of Basarabeasca District Viorica Costis, medical laboratory techicia, Ceter of Public Health of Teleesti District Valetia Tofa, medical laboratory techicia, Ceter of Public Health of Ughei District Igor Malic, residet physicia, State Uiversity of Medicie ad Pharmacy Nicolae Testemitau Elea Chesov, MD, Natioal Ceter of Public Health Viorica Savi, medical assistat, Natioal Ceter of Public Health Doia Lazurca, medical laboratory techicia, Natioal Ceter of Public Health Aastasia Madric, medical laboratory techicia, Prevetorium of the Academy of Scieces of Moldova 10

12 EXECUTIVE SUMMARY This atioal cross-sectioal survey o ocommuicable disease risk factors i the Republic of Moldova was coducted durig the period September 2013 May Preparatio for the survey was carried out betwee February ad September 2013 ad icluded establishmet of the Coordiatig Committee uder the Miistry of Health; preparatio ad adjustmet of the WHO STEPS Istrumet; samplig; equipmet procuremet; selectio of the project team; ad traiig of data collectors. Field data collectio was performed betwee 30 September ad 9 November Data aalysis ad report preparatio were carried out from December 2013 to May The goal of the survey was to evaluate the prevalece of the mai ocommuicable disease risk factors to eable more efficiet plaig of ocommuicable disease cotrol ad prevetio activities/policies. The mai objectives of the survey were: to determie the prevalece of behavioural risk factors for ocommuicable disease i the populatio aged years; to determie the prevalece of biological risk factors for ocommuicable disease hypertesio, hypercholesterolemia ad hyperglycaemia i the populatio aged years; to determie the differece i the prevalece of risk factors betwee sexes, areas of residece ad across age s. Based o multistage cluster samplig methodology for ocommuicable disease surveillace, 5760 subjects were radomly selected, i order to esure the equivalet distributio of participat accordig to age ad sex, ad factorig i a estimated 20% o-respose rate. A total of 4807 subjects aged years participated i the survey ad the respose rate was 83.5%. Of the total umber of respodets (=4807), 25.3% reported beig curret smokers ad 23.3% daily smokers. Me smoked more tha wome (43.6% vs 5.6%) ad wome i urba areas smoked more tha the rural female populatio (10.4% vs 1.3%). The mea age of startig smokig was 17.7 years for both sexes (17.5 years for me ad 19.5 years for wome). Maufactured cigarettes were used by smokers i 98.9% of cases. The mea umber of cigarettes smoked (daily) amog daily smokers was Oly 14% of respodets were lifetime alcohol abstaiers, whereas 7.0% were past 12-moths abstaiers. Past 30-days drikers amouted to 61.9% of respodets ad 1 i every 5 respodets (19.5%) were episodically heavy drikers. Me episodically drak heavily three times as ofte as wome. Almost half of the respodets reported cosumptio of urecorded alcohol durig the past seve days amog curret drikers (51.2% of the me ad 40.2% of the wome). 11

13 Fruit ad vegetable cosumptio was geerally low: 66.6% of respodets reported cosumptio of fewer tha five servigs of fruit ad vegetables per day, thus beig at higher risk for ocommuicable disease. The proportio was similar for me ad wome. Cosumptio of both fruit ad vegetables was more frequet i youger age s. Households most ofte used vegetable oil for the preparatio of meals (94.9%). Oe i 10 idividuals (10.1%) did ot meet WHO recommedatios o physical activity for health (with o sigificat differece betwee me (10.7%), ad wome (9.4%)). The highest percetage of those ot meetig WHO recommedatios was idetified i the years age (14.6%). The total media time spet carryig out physical activity costituted miutes per day (higher amog me (282.9 miutes) tha wome (180 miutes)). Seve out of 10 wome aged years reported havig bee screeed for cervical cacer. More tha half of respodets reported receivig healthy lifestyle advice from a doctor or a health worker durig the past three years. As a result of physical measuremets, oe i every six respodets was overweight (body mass idex 25 kg/m 2 ), with o differeces betwee sexes. Oe fifth of respodets (22.9%) were obese (body mass idex 30 kg/m 2 ), ad the proportio of obese wome (28.5%) was 1.6 times higher tha that of me (17.8%). Mea body mass idex recorded was 26.6 kg/m 2, ad mea waist circumferece was 85.7 cm for wome ad 89.2 cm for me. The waist hip circumferece ratio was equal to 0.9 for me ad 0.8 for wome, at the lower limit of obesity. Mea systolic ad diastolic blood pressure (icludig idividuals takig medicatio for hypertesio) was mmhg ad 85.0 mmhg, with o substatial differece betwee me ad wome. Four out of 10 respodets had hypertesio (systolic blood pressure 140 ad diastolic blood pressure 90 mmhg), without sigificat differeces betwee sexes. Three quarters (76.2%) of respodets with icreased blood pressure were ot takig ay medicatio, with the proportio of me (84.1%) beig higher tha that of wome (67.5%). The survey revealed that the proportio of respodets with impaired fastig blood glycaemia ( 5.6 mmol/l ad <6.1 mmol/l) was 8.3% ad this proportio was higher amog wome (9.1%) tha me (7.4%). Mea fastig blood glucose was 5.2 mmol/l, with o differeces betwee me ad wome. Oe i 10 idividuals (12.3%) had diabetes or reduced tolerace to glucose (fastig blood glucose 6.1 mmol/l or takig atidiabetic medicatio), without sigificat differeces betwee me ad wome. It was also established that oe i three idividuals (29.4%) had a raised total cholesterol level ( 5 mmol/l or takig medicatio for hypercholesterolemia), with the proportio of wome (32.0%) beig higher tha that of me (26.7%). I coclusio, the survey showed that every third perso (30.3%) had three or more risk factors for ocommuicable diseases, ad this icreases proportioally with age. Me were more affected (35.2%) tha wome (25.0%). A total of 61.7% of respodets had 1 2 risk factors, ad oly 8% of the populatio studied had oe of the five risk factors for ocommuicable diseases. The STEPS Fact Sheet is preseted i Aex 1. 12

14 BACKGROUND Nocommuicable diseases (NCDs) worldwide NCDs represet a leadig threat to huma health ad ecoomic developmet. NCDs are the leadig cause of death globally, causig more deaths tha all other causes combied. I 2008, NCDs i particular cardiovascular disease (CVD), cacer, diabetes ad chroic respiratory disease were resposible for more tha 60% of populatio mortality globally. The burde of NCDs is rapidly icreasig, especially i developig coutries, ad their social, ecoomic ad health cosequeces will be sigificat. Over 80% of deaths resultig from CVDs ad diabetes, almost 90% of deaths from chroic obstructive pulmoary disease ad more tha two thirds of deaths from cacer occur i low- ad middle-icome coutries (1). However, the existig evidece demostrates that the NCD epidemic could be reduced by cotrollig the four mai behavioural risk factors for NCDs: tobacco use, physical iactivity, harmful use of alcohol, ad uhealthy diet. Tobacco icludig both tobacco use ad secod-had smoke is resposible for more tha 6 millio deaths aually. Smokig is estimated to cause about 71% of lug cacer, 42% of chroic respiratory disease ad 10% of CVD. The proportio of mortality attributable to tobacco is higher amog me tha amog wome (2). About 4.5% of the global burde of disease ad ijury is attributable to alcohol. Alcohol cotributes to traumatic outcomes that kill or disable people at a relatively youg age, resultig i the loss of may years of life, as well as disability ad deaths. Harmful use of alcohol causes about 3.8% of all deaths each year. More tha half of these deaths occur from NCDs, icludig liver cirrhosis, cacer ad CVD. Harmful use of alcohol is the leadig risk factor for death i me aged years (3). Low cosumptio of fruit ad vegetables is associated with higher risk for CVDs, ad stomach ad colorectal cacers. High salt cosumptio is a importat determiat of high blood pressure ad CVD risk. High cosumptio of saturated fat ad tras-fat is associated with icreased risk for heart disease ad stroke. Raised blood pressure is the leadig risk factor for global disease burde. It is estimated to cause 9.4 millio deaths every year more tha half of the estimated 17 millio aual deaths from all CVDs 13

15 (4). Raised blood cholesterol is estimated to cause 2.6 millio deaths aually. Both are major risk factors for CVD ad stroke. Physically iactive people have a 20 30% icreased risk for all-cause mortality. Raised body mass idex (BMI) icreases the risk for heart disease, strokes, diabetes ad certai cacers. The NCD epidemic disproportioately strikes people of lower socioecoomic status. NCDs ad poverty create a vicious cycle whereby poverty exposes people to behavioural risk factors for NCDs ad, i tur, resultig NCDs may become a importat driver i the dowward spiral that leads families towards poverty. Improvig surveillace ad moitorig must be a top priority i the fight agaist NCDs at coutry level. NCDs i the Republic of Moldova The Republic of Moldova is a developig coutry with a populatio of 3.4 millio, of which 53% live i rural areas. It is situated i south-easter Europe, has commo borders with Romaia ad Ukraie, ad a territory of km 2. The admiistrative structure cosists of muicipalities, a autoomous territorial-admiistrative uit, ad districts divided ito commues. The coutry s GDP per capita is icreasig, but is lower tha that of other coutries i the regio. The coutry has bee udergoig a epidemiological trasitio sice the 1990s. As a result, the prevalece of disease related to lifestyle ad health behaviours icludig CVD, diabetes, cacer, chroic hepatitis ad cirrhosis is icreasig steadily, ad these diseases have become the leadig causes of populatio mortality. NCDs are resposible for more tha 85% of all deaths aually. The Republic of Moldova as is the case i other developig coutries is ow facig a double burde of disease, comprisig ewer challeges, such as obesity ad NCDs, as well as ifectious diseases, such as tuberculosis ad HIV/AIDS. Accordig to atioal health statistics from 2012, the followig diseases were the leadig causes of death i the Republic of Moldova (5): diseases of the circulatory system (641.6 per populatio) eoplasms (163.2 per populatio) chroic hepatitis ad cirrhosis (81.6 per populatio) ijury ad poisoig (86.8 per populatio) diabetes (9.8 per populatio). Diseases of the circulatory system are the leadig cause of populatio morbidity ad mortality, ad accouted for every secod death i Cervical cacer icidece ad mortality rates are very high at 17.2 ad 7.4 per populatio, respectively. The icidece of cervical cacer has icreased betwee 2005 ad 2009, with this type of cacer foud to be the most commo amog wome i 2011, whe it accouted for 39.3% of all 14

16 cacer cases. As is the case i other coutries, the majority of cervical cacers occur i middle-aged wome with approximately 75% of cases occurrig i wome aged years (6). More tha patiets with diabetes were registered i 2011, ad the umber of idividuals with latet diabetes is 2 3 times higher. More tha 80% of patiets with diabetes were adults aged over 40 years with type 2 diabetes (7). Prevalece of NCD risk factors i the Republic of Moldova Data o risk factors for NCDs are ot part of the coutry s health iformatio system. NCD risk factors were previously assessed i the followig surveys carried out i the Republic of Moldova: Demographic ad Health Survey (DHS), 2005 (BMI, tobacco use ad alcohol cosumptio) (8); Results of survey o health status of populatio i the Republic of Moldova, carried out i 2005 (BMI, food cosumptio patters, tobacco use ad alcohol cosumptio) (9). Tobacco cosumptio i Moldova was also assessed i the iteratioal Global Youth Tobacco Survey (GYTS), performed i 2004 ad 2008 (10, 11). Accordig to the DHS, the rate of daily smokig was 28% i Tobacco use was the secod most prevalet risk factor for me, cotributig to 14.9% of disability-adjusted life years (DALYs) i 2002 (12). Accordig to WHO statistics, the mortality rate attributed to tobacco smokig i the Republic of Moldova was 678 deaths per i 2012 ad is about twofold higher tha i the coutries of the WHO Europea Regio (13). Alcohol cosumptio is the mai risk factor for me ad the third largest risk factor for wome, cotributig to 27.2% ad 12.8% of DALYs, respectively, i Accordig to WHO, the burde of diseases attributed to alcohol cosumptio i the Republic of Moldova was estimated at the fourth largest level of risk (o a scale from 1 to 4) (14). Oly oe fifth of the populatio cosumed fruit daily i Low cosumptio of fruit ad vegetables was resposible for 6.6% of DALYs i wome ad 5.1% of DALYs i me i I additio, half of the adult populatio i the Republic of Moldova was overweight i Hypertesio was the mai risk factor i wome ad the third largest risk factor i me, accoutig for 15.3% ad 11.3% of DALYs, respectively, i

17 SURVEY GOAL AND OBJECTIVES Survey goal The geeral goal of the survey was to determie the prevalece of major risk factors for NCDs usig WHO-approved methods for the evaluatio of the baselie situatio ad more efficiet plaig of activities for the prevetio ad cotrol of NCDs. Survey objectives The objectives of the survey were: to determie the prevalece of behavioural risk factors for NCDs i the populatio aged years; to determie the prevalece of biological risk factors for NCDs hypertesio, hypercholesterolemia ad hyperglycaemia i the populatio aged years; to determie the differece i the prevalece of risk factors betwee sexes, areas of residece ad across age s. Ratioale for the survey Limited ad fragmeted data are available o the prevalece of risk factors for NCDs from previous surveys coducted i the Republic of Moldova. There was a eed for comprehesive ad up-to-date data o NCD risk factors i order to evaluate the effectiveess of ogoig public health policies ad to develop further NCD prevetio ad cotrol itervetios. The survey was coducted i accordace with WHO methodology that provides comparable ad reliable iformatio o the prevalece of risk factors for NCDs i differet coutries across the world. The WHO STEPS (STEP-wise approach to surveillace) survey is a importat tool for estimatig the prevalece of NCD risk factors ad it provides the ecessary evidece for a NCD epidemiological surveillace system. 16

18 SURVEY METHODOLOGY Survey desig The survey o the prevalece of NCD risk factors was coducted with the purpose to establish the baselie iformatio for the developmet of the Natioal actio pla for the implemetatio of the atioal strategy o prevetio ad cotrol of NCDs for the years The survey was carried out usig three cosecutive steps, accordig to the WHO cocept of usig a step-wise approach to the surveillace of NCD risk factors ad cosiderig local ecessities ad resources. STEP 1 comprised a questioaire survey the WHO STEPS Istrumet for Chroic Disease Risk Factor Surveillace (see Aex 2). This was face-to-face iterview, usig a questioaire to collect demographic iformatio, as well as iformatio o tobacco use, alcohol cosumptio, diet (icludig fruit ad vegetable cosumptio, oil ad fat cosumptio, meal cosumptio outside home ad dietary salt), physical activity, history of high blood pressure ad/or raised cholesterol, history of diabetes ad of CVDs, lifestyle cousellig, cervical cacer screeig ad health care access. STEP 2 comprised a series of physical measuremets of overweight ad obesity usig specific tests ad devices (body weight ad height, waist ad hip circumferece), blood pressure ad heart rate. STEP 3 comprised a series of biochemical measuremets i capillary blood, usig wet chemical methods. Measuremets icluded blood glucose, total cholesterol ad high-desity lipoprotei (HDL) cholesterol. The WHO STEPS Istrumet for Chroic Disease Risk Factor Surveillace was traslated ito Romaia ad Russia ad used to take ito cosideratio specific characteristics/requiremets withi the coutry. Survey populatio ad samplig A total of 4807 radomly selected respodets participated i the survey. They were all aged years, ad the comprised both sexes, as well as residets of all districts ad the territorial- 17

19 admiistrative uit Gagauz-Yeri, alog with Chişiãu ad Balti muicipalities. The survey did ot cover the districts from the left bak of the Nistru River ad the muicipality of Beder. For calculatig the survey size, the prevalece of overweight ad obesity (P=50.0%) idetified durig the previous survey o the health status of the populatio was used (9), assumig a 95% cofidece iterval (CI) (Z=1.96), a 5% acceptable margi of error, a complex samplig desig effect coefficiet of 1.5, ad equal represetatio of sexes i each age (four age s for each sex or a total of eight s). Calculatios resulted i a sample size of 4608 idividuals, which was further icreased by 20% (5760) to accout for cotigecies such as o-respose ad recordig errors (see Formula 1). Formula 1 Sample size calculatio formula = = = desig effect age-sex factor = = /probability of o-respose = 4608/0.80 = A two-stage cluster samplig procedure was carried out to select radomly participats from amog the target populatio. Cluster sectors from the 2004 Moldova Populatio Cesus were used as a basic uit (15). Give the differeces i lifestyle ad disease status betwee populatios i urba ad rural areas, the target populatio was stratified ito urba ad rural areas of residece for the STEPS survey. At the first stage, withi each stratum, primary samplig uits (PSUs) (eumeratio areas (EAs)) were selected systematically with probability proportioal to the 2004 Populatio Cesus EAs (measure of size equal to the umber of populatio i the EAs, provided by the cesus). Before selectio, the cesus sectors were sorted geographically from orth to south withi each stratum, i order to esure additioal implicit stratificatio accordig to geographical criteria. A total of 400 clusters represetig 400 EAs were selected from the cesus EAs. These probabilistically selected clusters were used also i Moldova s DHS coducted i 2005, ad the Multiple Idicator Cluster Surveys (MICS) coducted i 2012 (16). Cartographic materials from the Populatio Cesus coducted i Moldova i 2004 were ot available, thus it was ot possible to use them for the STEPS survey. Therefore, for the first stage the probabilistic samples from the abovemetioed surveys were used. 18

20 Out of the 400 selected clusters, 167 were rural ad 233 were urba. The distributio of the sample of 400 PSUs (EAs) for the DHS/MICS surveys was iversely proportioal to the umber of populatio withi each stratum, takig ito accout that the respose rate is lower i urba areas tha rural owig to the smaller average size of the households i urba areas compared with rural areas. Thus, disproportioal allocatio with oversamplig for urba areas was applied i the STEPS survey. A fial weightig adjustmet procedure was carried out to eable estimates at atioal ad urba/rural levels. At the secod stage, 15 households (secodary samplig uits (SSUs)) were selected withi each of the 400 PSUs. From the updated list of households used for the MICS 2012 survey, 15 households were selected radomly per cluster, usig the Microsoft Excel radom sample tool. A total of 6000 idividuals were selected from amog the 400 clusters. The Kish method (17) was applied for the radom selectio of oe idividual aged years from each household. Ethical cosideratio Ethical approval for the survey was obtaied from the Natioal Ethics Committee of the Miistry of Health. Two iformed cosets were obtaied separately from each participat i the survey: oe for STEPS 1 ad 2, ad the secod for STEP 3. Prior to data collectio the selected household participat received a iformative letter ad a coset form, i which the goal ad objectives of the survey were explaied. To esure cofidetiality for all collected ad archived data, uique idetificatio umbers were assiged to each participat ad data registers refers oly to these umbers. The iformatio ad coset forms were available i Romaia ad Russia. Traiig of field data collectors i survey methodology Field data collectors ad field data supervisors were recruited from the Natioal Ceter of Public Health ad the Territorial Ceters of Public Health. A four-day workshop o the STEPS survey o the prevalece of NCD factors ad data collectio methodology was coducted by the Natioal Ceter of Public Health i collaboratio with the Miistry of Health ad the WHO Coutry Office i the Republic of Moldova o September A total of 48 atioal data collectors atteded the workshop. The traiig of data collectors was coducted by the survey s techical workig, which had previously bee give geeral traiig (without differetiatio) durig a four-day regioal semiar, orgaized by WHO i Ashgabat, Turkmeista o 9 12 September O the first two days the traiees were exposed to methods of samplig at the household level ad of obtaiig iformed 19

21 coset from selected survey respodets. The core of the traiig was focused o the survey questioaire, capillary blood collectio ad testig, ad the skills required to use persoal digital assistats (PDAs) for data etry. The last two days of the traiig comprised iteractive sessios to itroduce data collectio methods for STEPS 1, 2 ad 3 of the survey. Pilot testig The traied data collectors carried out pre-testig i Chişiãu city, comprisig all three survey steps. Over 80 idividuals participated i the pre-testig phase. It started with the selectio of oe idividual withi the household, accordig to the Kish samplig methodology, ad dissemiatio of iformatio about the survey. There were 12 data collectio teams, each comprisig four idividuals: two iterviewers, oe cliical health professioal ad oe team coordiator/ supervisor. Each team distributed the questioaire, performed physical measuremets o 3 4 idividuals, ad performed laboratory testig o 2 3 idividuals. The pre-testig was aimed at validatig the field data collectors skills i usig the survey questioaire, performig physical measuremets, laboratory testig, ad usig PDAs. Data collectio process Validated questioaires (WHO STEPS Istrumet for Chroic Disease Risk Factors Surveillace) comprisig core ad expaded items as well as two optioal modules o dietary salt ad health care were traslated ito Romaia ad Russia, adapted to coutry specifics, traslated back ito Eglish, reviewed ad approved by the STEPS Coordiatig Committee, ad used for the survey data collectio. The survey data were collected betwee 30 September ad 9 November STEP 1: Questioaire survey The questioaire was used to collect data o respodet s demographic ad socioecoomic status; tobacco use; alcohol cosumptio; diet, icludig fruit ad vegetable cosumptio, oil ad fat cosumptio, meal cosumptio outside the home, ad dietary salt itake; physical activity; history of raised blood pressure, diabetes, raised cholesterol ad/or CVDs; lifestyle advice; screeig for cervical cacer; health care isurace coverage; ad use of health services i relatio to NCDs. Assessig tobacco use Tobacco use was assessed i terms of curret ad previous smokig status, duratio of smokig, quatity of tobacco use, smokeless tobacco use, ad exposure to secod-had smokig. Data collectors used show cards, depictig four types of commoly used tobacco products. 20

22 Assessig alcohol cosumptio Alcohol cosumptio was assessed usig the cocept of a stadard drik. A stadard drik is ay drik cotaiig about 10 g of pure alcohol. Data collectors used show cards depictig four types of commoly cosumed alcoholic beverages as stadard driks. Respodets who reported usig alcohol withi the past moth were classified as curret drikers. Three risk categories were used to classify respodets who cosumed alcohol accordig to the average amout of alcohol cosumed per day. These categories are defied i Table 1. Table 1 Categories of risk associated with alcohol cosumptio levels, by sex Sex Category 1 Category 2 Category 3 Me <40.0 g g >60.0 g Wome <20.0 g g >40.0 g Note. Uits relate to the amout of alcohol cosumed o average per day. Source: WHO, 2005 (18). Bige drikig was defied as cosumig 6 or more stadard driks o oe occasio. This defiitio is the same for both for me ad wome. Assessig diet I order to assess the diet patter of the surveyed populatio, the respodets were asked about frequecy of fruit ad vegetable cosumptio, mea umber of portios of these foods cosumed daily, type of oils ad fat used for meal preparatio, umber of meals eate outside the household per week ad the amout of salt cosumed daily. Cosumptio of fruit ad vegetables was assessed i terms of the umber of servigs, with a servig beig equal to 80 g. Show cards were used to collect data o fruit ad vegetable cosumptio o a typical day. Oil ad fat itake was assessed by askig about the type of oil or fat most frequetly used for cookig. Salt cosumptio was assessed by askig about frequecy of additio of salt or a salty sauce to food durig preparatio, or before or while eatig; ad/or frequecy of cosumptio of processed food high i salt. Participats were also asked about their perceptio of the quatity of salt they cosumed ad its lik with health problems, as well as about the importace of reducig salt itake, ad the measures udertake to cotrol it. Assessig physical activity Physical activity was assessed based o itesity, duratio ad frequecy of physical activity at work, i recreatioal settigs ad ivolvig trasportatio (joureys), usig a set of 16 questios. Data were collected o the umber of days, hours ad miutes of physical activity performed at work, ivolvig trasportatio ad i recreatioal settigs for at least 10 miutes or more cotiuously 21

23 each day. The complex questioaire has the advatage of assessig ot oly the duratio, but also the itesity of physical activity. Show cards were used to depict differet types of physical activity. The total time spet o physical activity per day at work, ivolvig trasport ad i recreatioal activities was measured by usig a cotiuous idicator: the metabolic equivalet (MET) time i miutes per week spet i physical activity (see Table 2). The populatio was classified ito specific s accordig to their amout of physical activity. METs are commoly used to express the itesity of physical activities, ad are also used for the aalysis of Geeral Physical Activity Questioaire (GPAQ) data. MET is the ratio of a perso s workig metabolic rate relative to their restig metabolic rate. Oe MET is defied as the eergy cost of sittig quietly, ad is equivalet to a caloric cosumptio of 1 kcal/kg/hour. For the aalysis of GPAQ data, existig guidelies have bee adapted. It was estimated that, compared with sittig quietly, a perso s caloric cosumptio is four times as high as whe beig moderately active, ad eight times as high as whe beig vigorously active. For the calculatio of a perso s total physical activity usig GPAQ data, the followig values show i Table 2 were used. Table 2 MET values for the calculatio of a perso s total physical activity Domai MET value Work Moderate MET value = 4.0 Vigorous MET value = 8.0 Trasport Cyclig ad walkig MET value = 4.0 Recreatio Moderate MET value = 4.0 Vigorous MET value = 8.0 Source: WHO, 2005 (18). I order to calculate the categorical idicator for the recommeded amout of physical activity for (good) health, the total time spet carryig out physical activity durig a typical week ad the itesity of the physical activity were take ito accout. Accordig to WHO s global recommedatios o physical activity for health, throughout a ormal week adults should do at least the followig amout of exercise (icludig activity for work, as well as durig trasport ad leisure time): 150 miutes of moderate-itesity physical activity; or 75 miutes of vigorous-itesity physical activity; or a equivalet combiatio of moderate- ad vigorous-itesity physical activity achievig at least 600 MET-miutes. For compariso purposes, tables presetig cut-offs from WHO recommedatios (19) were also used durig the data aalysis. The three levels of physical activity suggested i these recommedatios for classifyig populatios are: (1) low, (2) moderate, ad (3) high. The criteria for these levels are detailed i the remaider of this sectio. 22

24 High-level physical activity ivolves a perso reachig ay of the followig criteria: vigorous-itesity activity at least three days per week, achievig at least 1500 MET-miutes per week; or seve or more days of ay combiatio of walkig, moderate- or vigorous-itesity activities achievig a at least 3000 MET-miutes per week. Moderate level physical activity ivolves a perso ot meetig the criteria for the high-level category, but meetig ay of the followig criteria: three or more days of vigorous-itesity activity of at least 20 miutes per day; or five or more days of moderate-itesity activity or walkig for at least 30 miutes per day; or five or more days of ay combiatio of walkig, moderate- or vigorous-itesity activities achievig at least 600 MET-miutes per week. Low level physical activity ivolves a perso ot meetig ay of the above-metioed criteria for the moderate- or high-level categories. History of NCDs ad their risk factors History of diabetes, CVDs, raised blood pressure ad raised cholesterol were assessed by askig whether specific measuremets for these purposes had bee performed by a doctor or health worker. Participats were also asked about ay medicatio take. Lifestyle advice The participats were asked about ay advice give by a doctor or a health worker durig the past three years relatig to reducig commo risk factors for NCDs. Assessig cervical cacer screeig status Cervical cacer screeig status was assessed by askig about whether participats had udergoe visual ispectio with acetic acid (VIA) testig, a Pap smear ad/or huma papillomavirus (HPV) test. VIA is a ispectio of the surface of the uterie cervix after acid acetic (essetially viegar) has bee applied to it. The Pap smear ad HPV tests are medical procedures i which a sample of cells is collected from a woma s cervix ad spread o a microscope slide. The cells are examied uder a microscope after staiig with Papaicolau dye. This method is importat i differetial diagosis of maligat, beig, precacerous ad iflammatory lesios. STEP 2: Physical measuremets Body weight, height, waist circumferece, hip circumferece, blood pressure, ad heart rate were measured i all survey participats, excludig pregat wome. Body weight ad height was measured with the electroic Growth Maagemet Scale. This is a device suitable for survey purposes that is used to measure a combiatio of factors (body scale with height gauge) with laser. It measures body weight ad height, ad calculates BMI. 23

25 BMI is a ratio of body weight i kilograms to the square of body height i metres ad is calculated accordig to Formula 2. Formula 2 BMI calculatio formula BMI = Body weight (kg) : Body height (m 2 ). A BMI 25 idicates that a perso is overweight, while a BMI 30 idicates that a perso is obese. Waist ad hip circumfereces were measured by MioType, a o-stretch tape with millimetre precisio. Waist circumferece was measured by placig a tape measure aroud the abdome at the midpoit betwee the lower margi of the last palpable rib ad the top of iliac crest (hip boe). Hip circumferece was measured by placig a tape measure aroud the bare abdome at the maximum circumferece over the buttocks. The waist hip ratio (WHR) was computed usig measuremets of waist ad hip circumfereces amog all respodets, excludig pregat wome. The WHO referece cut-off for WHRs was used to defie obesity at above 0.90 for males ad above 0.86 for females. Blood pressure ad heart rate measuremets were take three times o the right arm of the survey participats i a sittig positio, usig a Boso-Medicus Uo istrumet with a uiversal cuff ad automatic blood pressure ad heart rate moitor. The mea of three measuremets was take for aalysis. The measuremets were take after the participat had rested for 15 miutes, ad each with three miutes of rest betwee the measuremets (maximum deviatio of cuff pressure measuremet ± 3 mmhg, ad of pulse rate display ± 5%). Percetage of raised blood pressure was defied as: systolic blood pressure (SBP) 140 mmhg ad/or diastolic blood pressure (DBP) 90 mmhg, or curretly takig medicatio for raised blood pressure. The percetage of respodets with treated ad/or cotrolled raised blood pressure amog those with raised blood pressure (SBP 140 ad or DBP 90 mmhg) or curretly takig medicatio for raised blood pressure was categorized as follows: % takig medicatio ad SBP <140 mmhg ad DBP <90 mmhg % takig medicatio ad SBP 140 mmhg ad/or DBP 90 mmhg % ot takig medicatio ad SBP 140 mmhg ad/or DBP 90 mmhg. 24

26 STEP 3: Laboratory aalysis Laboratory tests were performed for blood glucose, total cholesterol ad HDL cholesterol. Cocetratios of glucose, total cholesterol ad HDL cholesterol were measured i capillary blood the ext day after STEPS 1 ad 2 of the data collectio. Capillary blood tests were performed for all survey respodets usig a CardioCheck PA Aalyzer, after fastig. Laboratory test results were assessed ad categorized accordig to the defiitios show i Table 3 (18). Table 3 Biochemical idicators Biochemical idicators Normal At risk Icreased Glucose <5.6 mmol/l 5.6 mmol/l & <6.1 mmol/l 6.1 mmol/l or usig glucose-lowerig drugs Cholesterol <5.0 mmol/l 5.0 mmol/l & <6.1 mmol/l 6.2 mmol/l or usig cholesterol-lowerig drugs HDL cholesterol HDL levels decreased Source: WHO, 2005 (18). Survey data collectio Survey data collectio was carried out by 12 teams with five people i each team. Survey teams cosisted of coordiator/supervisor/team leader, two iterviewers, oe laboratory techicia, ad a driver with a car. Local guidace, i the form of a family doctor or a urse, was brought i to reach selected households. O the day of data collectio the selected households were visited ad geeral iformatio was give (verbally) o the goal ad objectives of the survey. The oe participat was selected from amog all adults aged years i each household. Further iformatio was give to the selected participat ad two active cosets were requested (oe for each of STEPS 1 ad 2); the, after fiishig the data collectio roud for the first two steps, coset was requested for STEP 3. The collectio of capillary blood was carried out the day after STEP 1 ad STEP 2 data collectio. Blood was take from fastig participats at the territorial primary health care facility. Moitorig of data collectio The moitorig team comprised four represetatives from the Natioal Ceter of Public Health, with the task of moitorig the survey data collectio. The teams carried out this moitorig i the field ad provided techical ad logistical support to data collectio teams throughout the data collectio process. Data etry ad cleaig The survey data were collected etirely usig PDAs. Data from 38 PDAs used by the data collectio teams were dowloaded ito a database, completig the data etry process. The data were coverted ito Microsoft Excel format. Each survey respodet had a uique idetifier comprised cluster, household umber withi cluster ad idividual ID umber. Next, the survey data were compiled ito a sigle file, ad the accuracy of recordig respodets age ad sex, amog other variables, was established withi a week usig rage ad logic checkig fuctios. Fially, data 25

27 checkig was also carried out usig the aalysis code provided by WHO HQ, which icludes a code to check the data prior to every aalysis performed. Weightig of data Because the data comprised a sample of the target populatio, it was ecessary to weight the data. Thus, sample weightig ad adjustmets were carried out to correct differeces i the age, sex ad area of residece distributio of the sample versus (vs) the target populatio ad probabilities of selectio. The sample weight for each case i the survey sample accouts for the umber of cases it represets i the samplig frame, based o the sample selectio procedure. The product of the sample weight ad the populatio adjustmet weight was used i all weighted aalysis. Data aalysis Statistical aalysis of the survey data was performed by a statistical aalysis team of the Natioal Ceter of Public Health uder the guidace of Melaie Cowa. Data aalysis was performed usig EpiIfo versio 3.5.4, usig appropriate methods for the complex sample desig of the survey. The prevalece ad measures of cetral tedecy of NCD risk factors were estimated. Outcome measures (prevalece ad mea variace) ad differeces betwee s (age, sex ad urba/ rural s) were calculated with a. Samplig error, which could potetially affect the accuracy of the results of the curret survey, was measured by the stadard error of variables. Margis of error i prevalece ad i measures of cetral tedecy are represeted by umeric values for the lower ad upper limits of a. Results of the survey o the prevalece of NCD risk factors, ad the measures of cetral tedecy ca be cosidered represetative for the target populatio, sice they were adjusted usig populatio ad sample weights. 26

28 SURVEY RESULTS Demographic idicators Several demographic idicators were aalysed, icludig age, sex, educatio, ethicity, occupatio, household icome ad marital status of the respodets. Survey participats icluded 4807 respodets aged years from all admiistrative uits i the Republic of Moldova, icludig the Chişiãu muicipality. The districts from the left bak of Nistru River ad muicipality Beder did ot participate i the survey. Of the 4807 respodets, 1827 were me ad 2980 were wome (see Table 4). I terms of age s, 848 idividuals were aged years, 1233 were aged years, 1688 were aged years ad 1038 were aged years. Table 4 Distributio of study populatio, by age ad sex Me Wome Both sexes % % % Of all the survey respodets, 77.4% were Romaia/Moldova, 8.9% were Russia, 6.7% Ukraiia, 3.8% Gagauz, 0.5% Roma, ad 2.6% were from other ethic s. I terms of residece, 2753 people were from urba areas ad 2042 from rural areas (Table 5). Table 5 Distributio of study populatio, by ethicity ad area of residece Rural Urba Total Ethicity % % % % % % (ethicity) (area) (ethicity) (area) (ethicity) (area) Romaia/Moldova Russia Ukraiia Gagauz Roma Other ethic s Total

29 The distributio of the survey respodets by their age s, sex ad urba/rural areas of residece was comparable to that of the geeral populatio. Marital status The majority (64.7%) of the survey respodets were married, 10.9% had ever bee married, 11.7% were widowed, 7.7% were divorced, 2.6% were cohabitatig ad 2.5% were separated. The proportio of idividuals that had ever bee married was higher amog me (14.4%) tha wome (8.7%) ad the proportio of people widowed was three times higher amog wome (15.5%) tha amog me (5.2%) (see Aex 3). The average umber of years spet i educatio was 11.7 years, with the male respodets spedig a average of 11.6 years ad the females spedig o average 11.7 years (Table 6). Youger age s teded to have slightly more years of schoolig i compariso with older age s. Table 6 Mea umber of years of educatio, by sex ad age Me Wome Both sexes Mea o. of years Mea o. of years Mea o. of years Survey results showed that about 0.5% of the populatio had o formal schoolig or had ot completed primary school, 0.9% had completed primary school, 17.2% had completed gymasium educatio, % had completed lyceum educatio, % had completed college or vocatioal school ad 21.8% had completed a uiversity or postgraduate degree (Table 7). Compariso of educatio level by sex deoted that wome were more likely to have completed a uiversity or postgraduate degree, while me were more likely to have completed secodary school or college/vocatioal school (see Aex 3 for further details). Compariso of educatio level by age revealed that people i the age s years ad years (amog both me ad wome) were more likely to have completed secodary school tha those aged ad years. The proportio of respodets that had completed a uiversity or postgraduate degree was higher i the youger age s (18 29 years ad years) tha amog respodets aged years, ad wome were more likely tha me to have completed these levels of educatio. 1 Gymasium educatio is full-time educatio from 11 to 16 years old. 2 Lyceum educatio comprises a further three years of educatio after gymasium-level (16 to 18/19 years old). 28

30 Table 7 Highest level of educatio, both sexes, by age Without Secodary College/ formal Primary Uiversity/ Gymasium school/ vocatioal schoolig/ot school postgraduate completed* lyceum** school completed completed degree completed completed completed primary school * Full-time educatio from 11 to 16 years old. ** Three years of educatio after gymasium-level (16 to 18/19 years old). Employmet status Of the survey respodets, less tha half (48.4%) were employed (57.2% me ad 43.2% wome). The survey results show that of the 48.4% employed idividuals, 21.6% of respodets were govermet employees, 17.0% were ot govermet employees ad 9.8% were self-employed. Me were predomiatly employed i ogovermetal istitutios ad orgaizatios (21.6%) or were self-employed (15.9%) ad wome were more likely to be employed i govermetal istitutios (22.8%) (see Table 8 ad Aex 3). Table 8 Employmet status, both sexes, by age Govermet employee No-govermet employee Self-employed Upaid The amout of upaid ad uemployed populatio represeted 51.6%, with a higher prevalece amog wome (56.9%) tha me (42.9%) (see Aex 3). Of those upaid idividuals, 8.9% were studets, 28.1% were home-makers, 41.3% were retired, ad 1.8% were otherwise o-paid. 3 Amog those that were uemployed, 16.8% were able to work ad 3.2% were uable. The umbers of home-makers ad retired people were higher amog wome (33.6% ad 44.1%) tha me (16.2% ad 35.1%) ad there were more studets amog me (10.9%) tha amog wome (7.9%). The rate of uemployed me that were able to work (30.6%) was about three times higher tha that of wome (10.4%) (see Table 9 ad Aex 3). 3 The terms upaid ad o-paid are used here i coformity with stadardized WHO questioaire termiology. 29

31 Table 9 Upaid work ad uemploymet, both sexes, by age No-paid Studet Both sexes Home-maker Retired Able to work Uemployed Uable to work Household icome The household icome of the idividuals surveyed was assessed based o average earigs over the past year. A total of 3845 of the 4807 survey respodets aswered the questio What was the average earig of the household i the past year?, takig ito accout the joit earigs of workig-age adults (aged 18 years ad over). Mea aual reported per capita icome was MDL (see Table 10). Table 10 Mea aual per capita icome (MDL) Mea aual per capita icome Mea (MDL) Tobacco use The survey participats were asked about their curret smokig status, previous smokig experiece, the age they started smokig, duratio of smokig, the quatity of tobacco smoked daily, use of smokeless tobacco, types of tobacco products used, ad duratio of exposure to secod-had smoke. The percetage of curret smokers (daily ad o-daily smokers) of all tobacco products amog all respodets was 25.3% (: ). There were more male smokers (43.6%) amog the respodets tha female (5.6%). There was also a otable icrease i the proportio of smokers i youger age s, observed i both the male ad female respodets (see Table 11). 30

32 Table 11 Percetage of curret smokers, by age ad sex Me Wome Both sexes Curret Curret Curret smoker smoker smoker There was o sigificat statistical differece betwee the percetage of curret male smokers i urba ad rural areas, aside from a slightly higher prevalece of smokig amog the rural populatio (44.3%, : vs 42.9%, : ). There was a statistically sigificat differece i prevalece of smokig amog wome i rural ad urba areas: 1.3% (: ) ad 10.4% (: ), respectively (Fig. 1). The proportio of curret daily ad o-daily smokers was higher i the youger age s of the study populatio (18 44) (Fig. 2). Fig. 1. Percetage of curret smokers, by sex ad area of residece 60.0% 40.0% 20.0% 0.0% Rural Urba Total Fig. 2. Smokig status, by age 100.0% Me Wome Both sexes 80.0% 60.0% % 20.0% 0.0% years years years years Daily smokers No-daily smokers Former smokers Never smoked 31

33 The DHS coducted i Moldova i 2005 (8) revealed that the percetage of me who smoked cigarettes was 51.1% ad that of wome was 7.1%. It ca therefore be said that ati-tobacco policies have had a positive effect i the period The DHS also foud smokig prevalece amog wome to be much higher i urba areas (14%) tha i rural areas (2%). I males, the differece i smokig treds accordig to urba or rural area of residece was reversed i compariso with the curret survey: 49% i urba areas ad 53% i rural areas. It should be take ito accout that the DHS was coducted i the populatio aged years for me ad years for wome. Amog all curret smokers of both sexes, 92% smoked daily i the Republic of Moldova. The proportio of daily smokers amog me was 93%, which was higher tha that of wome (82.3%), but the populatio with the highest prevalece of daily smokers was females aged years (100%). The percetage of daily smokers icreased margially with the age of respodets (Fig. 3). Fig. 3. Percetage of curret daily smokers amog smokers, by sex ad age 100.0% 80.0% 60.0% 40.0% % 0.0% years years years years Total Me Wome Both sexes The survey revealed that me started smokig earlier tha wome (mea age = 17.5 years i me vs 19.5 years i wome). There was almost o differece betwee male age s i terms of the mea age of startig smokig ad it varied from 17 years old i the age years to 17.7 years old i the age years. The variace amog wome was slightly greater, from 17.7 to 24.5 years o average i the respective age s (Fig. 4). 32

34 Fig. 4. Mea age of startig smokig, by sex ad age years years years years Me Wome Both sexes The vast majority of smokers (99%) smoked maufactured cigarettes. The mea umber of cigarettes smoked per day by daily smokers was 16.7 for all age s (: ). Me smoked o average 17.2 cigarettes ad wome 11.4 cigarettes per day. The highest umber of cigarettes smoked per day was foud i the age years, for both sexes (Fig. 5). Fig. 5. Mea umber of maufactured cigarettes smoked by daily smokers per day, by sex ad age Mea o. of cigarettes years years years years Total Me Wome Both sexes The majority of daily smokers (86%) smoked over 10 cigarettes per day (Fig. 6). The highest percetage of male daily smokers smoked cigarettes per day (: ), compared with 22.8% of wome (: ) that smoked the same amout. 33

35 Fig. 6. Distributio of daily smokers by quatity of maufactured or had-rolled cigarettes smoked per day, by sex Both sexes Wome Me % 20.0% 40.0% 60.0% 80.0% 100.0% <5 cigarettes 5 9 cigarettes cigarettes cigarettes 25 cigarettes Of the total umber of curretly smokig respodets, about 40% had tried to stop smokig durig the last year (39.9% of me (: ) ad 34.7% of wome (: )). The differece betwee the sexes i terms of the proportio of those who tried to stop smokig does ot appear to be statistically sigificat (Fig. 7). Approximately 49% of male respodets ad 39% of females amog those smokers who had visited a doctor or other health worker i the past 12 moths had bee advised to stop smokig. Fig. 7. Percetage of curret smokers who had tried to stop smokig durig the past 12 moths, by sex ad age 60.0% 40.0% 20.0% % years years years years Total Me Wome Both sexes 34

36 About 16.5% of respodets i the study populatio were exposed to secod-had smoke at home. Cotrary to expectatios, me were more exposed tha wome (17.3% vs 15.7%) (Fig. 8). A sigificat differece betwee the sexes ca be observed i exposure to secod-had smoke i the workplace: the distributio of secod-had smokig at work was 35% for me (: ) ad 17.2% for wome (: ) (Fig. 9). Fig. 8. Percetage of respodets exposed to secod-had smoke i the home durig the past 30 days, by sex ad age 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% % years years years years Total Me Wome Both sexes Fig. 9. Percetage of respodets exposed to secod-had smoke i the workplace durig the past 30 days, by sex ad age 60.0% 40.0% 20.0% 0.0% years years years years Total Me Wome Both sexes

37 Coclusios 1. I the Republic of Moldova a quarter of the populatio (25.3%), ad 4 out of 10 me were curret smokers, puttig them at high risk for NCDs. Wome i urba areas smoked more (10.4%) tha those i rural areas (1.3%). 2. Nie out of 10 smokers (92.0%) were daily smokers. The share of daily smokers amog me (93.0%) was higher tha amog wome (82.3%). 3. Maufactured cigarettes were the most commoly used tobacco product (used by 99% of the study populatio). Male daily smokers smoked more cigarettes (17.2 cigarettes) tha females (11.4 cigarettes). 4. Oe i six idividuals (16.5%) were exposed to secod-had smoke at home ad oe i four i the workplace (26.2%), with more me (35.0%) exposed tha wome (17.2%), which cosiderably icreases the risk of NCDs amog exposed idividuals. Alcohol cosumptio Alcohol cosumptio patters, frequecy of alcohol drikig ad risks associated with alcohol cosumptio were studied accordig to the sex, age ad place of residece of the survey respodets. Amog all respodets i the age years, 61.9% (: ) had cosumed alcohol durig the past 30 days. The proportio of males (69.8%, : ) was sigificatly higher tha that of females (53.5%, : ) (see Fig. 10 ad Table 12). Figures show a decrease i alcohol cosumptio i the Republic of Moldova i compariso with the DHS results from 2005 (8) that reported a prevalece of 81% amog me ad 59% amog wome. Although the DHS aalysed differet age s (15 59 for me ad for wome), the lower prevalece of alcohol cosumptio i both the yougest ad eldest age s support the coclusio that a positive tred is emergig i terms of a reductio i alcohol use. Fig. 10. Alcohol cosumptio status, by sex Both sexes Wome Me % 20.0% 40.0% 60.0% 80.0% 100.0% Curret driker (past 30 days) Past 12 moths abstaier Drak i past 12 moths, ot curret Lifetime abstaier 36

38 Table 12 Distributio of curret alcohol cosumers, by sex ad age Me Wome Both sexes % % % The survey results attested to a higher prevalece of curret drikers i rural areas. Of all respodets of both sexes amog the rural populatio, 64.5% (: ) had cosumed alcohol i the past 30 days, while i urba areas the prevalece was 59% (: ) (Fig. 11). Fig. 11. Distributio of curret drikers, by sex ad area of residece 100.0% 80.0% 60.0% 40.0% 20.0% 0.0% Urba Rural Total Me Wome Both sexes About 9% of me ad 3% of wome i the study populatio drak alcohol every day. A icrease ca be see i daily cosumptio of alcohol amog both sexes i compariso with the 2005 DHS, which showed a prevalece of 3.8% for me ad 0.7% for wome (8). The proportio of all respodets who drak alcohol daily costituted 6.1%; those who cosumed alcohol o 5 6 days per week costituted 2.8%; ad those that drak 1 3 times per week costituted 29.7%. The remaider of the respodets (71.4%) reported cosumig alcohol three days per moth or less ofte (Fig. 12). 37

39 Fig. 12 Frequecy of alcohol cosumptio i the past 12 moths, by sex ad age years years years years years Both Sexes Wome Me Both Sexes Wome Me Both Sexes Wome Me Both Sexes Wome Me Both Sexes Wome Me % 20.0% 40.0% 60.0% 80.0% 100.0% Daily 5 6 days/week 3 4 days/week 1 2 days/week 1 3 days/moth <oce a moth The alcohol cosumptio patter was further aalysed by elucidatig the frequecy of drikig i the past 30 days ad the umber of stadard driks per drikig occasio. I the past 30 days curret alcohol drikers had cosumed alcohol o average o 3.7 occasios (: ), with me attestig to 4.5 occasios (: ) ad wome 2.6 occasios (: ). The highest average umber of drikig occasios was registered i the age years (Fig. 13). The mea umber of drikig occasios was foud to be higher amog rural populatios, at 4.2 occasios (: ) tha amog urba residets, at 3.1 occasios (: ) (Table 13). Fig. 13. Mea umber of drikig occasios i the past 30 days amog curret (past 30 days) drikers, by sex ad age Mea o. of drikig occasios years years years years Total Me Wome Both sexes

40 Table 13 Mea umber of drikig occasios i the past 30 days amog curret (past 30 days) drikers, by sex ad area of residece Me Wome Both sexes Mea o. of Mea o. of Mea o. of occasios occasios occasios Rural Urba Total Curret drikers cosumed o average 3.4 driks per drikig occasio (: ), with me cosumig 4.2 driks (: ) ad wome cosumig 2.2 driks (: ). I all age s me cosumed almost two times more per drikig occasio tha wome (Fig. 14). It is oteworthy that while the umber of drikig occasios was higher amog the rural populatio, the mea umber of stadard driks per drikig occasio was foud to be higher amog the urba populatio at 3.4 driks (: ) as opposed to 3.3 driks (: ) for rural residets (Table 14). Fig. 14. Mea umber of stadard driks per drikig occasio amog curret (past 30 days) drikers, by sex ad age Mea o. of stadard driks years years years years Total Me Wome Both sexes Table 14 Mea umber of stadard driks per drikig occasio amog curret (past 30 days) drikers, by sex ad area of residece Me Wome Both sexes Mea o. Mea o. Mea o. of driks of driks of driks Rural Urba Total

41 The risk associated with alcohol cosumptio was assessed i curret (past 30 days) drikers based o the average amout of alcohol cosumed per drikig occasio i the past 30 days. Results showed that 97.5% of all curret drikers (: ) had a low risk associated with alcohol cosumptio; 0.8% of me (: ) ad 0.9% of wome (: ) had a medium risk; ad 2.4% of me (: ) ad 0.7% of wome (: ) had a high risk (Table 15). Table 15 High-, itermediate-, ad low-volume drikig levels amog curret (past 30 days) drikers, by sex High level of drikig ( 60 g) Itermediate drikig level ( g) Low level of drikig (< 40 g) Me Wome Both sexes Amog the survey respodets, oe i five idividuals had cosumed six or more driks o a sigle occasio at least oce durig the past 30 days, with a sigificat differece betwee me ad wome. A total of 29% of me (: ) ad 9.2% of wome (: ) reported havig cosumed six or more driks at least oce durig the last 30 days. It is alarmig that the proportio of people reportig this experiece is higher i the youger age s for both me ad wome (Fig. 15). Fig. 15. Cosumptio of six or more driks o a sigle occasio at least oce durig the past 30 days amog total populatio 40.0% 30.0% 20.0% 10.0% % years years years years Total Me Wome Both sexes 40

42 Almost half of the curret (past 30 days) drikers reported cosumig urecorded alcohol (homebrewed alcohol, alcohol brought across the Republic of Moldova border, alcohol ot iteded for drikig or other utaxed alcohol) durig the past seve days: 51.2% amog me (: ) ad 40.2% of wome (: ) (Table 16). Table 16 Cosumptio of urecorded alcohol*, by sex ad area of residece Me Wome Both sexes % % % Rural Urba Total * Homebrewed alcohol, alcohol brought across the border, alcohol ot iteded for drikig or other utaxed alcohol. A aalysis was carried out of the differet types of alcohol cosumed i the past seve days amog curret (past 30 days) drikers, icludig recorded ad urecorded types of alcohol (homemade wie ad spirits, amog others). Cosumptio of urecorded alcohol is kow to be quite high i the Republic of Moldova owig to local traditios of home alcohol productio. Fig. 16 shows that i the last seve days, of the total alcohol cosumed by curret drikers, 37% costituted urecorded alcohol. Withi this tred, there was o statistically sigificat differece betwee me ad wome, aside from a slightly higher cosumptio of urecorded alcohol amog wome. Cosumptio of homemade wie accouted for 28.8% ad homemade spirits 5.9%. A total of 6.1% of all urecorded alcohol (2.3% of all alcohol cosumed) was alcohol brought across the coutry s border, surrogate alcohol ad other types of alcohol. Fig. 16. Alcohol cosumptio durig the past seve days, by type ad sex Both sexes Wome Me % 20.0% 40.0% 60.0% 80.0% 100.0% Recorded Homemade wie Homemade spirits Other urecorded alcohol 41

43 Coclusios 1. Oly oe i seve idividuals was a lifetime alcohol abstaier. The prevalece of curret drikers was higher i rural areas (64.5%) tha urba (58.0%). 2. Frequecy of alcohol cosumptio was higher i me tha wome. 3. O a average drikig occasio me cosumed more stadard driks (4.2) tha wome (2.2). 4. Oe i five idividuals was a bige driker ad bige drikig was more commo i me (29.0%) tha wome (9.2%). 5. Oe i two idividuals cosumed urecorded alcohol, owig to local traditios of home alcohol productio. Diet Fruit ad vegetable cosumptio Cosumptio of fruit ad vegetables was assessed i the survey populatio by sex, age ad area of residece. The average umber of days per week o which fruit ad vegetables were cosumed was 5.6 (: ) ad 5.9 (: ) (for fruit ad vegetables respectively). Fruit cosumptio was more frequet i wome, at 5.8 days per week (: ) tha i me, at 5.4 days per week (: ), with the differece beig statistically sigificat, while me cosumed vegetables o average 5.9 days per week ad wome 5.8 days per week. Cosumptio of both fruit ad vegetables was more frequet i youger age s (Table 17 ad Table 18). It is worth otig that the data collectio was performed i autum, whe the availability of fruit ad vegetables is supposed to be at a peak for the coutry. These data o higher cosumptio of fruit ad vegetables i autum (related to icreased seasoal availability) are cofirmed by upublished data from a survey o food cosumptio carried out i The frequecy of fruit cosumptio was foud to be higher amog rural populatios (5.7 days per week with a of ) tha amog urba populatios (5.5 days, : ). Coversely, the urba populatio cosumed vegetables more frequetly (6 days per week) tha those i rural areas (5.8 days per week) (Fig. 17). Table 17 Mea umber of days o which fruit was cosumed i a typical week, by sex ad age Me Wome Both sexes Mea o. Mea o. Mea o. of days of days of days Upublished study from 1998 by the Uited Natios Childre s Fud o sprig autum dietary itake i the Republic of Moldova. 42

44 Table 18 Mea umber of days o which vegetables were cosumed i a typical week, by sex ad age Me Wome Both sexes Mea o. Mea o. Mea o. of days of days of days Fig. 17. Mea umber of days o which fruit ad vegetables were cosumed i a typical week, by sex ad area of residece Mea o. of days Rural Urba Total Rural Urba Total Fruit Vegetables Me Wome Both sexes The umber of servigs of fruit ad vegetables cosumed per day was foud to be very similar amog the urba ad rural populatios, with oly slightly more fruit servigs cosumed i rural areas (2.2 servigs, : )) tha i urba areas (1.8 servigs, : ), ad a higher frequecy of daily vegetable itake amog the urba populatio (2.1 servigs) tha amog the rural populatio (o average 2.0 servigs per day) (Fig. 18). 43

45 Fig. 18. Mea umber of servigs of fruit ad vegetables o average per day, by sex ad area of residece Mea o. of servigs Rural Urba Total Rural Urba Total Fruit Me Wome Both sexes Vegetables The average umber of servigs of both fruit ad vegetables per day was equal to four ad it was the same for both sexes. A higher frequecy of servigs could be see i rural areas (4.2 servigs, : ) tha i urba areas (3.9 servigs per day, : ), which could i part be explaied by more access to these products i rural areas, but also by the icreased availability of fruit ad vegetables durig the harvest period i the autum, which is whe the study populatio was iterviewed (Fig. 19). Fig. 19. Mea umber of servigs of fruit ad/or vegetables o average per day, by sex ad area of residece Total Urba Rural Mea o. of servigs Me Wome Both sexes 44

46 The majority of respodets (66.4%) of both sexes cosumed three or more servigs of fruit ad/or vegetables per day (66% of me ad 66.8% of wome). About 5% of the study populatio reported ot cosumig fruit or vegetables at all (Fig. 20). Fig. 20. Distributio of respodets, by umber of servigs of fruit ad/or vegetables per day Both sexes Wome Me % 20.0% 40.0% 60.0% 80.0% 100.0% 5 servigs 3 4 servigs 1 2 servigs No fruit ad/or vegetables Oil ad fat cosumptio Cosumptio of oils ad fats most ofte used for meal preparatio i households was aalysed. Of the total umber of households ivestigated, 94.9% (: ) used vegetable oil, 3.1% (: ) prepared meals usig aimal fat, ad the rest (2%) did ot state ay preferece or did ot use ay oils or fats (Table 19). The survey o the health status of the populatio i the Republic of Moldova coducted i 2005 (9) showed that 65.8% of the populatio cosumed oly vegetable oils, 31.2% cosumed vegetable oils ad aimal fats equally, ad 1.4% cosumed oly aimal fats. It should be oted that the survey was coducted amog the populatio aged years of both sexes. Table 19 Type of oil or fat most ofte used i household meal preparatio (households) Vegetable oil Lard or suet Noe i particular/ other Noe used

47 Meal behaviour O average, the umber of reported meals eate outside the home was 1.4 for both sexes ad across all ages (: ), with a sigificat differece betwee me ad wome: 1.7 meals (95% CI: ) for me ad 1.1 meals for wome (: ). There was a sigificat differece betwee age s, with a average of 2.1 meals eate outside the home i the age years, ad 0.3 meals for the age years (Fig. 21). The frequecy of eatig out also sigificatly differed by area of residece: the urba populatio ate out o average two times more meals tha rural respodets (Fig. 22). Fig. 21. Mea umber of meals eate outside the home, by age ad sex Mea o. of meals years years years years years Me Wome Both sexes Fig. 22. Mea umber of meals eate outside the home, by sex ad area of residece Total Urba Rural Mea o. of meals Me Wome Both sexes 46

48 Dietary salt Cosumptio of salt was aalysed i the study populatio by askig the idividuals that were iterviewed questios regardig the frequecy, quatity ad type of salt used i their household, their cookig habits ad their attitude towards dietary salt. A total of 24.3% of respodets metioed that they added salt always or ofte before eatig or while eatig, with o sigificat differece betwee age s. The percetage of me who added salt always or ofte to their meal was much higher tha that of wome (28%, : vs 20.3%, : ). A higher prevalece was idetified amog the rural populatio (25.2%, : ) tha amog urba residets (23.4%, : ). It is oteworthy that the mai differece was betwee urba ad rural me, while almost o differece was foud betwee wome from both areas of residece (Table 20). Table 20 Percetage of respodets always or ofte addig salt before or while eatig Me Wome Both sexes % % % Rural Urba Total The majority of respodets of all ages (81.4%, : ) reported usig iodized salt whe cookig or preparig food at home, with o substatial differece betwee sexes. Cosumptio of iodized salt was foud to decrease with age, but the differece was ot foud to be statistically sigificat (Fig. 23). A higher prevalece ad statistically sigificat differece was foud i salt cosumptio betwee rural ad urba residets: 74.4% (: ) of respodets from rural areas used iodized salt more frequetly, i compariso with 89.2% (: ) amog the urba populatio (Table 21). Fig. 23. Percetage of respodets usig iodized salt whe cookig or preparig food at home, by age ad sex 100.0% 80.0% 60.0% 40.0% % 0.0% years years years years Total Me Wome Both sexes 47

49 Table 21 Percetage of respodets usig iodized salt whe cookig or preparig food at home, by area of residece ad sex Me Wome Both sexes % % % Rural Urba Total Respodets were asked how ofte they cosumed processed food high i salt. Amog all survey participats, 32.4% (: ) gave a affirmative aswer. The percetage of me (36.5%, : ) who reported eatig processed food high i salt was higher tha that of wome (28.1%, : ) ad the differece betwee the sexes was statistically sigificat (Fig. 24). The proportio of respodets eatig such foods decreased with age. Furthermore, a sigificat differece was idetified betwee rural ad urba residets (Table 22), with higher prevalece for the latter (29%, : vs 36.3%, : ). Fig % Percetage of respodets always or ofte eatig processed foods high i salt, by age ad sex 50.0% 40.0% 30.0% 20.0% 10.0% % Table years years years years Total Me Wome Both sexes Percetage of respodets always or ofte eatig processed foods high i salt, by area of residece ad sex Me Wome Both sexes % % % Rural Urba Total

50 Oly 14.7% of all respodets believed that they cosume too much or far too much salt. The percetage of me with this perceptio was higher tha that of wome. The proportio of wome who thought they cosume too little or far too little is higher (13.5%) tha that of me (11.3%), while the percetages of those usig (i their opiio) just the right amout was equal across the sexes (72.9%) (Fig. 25). Fig. 25. Self-reported quatity of salt cosumed, by sex Both sexes Wome Me % 20.0% 40.0% 60.0% 80.0% 100.0% Far too much/too much Just the right amout Too little/far too little The vast majority of respodets believed that cosumig too much salt could cause serious health problems (89.7%, : ). The prevalece of wome (92.8%, : ) with this belief was higher tha that of me (92.8%, : ) ad the differece was statistically sigificat. No sigificat differeces by age were idetified for this specific questio (Table 23). Table 23 Percetage of respodets thikig that cosumig too much salt could cause serious health problems, by age ad sex Me Wome Both sexes % % % Although a high percetage of respodets were aware that salt ca cause serious health problems, oly 30.7% of them cosidered lowerig salt i diet to be very importat; 44.4% thought this was somewhat importat; ad 24.9% thought it was ot at all importat. The proportio of wome who cosidered lowerig salt i their diet to be very or somewhat importat was higher (82.1%) tha that of me (75.1%) (Fig. 26). No sigificat age differece was idetified for the aswers to this questio. 49

51 Fig. 26. Importace of lowerig salt i diet, by sex Both sexes Wome Me % 20.0% 40.0% 60.0% 80.0% 100.0% Very importat Somewhat importat Not at all importat Respodets were asked what actios they took to cotrol salt itake o a regular basis. The aalysis showed that less tha half (41.4%) of the study populatio udertook actios to limit their cosumptio of processed foods high i salt. A statistically sigificat differece was idetified betwee sexes: 46.4% (: ) for wome ad 36.9% (: ) for me (Fig. 27). A total of 41.5% of respodets of both sexes (: ) reported usig salty products (such as sauces) other tha salt whe cookig. Oly 15.8% (: ) of respodets metioed that they looked at the salt or sodium cotet o food labels, ad 14.5% of them (: ) affirmed that they bought low-salt/sodium alteratives. The prevalece of respodets i the last two categories might be so low because there is o specific regulatio o salt labellig for processed foods i the Republic of Moldova. Fig. 27. Percetage of respodets takig specific actio to cotrol salt itake, by sex 60.0% 40.0% 20.0% % Limitig cosumptio of processed foods Use spices other tha salt whe cookig Lookig at the salt or sodium cotet o food labels Me Wome Both sexes Buyig low-salt/-sodium alteratives 50

52 Coclusios 1. The average daily itake of fruit ad vegetables amog the Moldova populatio was four servigs, with a higher frequecy i rural areas (4.2) tha i urba areas (3.9). 2. Two thirds of the Moldova populatio cosumed fewer tha five servigs of fruit ad vegetables daily. 3. The survey populatio used predomiatly vegetable oil for cookig. 4. Youger age s amog both sexes ad amog the urba populatio ate outside the home more frequetly. 5. Every fourth perso (24.3%) reported addig salt while eatig, with a higher prevalece amog me (28%) tha amog wome (20.3%) ad, of these me, a higher prevalece i urba areas (29.8%) tha rural (26.4%). 6. The populatio geerally kow the beefits of cosumig iodized salt, with 81.4% of the survey respodets usig iodized salt i food preparatio at home (with a higher prevalece amog the urba populatio (89.2%) tha amog rural residets (74.4%)). 7. Oe third of the populatio (32.4%) ofte cosumed processed food high i salt, with more me (36.5%) reportig this tha wome (28.1%) ad with a higher prevalece i urba areas (36.3%) tha rural (29%). 8. The survey populatio was aware of the icreased risk associated with high levels of salt cosumptio. A total of 89.7% cosidered that the cosumptio of high levels of salt poses serious health risks (with a higher prevalece of this opiio amog wome (92.8%) tha me (86.6%)), but oly 30.7% of the respodets were aware of the importace of lowerig salt cosumptio i their ow diets to improve their health. 9. The populatio was ot aware of the recommeded level of salt cosumptio, ad oly 14.7% perceived that they cosume too much salt. More tha seve out of 10 idividuals (72.9%) perceived that they cosume just the right amout of salt. 51

53 Physical activity Physical activity i the study populatio was aalysed usig cotiuous idicators, such as time spet participatig i differet physical activities, as well as categorical idicators, such as cut-off poits for specific amouts of physical activity. Total physical activity per day was recorded, takig ito accout all domais (work-, trasport- ad recreatio-related activities). Aalysis of the collected data showed that oe i 10 idividuals i the study populatio (or 10.1%, : ) did ot meet WHO recommedatios o physical activity for health; amely, performig 150 miutes of moderate-itesity physical activity per week (or equivalet) (19). No sigificat differece was observed betwee me (10.7%, : ) ad wome (9.4%, 95% CI: ). The highest percetage of idividuals ot meetig the WHO recommedatios was idetified i the age years (14.6%) (Fig. 28). Differeces were also idetified betwee the coutry s urba ad rural populatios, with a higher prevalece i urba areas of ot correspodig to WHO s physical activity recommedatios. The differece betwee sexes for all age s costituted approximately 3% (Table 24). Fig. 28. Proportio of respodets ot meetig WHO recommedatios o physical activity for health, by age ad sex 20.0% 15.0% 10.0% 5.0% % years years years years Total Me Wome Both sexes 52

54 Table 24 Proportio of respodets ot meetig WHO recommedatios o physical activity for health, by area of residece ad sex Me Wome Both sexes Not meetig Not meetig Not meetig rec s rec s rec s Rural Urba Total Note. Rec s: recommedatios. Accordig to WHO recommedatios (19), 63.2% of the study populatio fell ito the high level of physical activity category; 24.8% were attributed to the moderate-level activity ; ad 12% were i the low level of activity. No statistically sigificat differece was recorded betwee the sexes, with 66.3% of me (: ) ad 59.9% of wome (: ) i the high-level activity, while 12.9% of me (: ) ad 10.9% of wome (: ) were i the low-level activity category (Fig. 29). Fig. 29. Level of total physical activity accordig to WHO recommedatios Both sexes Wome Me % 20.0% 40.0% 60.0% 80.0% 100.0% High Moderate Low Source: WHO Global recommedatios o physical activity for health, As already metioed, total physical activity per day was recorded, icludig work-related, trasport-related ad recreatio-related activities. Altogether, respodets aged years carried out a average of miutes of physical activity per day, with a statistically sigificat 53

55 differece betwee me (313.2 miutes, : ) ad wome (255.7 miutes, : ). No sigificat differece was recorded betwee age s of the same sex (Fig. 30). Fig. 30. Mea miutes of total physical activity per day, by age ad sex Mea miutes years years years years Total Me Wome Both sexes The survey showed that idividuals i rural areas were more exposed to physical activity, amog both me ad wome. The highest mea differece was discovered i wome, with a average of miutes (: ) amog the rural populatio, compared with miutes (: ) amog wome i urba areas (Table 25). Table 25 Mea miutes of physical activity per day, by area of residece ad sex Me Wome Both sexes Mea Mea Mea miutes miutes miutes Rural Urba Total Fig. 31 shows the distributio of the mea miutes of total physical activity by type of activity. I terms of the amout of time spet o physical activity, the greatest differeces betwee sexes were foud i work-related ad recreatio-related physical activities. 54

56 Fig. 31. Mea miutes of physical activity per day, by type of activity ad sex Both sexes Wome Me Mea miutes Work-related activity Trasport-related activity Recreatio-related activity Aother measuremet of the physical activity levels amog the study populatio was the media time spet performig physical activity. Media duratio of all physical activity carried out daily recorded by respodets of all ages was miutes; miutes for me ad 180 miutes for wome (Table 26). The media time spet carryig out physical activity was much lower tha the mea time, especially for wome (Table 25), idicatig disproportioal distributio of the idicator amog the populatio, with the media value far removed from the mea. Table 26 Media miutes of physical activity per day, by age ad sex Me Wome Both sexes Iterquartile Iterquartile Media Media rage rage miutes miutes (P25 P75) (P25 P75) Media miutes Iterquartile rage (P25 P75)

57 Coclusios 1. Oe i 10 idividuals was physically iactive ad did ot meet WHO recommedatios o physical activity for health, resultig i a icreased risk for NCDs. The prevalece of physical iactivity was higher i urba areas tha rural, ad was foud to icrease with age. 2. Amog the rural populatio, both sexes were more exposed to physical activity tha i urba areas, with the highest differece foud i wome. 3. The daily media duratio of all physical activities was miutes, ad me were foud to be 1.5 times more physically active tha wome. 4. Almost two thirds (63.4%) of time spet carryig out physical activity was work related ad approximately oe third was trasport related. Me spet more time i work-related physical activity, while wome spet loger carryig out trasport-related physical activity. History of raised blood pressure Respodets were asked whether they had ever udergoe blood pressure measuremet ad whether they had bee diagosed with high blood pressure. Amog all age s, 8.5% reported that their blood pressure had ever bee measured; 69% had udergoe blood pressure measuremet but had ot bee diagosed with hypertesio; 4.3% had bee diagosed with high blood pressure more tha a year before; ad 18.3% had bee diagosed with hypertesio withi the 12 moths prior to the iterview. These comprehesive results could be due to the iclusio of hypertesio detectio ad its moitorig by primary health care services as a performace idicator. 5 As the prevalece of high blood pressure is usually greater i elderly people, it follows that youger age s aswered more frequetly that they were ever checked or diagosed with hypertesio, while the older age s more frequetly aswered that they were checked ad diagosed with blood pressure problems more ofte (Table 27). Some statistically sigificat differeces emerged i terms of raised blood pressure history betwee the sexes. A total of 10.8% of me (: ) had ever had their blood pressure measured, compared with 6% of wome (: ). The percetage of wome diagosed with high blood pressure durig the previous 12 moths was higher (21.6%, : ) tha that of me (15.2%, : ) (Fig. 32). 5 Commo Order of the Miistry of Health ad Natioal Health Isurace Compay No. 142/68A of 27 February 2014, o the approval of the Regulatio o performace idicators accomplishmet ad validatio criteria. 56

58 Table 27 Blood pressure measuremet ad diagosis, by age Never measured Measured, ot diagosed Both sexes Diagosed, but ot withi past 12 moths Diagosed withi past 12 moths Fig. 32. Blood pressure measuremet ad diagosis, by sex Both sexes Wome Me % 20.0% 40.0% 60.0% 80.0% 100.0% Never measured Measured, ot diagosed Diagosed, but ot withi past 12 moths Diagosed withi past 12 moths Compliace with high blood pressure treatmet was foud to be very low. Of all respodets aged years diagosed with high blood pressure, less tha half were takig medicatio prescribed by a doctor or health worker. The age differece was statistically sigificat, with a icrease i the proportio of those takig medicatio from 18% (: ) amog the age years to 65.1% (: ) i the age years (Fig. 33). 57

59 Fig. 33. Proportio curretly takig medicatio for raised blood pressure prescribed by doctor or health worker amog those diagosed 80.0% 60.0% 40.0% 20.0% 0.0% years years years years Total Me Wome Both sexes 46.1 Coclusios 1. A total of 8.5% of respodets reported that their blood pressure had ever bee measured, with a sigificat differece betwee the sexes (10.8% of me vs 6% of wome). 2. More tha a year before the survey, 4.3% of respodets had bee diagosed with high blood pressure ad 18.3% had bee diagosed with hypertesio withi the past 12 moths. 3. Compliace with high blood pressure treatmet was foud to be very low (less tha half). History of diabetes History of diabetes, icludig blood sugar measuremet, established diagosis ad treatmet for diabetes were aalysed. Of all the respodets, 40.3% had ever had their blood sugar measured ad 54.1% of them had udergoe the test but had ot bee diagosed with diabetes. A total of 1.2% of the respodets of all ages had bee diagosed with high blood glucose more tha 12 moths before the survey ad 4.3% withi the previous 12 moths (Table 28). The proportio of respodets that had ever udergoe a test for diabetes was higher i the youger age s, with a statistically sigificat differece betwee age s, varyig from 56.1% (: ) i the respodets aged years to 22.8% (: ) i those aged years. This tred is also characteristic for those whose blood glucose level had bee tested but who had ot bee diagosed with high blood sugar. The percetage of people diagosed both withi the past 12 moths ad earlier was also associated with age, but with a positive relatioship; amely, a higher proportio i the older age s. 58

60 Table 28 Blood sugar measuremet ad diagosis, by age Never measured Measured, ot diagosed Both sexes Diagosed, but ot withi past 12 moths Diagosed withi past 12 moths I terms of blood sugar testig, sigificat differeces betwee sexes were idetified amog the survey respodets: the percetage of me of all ages who had ever had their blood glucose measured was 45.4% (: ), compared with 34.9% of wome of the same age (: ). The proportio of those who had udergoe blood sugar measuremet but had ot bee diagosed was 34.9% (: ) i me ad 34.9% (: ) i wome. No statistically sigificat differeces betwee the sexes were detected i the proportio of people diagosed with high blood sugar (Fig. 34). Fig. 34. Blood sugar measuremet ad diagosis, by sex Both sexes Wome Me % 20.0% 40.0% 60.0% 80.0% 100.0% Never measured Diagosed, but ot withi past 12 moths Measured, ot diagosed Diagosed withi past 12 moths Respodets previously diagosed with raised blood sugar or diabetes were asked whether they had bee prescribed ay medicatio for diabetes by a health worker durig the previous two weeks, or whether they were takig isuli for diabetes prescribed by a doctor or other health worker. 59

61 Isigificat differeces were idetified betwee the sexes, with 36.7% of me (: ) ad 35.7% of wome (: ) takig ay medicatio for diabetes prescribed by a doctor or a health worker. A higher discrepacy was detected for those takig suli, with 13% of me (: ) ad 10.8% of wome (: ) takig isuli recommeded by a doctor or a health worker (Fig. 35). Fig. 35. Proportio of respodets takig ay medicatio or isuli prescribed for diabetes amog those previously diagosed 60.0% 40.0% 20.0% 0.0% Me Wome Both sexes Takig medicatio Takig isuli Coclusios 1. A total of 40.3% of respodets had ever udergoe blood sugar measuremet/testig, with sigificat differeces betwee the sexes (45.4% of me vs 34.9% of wome). 2. Of all the respodets, 1.2% had bee diagosed with high blood sugar more tha 12 moths prior to the iterview ad 4.3% withi the previous year. History of raised cholesterol A total of 60% of respodets of all ages declared that they ever had their blood cholesterol measured withi a health care facility, while 34.7% had udergoe a test for blood cholesterol level but had ot bee diagosed with raised cholesterol. Oly 0.9% of the study populatio had bee diagosed with a high level of cholesterol more tha 12 moths before the iterview, ad 4% withi the past year. The proportio of people diagosed with a high level of blood cholesterol was foud to icrease with age, while proportio of those that had ever udergoe a test for cholesterol decreases with age. There was o substatial differece betwee the sexes i terms of cholesterol measuremet ad diagosis history (see Table 29 ad Fig. 36). It should be oted that measuremet 60

62 of total cholesterol is madatory for the age years ad is part of the performace idicator determiatio of SCORE idex at the primary health care level. 6 Table 29 Total cholesterol measuremet ad diagosis, by age Never measured Measured, ot diagosed Both sexes Diagosed, but ot withi past 12 moths Diagosed withi past 12 moths Fig. 36. Total cholesterol measuremet ad diagosis, by sex Both sexes Wome Me % 20.0% 40.0% 60.0% 80.0% 100.0% Never measured Diagosed, but ot withi past 12 moths Measured, ot diagosed Diagosed withi past 12 moths Amog those diagosed with a high level of total blood cholesterol, 24.6% had take oral medicatio durig the previous two weeks based o a prescriptio by a doctor or health worker. Of these idividuals, 30.2% were me (: ) ad 21.5% were wome (: ). 6 Commo Order of the Miistry of Health ad Natioal Health Isurace Compay No. 142/68A of 27 February 2014, o the approval of the Regulatio o performace idicators accomplishmet ad validatio criteria. 61

63 Coclusios 1. A total of 60% of respodets of all ages had ever had their blood cholesterol level measured. 2. Oly 0.9% of the study populatio had bee diagosed with high cholesterol more tha 12 moths before the iterview, ad 4% withi the past year. 3. Of the respodets with high cholesterol, 24.6% had take oral medicatio for it durig the previous two weeks, with a sigificat differece betwee the sexes (30.2% of me vs 21.5% of wome). CVD history Amog all respodets, 12.9% reported havig ever had a heart attack or chest pai from heart disease (agia) or stroke ad prevalece was foud to icrease gradually with age, from 6.7% (95% CI: ) i the age years to 27.9% (: ) i the age years. Me reported cases of heart attack or stroke less frequetly (9.7%, : ) tha wome (16.3%, : ), with the differece beig statistically sigificat (Fig. 37). Fig. 37. Percetage of respodets havig ever had a heart attack or chest pai from heart disease or a stroke, by age ad sex 40.0% 30.0% 20.0% 10.0% 0.0% years years years years Total 12.9 Me Wome Both sexes A total of 7% of all respodets reported regularly takig aspiri ad 2% of them also took statis to prevet or treat heart disease (Fig. 38). The proportio of wome that reported usig aspiri for prevetio or treatmet of CVDs was twice as high as that of me: 10.1% for males (: ) ad 4.8% for females (: ). Use of statis was less frequetly reported but the proportio amog wome was higher (2.5%, : ) tha amog me (1.5%, : ). 62

64 Fig. 38. Percetage of respodets curretly takig regularly aspiri or/ad statis to prevet or treat heart disease 12.0% 10.0% 8.0% 6.0% 4.0% 2.0% 0.0% Me Wome Both sexes Takig aspiri Takig statis Coclusios 1. Amog all respodets, 12.9% reported ever havig had a heart attack or chest pai from heart disease (agia) or a stroke. 2. A total of 7% of all respodets reported takig aspiri regularly ad 2% of them took statis to prevet or treat heart disease. The proportio of wome who reported usig aspiri for prevetio or treatmet of CVDs was twice as high as that of me. Lifestyle advice Fig. 39 shows the proportio of respodets who reported receivig differet types of lifestyle advice from a doctor or a health worker durig the past three years. Some of the figures are detailed here. 41.6% of respodets had bee advised to stop smokig or ot to start: 50.4% amog me (: ) ad 32.1% amog wome (: ). 57.8% of respodets had bee advised to reduce salt i their diet: 54.7% amog me (95% CI: ) ad 61.2% amog wome (: ) % of respodets had bee advised to eat at least five servigs of fruit ad/or vegetables each day: 59.2% amog me (: ) ad 66.4% amog wome (: ). 62.3% of respodets had bee advised to reduce fat i their diet: 58% amog me (: ) ad 66.9% amog wome (: ). 54.3% of respodets had bee advised to start or to do more physical activity: 51.6% amog me (: ) ad 57.2% amog wome (: ). 52.1% of respodets had bee advised to maitai a healthy body weight or to lose weight: 48.6% amog me (: ) ad 56% amog wome (: ). 63

65 Very little differece was revealed i terms of the resposes provided by people from differet age s ad betwee the sexes. The greatest differece betwee sexes was i the advice give to stop smokig, with a higher proportio of me aswerig that they had received such advice. Fig % Percetage of respodets reportig havig received lifestyle advice from a doctor or health worker durig the past three years, by sex 60.0% 40.0% 20.0% % To stop smokig or do t start To reduce salt i the diet To eat at least 5 servigs of fruit ad/or vegetables each day Me Wome Both sexes To reduce fat i theto start or do more diet physical activity To maitai a healthy body weight or to lose weight Coclusios 1. Fruit ad vegetable cosumptio, alogside reductio of fat ad salt i the diet were the most frequet health advice topics addressed by a doctor or health worker to the survey respodets. Wome reported receivig such advice more frequetly tha me. 2. More tha half of the study populatio received advice o physical activity for health ad o healthy body weight, with a higher prevalece of this i wome tha me. Cervical cacer screeig Female respodets were asked whether they had ever had a screeig test for cervical cacer. Of all the wome aged years participatig i the study, 63.2% (: ) reported ever havig udergoe a screeig test for cervical cacer. The highest prevalece of testig amog wome was i the age years, with 73.1% (: ) ad the lowest was i the age years, with 49.9% (: ). Wome i rural areas reported more frequetly havig ever udergoe cervical cacer screeig tha the urba female populatio (see Fig. 40 ad Table 30). It should be oted that accordig to atioal legislatio all wome aged years should be screeed for cervical cacer oce every two years (20), ad screeig for cervical cacer is also a performace idicator for primary health care. Accordig to the Miistry of Health s official statistics, the rates of wome screeed for cervical cacer i were 60.1% ad 59.9% (21). 64

66 Fig. 40. Percetage of wome tested for cervical cacer, by age Total years years years years % 20.0% 40.0% 60.0% 80.0% Table 30 Percetage of wome aged years tested for cervical cacer, by area of residece Ever tested Rural Urba Total The percetage of female respodets aged years that had ever udergoe screeig for cervical cacer was 69.7% (: ) (Table 31). Table 31 Percetage of wome aged years tested for cervical cacer Ever tested Coclusios 1. Six out of 10 wome (63.2%) had bee screeed for cervical i the past, with a higher prevalece amog wome i rural areas tha amog those i urba areas. 2. Seve out of 10 wome i the age most at risk for cervical cacer (30 49 years) had udergoe cervical cacer screeig. Wome aged years had the highest (73.1%) cervical screeig coverage, compared with wome aged years, who had the lowest (49.9%). 65

67 Physical measuremets Hypertesio as a risk factor for NCD was assessed by meas of blood pressure measuremet. Mea SBP i the study populatio was mmhg (: ); mmhg for me (: ) ad mmhg (: ) for wome. Mea DBP was 85.0 mmhg (95% CI: ) i the study populatio; 85.0 mmhg (: ) i me ad 84.6 mmhg (95% CI: ) i wome (Fig. 41). Both SBP ad DBP were foud to icrease with age. The SBP i the age years was approximately 30% higher tha i the age years, ad the differece i DBP betwee the same age s was about 15%. Fig. 41. Mea SBP ad DBP (mmhg), by sex ad age * Mea SBP/DBP (mmhg) Mea SBP Mea DBP Mea SBP Mea DBP Mea SBP Mea DBP Mea SBP Mea DBP Mea SBP Mea DBP years years years years Total Me Wome Both sexes *=4226. The prevalece of hypertesio i the study populatio was 39.8% (: ); 40.3% (: ) for me ad 39.3% (: ) for wome. There was a statistically sigificat differece betwee ages, with a icrease i prevalece from 16.9% (: ) i the youger age, to 76.7% (: ) i the older age (Fig. 42). The percetage of those with a SBP of 160 mmhg ad/or a DBP of 100 mmhg, or takig medicatio for raised blood pressure was 21.7% (: ); 19.3% (: ) for me ad 24.2% (: ) for wome. 66

68 Fig. 42. Percetage of respodets with raised blood pressure, or curretly takig medicatio for raised blood pressure, by sex 60.0% 40.0% 20.0% 0.0% Me Wome Both sexes SBP 140 ad/or DBP 90 mmhg SBP 160 ad/or DBP 100 mmhg Of all the respodets ot curretly takig medicatio for hypertesio, 33.2% (: ) had a SBP of 140 mmhg ad/or a DBP of 90 mmhg. The proportio of me i this category was 35.9% (: ) ad that of wome was 30.1% (: ) (Fig. 43). Fig. 43. Percetage of respodets with raised blood pressure, excludig those takig medicatio for raised blood pressure, by sex 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% Me Wome Both sexes SBP 140 ad/or DBP 90 mmhg SBP 160 ad/or DBP 100 mmhg Respodets idetified as havig high blood pressure (SBP 140 mmhg ad/or DBP 90 mmhg) ad those takig medicatio for raised blood pressure were aalysed together: 4.1% (: ) of them were takig medicatio for high blood pressure (SPB <100 mmhg ad DBP <90 mmhg). 67

69 A total of 19.7% (: ) were takig medicatio but still had icreased blood pressure (SBP 140 mmhg ad/or DBP 90 mmhg). The remaiig 76.2% (: ) were ot takig medicatio but had icreased blood pressure (Fig. 44). The percetage of respodets with cotrolled blood pressure was higher amog the urba populatio (5.2%, : ) tha amog those i rural areas (3.4%, : ). Also, the urba populatio comprised a higher proportio of idividuals with hypertesio that ad takig medicatio. A statistically sigificat differece was idetified betwee me ad wome i terms of the distributio of cotrolled blood pressure: 6.0% of wome (: ) were takig medicatio with SPB <100 mmhg ad DBP <90 mmhg, i compariso with 2.4% amog me (: ). A total of 84.1% (: ) of me were ot takig medicatio but had raised blood pressure, i compariso with 67.5% of wome (: ). I cotrast, the proportio of wome that were takig medicatio but that still had high blood pressure was twice that of me (Fig. 44). Fig. 44. Respodets with treated ad/or cotrolled blood pressure amog those with raised blood pressure or curretly takig medicatio, by sex ad area of residece Both sexes Wome Me % 20.0% 40.0% 60.0% 80.0% 100.0% % O medicatio ad SBP<140 ad DBP<90 % O medicatio ad SBP 140 ad/or DBP 90 % Not o medicatio ad SBP 140 ad/or DBP 90 Athropometric measuremets such as height, weight, ad waist ad hip circumferece were used to calculate BMI ad mea WHR i order to estimate the prevalece of overweight ad obesity i the study populatio (excludig pregat wome) by age, sex ad area of residece. Male respodets were o average 173 cm tall (: ) ad weighed o average 79.2 kg (: ), ad females were o average cm tall (: ) ad weighed o average 70.7 kg (: ). The weight ad height data were used to compute 68

70 BMI. Mea BMI for the study populatio (both sexes) was 26.6 (: ); 26.2 (: ) for me ad 27.0 (: ) for wome. The gradual icrease i BMI that was foud to occur with age is depicted i Fig. 45. Fig. 45. Mea BMI (kg/m 2 ), by sex ad age Mea BMI (kg/m 2 ) years years years years Total Me Wome Both sexes No substatial differece betwee sexes was foud for this idicator amog the study populatio. However, while disaggregatig by area of residece, sigificat differeces were foud i the female populatio, with a mea BMI of 27.8 (: ) for rural wome ad 26.1 (: ) for wome i urba areas. I cotrast, me from urba areas had a lower BMI tha me from rural areas (Table 32). Table 32 Mea BMI (kg/m 2 ), by sex ad area of residece Me Wome Both sexes Mea BMI Mea BMI Mea BMI Rural Urba Total The study populatio was ed ito four BMI categories: uderweight (BMI <18.5), ormal weight (BMI ), overweight (BMI ) ad obese (BMI 30.0). A total of 56% of all respodets (both sexes) had a BMI greater tha 25 ad thus fell ito the overweight or obese categories; 41.65% were ed i the ormal weight category ad 2.5% i the uderweight category (Fig. 46). The combied percetages of overweight ad obese categories i me ad wome were very similar. Wome had a higher prevalece of BMI 30.0 (28.5%, : ) tha me (17.8%, : ), while a higher prevalece of me i the overweight category was recorded. Statistically sigificat differeces were recorded betwee the sexes. 69

71 The survey o the health status of the populatio i the Republic of Moldova (9) showed that the mea BMI was 25.6, with o differece betwee the sexes (25.6 for both) or area of residece (25.5 i urba areas ad 25.6 i rural areas). The prevalece of overweight was higher i me tha i wome (36.9 vs 32.7) ad i rural areas i compariso with urba settigs (35.1 vs 33.9). I cotrast, the prevalece of obesity was higher i wome tha i me (17.1 vs 13.3) ad i urba areas i compariso with rural settigs (16.3 vs 14.7). This highlights that the situatio worses i the absece of cocrete policy actios to address these issues. Fig. 46. Distributio by BMI category Both sexes Wome Me % 20.0% 40.0% 60.0% 80.0% 100.0% Uderweight Normal weight Overweight Obese WHR was computed for all respodets (excludig pregat wome), usig measuremets of waist ad hip circumfereces. Results showed a WHR equal to 0.9 for me ad 0.8 for wome (Table 33). WHO defies obesity as havig a WHR above 0.90 for males ad above 0.86 for females. The values for both sexes i the curret study were foud to be at the lower limit of obesity. Almost o differeces were foud betwee the various age s i terms of mea WHR. Table 33 Mea WHR, by sex ad age Me Wome Mea WHR Mea BMI

72 Coclusios 1. Mea SBP amog the Moldova populatio was mmhg, with the higher values foud i me (134.5 mmhg). Mea DBP was 85 mmhg, with o differeces betwee the sexes. 2. Prevalece of hypertesio amog Moldova s adult populatio was 39.8%, with o differece betwee the sexes. 3. A total of eight out of 10 (76.2%) idividuals idetified as havig hypertesio were ot cotrollig their blood pressure, with a higher prevalece of this amog the rural populatio ad amog me. This could be due to the a lack of kowledge about hypertesio as a risk factor for NCDs. 4. Mea body weight ad height of Moldova me was 79.2 kg ad 173 cm, respectively. For wome, mea body weight was 70.7 kg ad height was cm. 5. Mea BMI i the study populatio was 26.6; 26.2 for me ad 27.0 for wome. Mea BMI i wome from rural areas was higher tha that of urba wome ad rural me. 6. More tha oe i two idividuals (56%) were overweight or obese, with a higher prevalece of overweight i me ad a higher prevalece of obesity i wome. The prevalece of overweight ad obesity was foud to icrease with age. 7. The populatios of both sexes were foud to be at the lower limits of the obesity category, accordig to their WHRs. Biochemical measuremets The level of blood glucose of the survey participats was assessed usig rapid diagostic tests ad capillary whole blood values. Accordig to the commo epidemiological classificatio of diabetes, participats with pre-diabetes (with fastig blood glucose betwee 5.6 ad 6.1 mmol/l) were cosidered at higher risk for cardiovascular pathology ad were icluded i the with impaired fastig glycaemia (IFG). Raised blood glucose was defied as a capillary whole blood value equal to or greater tha 6.1 mmol/l. Mea fastig blood glucose level was foud to be 5.2 mmol/l (: ) i the total study populatio, icludig those curretly takig medicatio for diabetes; 5.1 mmol/l (: ) i me ad 5.2 mmol/l (: ) i wome. Figures for mea fastig blood glucose were lowest i the age years (4.8 mmol/l, : ) ad highest i the age years (5.7 mmol/l, : ) (Fig. 47). 71

73 Fig. 47. Mea fastig blood glucose level (mmol/l), by sex ad age Mea blood glucose level (mmol/l) years years years years Total Me Wome Both sexes 5.2 The percetage of respodets with IFG was aalysed based o the aforemetioed fastig blood glucose limits. No-fastig subjects were excluded. A total of 8.3% of the study populatio was foud to have IFG: it was detected i 7.4% of me (: ) ad 9.1% of wome (: ). Although the prevalece was higher i wome, the differece was ot statistically sigificat. Levels of IFG were foud to differ amog age s, with a prevalece amog people aged years of almost three times higher tha amog those aged years. Fig. 48. Prevalece of IFG, by sex ad age 20.0% 15.0% 10.0% 5.0% 0.0% years years years years Total Me Wome Both sexes A total of 12.3% of the study populatio had a blood glucose level of 6.1 mmol/l, with 11.5% (95% CI: ) i me ad 13% (: ) i wome. The proportio of the study populatio 72

74 with raised blood glucose values was foud to icrease from 5.3% (: ) i the age years to 23.3% (: ) i those aged years (Fig. 49). Fig. 49. Prevalece of raised blood glucose or curretly takig medicatio for diabetes, by sex ad age 40.0% 30.0% 20.0% 10.0% 0.0% years years years years Total Me Wome Both sexes Blood cholesterol level was tested i the study populatio, icludig participats receivig cholesterol-lowerig medicatio. Mea total blood cholesterol of the survey populatio was 4.5 mmol/l (: ); 4.4 mmol/l (: ) i me ad 4.6 mmol/l (: ) i wome. Mea total blood cholesterol levels teded to icrease with age i both sexes ad the differece was statistically sigificat (Table 34). Table 34 Mea total cholesterol (mmol/l), by sex ad age Me Wome Both sexes Mea Mea Mea mmol/l mmol/l mmol/l Fig. 50 shows the percetage of respodets that had raised total cholesterol of 5.0 mmol/l ad those with a blood cholesterol level of 6.2 mmol/l. Respodets that were curretly takig medicatio for raised cholesterol were also icluded i these categories. A total of 29.4% of the study populatio had a blood cholesterol level of 5 mmol/l (: ), ad 6.5% had a blood 73

75 cholesterol level of 6.2 mmol/l (: ). The proportio of wome i both categories was higher tha that of me, but the differece was ot statistically sigificat. Fig. 50. Percetage of respodets with a total cholesterol level of 5.0 ad 6.2 mmol/l, or curretly takig medicatio for raised cholesterol, by sex 40.0% 30.0% 20.0% 10.0% % Cholesterol 5.0 mmol/l Cholesterol 6.2 mmol/l Me Wome Both sexes The mea level of HDL cholesterol i all respodets blood was 1.4 mmol/l (: ), with a higher level foud i wome (1.5 mmol/l, : ) tha i me (1.3 mmol/l, : ) (Table 35). Table 35 Mea HDL cholesterol, by sex ad age Me Wome Both sexes Mea Mea Mea HDL HDL HDL Fig. 52 shows the proportio of the populatio with a HDL cholesterol level uder 1.29 mmol/l for wome ad uder 1.03 mmol/l for me. Amog wome, 39.8% (: ) had a HDL level of less tha 1.29 mmol/l. Amog me, 27.4% (: ) had a HDL level of less tha 1.03 mmol/l. No sigificat differeces betwee age s were foud. 74

76 Fig. 51. Proportio of populatio with decreased HDL cholesterol 60.0% 40.0% 20.0% % % years years years years Total Me (HDL <1.03 mmol/l) Wome (HDL <1.29mmol/L) Coclusios 1. Mea fastig blood glucose level was 5.2 mmol/l ad was foud to icrease with age for both sexes. It was at the lower limit for pre-diabetes i the older age (aged years). 2. Oe i 10 idividuals (8.3%) were categorized as havig IFG ad thus a higher risk for CVD, with a higher prevalece of this i wome tha i me. 3. More tha oe i 10 idividuals (12.3%) had raised blood glucose ad diabetes, ad the proportio was foud to be four times higher i the older age tha amog youger people. 4. Mea blood cholesterol level was 4.5 mmol/l ad teded to icrease with age for both sexes. 5. The prevalece of high-risk cholesterol level or hypercholesterolemia i the populatio was foud to be 29.4% ad the prevalece of hypercholesterolemia was 6.5% higher amog wome tha me. 6. Four i 10 wome ad every fourth ma had a decreased level of HDL cholesterol, resultig i them beig at higher risk for CVDs. CVD risk Respodets aged years were assessed to establish those with a 10-year CVD risk of 30%, ad those with existig CVD. A 10-year CVD risk of 30% is defied accordig to age, sex, blood pressure, smokig status (curret smokers or idividuals who stopped smokig less tha oe year before the assessmet), total cholesterol, ad diabetes (previously diagosed or with a fastig plasma glucose cocetratio of >7.0 mmol/l). The percetage of respodets i the age years fallig withi the category of 10-year CVD risk of 30% or with existig CVD was 23% (: ). Prevalece of this 75

77 was much higher amog wome at 27% (: ) tha amog me at 18.5% (: ), ad the differece was statistically sigificat. Amog respodets i the age years, 16% (: ) were foud to have a 10-year CVD risk of 30% or existig CVD, compared with 33.1% (: ) for this idicator i the age years, ad, agai, the differece was statistically sigificat (Table 36). Of the aforemetioed of respodets (40 69 years old, with a 10-year CVD risk of 30%, icludig those with existig CVD), 51.3% (: ) were receivig drug therapy ad cousellig (icludig glycaemic cotrol) to prevet heart attacks ad strokes. Cousellig was defied as receivig advice from a doctor or other health worker to: stop smokig or ot to start; reduce salt i diet; eat at least five servigs of fruit ad/or vegetables per day; reduce fat i diet; start or do more physical activity; maitai a healthy body weight; or to lose weight. No sigificat differeces were idetified betwee the sexes or the various age s (Fig. 52). Table 36 Percetage of respodets with a 10-year CVD risk ( 30%) or with existig CVD Me Wome Both sexes % % % Fig. 52. Percetage of eligible idividuals receivig drug therapy ad cousellig to prevet heart attacks ad strokes* 80.0% 60.0% 40.0% 20.0% % *= years years years Me Wome Both sexes 76

78 Coclusios 1. The prevalece of idividuals aged years with a 10-year CVD risk of 30% or with existig CVD costituted 23% (: ). Of these, 51.3% (: ) were receivig drug therapy ad cousellig to prevet heart attack ad stroke. 2. A statistically sigificat differece betwee the sexes was foud, with much higher prevalece amog wome 27% (: ) tha amog me 18.5% (: ). Summary of combied risk factors Combied CVD risk factors were aalysed i the study populatio. Based o the iterview results ad physical ad biochemical measuremets, the followig risk factors were used: curret daily smokig; fewer tha five servigs of fruit ad/or vegetables per day; ot meetig WHO recommedatios o physical activity for health (<150 miutes of moderate activity per week, or equivalet); overweight or obese (BMI 25 kg/m2); raised blood pressure (SBP 140 mmhg ad/or DBP 90 mmhg, or curretly takig medicatio for raised blood pressure). The percetage of respodets with 0, 1 2 or 3 5 risk factors by age ad sex are preseted i Fig. 53. I 8% (: ) of the study populatio, oe of the abovemetioed five risk factors were idetified; 61.7% (: ) of the respodets had 1 2 risk factors; ad 30.3% (95% CI: ) has 3 5 of the risk factors listed. Prevalece of 3 5 combied risk factors was much higher i the age years (47.6%, : ), while prevalece of 1 2 risk factors was higher i the age years (68.9%, : ). Differeces were statistically sigificat. A higher proportio of me had 3 5 risk factors (35.2%, : ) tha wome (25%, : ). I additio, the percetage of wome with 1 2 risk factors (64.6%, : ) was higher tha that of me (59.1%, : ). Noe of the above-metioed risk factors were idetified i 5.7% of me (: ), ad the percetage of wome with oe of the risk factors was 10.4% (: ). 77

79 Fig. 53. Summary of combied risk factors, by age ad sex Me Wome Both sexes years years years years years years years years years % 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0% 100.0% 0 risk factors 1 2 risk factors 3 5 risk factors Health care Level of health isurace, as well as fiacial ad physical access to health care were aalysed, based o the results of the survey questioaires. Amog all respodets aged years, 66.4% (: ) declared that they were covered by health isurace at the time of the iterview, with a statistically sigificat differece betwee wome ad me, whereby wome had better coverage (71.2%, : for wome vs 62.1%, : for me). The percetage of isured idividuals was foud to icrease with age ad reached its highest level i the idividuals aged years amog the study populatio (93%, : ) (Fig. 54). Results of the study showed a much lower level of health isurace coverage compared with official data from the Miistry of Health. The Miistry of Health s 2013 aual activity report (22) shows a level of populatio health isurace coverage of 83.2%. Takig ito accout that the STEPS survey oly icluded the populatio aged years, ad the fact that childre ad retired people are isured by State, the actual differece would appear to be eve higher. A statistically sigificat differece was idetified i terms of health isurace coverage by area of residece (Table 37). The percetage of respodets with health isurace coverage amog the urba populatio was 79.2% (: ), which is much higher tha amog respodets from rural areas (55.1%, : ). 78

80 Fig. 54. Percetage of respodets covered by health isurace, by age ad sex 100.0% 80.0% 60.0% 40.0% 20.0% % Table years years years years Total Me Wome Both sexes Percetage of respodets covered by health isurace, by area of residece ad sex Me Wome Both sexes % % % Rural Urba Total Survey participats were asked which of a list of fiacial sources they had used to pay for health care expediture, such as medicies, cosultatios, treatmet, hospitalizatio or patiet care durig the previous 12 moths. The percetages of respodets usig various fiacial sources for health expediture are represeted i Fig. 55. The majority of respodets (66%, : ) used their curret icome to pay for health expediture. The secod most frequet aswer was paymet or reimbursemet from health isurace (26.6%, : ), followed by fiacial sources from family member or fried outside household (19.8%, : ), borrowed from someoe other tha family or fried (8.6%, : ), savigs (8.3%, : ), ad sold items (5%, : ). 79

81 Fig. 55. Fiacial sources used for health expediture, by sex 80.0% 60.0% 40.0% 20.0% 0.0% Curret icome Savigs Health isurace paymet or reimbursemet Sold items Member or fried outside household Someoe other tha family or fried Me Wome Both sexes Based o self-reported data, the percetages of respodets with NCDs (cacer, chroic respiratory disease, diabetes, or CVDs, icludig heart disease ad stroke) were aalysed. A total of 14.8% (: ) of the study populatio (both sexes, aged years) reported havig bee diagosed with a NCD (Table 38). The prevalece of NCDs i wome (18.2, : ) was sigificatly higher tha i me (11.6%, : ) ad was foud to icrease with age for both sexes. Table 38 Percetage of respodets with NCDs, by age ad sex Me Wome Both sexes % % % Amog the respodets with NCDs, 92.1% (: ) declared that they had visited a health care facility due to a NCD, excludig hospitalizatio, at least oce (Table 39). A total of 34.3% of them (: ) had visited a health care facility for a curret NCD durig the past 30 days. No sigificat differeces were idetified betwee sexes ad age s. 80

82 Table 39 Percetage of respodets with NCDs who visited a health care facility for a NCD, by sex Me Wome Both sexes % % % Mea travel time to a health care facility for the most recet visit, amog respoders with a NCD who reported ever havig visited a health care facility was 79.7 miutes (: ) ad it was higher amog wome (85.3 miutes) tha me (70.9 miutes). Mea travel time for the rural populatio was 97.2 miutes (: ), whereas for the urba populatio it was 56.2 miutes (: ), ad the differece was statistically sigificat (Table 40). Table 40 Mea time spet travelig to ad from a health care facility durig the most recet visit for a NCD, by area of residece ad sex Me Wome Both sexes Mea Mea Mea miute) miute) miute) Rural Urba Total Mea waitig time at a health care facility durig the last visit, amog respoders with a NCD who reported ever havig visited a health care facility was 49.8 miutes (: ) ad it was higher amog me (55.1 miutes, : ) tha wome (46.3 miutes, : ), with o sigificat statistical differece. There was, however, a large differece i the mea waitig time betwee age s, especially amog me (Fig. 56). 81

83 Fig. 56. Mea waitig time (i miutes) before appoitmet at last visit to health care facility for a NCD, by age ad sex Mea miutes years years years years Total Me Wome Both sexes A aalysis was carried out of the mea umber of visits to specific health care facilities durig the past 30 days amog respodets with a NCD that reported havig visited a health care facility durig the past 30 days. The mea umber of visits to a health cetre for all eligible respodets aged years was 1.7 (: ). Respodets had visited a public hospital o average 0.5 times (: ), ad a private hospital 0.1 times (: ) durig the previous 30 days (Table 41). No sigificat differeces betwee sexes or age s were idetified. Table 41 Mea umber of visits to specific health care facilities Mea o. of visits to health cetre Both sexes Mea o. of visits to public hospital Mea o. of visits to private hospital The mea amout (MDL) of expediture by respodets for specific health care costs ad i total for all visits i the past 30 days to a health care facility due to a NCD amog those with NCDs who had visited a health care facility for that NCD i the past 30 days was MDL (: ), with o sigificat differece betwee the sexes. The highest mea amout was spet o medicies: MDL (: ) (Table 42). 82

84 Table 42 Mea MDL spet o visits to a health care facility for a NCD, by type of expediture ad sex Me Wome Both sexes MDL MDL MDL Provider fees Medicie Tests Trasport Other expeses Total The mea amout spet by respodets o health care ot related to a visit to a health care facility durig the past 30 days was MDL 223 (: ), with a higher mea for wome (MDL 249.7, : ) tha me (MDL 182.6, : ). No sigificat differece was idetified betwee wome ad me, or betwee age s, i terms of the mea amout of moey spet o health care ot related to visits to health care facilities (Fig. 57). Fig. 57. Mea MDL spet o health care ot related to a visit to a health care facility or hospital, by age ad sex Mea MDL years years years years Total Me Wome Both sexes Of all respodets with a NCD, 21.6% (: ) had bee hospitalized due to a NCD durig the 12 moths prior to the iterview. The percetage of hospitalizatios amog me was higher tha amog wome (24.2%, : vs 19.9%, : ). The differece was ot statistically sigificat (Fig. 58). 83

85 Fig. 58. Percetage of respodets with a NCD havig bee hospitalized as a result of that NCD, by age ad sex 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% years years years years Total Me Wome Both sexes 21.6 Amog respodets of all ages ad both sexes with NCDs, 7.8% (: ) had received home care from a family member or a fried durig the previous 30 days due to a NCD (Fig. 59). The proportio of those who reported havig received home care was foud to icrease with age, from 6.8% (: ) i the age years to 11% (: ) amog idividuals aged years. No sigificat differeces betwee ages or sexes were idetified. Fig. 59. Percetage of respodets with a NCD havig received home care, by age ad sex 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% years years years years Total Me Wome Both sexes

86 Coclusios 1. Fewer tha seve i 10 idividuals (66.4%) had (self-reported) health isurace coverage, with a higher prevalece amog wome (71.2%) tha me (62.1%). Populatio coverage was higher i urba areas (79.2%) tha rural (55.1%). 2. Curret icome was the mai source used to pay for health expediture (66%), followed by health isurace (26.6%). 3. Self-reported prevalece of diagosed NCDs was 14.8%, with a higher prevalece amog wome (18.2%) tha me (11.6%), ad this was foud to icrease with age for both sexes. 4. Nie out of 10 (92.1%) idividuals with NCDs had visited a health care facility at least oce. Mea travel time to ad from a health care facility for the most recet visit was 80 miutes. 5. Mea expediture o health care related to a visit to a health care facility for a NCD i the past 30 days was MDL 456.4, with 81% of this amout beig spet o medicatio. The mea amout spet o health care ot related to a visit to a health care facility i the past 30 days was MDL

87 RECAP AND CONCLUSIONS The curret survey o the prevalece of NCD risk factors was coducted usig iteratioally validated survey methodology, with exteral fiacial ad techical support based o local capacities ad effective collaboratio betwee differet stakeholders. A geeral summary of the STEPS survey results is detailed here. 1. Oe quarter of the Moldova adult populatio aged years were foud to be curret daily smokers; 62% were curret alcohol drikers; 66.6% cosumed fewer tha five servigs of fruit ad vegetables per day; 10% were physically iactive; 56% were overweight; ad 40% had hypertesio. 2. The populatio was foud to be aware of the icreased risk of high salt cosumptio, but uaware of the recommeded salt cosumptio levels. Eight out of 10 idividuals were aware of the beefits of iodized salt cosumptio. 3. Oe i four adults aged years had a 10-year CVD risk of over 30%. 4. The high prevalece of NCD risk factors i the adult populatio is uderlied by the fact that 8.3% had IFG ad 12.3% had raised blood glucose levels; 29.4% had raised total cholesterol; ad 39.8% of wome ad 27.4% of me had low levels of HDL cholesterol. 5. The summary of combied risk factors demostrates that oe i three Moldova adults aged years ad oe i two adults over 45 years of age had three or more behavioural NCD risk factors. Youg me had a 2.5 times higher risk for NCDs tha youg wome, ad over half of adults over 45 years of age are at high risk for NCDs. 6. Six out of 10 wome (63.2%) had udergoe cervical cacer screeig. 7. Seve out of 10 idividuals had self-reported health isurace coverage with a higher prevalece amog wome (71.2%) tha me (62.1%) ad a greater proportio of the urba populatio (83.2%) tha rural (55.1%). 8. Curret icome was the mai source used to pay for health expediture (66%). More tha two thirds of the expediture o care related to a visit to health care facility was spet o medicies. The fidigs of the survey will serve as a baselie for establishig objectives for Moldova s atioal health policy programmes ad actio plas ad for evaluatig implemeted policy actios aimig to reduce risk factors for NCDs. 86

88 REFERENCES 1. Alawa A. Global status report o ocommuicable diseases Geeva: World Health Orgaizatio; 2011 ( accessed 2 Jue 2014). 2. WHO global report: mortality attributable to tobacco. Geeva: World Health Orgaizatio; 2012 ( accessed 2 Jue 2014). 3. Global status report o alcohol ad health. Geeva: World Health Orgaizatio; 2011( A global brief o hypertesio. Silet killer, global public health crisis. World Health Day Geeva: World Health Orgaizatio; 2013 ( WHO_DCO_WHD_2013.2_eg.pdf?ua=1, accessed 6 Jue 2014). 5. Aual public health statistical book of the Republic of Moldova, Chişiãu: Natioal Cetre for Health Maagemet; 2012 ( publică î Moldova 2012.zip, accessed 12 Jue 2014). 6. Davies P, Valuta D. Capacity assessmet ad recommedatios for a atioal cervical cacer screeig program i the Republic of Moldova. Chişiãu: Uited Natios Populatio Fud Republic of Moldova Coutry Office ad Europea Cervical Cacer Associatio; 2014 ( accessed 2 Jue 2014). 7. Govermet Decisio No. 549 of 21 July 2011 o the approval of a atioal program o prevetio ad cotrol of diabetes for Official Moitor of the Republic of Moldova, 2011, No , art Republic of Moldova Demographic ad Health Survey Calverto, MA: Natioal Scietific ad Applied Ceter for Prevetive Medicie (Moldova) ad ORC Macro; 2006 ( uece.org/fileadmi/dam/stats/geder/vaw/surveys/moldova/dhs_moldova.pdf, accessed 2 Jue 2014). 9. Results of survey o health status of populatio i the Republic of Moldova. Chişiău: Natioal Bureau of Statistics of the Republic of Moldova; Moldova (ages 13 15). Global Youth Tobacco Survey (GYTS). Fact sheet. Atlata, GA: Ceters for Disease Cotrol ad Prevetio; 2004 ( DataReports.aspx?CAID=1, accessed 2 Jue 2014). 87

89 11. Moldova (ages 13 15). Global Youth Tobacco Survey (GYTS). Fact sheet. Atlata, GA: Ceters for Disease Cotrol ad Prevetio; 2008 ( DataReports.aspx?CAID=1, accessed 2 Jue 2014). 12. Highlights o health i the Republic of Moldova Copehage: WHO Regioal Office for Europe; 2006 ( data/assets/pdf_file/0003/103566/e88552.pdf, accessed 2 Jue 2014). 13. Europea Health For All database [olie database]. Copehage: WHO Regioal Office for Europe; 2012 ( accessed 6 Jue 2014). 14. Møller L, Aderso P, Moloey K. Europea status report o alcohol ad health Copehage: WHO Regioal Office for Europe; 2010 ( data/assets/ pdf_file/0004/128065/e94533.pdf, accessed 2 Jue 2014). 15. Populatio cesus 2004 [website]. Chişiău: Natioal Bureau of Statistics of the Republic of Moldova; 2004 ( accessed 2 Jue 2014). 16. Republic of Moldova Multiple Idicator Cluster Survey Summary report. New York, NY: Uited Natios Childre s Fud ( Summary.pdf, accessed 2 Jue 2014). 17. WHO STEPS surveillace maual. Part 6: templates ad forms. Geeva: World Health Orgaizatio; 2008 ( accessed 2 Jue 2014). 18. WHO STEPS surveillace maual: the WHO STEPwise approach to chroic disease risk factor surveillace. Geeva: World Health Orgaizatio; 2005 ( publicatios/2005/ _eg.pdf, accessed 1 Jue 2014). 19. Global recommedatios o physical activity for health. Geeva: World Health Orgaizatio; 2010 ( html, accessed 12 Jue 2014). 20. Miistry of Health ad Natioal Health Isurace Compay Order No. 1239/253 of 19 December 2012 o the approval of methodological orms for services provided uder the uique program of compulsory health isurace for Chişiău: Miistry of Health of the Republic of Moldova; 2012 ( accessed 30 May 2014). 21. Prelimiary idicatios i abbreviated form o populatio health ad medical istitutios activity for the years Chişiău: Natioal Cetre for Health Maagemet; 2014 ( accessed 4 May 2014). 22. Aual activity report of the Miistry of Health for 2013 [i Romaia]. Chişiău; Miistry of Health of the Republic of Moldova; 2014 ( activitate_al_miisterului_saatatii_petru_2013.pdf, accessed 24 April ). 88

90 ANNEX 1 WHO STEPS SURVEY 2013 Republic of Moldova STEPS Survey 2013 FACT SHEET The STEPS survey of ocommuicable disease (NCD) risk factors i the Republic of Moldova was carried out from September 2013 to May Field data collectio was performed betwee 30 September ad 9 November The Republic of Moldova implemeted STEP 1, STEP 2 ad STEP 3. Socio-demographic ad behavioural iformatio was collected i STEP 1. Physical measuremets, such as height, weight, blood pressure ad heart rate were collected i STEP 2. Biochemical measuremets were collected to assess blood glucose ad cholesterol levels i STEP 3. The survey was a populatio-based survey of adults aged years. A multi-stage cluster sample desig was used to produce represetative data for that age rage i the Republic of Moldova. A total of 4807 adults participated i the survey. The overall respose rate was 83.5%. The ext STEPS survey is plaed for 2018, if fuds permittig. Results for adults aged years (with a 95% cofidece iterval (CI)) STEP 1. Tobacco use Percetage who curretly smoke tobacco Percetage who curretly smoke tobacco daily Amog those who smoke tobacco daily Average age started smokig Percetage of daily smokers smokig maufactured cigarettes Mea umber of maufactured cigarettes smoked per day (by smokers of maufactured cigarettes) STEP 1. Alcohol cosumptio Percetage who are lifetime abstaiers Percetage who are past 12-moth abstaiers Percetage who curretly drik (drak alcohol i the past 30 days) Percetage who egage i heavy episodic drikig (6 or more driks o ay oe occasio i the past 30 days) Both sexes (CI) 25.3% ( ) 23.3% ( ) 17.7 ( ) 98.9% ( ) 16.7 ( ) 14.0% ( ) 7.0% ( ) 61.9% ( ) 19.5% ( ) Males (CI) 43.6% ( ) 40.6% ( ) 17.5 ( ) 98.8% ( ) 17.2 ( ) 10.8% ( ) 5.7% ( ) 69.8% ( ) 29.0% ( ) Females (CI) 5.6% ( ) 4.6% ( ) 19.5 ( ) 99.7% ( ) 11.4 ( ) 17.4% ( ) 8.5% ( ) 53.5% ( ) 9.2% ( ) 89

91 STEP 1. Fruit ad vegetable cosumptio (i a typical week) Mea umber of days cosumig fruit Mea umber of servigs of fruit cosumed o average per day Mea umber of days cosumig vegetables Mea umber of servigs of vegetables cosumed o average per day Percetage who ate fewer tha 5 servigs of fruit ad/or vegetables o average per day STEP 1. Physical activity Percetage carryig out isufficiet physical activity (defied as < 150 miutes of moderate-itesity activity per week, or equivalet)* Media time spet i physical activity o average per day (miutes) (preseted with iterquartile rage) Percetage ot egagig i vigorous activity STEP 1. Cervical cacer screeig Percetage of wome aged years who have ever had a screeig test for cervical cacer 5.6 ( ) 2.0 ( ) 5.9 ( ) 2.0 ( ) 66.6% ( ) 10.1% ( ) ( ) 75.7% ( ) 5.4 ( ) 1.9 ( ) 5.9 ( ) 2.1 ( ) 65.8% ( ) 10.7% ( ) ( ) 65.7% ( ) 5.8 ( ) 2.1 ( ) 5.8 ( ) 2.0 ( ) 67.5% ( ) 9.4% ( ) ( ) 86.5% ( ) 69.7% ( ) STEP 2. Physical measuremets Mea body mass idex (BMI) (kg/m 2 ) Percetage who are overweight (BMI 25 kg/m 2 ) Percetage who are obese (BMI 30 kg/m 2 ) 26.6 ( ) 55.9% ( ) 22.9% ( ) Average waist circumferece (cm) Mea systolic blood pressure (SBP) (mmhg), icludig those curretly takig medicatio for raised blood pressure Mea diastolic blood pressure (DBP) (mmhg), icludig those curretly takig medicatio for raised blood pressure Percetage with raised blood pressure (SBP 140 ad/or DBP 90 mmhg or curretly takig medicatio for raised blood pressure) Percetage of those with raised blood pressure (SBP 140 ad/ or DBP 90 mmhg) who are ot curretly takig medicatio for raised blood pressure STEP 3. Biochemical measuremets Mea fastig blood glucose (mmol/l), icludig those curretly takig medicatio for raised blood glucose Percetage with impaired fastig glycaemia (capillary whole blood value 5.6 mmol/l (100 mg/dl) ad < 6.1 mmol/l (110 mg/dl)) Percetage with raised fastig blood glucose as defied below or curretly takig medicatio for raised blood glucose (capillary whole blood value 6.1 mmol/l (110 mg/dl)) Mea total blood cholesterol, icludig those curretly takig medicatio for raised cholesterol (mmol/l) Percetage with raised total cholesterol ( 5.0 mmol/l or 190 mg/dl or curretly o medicatio for raised cholesterol) ( ) 85.0 ( ) 39.8% ( ) 76.2% ( ) 5.2 ( ) 8.3% ( ) 12.3% ( ) 4.5 ( ) 29.4% ( ) 26.2 ( ) 56.0% ( ) 17.8% ( ) 89.2 ( ) ( ) 85.3 ( ) 40.3% ( ) 84.1% ( ) 5.1 ( ) 7.4% ( ) 11.5% ( ) 4.4 ( ) 26.7% ( ) 27.0 ( ) 55.9% ( ) 28.5% ( ) 85.7 ( ) ( ) 84.6 ( ) 39.3% ( ) 67.5% ( ) 5.2 ( ) 9.1% ( ) 13.0% ( ) 4.6 ( ) 32.0% ( ) 90

92 Cardiovascular disease (CVD) risk Percetage aged years with a 10-year CVD risk 30%, or with existig CVD** Summary of combied risk factors curret daily smokers fewer tha 5 servigs of fruit ad/or vegetables per day isufficiet physical activity Percetage with oe of the above risk factors Percetage with three or more of the above risk factors, aged years Percetage with three or more of the above risk factors, aged years Percetage with three or more of the above risk factors, aged years 23.0% ( ) 18.5% ( ) 27.0% ( ) overweight (BMI 25 kg/m 2 ) raised blood pressure (SBP 140 ad/or DBP 90 mmhg or curretly takig medicatio for raised blood pressure) 8.0% 5.7% 10.4% ( ) ( ) ( ) 20.1% 27.6% 11.0% ( ) ( ) ( ) 47.6% 49.9% 45.5% ( ) ( ) ( ) 30.3% 35.2% 25.0% ( ) ( ) ( ) * For complete defiitios of isufficiet physical activity, refer to the WHO Geeral Physical Activity Questioaire (GPAQ) aalysis guide (see the WHO global physical activity surveillace web site for details ( or the WHO Global recommedatios o physical activity for health (2010) ( ** A 10-year CVD risk of 30% is defied accordig to age, sex, blood pressure, smokig status (curret smokers or those who quit smokig less tha 1 year before the assessmet), total cholesterol, ad diabetes (previously diagosed or with a fastig plasma glucose cocetratio of > 7.0 mmol/l (126 mg/dl). For additioal iformatio, please cotact: the STEPS coutry focal poit - Carolia Cericiuc: carolia.cericiuc@ms.gov.md the STEPS survey atioal coordiator Galia Obreja; gobreja@csp.md WHO Coutry Office Republic of Moldova la Ciobau; ciobaua@euro.who.it 91

93 ANNEX 2 WHO STEPS Istrumet for Chroic Disease Risk Factor Surveillace Republic of Moldova Survey iformatio Locatio ad Date Respose Code Cluster ID Locality ame Iterviewer ID Date of completio of the istrumet dd mm yyyy I1 I2 I3 I4 Participat ID Coset, Iterview laguage ad Name Respose Code Coset has bee read ad obtaied Yes 1 No 2 If NO, END Iterview laguage Romaia 1 Russia 2 I5 I6 Time of iterview (24-hour clock) Family surame First ame Additioal iformatio that may be helpful Cotact phoe umber (where possible) : hrs mis I7 I8 I9 I10 92

94 Step 1 Demographic iformatio CORE: Demographic iformatio Questio Respose Code Sex (Record Male / Female as observed) Male 1 Female 2 C1 What is your date of birth? Do t kow If kow, Go to C4 dd mm yyyy C2 How old are you? Years C3 I total, how may years have you spet at school ad i full-time study (excludig pre-school)? Years C4 EXPANDED: Demographic iformatio What is the highest level of educatio you have completed? [INSERT COUNTRY-SPECIFIC CATEGORIES] What is your ethic backgroud? What is your marital status? No formal schoolig/less tha 1 primary school Primary school completed 2 (grades 1 4) Gymasium completed (grades 3 5 9) Lyceum/secodary school completed 4 College/vocatioal school completed 5 Uiversity completed/ postgraduate degree 6 Refused 88 Romaia/Moldova 1 Russia 2 Ukraiia 3 Roma 4 Gagauz 5 Other ethic s 6 Refused 88 Never married 1 Curretly married 2 Separated 3 Divorced 4 Widowed 5 Cohabitatig 6 Refused 88 C5 C6 C7 93

95 Which of the followig best describes your mai work status over the past 12 moths? How may people older tha 18 years, icludig yourself, live i your household? Govermet employee 1 No-govermet employee 2 Self-employed 3 No-paid 4 Studet 5 Home-maker 6 C8 Retired 7 Uemployed (able to work) 8 Uemployed (uable to work) 9 Refused 88 Number of people C9 EXPANDED: Demographic iformatio cotiued Questio Respose Code Takig ito accout the past 12 moths, ca you tell me what the average mothly earigs of the Go to T1 C10b household have bee? Refused 88 C10d If you do t kow the amout, ca you give a estimate of the mothly household icome durig the past 12 moths if I read some optios to you? Is it: More tha 1500, More tha 2500, More tha 3800, More tha Do t kow 77 Refused 88 C11 94

96 STEP 1 Behavioural measuremets CORE: Tobacco use Now I am goig to ask you some questios about tobacco use. Questio Respose Code Do you curretly smoke ay tobacco products, such as cigarettes, cigars or pipes? Do you curretly smoke tobacco products daily? How old were you whe you first started smokig? Do you remember how log ago it was? Yes 1 No 2 If No, go to T8 Yes 1 No 2 Do t kow 77 If Kow, go to T5a/T5aw I Years If Kow, go to T5a/T5aw T4a OR i Moths If Kow, go to T5a/T5aw T4b T1 T2 T3 Do t kow 77 O average, how may of the followig products do you smoke each day/ week? Do t kow 7777 Durig the past 12 moths, have you tried to stop smokig? Durig ay visit to a doctor or other health worker i the past 12 moths, were you advised to quit smokig tobacco? I the past, did you ever smoke ay tobacco products? (USE SHOWCARD) OR i Weeks T4c DAILY WEEKLY Maufactured cigarettes T5a/T5aw Had-rolled cigarettes T5b/T5bw Pipes full of tobacco T5c/T5cw Cigars, cheroots, cigarillos T5d/T5dw Number of Shisha sessios T5e/T5ew Other Other (please specify): Yes 1 No 2 If Other, go to T5other, else go to T6 Yes 1 If T2=Yes, go to T12; if T2=No, go to T9 No 2 If T2=Yes, go to T12; if T2=No, go to T9 No visit durig the past 12 moths 3 If T2=Yes, go to T12; if T2=No, go to T9 Yes 1 No 2 If No, go to T12 T5f/T5fw T5other/ T5otherw T6 T7 T8 I the past, did you ever smoke daily? Yes 1 If T1=Yes, go to T12, else go to T10 No 2 If T1=Yes, go to T12, else go to T10 T9 95

97 EXPANDED: Tobacco use Questio Respose Code How old were you whe you stopped smokig? How log ago did you stop smokig? (RECORD ONLY 1, NOT ALL 3) Do t kow 77 Do you curretly use ay smokeless tobacco products such as [suff, chewig tobacco, betel]? Do t kow 77 If Kow, go to T12 T10 Years ago If Kow, go to T12 T11a OR Moths ago If Kow, go to T12 T11b OR Weeks ago T11c Yes 1 No 2 If No, go to T15 T12 Do you curretly use smokeless tobacco products daily? Yes 1 No 2 If No, go to T14aw T13 O average, how may times a day/week do you use. Do t kow 7777 Suff, by mouth Suff, by ose Chewig tobacco Betel, quid Other DAILY WEEKLY If Other, go to T14other, if T13=No, go to T16, else go to T17 T14a/ T14aw T14b/ T14bw T14c/ T14cw T14d/ T14dw T14e/ T14ew Other (please specify): If T13=No, go to T16, else go to T17 T14other/ T14otherw I the past, did you ever use smokeless tobacco products such as [suff, chewig tobacco, or betel]? Yes 1 No 2 If No, go to T17 T15 I the past, did you ever use smokeless tobacco products such as [suff, chewig tobacco, or betel] daily? Yes 1 No 2 T16 Durig the past 30 days, did someoe smoke i your home? Yes 1 No 2 T17 Durig the past 30 days, did someoe smoke i closed areas i your workplace (i the buildig, i a work area or a specific office)? Yes 1 No 2 Do t work i a closed area 3 T18 96

98 CORE: Alcohol cosumptio The ext questios are about cosumptio of alcohol. Questio Respose Code Have you ever cosumed ay alcohol such as beer, wie, alcoholic cocktails, liqueurs, rachiu spirits or other alcoholic driks? Have you cosumed ay alcohol withi the past 12 moths? Have you stopped drikig due to health reasos, such as a egative impact o your health or o the advice of your doctor or other health worker? Durig the past 12 moths, how frequetly have you had at least 1 stadard alcoholic drik? Have you cosumed ay alcohol withi the past 30 days? Yes 1 No 2 If No, go to A16 Yes 1 If Yes, go to A4 No 2 Yes 1 If Yes, go to A16 No 2 If No, go to A16 Daily days per week days per week days per week days per moth 5 Less tha oce a moth 6 Yes 1 No 2 If No, go to A13 A1 A2 A3 A4 A5 Durig the past 30 days, o how may occasios did you have at least 1 stadard alcoholic drik? Durig the past 30 days, whe you drak alcohol, how may stadard driks o average did you have durig 1 drikig occasio? Durig the past 30 days, what was the largest umber of stadard 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 6 or more stadard driks o a sigle drikig occasio? Durig each of the past 7 days, how may stadard driks did you have each day? Do t kow 77 Number Do t kow 77 A6 Number Do t kow 77 Largest umber Do t kow 77 A7 A8 Number of times Do t kow 77 A9 Moday A10a Tuesday A10b Wedesday A10c Thursday A10d Friday A10e Saturday A10f Suday A10g 97

99 CORE: Alcohol cosumptio cotiued I have just asked you about your cosumptio of alcohol durig the past 7 days. Those questios were about alcohol i geeral, while the ext questios refer to your cosumptio of homebrewed alcohol, alcohol brought over the border/from aother coutry, ay alcohol ot iteded for drikig, or ay other utaxed alcohol. Please oly thik about these types of alcohol whe aswerig the ext questios. Questio Respose Code Durig the past 7 days, did you cosume ay homebrewed alcohol, ay alcohol brought over the border/ from aother coutry, ay alcohol ot iteded for drikig or other ot bought/illegally received alcohol? O average, how may stadard driks of the followig types did you cosume durig the past 7 days? [INSERT COUNTRY-SPECIFIC EXAMPLES] (USE SHOWCARD) Do t kow 77 Yes 1 No 2 If No, go to A13 Homebrewed spirits, e.g. rachiu, cherry brady ad others Homebrewed wie Alcohol brought over the border/from aother coutry Alcohol ot iteded for drikig, e.g. alcoholbased medicies, perfumes, aftershaves Other, ot bought/illegally received alcohol A11 A12a A12b A12c A12d A12e EXPANDED: Alcohol cosumptio Durig the past 12 moths, how ofte have you foud that you were ot able to stop drikig oce you had started? Durig the past 12 moths, how ofte have you failed to do what was ormally expected of you because of drikig? Durig the past 12 moths, how ofte have you eeded a first drik i the morig to get yourself goig after a heavy drikig sessio? Durig the past 12 moths, have you had family problems or problems with your parter due to someoe else s drikig? Daily or almost daily 1 Weekly 2 Mothly 3 Less tha mothly 4 Never 5 Daily or almost daily 1 Weekly 2 Mothly 3 Less tha mothly 4 Never 5 Daily or almost daily 1 Weekly 2 Mothly 3 Less tha mothly 4 Never 5 Yes, more tha mothly 1 Yes, mothly 2 Yes, several times but less tha mothly 3 Yes, oce or twice 4 No 5 A13 A14 A15 A16 98

100 CORE: Diet The ext questios are about the fruit 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 I a typical week, o how may days do you eat fruit? Number of days Do t kow 77 If Zero days, go to D3 D1 How may servigs of fruit do you eat o 1 of those days? I a typical week, o how may days do you eat vegetables? Number of servigs Do t kow 77 Number of days Do t kow 77 If Zero days, go to D5 D2 D3 How may servigs of vegetables do you eat o 1 of those days? Number of servigs Do t kow 77 D4 EXPANDED: Diet What type of oil or fat is most ofte used for meal preparatio i your household? O average, how may meals per week do you eat that were ot prepared at a home? By meal, I mea breakfast, luch or dier Vegetable oil 1 Lard or suet 2 Butter or ghee 3 Margarie 4 Other 5 If Other, go to D5 other Noe i particular 6 Noe used 7 Do t kow 77 Other Number Do t kow 77 D5 D5other D6 99

101 Dietary salt Dietary salt With the ext questios, we would like to lear more about the salt i your diet. Dietary salt icludes ordiary table salt, urefied salt such as sea salt, iodized salt, salty stock cubes ad powders, ad salty sauces such as soya sauce or fish sauce [USE SHOWCARDS]. The followig questios are about addig salt to the food before you eat it, o how food is prepared i your home, o eatig processed foods that are high i salt such as [INSERT COUNTRY-SPECIFIC EXAMPLES], ad questios o cotrollig your salt itake. Please aswer the questios eve if you cosider yourself to eat a diet low i salt. Questio Respose Code How ofte do you add salt or a salty sauce such as ketchup, adjica, or soya sauce to your food before you eat it or as you are eatig it? How ofte is salt, salty seasoig or a salty sauce added i cookig or preparig foods i your household? Dietary salt cotiued Always 1 DS1 Ofte 2 Sometimes 3 Rarely 4 Never 5 Do t kow 77 Always 1 DS2 Ofte 2 Sometimes 3 Rarely 4 Never 5 Do t kow 77 Questio Respose Code What kid of salt do you use for cookig or meal preparatio i your household? How ofte do you eat processed food high i salt? By processed food high i salt, I mea foods that have bee altered from their atural state, such as packaged salty sacks, caed salty food, salty foods prepared for fast-food service [e.g. pickles, mariates, sheep s cheese, salami, sausages, pastrami, ham ad other meat products, salted fish, salted uts/biscuits]. How much salt or salty sauce do you thik you cosume? Iodized 1 DS2 1 No-iodized 2 Do t kow 77 Always 1 DS3 Ofte 2 Sometimes 3 Rarely 4 Never 5 Do t kow 77 Far too much 1 DS4 Too much 2 Just the right amout 3 Too little 4 Far too little 5 Do t kow

102 How importat to you is lowerig the salt i your diet? Do you thik that too much salt or salty sauce i your diet could cause a health problem? Very importat 1 DS5 Somewhat importat 2 Not at all importat 3 Do t kow 77 Yes 1 DS6 No 2 Do t kow 77 Do you do ay of the followig o a regular basis to cotrol your salt itake? Limit cosumptio of processed Yes 1 DS7a foods No 2 Look at the salt or sodium cotet Yes 1 DS7b o food labels No 2 Buy low-salt/-sodium alteratives Yes 1 DS7c No 2 Use spices other tha salt whe Yes 1 DS7d cookig No 2 Avoid eatig foods prepared Yes 1 DS7e outside of the home No 2 Do other thigs specifically to Yes 1 If Yes, go to S7other DS7f cotrol your salt itake No 2 Other (please specify) DS7other CORE: 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 Does your work ivolve vigorousitesity activity that causes large icreases i breathig or heart rate, such as 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 I a typical week, o how may days do you do vigorous-itesity activities as part of your work? Number of days P2 101

103 How much time do you sped doig vigorous-itesity activities at work o a typical day? Does your work ivolve moderateitesity activity, which causes small icreases i breathig or heart rate, such as brisk walkig or carryig light loads for at least 10 miutes cotiuously? Hours : miutes Yes 1 : hrs mis No 2 If No, go to P 7 P3 (a-b) P4 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? 102 Number of days Hours : miutes : hrs mis P5 P6 (a-b) 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 way you usually travel to ad from places. For example to work, for shoppig, to the market, to church. Do you walk or use a bicycle (pedal cycle) for at least 10 miutes Yes 1 cotiuously to get to ad from places? No 2 If No, go to P 10 P7 I a typical week, o how may days do you walk or bicycle for at least 10 miutes cotiuously to get Number of days P8 to ad from places? How much time do you sped walkig or bicyclig for travel purposes o a typical day? CORE: 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). Do you do ay vigorous-itesity sports, fitess or recreatioal Yes 1 (leisure) activities that cause large icreases i breathig or heart rate, such as ruig or football, for at least 10 miutes cotiuously? No 2 If No, go to P 13 I a typical week, o how may days do you do vigorous-itesity sports, fitess or recreatioal Number of days (leisure) activities? How much time do you sped doig vigorous-itesity sports, fitess or recreatioal activities o a typical Hours : miutes : day? hrs mis P10 P11 P12 (a-b)

104 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? I a typical week, o how may days do you do moderate-itesity sports, fitess or recreatioal (leisure) activities? How much time do you sped doig moderate-itesity sports, fitess or recreatioal (leisure) activities o a typical day? Yes 1 Number of days Hours : miutes No 2 If No, go to P16 : hrs mis P13 P14 P15 (a-b) EXPANDED: 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 a car, bus, or trai; readig; playig cards or other games; watchig televisio or usig a computer. Do ot iclude time spet sleepig. How much time do you usually sped sittig or recliig o a typical day? Hours : miutes : hrs mis P16 (a-b) CORE: History of raised blood pressure Questio Respose Code Have you ever had your blood pressure measured by a doctor or other health worker? Yes 1 No 2 If No, go to H6 H1 Have you ever bee told by a doctor or other health worker that you have raised blood pressure or hypertesio? Have you bee told this i the past 12 moths? I the past 2 weeks, have you take ay medicatio for raised blood pressure prescribed by a doctor or other health worker? Have you ever see a traditioal healer for raised blood pressure or hypertesio? Are you curretly takig ay herbal or traditioal remedy for your raised blood pressure? Yes 1 No 2 If No, go to H6 Yes 1 No 2 Yes 1 No 2 Yes 1 No 2 Yes 1 No 2 H2a H2b H3 H4 H5 103

105 CORE: History of diabetes Have you ever had your blood sugar 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 sugar or diabetes? Have you bee told this i the past 12 moths? I the past 2 weeks, have you take ay medicatio for diabetes prescribed by a doctor or other health worker? Are you curretly takig isuli for diabetes prescribed by a doctor or other health worker? Have you ever see a traditioal healer for diabetes or raised blood sugar? Are you curretly takig ay herbal or traditioal remedy for your diabetes? Yes 1 No 2 If No, go to H12 Yes 1 No 2 If No, go to H12 Yes 1 No 2 Yes 1 No 2 Yes 1 No 2 Yes 1 No 2 Yes 1 No 2 H6 H7a H7b H8 H9 H10 H11 CORE: History of raised total cholesterol Questio Respose Code Have you ever had your cholesterol (fat levels i your blood) measured by a doctor or other health worker? Have you ever bee told by a doctor or other health worker that you have raised cholesterol? Yes 1 No 2 If No, go to H17 Yes 1 No 2 If No, go to H17 H12 H13a Have you bee told this i the past 12 moths? I the past 2 weeks, have you take ay oral treatmet (medicatio) for raised cholesterol prescribed by a doctor or other health worker? Have you ever see a traditioal healer for raised cholesterol? Are you curretly takig ay herbal or traditioal remedy for your raised cholesterol? Yes 1 No 2 Yes 1 No 2 Yes 1 No 2 Yes 1 No 2 H13b H14 H15 H16 104

106 CORE: History of cardiovascular disease Have you ever had a heart attack or chest pai from heart disease (agia) or a stroke (cerebrovascular accidet or icidet)? Are you curretly takig aspiri regularly to prevet or treat heart disease? Are you curretly takig statis (Lovastati/Simvastati/Atorvastati or ay other stati) regularly to prevet or treat heart disease? Yes 1 No 2 Yes 1 No 2 Yes 1 No 2 H17 H18 H19 CORE: Lifestyle advice Durig the past 3 years, has a doctor or other health worker advised you to do ay of the followig? Quit usig tobacco or do t start Reduce salt i your diet Eat at least 5 servigs of fruit ad/or vegetables each day Reduce fat i your diet Start or do more physical activity Maitai a healthy body weight or lose weight Yes 1 No 2 Yes 1 No 2 Yes 1 No 2 Yes 1 No 2 Yes 1 No 2 Yes 1 If C1=1 go to M1 No 2 If C1=1 go to M1 H20a H20b H20c H20d H20e H20f CORE (for wome oly): cervical cacer screeig The ext questio is about cervical cacer prevetio. Screeig tests for cervical cacer prevetio ca be doe i differet ways, icludig visual ispectio with acetic acid (VIA), Pap smear ad huma papillomavirus (HPV) test. VIA is a ispectio of the surface of the uterie cervix after acetic acid (or viegar) has bee applied to it. For both a Pap smear ad a HPV test, a doctor or urse uses a swab to wipe from iside your vagia, take a sample ad sed it to a laboratory. It is possible that you were give the swab yourself ad asked to swab the iside of your vagia. The laboratory checks for abormal cell chages if a Pap smear is carried out ad for HPV if a HPV test is carried out. Questio Respose Code Have you ever had a screeig test for cervical cacer, usig ay of these methods described above? Yes 1 No 2 Do t kow 77 CX1 105

107 Health care Health care Next I am goig to ask you about your health isurace coverage ad your use of health services i relatio to ay ocommuicable disease (NCD) you may have. NCDs iclude cardiovascular diseases (CVDs) (such as heart disease, cerebrovascular disease ad stroke, peripheral arterial disease, deep vei thrombosis, ad pulmoary embolism), cacer, chroic respiratory diseases (such as asthma, chroic obstructive pulmoary disease, occupatioal lug diseases or pulmoary hypertesio) ad diabetes. Health care coverage Please provide iformatio about your curret health isurace coverage. Health isurace coverage meas beig erolled with a orgaizatio that pays for health care costs if you get sick or ijured. Yes 1 Do you curretly have health isurace? HC1 No 2 If No, go to HC3 Durig the past 12 moths, which of the followig fiacial sources did you use to pay for ay health expediture, such as medicies, cosultatios, treatmet, hospitalizatio or patiet care? Curret icome of ay household members Savigs (e.g. bak accout) Paymet or reimbursemet from a health isurace pla Sold items (e.g. furiture, aimals, jewellery) Family members or frieds from outside the household Borrowed from someoe other tha a fried or family member Other Yes 1 No 2 Yes 1 No 2 Yes 1 No 2 Yes 1 No 2 Yes 1 No 2 Yes 1 No 2 Yes No 2 1 If Other, go to HC3other HC3a HC3b HC3c HC3d HC3e HC3f HC3g HC3 Other (please specify): other Health care utilizatio Please thik about your visits to ay health ceter ad ay treatmets you received there which were related to a NCD you may have. Have you ever had or do you curretly have a NCD, such as ay CVD, icludig heart disease ad stroke, cacer, chroic respiratory disease, or diabetes? Have you ever visited ay health care facility due to a NCD you have? Please exclude ay hospitalizatio. Yes 1 No 2 If No, go to [ext sectio] Yes 1 No 2 If No, go to HC11 HC4 HC5 106

108 How much time did you sped travellig the last time you visited a health care facility (takig the retur jourey (both ways) ito accout)? Days : hours : miutes : : days hrs mis HC6 Do t kow 77:77:77 How log was the waitig time before your appoitmet started whe you last visited a health care facility? Do t kow 77:77 Durig the past 30 days, have you visited ay health care facility due to a NCD you have? Please exclude ay hospitalizatio. Health care cotiued : Hours : miutes hrs mis Yes 1 No 2 If No, go to HC11 HC7 HC8 Family doctors cetre/ Health cetre HC9a Durig the past 30 days, how may times have you visited a health care facility due to a NCD you have? Public hospital Private hospital HC9b HC9c Do t kow 77 Other If Other, go to HC9other HC9e Other (please specify): HC9otehr Health care provider s fees [MDL] HC10a Durig the past 30 days, takig all your visits to a health care facility due to a NCD ito accout, how much did you pay yourself for these visits i total? Do t kow Medicies [MDL] HC10b Tests [MDL] HC10c Trasport [MDL] HC10d Other [MDL] HC10e OR Total amout [MDL] HC10f Durig the past 30 days, how much did you pay yourself for health care ot related to ay visit of a health care facility or hospital (such as routie medicatio)? Amout [MDL] HC11 Do t kow Durig the past 12 moths, have you bee hospitalized due to a NCD? Durig the past 12 moths, how may days have you bee hospitalized due to a NCD? Do t kow 777 Number of days Yes 1 No 2 If No, go to HC15 HC12 HC13 107

109 Health care provider s fees [MDL] HC14a Durig the past 12 moths, takig all your visits to a hospital due to a NCD ito accout, how much did you pay yourself for these visits i total? Do t kow Medicies [MDL] HC14b Tests [MDL] HC14c Trasport [MDL] HC14d Other [MDL] HC14e OR Total amout [MDL] HC14f Home care Please thik about home care from family members ad/or frieds because of a NCD you have. Durig the past 30 days, has a family member or fried provided care for you at home due to your NCD? Durig the past 30 days, how may hours per week have they provided care for you? Do t kow 777 Yes 1 Hours per week No 2 If No, go to HC17 hrs HC15 HC16 Loss of productivity Please thik about time durig which you could t carry out your usual activities (for example, work, work at home, study) because of a NCD you have. Durig the past 30 days, have you missed ay of your usual activity time (work, work at home, study) due to a NCD? Durig the past 30 days, how may days of your usual activity have you missed due to a NCD? Do t kow 77 Yes 1 Number of days No 2 If No, go to [ext sectio] days HC17 HC18 108

110 Step 2 Physical measuremets CORE: Blood pressure Questio Respose Code Iterviewer ID M1 Device ID for blood pressure M2 Readig 1 Readig 2 Readig 3 Durig the past 2 weeks, have you bee treated for raised blood pressure with drugs (medicatio) prescribed by a doctor or other health worker? CORE: Height ad weight For wome: Are you pregat? Iterviewer ID Device IDs for height ad weight Systolic ( mmhg) Diastolic (mmhg) Systolic ( mmhg) Diastolic (mmhg) Systolic ( mmhg) Diastolic (mmhg) Yes 1 No 2 Yes 1 If Yes, go to M 16 No 2 M4a M4b M5a M5b M6a M6b M7 M8 M9 M10a Height i Cetimetres (cm). M11 Weight If too large for scale, CORE: Waist i Kilograms (kg). M12 Device ID for waist M13 Waist circumferece i Cetimetres (cm). M14 EXPANDED: Hip circumferece ad heart rate Hip circumferece i Cetimeters (cm). M15 Heart Rate Readig 1 Beats per miute M16a Readig 2 Beats per miute M16b Readig 3 Beats per miute M16c 109

111 Step 3 Biochemical measuremets CORE: Blood glucose Questio Respose Code Durig the past 12 hours have you had aythig to eat or drik, other tha water? Yes 1 No 2 B1 Health professioal ID Device ID Time of day blood specime take (24-hour clock) Hours : miutes : hrs mis B2 B3 B4 Fastig blood glucose mmol/l. B5 Today, have you take isuli or other medicatio that have bee prescribed by a doctor or other health worker for raised blood glucose? CORE: Blood lipids Yes 1 Device ID B7 Total cholesterol mmol/l. B8 No 2 B6 Durig the past 2 weeks, have you bee treated for raised cholesterol with medicatio prescribed by a doctor or other health worker? Yes 1 No 2 B9 EXPANDED: high-desity lipoprotei (HDL) cholesterol HDL cholesterol mmol/l. B11 110

112 ANNEX 3 WHO STEPS SURVEY 2013 PREVALENCE OF NONCOMMUNICABLE DISEASE RISK FACTORS IN THE REPUBLIC OF MOLDOVA STEPS 2013 Data book Cotets DEMOGRAPHIC INDICATORS TOBACCO USE ALCOHOL CONSUMPTION FRUIT AND VEGETABLE CONSUMPTION DIETARY SALT PHYSICAL ACTIVITY HISTORY OF RAISED BLOOD PRESSURE HISTORY OF DIABETES HISTORY OF RAISED CHOLESTEROL CARDIOVASCULCAR DISEASE (CVD) HISTORY LIFESTYLE ADVICE CERVICAL CANCER SCREENING PHYSICAL MEASUREMENTS BIOCHEMICAL MEASUREMENTS CARDIOVASCULCAR DISEASE (CVD) RISK SUMMARY OF COMBINED RISK FACTORS HEALTH CARE

113 Demographic idicators by sex Descriptio Summary iformatio by age ad sex of the respodets Istrumet questios Sex Date of birth ad sex of respodets Me Wome Both sexes % % % 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 o. of Mea o. of Mea o. of years years years

114 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? Without formal schoolig/ ot completed primary school Highest level of educatio Primary school completed Me Gymasium completed Secodary school/lyceum completed College/ vocatioal school completed Uiversity/ postgraduate degree completed Without formal schoolig/ ot completed primary school Highest level of educatio Primary school completed Wome Gymasium completed Secodary school/lyceum completed College/ vocatioal school completed Uiversity/ postgraduate degree completed Without formal schoolig/ ot completed primary school Highest level of educatio Primary school completed Both sexes Gymasium completed Secodary school/lyceum completed College/ vocatioal school completed Uiversity/ postgraduate degree completed

115 Ethicity Descriptio Summary results for the ethicity of the respodets Istrumet questio What is your [isert relevat ethic /racial /cultural sub/others] backgroud? Ethic Romaia/ Moldova Ethic of respodets Ethic Russia Both sexes Ethic Ukraiia Ethic Gagauz Ethic Roma Other ethic Martial status Descriptio Marital status of survey respodets Istrumet questio What is your marital status? Never married Curretly married Marital status Me Separated Divorced Widowed Cohabitig Never married Curretly married Marital status Wome Separated Divorced Widowed Cohabitig

116 Never married Curretly married Marital status Both sexes Separated Divorced Widowed Cohabitig Employmet status Descriptio Proportio of respodets i paid employmet ad those who are upaid (upaid icludes idividuals who are o-paid, studets, home-makers, retired people, ad uemployed idividuals) Istrumet questio Which of the followig best describes your mai work status durig the past 12 moths? Employmet status Me Govermet No-govermet employee employee Self-employed Upaid Employmet status Wome Govermet No-govermet employee employee Self-employed Upaid Employmet status Me Govermet No-govermet employee employee Self-employed Upaid

117 Upaid work ad uemployed Descriptio Proportio of respodets i upaid work Istrumet questio Which of the followig best describes your mai work status durig the past 12 moths? No-paid Studet Upaid work ad uemployed Me Home-maker Retired Able to work Uemployed Not able to work No-paid Studet Upaid work ad uemployed Wome Home-maker Retired Able to work Uemployed Not able to work No-paid Studet Upaid work ad uemployed Both sexes Home-maker Retired Able to work Uemployed Not able to work

118 Per capita aual icome Descriptio Mea reported per capita aual icome of respodets i local currecy Istrumet questios 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 (MDL) 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? Quitile 1 ( MDL 1500) Estimated household earigs per moth Quitile 2 (MDL ) Quitile 3 (MDL ) Quitile 4 (MDL ) Quitile 5 (> MDL 5700)

119 Tobacco use Curret smokig Descriptio Percetage of curret smokers amog all respodets Istrumet questio Do you curretly smoke ay tobacco products, such as cigarettes, cigars, or pipes? Percetage of curret smokers Me Wome Both sexes Curret smoker Curret smoker Curret smoker Percetage of curret smokers Me Wome Both sexes Curret smoker Curret smoker Curret smoker Rural Urba Total

120 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? I the past, did you ever smoke ay tobacco products? Daily smokers Curret smokers Smokig status No-daily smokers Me Former smokers No-smokers No-smokers (ever smoked) Daily smokers Curret smokers Smokig status No-daily smokers Wome Former smokers No-smokers No-smokers (ever smoked) Daily smokers Curret smokers Smokig status No-daily smokers Both sexes Former smokers No-smokers No-smokers (ever smoked)

121 Daily smokig Descriptio Percetage of curret daily smokers amog smokers Istrumet questios 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 smokers Daily smokers Daily smokers Iitiatio ad duratio of smokig Descriptio Mea age at which respodets started smokig ad mea duratio of smokig, i years, amog smokers (o total age for mea duratio of smokig as age iflueces these values) Istrumet questios Do you curretly smoke ay tobacco products, such as cigarettes, cigars, or pipes? How old were you whe you first started smokig? Do you remember how log ago it was? Mea age of startig smokig Me Wome Both sexes Mea age Mea age Mea age Mea duratio of smokig Me Wome Both sexes Mea age Mea age Mea age

122 Maufactured cigarette smokers Descriptio Percetage of smokers who smoke maufactured cigarettes amog daily smokers ad amog curret smokers Istrumet questios Do you curretly smoke ay tobacco products, such as cigarettes, cigars, or pipes? Do you curretly smoke tobacco products daily? O average, how may of the followig products do you smoke each day? Maufactured cigarette smokers amog daily smokers Me Wome Both sexes % % % Maufactured cigarette smokers amog curret smokers Me Wome Both sexes % % %

123 Curret tobacco users Descriptio Percetage of daily ad curret (daily plus o-daily) tobacco smokers, icludig smokig ad smokeless tobacco, amog all respodets Istrumet questios Do you curretly smoke ay tobacco products, such as cigarettes, cigars, or pipes? Do you curretly smoke tobacco products daily? Do you curretly use ay smokeless tobacco such as [suff, chewig tobacco, betel]? Do you curretly use smokeless tobacco products daily? Curret tobacco users Me Wome Both sexes Curret smokers Curret smokers Curret smokers Daily tobacco users Me Wome Both sexes Daily smokers Daily smokers Daily smokers

124 Amout of tobacco smoked amog daily smokers by type Descriptio Mea amout of tobacco smoked by daily smokers per day, by type Istrumet questios Do you curretly smoke ay tobacco products, such as cigarettes, cigars, or pipes? Do you curretly smoke tobacco products daily? O average, how may of the followig products do you smoke each day? Mea amout of tobacco smoked by daily smokers, by type Mea o. of maufactured cigarettes Me Mea o. of other type of tobacco Mea amout of tobacco used by daily smokers, by type Mea o. of maufactured cigarettes Wome Mea o. of other type of tobacco * * * deotes data ot available. Mea amout of tobacco used by daily smokers, by type Mea o. of maufactured cigarettes Both sexes Mea o. of other type of tobacco

125 Smoked tobacco cosumptio Descriptio Percetage of curret smokers who smoke each of the followig products Istrumet questios Do you curretly smoke ay tobacco products, such as cigarettes, cigars, or pipes? Do you curretly smoke tobacco products daily? O average, how may of the followig products do you smoke each day/week? Percetage of curret smokers smokig each of the followig products Maufactured cigarettes Me Had-rolled cigarettes Tobacco pipes * * deotes data ot available. Percetage of curret smokers smokig each of the followig products Me Cigars Shisha Other * * * * * deotes data ot available Percetage of curret smokers smokig each of the followig products Maufactured cigarettes Wome Had-rolled cigarettes Tobacco pipes * 0.0 * * 0.0 * * 0.0 * * 0.0 * * 0.0 * * deotes data ot available. 124

126 Percetage of curret smokers smokig each of the followig products Wome N Cigars Shisha Other * * * * 0.0 * 0.0 * * 0.0 * 0.0 * * * deotes data ot available. Percetage of curret smokers smokig each of the followig products Maufactured cigarettes Both sexes Had-rolled cigarettes Tobacco pipes * * * deotes data ot available. Percetage of curret smokers smokig each of the followig products Both sexes Cigars Shisha Other * * * * 0.0 * 0.0 * * deotes data ot available. 125

127 Frequecy of daily cigarette smokig Descriptio Percetage of daily cigarette smokers smokig give quatities of maufactured or had-rolled cigarettes per day Istrumet questios Do you curretly smoke ay tobacco products, such as cigarettes, cigars, or pipes? Do you curretly smoke tobacco products daily? O average, how may of the followig products do you smoke each day? <5 cig s Percetage of daily smokers smokig give quatities per day 5 9 cig s cig s Me cig s 25 cig s Note. Cig s: cigarettes. <5 cig s Percetage of daily smokers smokig give quatities per day 5 9 cig s cig s Wome cig s 25 cig s Note. Cig s: cigarettes. <5 cig s Percetage of daily smokers smokig give quatities per day 5 9 cig s Both sexes cig s cig s 25 cig s Note. Cig s: cigarettes. 126

128 Former daily smokers ad former smokers Descriptio Percetage of former daily smokers amog all respodets ad amog respodets who have ever bee daily smokers, as well as mea duratio i years sice former smokers stopped smokig Istrumet questios Do you curretly smoke ay tobacco products, such as cigarettes, cigars, or pipes? Do you curretly smoke tobacco products daily? I the past did you ever smoke ay tobacco products? I the past, did you ever smoke daily? How old were you whe you stopped smokig? Former daily smokers (who do t smoke curretly) amog all respodets Me Wome Both sexes Former daily smokers Former daily smokers Former daily smokers Former daily smokers (who do t smoke curretly) amog respodets that have eve bee daily smokers Me Wome Both sexes Former daily smokers Former daily smokers Former daily smokers Mea years sice cessatio Me Wome Both sexes Mea years Mea years Mea years

129 Cessatio Descriptio Percetage of curret smokers who have tried to stop smokig durig the past 12 moths Istrumet questios Do you curretly smoke ay tobacco products, such as cigarettes, cigars, or pipes? Durig the past 12 moths, have you tried to stop smokig? Curret smokers who have tried to stop smokig Me Wome Both sexes % % % Advice to stop smokig Descriptio Percetage of curret smokers who have bee advised by a doctor or other health worker to stop smokig, amog smokers who have visited a doctor or other health worker i the past 12 moths Istrumet questios Do you curretly smoke ay tobacco products, such as cigarettes, cigars, or pipes? Durig ay visit to a doctor or other health worker i the past 12 moths, were you advised to quit smokig tobacco? Curret smokers who have bee advised to stop smokig Me Wome Both sexes % % %

130 Curret smokers of smokeless tobacco Descriptio Percetage of curret smokers of smokeless tobacco amog all respodets Istrumet questio Do you curretly use ay smokeless tobacco such as [suff, chewig tobacco, betel]? Curret smokers of smokeless tobacco Me Wome Both sexes % % %

131 Status of smokeless tobacco use Descriptio Smokeless tobacco use status amog all respodets Istrumet questios Do you curretly use ay smokeless tobacco such as [suff, chewig tobacco, betel]? Do you curretly use smokeless tobacco products daily? I the past, did you ever use smokeless tobacco such as [suff, chewig tobacco, betel]? Smokeless tobacco use Me Curret user No-user Daily user No-daily Past user Never used user Smokeless tobacco use Wome Curret user No-user Daily user No-daily Past user Never used user Smokeless tobacco use Both sexes Curret user No-user Daily user No-daily Past user Never used user

132 Former daily users of smokeless tobacco Descriptio Percetage of former daily users of smokeless tobacco amog all respodets ad amog respodets that have ever used smokeless tobacco daily Istrumet questios Do you curretly use ay smokeless tobacco such as [suff, chewig tobacco, betel]? Do you curretly use smokeless tobacco products daily? I the past, did you ever use smokeless tobacco such as [suff, chewig tobacco, betel]? I the past, did you ever use smokeless tobacco such as [suff, chewig tobacco, betel] daily? Former daily smokeless tobacco users (who do t use tobacco curretly) amog all respodets Me Wome Both sexes Former daily users Former daily users Former daily users Exposure to secodhad smoke i home i past 30 days Descriptio Percetage of respodets exposed secod-had smoke i the home i the past 30 days Istrumet questio I the past 30 days, did someoe smoke i your home? Exposure to secod-had smoke i the home durig the past 30 days Me Wome Both sexes Exposed Exposed Exposed

133 Exposure to secod-had smoke i the workplace i past 30 days Descriptio Percetage of respodets exposed to secod-had smoke i the workplace i the past 30 days Istrumet questio Durig the past 30 days, did someoe smoke i closed areas i your workplace (i the buildig, i a work area or a specific office)? Exposure to secod-had smoke i the workplace durig the past 30 days Me Wome Both sexes Exposed Exposed Exposed

134 Alcohol cosumptio Alcohol cosumptio status Descriptio Alcohol cosumptio status of all respodets Istrumet questios Have you ever cosumed ay alcohol such as? Have you cosumed ay alcohol i the past 12 moths? Have you cosumed ay alcohol i the past 30 days? Curret driker (past 30 days) Alcohol cosumptio status Drak i past 12 moths, ot curret Me Past 12 moths abstaier Lifetime abstaier Curret driker (past 30 days) Alcohol cosumptio status Drak i past 12 moths, ot curret Wome Past 12 moths abstaier Lifetime abstaier Curret driker (past 30 days) Alcohol cosumptio status Drak i past 12 moths, ot curret Both sexes Past 12 moths abstaier Lifetime abstaier

135 Alcohol cosumptio status (urba areas) Me Wome Both sexes Curret driker (past 30 days) Curret driker (past 30 days) Curret driker (past 30 days) Alcohol cosumptio status (rural areas) Me Wome Both sexes Curret driker (past 30 days) Curret driker (past 30 days) Curret driker (past 30 days) Stoppig drikig due to health reasos Descriptio Percetage of former drikers (who did ot drik durig the past 12 moths) who stopped drikig due to health reasos, such as the egative impact of drikig o health or as per advice from a doctor or other health worker, amog those respodets who drak i their lifetime, but ot i the last 12 moths Istrumet questios Have you cosumed ay alcohol i the past 12 moths? Did you stop drikig due to health reasos, such as egative impact of drikig o your health or as per advice from your doctor or other health worker? Stoppig drikig due to health reasos Me Wome Both sexes Stopped due to health reasos Stopped due to health reasos Stopped due to health reasos

136 Frequecy of alcohol cosumptio Descriptio Frequecy of alcohol cosumptio i the past 12 moths amog respodets who drak i the last 12 moths Istrumet questio Durig the past 12 moths, how frequetly have you had at least oe alcoholic drik? Daily Frequecy of alcohol cosumptio i the past 12 moths 5 6 days/ week 3 4 days/ week Me 1 2 days/ week 1 3 days/ moth < oce a moth Daily Frequecy of alcohol cosumptio i the past 12 moths 5 6 days/ week 3 4 days/ week Wome 1 2 days/ week 1 3 days/ moth < oce a moth Daily Frequecy of alcohol cosumptio i the past 12 moths 5 6 days/ week 3 4 days/ week Both sexes 1 2 days/ week 1 3 days/ moth < oce a moth

137 Drikig occasios i the past 30 days Descriptio Mea umber of occasios drikig at least oe drik i the past 30 days amog curret (past 30 days) drikers Istrumet questio Durig the past 30 days, o how may occasios did you have at least oe alcoholic drik? Mea umber of drikig occasios i the past 30 days amog curret (past 30 days) drikers Me Wome Both sexes Mea o. of occasios Mea o. of occasios Mea o. of occasios Mea umber of drikig occasios i the past 30 days amog curret (past 30 days) drikers Me Wome Both sexes Mea o. of occasios Mea o. of occasios Mea o. of occasios Rural Urba

138 Stadard driks per drikig occasio Descriptio Mea umber of stadard driks cosumed o a drikig occasio amog curret (past 30 days) drikers Istrumet questio Durig the past 30 days, whe you drak alcohol, o average, how may stadard alcoholic driks did you have durig oe occasio? Mea umber of stadard driks per drikig occasio amog curret (past 30 days) drikers Me Wome Both sexes Mea o. of driks Mea o. of driks Mea o. of driks Mea umber of stadard driks per drikig occasio amog curret (past 30 days) drikers Me Wome Both sexes Mea o. of driks Mea o. of driks Mea o. of driks Rural Urba

139 Average drikig levels (volume) amog all respodets Descriptio Percetage of respodets with differet drikig levels (a stadard drik cotais approximately 10 g of pure alcohol) Istrumet questios Durig the past 30 days, o 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 occasio? High volume cosumed amog all respodets ( 60g of pure alcohol for me ad 40g of pure alcohol for wome) Me Wome Both sexes 60 g 40 g High volume cosumed Itermediate volume cosumed amog all respodets ( g of pure alcohol for me ad g of pure alcohol for wome) Me Wome Both sexes g g N Itermediate volume cosumed Low volume cosumed amog all respodets (< 40 g of pure alcohol for me ad < 20g of pure alcohol for wome) Me Wome Both sexes < 40 g < 20 g Low volume cosumed

140 Average volume drikig levels amog curret (past 30 days) drikers Descriptio Percetage of curret (past 30 days) drikers with differet drikig levels (a stadard drik cotais approximately 10 g of pure alcohol) Istrumet questios Durig the past 30 days, o 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 occasio? High- itermediate- ad low-volume drikig amog curret (past 30 days) drikers High-volume ( 60 g) Me Itermediatevolume ( g) Low-volume (< 40 g) High- itermediate- ad low-volume drikig amog curret (past 30 days) drikers High-volume ( 40 g) Wome Itermediatevolume ( g) Low-volume (< 20 g) High- itermediate- ad low-volume drikig amog curret (past 30 days) drikers Both sexes High-volume Itermediatevolume Low-volume

141 Largest umber of driks i the past 30 days Descriptio Largest umber of driks cosumed durig a sigle occasio i the past 30 days amog curret (past 30 days) drikers Istrumet questio Durig the past 30 days, what was the largest umber of stadard alcoholic driks you drak o a sigle occasio, coutig all types of alcoholic driks together? Mea maximum umber of stadard driks cosumed o oe occasio i the past 30 days Me Wome Both sexes Mea maximum umber Mea maximum umber Mea maximum umber Six or more driks o a sigle occasio Descriptio Percetage of respodets who drak six or more driks at ay time i the past 30 days durig a sigle occasio amog the total populatio Istrumet questio Durig the past 30 days, how may times did you drik 6 or more stadard alcoholic driks i a sigle drikig occasio? 6 or more driks o a sigle occasio at least oce durig the past 30 days amog the total populatio Me Wome Both sexes 6 driks 6 driks 6 driks

142 Six or more driks o a sigle occasio Descriptio Mea umber of times i the past 30 days o which curret (past 30 days) drikers cosumed six or more driks durig a sigle occasio Istrumet questio Durig the past 30 days, how may times did you drik six or more stadard alcoholic driks i a sigle drikig occasio? Mea umber of times drikig 6 or more driks durig a sigle occasio i the past 30 days Me Wome Both sexes Mea o. of times Mea o. of times Mea o. of times

143 Drikig i the past seve days Descriptio Frequecy of alcohol cosumptio i the past seve days by curret (past 30 days) drikers Istrumet questio Durig each of the past seve days, how may stadard driks of ay alcoholic drik did you have each day? Daily Frequecy of alcohol cosumptio i the past 7 days 5 6 days Me 3 4 days 1 2 days 0 days Daily Frequecy of alcohol cosumptio i the past 7 days 5 6 days Wome 3 4 days 1 2 days 0 days Daily Frequecy of alcohol cosumptio i the past 7 days 5 6 days Both sexes 3 4 days 1 2 days 0 days

144 Stadard driks per day i the past seve days Descriptio Mea umber of stadard driks cosumed o average per day i the past seve days amog curret (past 30 days) drikers Istrumet questio Durig each of the past seve days, how may stadard driks of ay alcoholic drik did you have each day? Mea umber of stadard driks cosumed o average per day i the past 7 days Me Wome Both sexes Mea o. of driks Mea o. of driks Mea o. of driks Cosumptio of urecorded alcohol Descriptio Percetage of respodets who cosumed urecorded alcohol (homebrewed alcohol, alcohol brought over the border, alcohol ot iteded for drikig or other utaxed alcohol) durig the past seve days amog curret (past 30 days) drikers Istrumet questios Have you cosumed ay alcohol withi the past 30 days? Durig the past seve days, did you cosume ay homebrewed alcohol, ay alcohol brought over the border, alcohol ot iteded for drikig or other utaxed alcohol? Cosumptio of urecorded alcohol Me Wome Both sexes Cosumed urecorded alcohol Cosumed urecorded alcohol Cosumed urecorded alcohol Cosumptio of urecorded alcohol Me Wome Both sexes Cosumed urecorded alcohol Cosumed urecorded alcohol Cosumed urecorded alcohol Rural Urba Total

145 Stadard driks of urecorded alcohol per day i the past seve days Descriptio Mea umber of stadard driks of urecorded alcohol cosumed o average per day i the past seve days amog curret (past 30 days) drikers Istrumet questio O average, how may stadard driks of the followig type(s) did you cosume durig the past seve days? Mea umber of stadard driks of urecorded alcohol cosumed o average per day i the past 7 days Me Wome Both sexes Mea o. of driks Mea o. of driks Mea o. of driks Proportio of urecorded alcohol (% of all alcohol cosumed) Descriptio Proportio of urecorded alcohol as a percetage all alcohol cosumed durig the past seve days amog curret (past 30 days) drikers Istrumet questios Durig each of the past seve days, how may stadard driks did you have each day? Durig the past seve days, did you cosume ay homebrewed alcohol, ay alcohol brought over the border, alcohol ot iteded for drikig or other utaxed alcohol? O average, how may stadard driks of those types did you cosume durig the past seve days? Proportio of urecorded alcohol as a percetage of all alcohol cosumed durig the past 7 days Me Wome Both sexes Urecorded alcohol (% of all alcohol) Urecorded alcohol (% of all alcohol) Urecorded alcohol (% of all alcohol)

146 Types of urecorded alcohol Descriptio Proportio of each type of urecorded alcohol as a percetage of all urecorded alcohol cosumed i the past seve days amog curret (past 30 days) drikers Istrumet questios Durig the past seve days, did you cosume ay homebrewed alcohol, ay alcohol brought over the border, alcohol ot iteded for drikig or other utaxed alcohol? O average, how may stadard driks of those types did you cosume durig the past seve days? Urecorded alcohol cosumptio durig the past 7 days by type Homebrewed spirits Homebrewed wie Me Alcohol brought over border Surrogate alcohol Other Urecorded alcohol cosumptio durig the past 7 days by type Homebrewed spirits Homebrewed wie Wome Alcohol brought over border Surrogate alcohol Other Urecorded alcohol cosumptio durig the past 7 days by type Homebrewed spirits Homebrewed wie Both sexes Alcohol brought over border Surrogate alcohol Other

147 Frequecy of impaired cotrol relatig to drikig Descriptio Frequecy of ot beig able to stop drikig oce started durig the past 12 moths amog past 12-moth drikers Istrumet questios Have you cosumed ay alcohol withi the past 12 moths? How ofte durig the past 12 moths have you foud that you were ot able to stop drikig oce you had started? Frequecy of ot beig able to stop drikig oce started durig the past 12 moths Mothly or more frequetly Me Less tha mothly Never Frequecy of ot beig able to stop drikig oce started durig the past 12 moths Mothly or more frequetly Wome Less tha mothly Never Frequecy of ot beig able to stop drikig oce started durig the past 12 moths Mothly or more frequetly Both sexes Less tha mothly Never

148 Frequecy of failig to do what was ormally expected because of drikig Descriptio Frequecy of failig to do what was ormally expected of you as a result of drikig durig the past 12 moths amog past 12-moth drikers Istrumet questios Have you cosumed ay alcohol withi the past 12 moths? How ofte durig the past 12 moths have you failed to do what was ormally expected of you as a result of drikig? Frequecy of failig to do what was ormally expected durig the past 12 moths Mothly or more frequetly Me Less tha mothly Never Frequecy of failig to do what was ormally expected durig the past 12 moths Mothly or more frequetly Wome Less tha mothly Never Frequecy of failig to do what was ormally expected durig the past 12 moths Mothly or more frequetly Both sexes Less tha mothly Never

149 Frequecy of morig drikig Descriptio Frequecy of eedig a first drik i the morig to get goig after a heavy drikig sessio durig the past 12 moths amog past 12-moth drikers Istrumet questios Have you cosumed ay alcohol withi the past 12 moths? How ofte durig the past 12 moths have you eeded a first drik i the morig to get yourself goig after a heavy drikig sessio? Frequecy of eedig a first drik i the morig to get goig durig the past 12 moths Mothly or more frequetly Me Less tha mothly Never Frequecy of eedig a first drik i the morig to get goig durig the past 12 moths Mothly or more frequetly Wome Less tha mothly Never Frequecy of eedig a first drik i the morig to get goig durig the past 12 moths Mothly or more frequetly Both sexes Less tha mothly Never

150 Frequecy of problems with family/parter due to someoe else s drikig Descriptio Frequecy of havig had problems with family or parter due to someoe else s drikig i the past 12 moths amog all respodets Istrumet questio Have you had family problems or problems with your parter due to someoe else s drikig withi the past 12 moths? Frequecy of family/parter problems due to someoe else s drikig durig the past 12 moths amog all respodets Mothly or more frequetly Me Less tha mothly Never Frequecy of family/parter problems due to someoe else s drikig durig the past 12 moths amog all respodets Mothly or more frequetly Wome Less tha mothly Never Frequecy of family/parter problems due to someoe else s drikig durig the past 12 moths amog all respodets Mothly or more frequetly Both sexes Less tha mothly Never

151 Fruit ad vegetable cosumptio Fruit ad vegetable cosumptio (mea umber of days) 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? 150 Mea umber of days cosumig fruit i a typical week Me Wome Both sexes Mea o. of days Mea No. of days Mea o. of days Mea umber of days cosumig fruit i a typical week Me Wome Both sexes Mea o. of days Mea No. of days Mea o. of days Rural Urba Total Mea umber of days cosumig vegetables i a typical week Me Wome Both sexes Mea o. of days Mea No. of days Mea o. of days Mea umber of days cosumig vegetables i a typical week Me Wome Both sexes Mea o. of days Mea No. of days Mea o. of days Rural Urba Total

152 Fruit ad vegetable cosumptio (mea umber of servigs) 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 o. of servigs Mea o. of servigs Mea o. of servigs Mea umber of days cosumig fruit i a typical week Me Wome Both sexes Mea o. of servigs Mea o. of servigs Mea o. of servigs Rural Urba Total Mea umber of servigs of vegetables o average per day Me Wome Both sexes Mea o. of servigs Mea o. of servigs Mea o. of servigs Mea umber of days cosumig fruit i a typical week Me Wome Both sexes Mea o. of servigs Mea o. of servigs Mea o. of servigs Rural Urba Total

153 Mea umber of servigs of fruit ad/or vegetables o average per day Me Wome Both sexes Mea o. of servigs Mea o. of servigs Mea o. of servigs Mea umber of days cosumig fruit i a typical week Me Wome Both sexes Mea o. of servigs Mea o. of servigs Mea o. of servigs Rural Urba Total

154 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 No fruit ad/or vegetables 1 2 servigs Me 3 4 servigs 5 servigs Number of servigs of fruit ad/or vegetables o average per day No fruit ad/or vegetables 1 2 servigs Wome 3 4 servigs 5 servigs Number of servigs of fruit ad/or vegetables o average per day No fruit ad/or vegetables 1 2 servigs Both sexes 3 4 servigs 5 servigs

155 Fruit ad vegetable cosumptio per day Descriptio Percetage of respodets eatig fewer 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? Fewer tha 5 servigs of fruit ad/or vegetables o average per day Me Wome Both sexes < 5 servigs per day < 5 servigs per day < 5 servigs per day Type of oil used most frequetly Descriptio Type of oil or fat most ofte used for meal preparatio i households (preseted oly for both sexes because results are for the household, ot for idividuals) Istrumet questio What type of oil or fat is most ofte used for meal preparatio i your household? (households) Vegetable oil Type of oil or fat most ofte used for meal preparatio i household Lard or suet Noe i particular/ Other Noe used

156 Eatig outside the home Descriptio Mea umber of meals per week eate outside (a) home Istrumet questio 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. Mea umber of meals eate outside (a) home Me Wome Both sexes Mea o. of meals Mea o. of meals Mea o. of meals Mea umber of meals eate outside (a) home Me Wome Both sexes Mea o. of meals Mea o. of meals Mea o. of meals Rural Urba Total

157 Dietary salt Addig salt to meal Descriptio Percetage of all respodets who always or ofte add salt or salty sauces to their food before eatig or while they are eatig Istrumet questio How ofte do you add salt or a salty sauce such as soya sauce to your food before you eat it or while you are eatig? Add salt always or ofte before eatig or while eatig Me Wome Both sexes % % % Total Add salt always or ofte before eatig or while eatig Me Wome Both sexes % % % Rural Urba Total

158 Cosumptio of iodized salt Descriptio Percetage of all respodets who use iodized salt whe cookig or preparig food at home Istrumet questio What type of salt do you use while cookig or preparig food i your household? Use iodized salt whe cookig or preparig food at home Me Wome Both sexes % % % Total Use iodized salt whe cookig or preparig food at home Me Wome Both sexes % % % Rural Urba Total Addig salt whe cookig Descriptio Percetage of all respodets who always or ofte add salt to their food whe cookig or preparig food at home Istrumet questio How ofte is salt, salty seasoig or a salty sauce added i cookig or preparig food i your household? Add salt always or ofte whe cookig or preparig food at home Me Wome Both sexes % % % Total

159 Salty processed food cosumptio Descriptio Percetage of all respodets who always or ofte eat processed food high i salt Istrumet questios How ofte do you eat processed food high i salt? Always or ofte cosume processed food high i salt Me Wome Both sexes % % % Total Always or ofte cosume processed food high i salt Me Wome Both sexes % % % Rural Urba Total

160 Salt cosumptio Descriptio Percetage of all respodets who thik they cosume far too much or too much salt Istrumet questios How much salt or salty sauce do you thik you cosume? Thik they cosume far too much or too much salt Me Wome Both sexes % % % Total Far too much Self-reported quatity of salt cosumed Too much Me Just the right amout Too little Far too little Total Far too much Self-reported quatity of salt cosumed Too much Wome Just the right amout Too little Far too little Total

161 Far too much Self-reported quatity of salt cosumed Too much Both sexes Just the right amout Too little Far too little Total Salt kowledge Descriptio Percetage of respodets who thik cosumig too much salt could cause a serious health problem Istrumet questios Do you thik that too much salt or salty sauce i your diet could cause a health problem? Thik cosumig too much salt could cause a serious health problem Me Wome Both sexes % % % Total

162 Lowerig salt i diet Descriptio Percetage of respodets who thik lowerig salt i diet is very, somewhat or ot-at-all importat Istrumet questios How importat to you is lowerig the salt i your diet? Very importat Importace of lowerig salt i diet Me Somewhat importat Not-at-all importat Total Very importat Importace of lowerig salt i diet Wome Somewhat importat Not-at-all importat Total Very importat Importace of lowerig salt i diet Both sexes Somewhat importat Not-at-all importat Total

163 Cotrollig salt itake Descriptio Percetage of respodets who take specific actio o a regular basis to cotrol salt itake Istrumet questios Do you do ay of the followig o a regular basis to cotrol your salt itake? Limit cosumptio of processed food Me Wome Both sexes % % % Total Look at the salt or sodium cotet o food labels Me Wome Both sexes % % % Total Buy low salt/sodium alteratives Me Wome Both sexes % % % Total Use spices other tha salt whe cookig Me Wome Both sexes % % % Total

164 Avoid eatig food prepared outside of (a) home Me Wome Both sexes % % % Total Take other measures specifically to cotrol your salt itake Me Wome Both sexes % % % Total

165 Physical activity Itroductio A populatio s physical activity (or iactivity) ca be described i differet ways. The two most commo ways are: (1) estimatig a populatio s mea or media physical activity usig a cotiuous idicator such as metabolic equivalet (MET)-miutes per week or time spet carryig out physical activity; ad (2) classifyig certai percetages of a populatio ito specific s by settig up cut-off poits for specific amouts of physical activity. Whe aalysig Geeral Physical Activity Questioaire (GPAQ) data, both cotiuous ad categorical idicators were used. MET METs are commoly used to express the itesity of physical activities, ad are also used for the aalysis of GPAQ data. Applyig MET values to activity levels allows us total physical activity to be calculated. A MET is the ratio of a perso s workig metabolic rate relative to their restig metabolic rate. 1 MET is defied as the eergy cost of sittig quietly, ad is equivalet to a caloric cosumptio of 1 kcal/kg/hour. For the aalysis of GPAQ data, existig guidelies have bee adopted. It is estimated that, compared to sittig quietly, a perso s caloric cosumptio is four times as high whe beig moderately active, ad eight times as high whe beig vigorously active. Therefore, for the calculatio of a perso s total physical activity usig GPAQ data, the MET values give i the table below were used. Domai MET value Work Moderate MET value = 4.0 Vigorous MET value = 8.0 Trasport Cyclig ad walkig MET value = 4.0 Recreatio Moderate MET value = 4.0 Vigorous MET value =

166 WHO Global recommeddatios o physical activity for health To calculate the categorical idicator for the recommeded amout of physical activity for health, the total time spet carryig out physical activity durig a typical week ad the itesity of the physical activity are take ito accout. Throughout a week, icludig activity for work, durig trasport ad leisure time, adults should do at least: 150 miutes of moderate-itesity physical activity OR 75 miutes of vigorous-itesity physical activity OR A equivalet combiatio of moderate- ad vigorous-itesity physical activity achievig at least 600 MET-miutes. Former recomme-datios for compariso purposes For compariso purposes, tables presetig cut-off poits from former recommedatios are also icluded i the GPAQ data aalysis. The 3 levels of physical activity suggested for classifyig populatios were low, moderate, ad high. The criteria for these levels are show below. High A perso reachig ay of the followig criteria is classified i the category of high-level physical activity: - vigorous-itesity activity at least three days per week, achievig at least 1500 MET-miutes per week; OR - seve or more days of ay combiatio of walkig, moderateor vigorous-itesity activities achievig a at least 3000 METmiutes per week. Moderate A perso ot meetig the criteria for the high category, but meetig ay of the followig criteria is classified i the category of moderatelevel physical activity: - 3 or more days of vigorous-itesity activity of at least 20 miutes per day; or - 5 or more days of moderate-itesity activity or walkig for at least 30 miutes per day; or - 5 or more days of ay combiatio of walkig, moderate- or vigorous-itesity activities achievig at least 600 METmiutes per week. - Low A perso ot meetig ay of the above-metioed criteria falls ito the category of low-level physical activity. 165

167 Not meetig WHO recommedatios o physical activity for health Descriptio Percetage of respodets ot meetig WHO recommedatios o physical activity for health (respodets achievig less tha 150 miutes of moderateitesity physical activity per week, or equivalet). Istrumet questios Activity at work Travel to ad from places Recreatioal activities Not meetig WHO recommedatios o physical activity for health Me Wome Both sexes Not meetig rec s Not meetig rec s Not meetig rec s Not meetig WHO recommedatios o physical activity for health Me Wome Both sexes Not meetig rec s Not meetig rec s Not meetig rec s Rural Urba Total

168 Levels of total physical activity accordig to former recommedatios Descriptio Percetage of respodets classified ito 3 categories of total physical activity accordig to former recommedatios Istrumet questios Activity at work Travel to ad from places Recreatioal activities Level of total physical activity accordig to former recommedatios Low Me Moderate High Level of total physical activity accordig to former recommedatios Low Wome Moderate High Level of total physical activity accordig to former recommedatios Low Both sexes Moderate High

169 Total physical activity (mea) 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 Mea miutes of total physical activity o average per day Me Wome Both sexes Mea miutes Mea miutes Mea miutes Mea miutes of total physical activity o average per day Me Wome Both sexes Mea miutes Mea miutes Rural Urba Total Total physical activity (media) 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 Iterquartile rage (P25 P75) Media miutes Iterquartile rage (P25 P75) Media miutes Iterquartile rage (P25 P75)

170 Domaispecific physical activity (mea) Descriptio Mea miutes spet carryig out 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 physical activity o average per day (Me) Work-related Trasport-related Recreatio-related Mea miutes Mea miutes Mea miutes Mea miutes of physical activity o average per day (Me) Work-related Trasport-related Recreatio-related Mea miutes Mea miutes Mea miutes Rural Urba Total Mea miutes of physical activity o average per day (Wome) Work-related Trasport-related Recreatio-related Mea miutes Mea miutes Mea miutes Mea miutes of physical activity o average per day (Wome) Work-related Trasport-related Recreatio-related Mea miutes Mea miutes Mea miutes Rural Urba Total

171 Mea miutes of physical activity o average per day (Both sexes) Work-related Trasport-related Recreatio-related Mea miutes Mea miutes Mea miutes Mea miutes of physical activity o average per day (Both sexes) Work-related Trasport-related Recreatio-related Mea miutes Mea miutes Mea miutes Rural Urba Total

172 Domaispecific physical activity (media) Descriptio Media miutes spet o average per day carryig out 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 Media miutes Me Wome Both sexes Iterquartile rage (P25 P75) Media miutes Iterquartile rage (P25 P75) Media miutes Iterquartile rage (P25 P75) Media miutes of trasport-related physical activity o average per day Media miutes Me Wome Both sexes Iterquartile rage (P25 P75) Media miutes Iterquartile rage (P25 P75) Media miutes Iterquartile rage (P25 P75) Media miutes of recreatio-related physical activity o average per day Mea miutes Me Wome Both sexes Iterquartile rage (P25 P75) Mea miutes Iterquartile rage (P25 P75) Mea miutes Iterquartile rage (P25 P75)

173 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 activity at work No work-related physical activity Me Wome Both sexes No activity at work No activity at work No activity for trasport No trasport-related physical activity Me Wome Both sexes No activity for trasport No activity for trasport No activity at recreatio No recreatio-related physical activity Me Wome Both sexes No activity at recreatio No activity at recreatio

174 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 Activity at work Compositio of total physical activity Me Activity usig trasport Activity durig leisure time Activity at work Compositio of total physical activity Me Activity usig trasport Activity durig leisure time Rural Urba Total Activity at work Compositio of total physical activity Wome Activity usig trasport Activity durig leisure time Activity at work Compositio of total physical activity Wome Activity usig trasport Activity durig leisure time Rural Urba Total

175 Activity at work Compositio of total physical activity Both sexes Activity usig trasport Activity durig leisure time Activity at work Compositio of total physical activity Both sexes Activity usig trasport Activity durig leisure time Rural Urba Total No vigorous physical activity Descriptio Percetage of respodets ot egagig i vigorous physical activity Istrumet questios Activity at work Recreatioal activities No vigorous activity No vigorous physical activity Me Wome Both sexes No vigorous activity No vigorous activity

176 Sedetary Descriptio Miutes spet i sedetary activities o a typical day Istrumet questio Sedetary behaviour Sedetary miutes o average per day Me Mea miutes Media miutes Iterquartile rage (P25 P75) Sedetary miutes o average per day Mea miutes Media miutes Iterquartile rage (P25 P75) Rural Urba Total Me Sedetary miutes o average per day Wome Mea miutes Media miutes Iterquartile rage (P25 P75) Sedetary miutes o average per day Wome Mea miutes Media miutes Iterquartile rage (P25 P75) Rural Urba Total

177 Sedetary miutes o average per day Both sexes Mea miutes Media miutes Iterquartile rage (P25 P75) Sedetary miutes o average per day Both sexes Mea miutes Media miutes Iterquartile rage (P25 P75) Rural Urba Total

178 History of raised blood pressure Blood pressure measuremet ad diagosis Descriptio Blood pressure measuremet ad diagosis amog all respodets Istrumet questios 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? Have you bee told this i the past 12 moths? Never measured Blood pressure measuremet ad diagosis Measured, ot diagosed Me Diagosed, but ot withi past 12 moths Diagosed withi past 12 moths Never measured Blood pressure measuremet ad diagosis Measured, ot diagosed Wome Diagosed, but ot withi past 12 moths Diagosed withi past 12 moths

179 Never measured Blood pressure measuremet ad diagosis Measured, ot diagosed Both sexes Diagosed, but ot withi past 12 moths Diagosed withi past 12 moths Blood pressure treatmet amog those diagosed Descriptio Raised blood pressure treatmet results amog respodets previously diagosed with raised blood pressure Istrumet questios 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? I the past two weeks, have you take ay medicatio for raised blood pressure prescribed by a doctor or other health worker? Curretly takig medicatio for raised blood pressure prescribed by doctor or health worker amog those diagosed Takig medicatio Me Wome Both sexes Takig medicatio Takig medicatio

180 Blood pressure advice by a traditioal healer Descriptio Percetage of respodets who have sought advice or received treatmet from a traditioal healer for raised blood pressure amog those previously diagosed with raised blood pressure Istrumet questios 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? Have you ever see a traditioal healer for raised blood pressure? Are you curretly takig ay herbal or traditioal remedy for high blood pressure? See traditioal healer See a traditioal healer Me Wome Both sexes See traditioal healer See traditioal healer Curretly takig herbal or traditioal remedy for raised blood pressure Takig traditioal medicatio Me Wome Both sexes Takig traditioal medicatio Takig traditioal medicatio

181 History of diabetes Blood sugar measuremet ad diagosis Descriptio Blood sugar measuremet ad diagosis amog all respodets Istrumet questios Have you ever had your blood sugar 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 sugar or diabetes? Have you bee told this i the past 12 moths? Never measured Blood sugar measuremet ad diagosis Measured, ot diagosed Me Diagosed, but ot withi past 12 moths Diagosed withi past 12 moths Never measured Blood sugar measuremet ad diagosis Measured, ot diagosed Wome Diagosed, but ot withi past 12 moths Diagosed withi past 12 moths

182 Never measured Blood sugar measuremet ad diagosis Measured, ot diagosed Both sexes Diagosed, but ot withi past 12 moths Diagosed withi past 12 moths Diabetes treatmet amog those diagosed Descriptio Diabetes treatmet results amog those previously diagosed with raised blood sugar or diabetes Istrumet questios Have you ever had your blood sugar 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 sugar or diabetes? I the past two weeks, have you take ay medicatio for diabetes prescribed by a doctor or other health worker? Are you curretly takig isuli for diabetes prescribed by a doctor or other health worker? Takig isuli Curretly takig medicatio prescribed for diabetes Me Wome Both sexes Takig isuli Takig isuli Curretly takig isuli prescribed for diabetes amog those previously diagosed Me Wome Both sexes Takig medicatio Takig medicatio Takig medicatio

183 Diabetes advice from a traditioal healer Descriptio Percetage of respodets who have sought advice or treatmet from a traditioal healer for diabetes amog those previously diagosed Istrumet questios Have you ever had your blood sugar 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 sugar or diabetes? Have you ever see a traditioal healer for diabetes or raised blood sugar? Are you curretly takig ay herbal or traditioal remedy for your diabetes? See a traditioal healer for diabetes Me Wome Both sexes See traditioal healer See traditioal healer See traditioal healer Curretly takig herbal or traditioal treatmet for diabetes Me Wome Both sexes Takig traditioal medicatio Takig traditioal medicatio Takig traditioal medicatio

184 History of raised cholesterol Cholesterol measuremet ad diagosis Descriptio Total cholesterol measuremet ad diagosis amog all respodets Istrumet questios Have you ever had your cholesterol (fat levels i your blood) measured by a doctor or other health worker? Have you ever bee told by a doctor or other health worker that you have raised cholesterol? Have you bee told this i the past 12 moths? Never measured Total cholesterol measuremet ad diagosis Measured, ot diagosed Me Diagosed, but ot withi past 12 moths Diagosed withi past 12 moths Never measured Total cholesterol measuremet ad diagosis Measured, ot diagosed Wome Diagosed, but ot withi past 12 moths Diagosed withi past 12 moths Never measured Total cholesterol measuremet ad diagosis Measured, ot diagosed Both sexes Diagosed, but ot withi past 12 moths Diagosed withi past 12 moths

185

186 Cholesterol advice from traditioal healer Descriptio Percetage of respodets who have sought advice or treatmet from a traditioal healer for raised cholesterol amog those previously diagosed Istrumet questios Have you ever had your cholesterol (fat levels i your blood) measured by a doctor or other health worker? Have you ever bee told by a doctor or other health worker that you have raised cholesterol? Have you ever see a traditioal healer for raised cholesterol? Are you curretly takig ay herbal or traditioal remedy for raised cholesterol? See a traditioal healer for raised cholesterol Me Wome Both sexes See traditioal healer See traditioal healer See traditioal healer Curretly takig herbal or traditioal treatmet for raised cholesterol Me Wome Both sexes Takig traditioal medicatio Takig traditioal medicatio Takig traditioal medicatio

187 Cardiovascular disease (CVD) history History of CVDs Descriptio Percetage of respodets who have ever had a heart attack or chest pai from heart disease (agia) or a stroke amog all respodets Istrumet questios Have you ever had a heart attack or chest pai from heart disease (agia) or a stroke (cerebrovascular accidet or icidet)? Havig ever had a heart attack or chest pai from heart disease, or a stroke Me Wome Both sexes CVD history CVD history CVD history

188 Prevetio ad treatmet of heart disease Descriptio Percetage of respodets curretly takig aspiri or statis regularly to prevet or treat heart disease Istrumet questios Are you curretly takig aspiri regularly to prevet or treat heart disease? Are you curretly takig statis (Lovostati/Simvastati/Atorvastati or ay other stati) regularly to prevet or treat heart disease? Curretly takig aspiri regularly to prevet or treat heart disease Me Wome Both sexes Takig aspiri Takig aspiri Takig aspiri Curretly takig statis regularly to prevet or treat heart disease Me Wome Both sexes Takig statis Takig statis Takig statis

189 Lifestyle advice Lifestyle advice Descriptio Percetage of respodets who received lifestyle advice from a doctor or health worker durig the past three years amog all respodets Istrumet questio Durig the past three years, has a doctor or other health worker advised you to do ay of the followig? Advised by doctor or health worker to stop smokig/usig tobacco products or ot to start Me Wome Both sexes % % % Advised by doctor or health worker to reduce salt i diet Me Wome Both sexes % % % Advised by doctor or health worker to eat at least 5 servigs of fruit ad/or vegetables each day Me Wome Both sexes % % %

190 Advised by doctor or health worker to reduce fat i diet Me Wome Both sexes % % % Advised by doctor or health worker to start or do more physical activity Me Wome Both sexes % % % Advised by doctor or health worker to maitai a healthy body weight or to lose weight Me Wome Both sexes % % %

191 Cervical cacer screeig Cervical cacer screeig Descriptio Percetage of female respodets who have ever had a screeig test for cervical cacer amog all female respodets Istrumet questio Have you ever had a screeig test for cervical cacer (usig ay of these methods)? Wome % Wome % Rural Urba Total Cervical cacer screeig amog wome aged years Descriptio Percetage of female respodets aged years who have ever had a screeig test for cervical cacer amog all female respodets aged years. Istrumet questio Have you ever had a screeig test for cervical cacer (usig ay of these methods)? Wome % Wome % Rural Urba Total

192 Physical measuremets Blood pressure Descriptio Mea blood pressure amog all respodets, icludig those curretly takig medicatio for raised blood pressure Istrumet questio Readig 1 3 systolic blood pressure (SBP) ad diastolic blood pressure (DBP) Mea SBP Mea systolic blood pressure (mmhg) Me Wome Both sexes Mea SBP Mea SBP Mea DBP Mea diastolic blood pressure (mmhg) Me Wome Both sexes Mea DBP Mea DBP

193 Raised blood pressure Descriptio Percetage of respodets with raised blood pressure Istrumet questio Readig 1 3 SBP ad DBP Durig the past two weeks, have you bee treated for raised blood pressure with medicatio prescribed by a doctor or other health worker? SBP 140 ad/or DBP 90 mmhg, excludig those takig medicatio for raised blood pressure Me Wome Both sexes % % % SBP 140 ad/or DBP 90 mmhg or curretly takig medicatio for raised blood pressure Me Wome Both sexes % % % SBP 160 ad/or DBP 100 mmhg, excludig those takig medicatio for raised blood pressure Me Wome Both sexes % % % SBP 160 ad/or DBP 100 mmhg or curretly takig medicatio for raised blood pressure Me Wome Both sexes % % %

194 Treatmet ad cotrol of raised blood pressure Descriptio Percetage of respodets with treated ad/or cotrolled raised blood pressure amog those with raised blood pressure (SBP 140 ad/or DBP 90 mmhg) or curretly takig medicatio for raised blood pressure Istrumet questios Durig the past two weeks, have you bee treated for raised blood pressure with medicatio prescribed by a doctor or other health worker? Readig 1 3 SBP ad DBP Respodets with treated ad/or cotrolled raised blood pressure Takig medicatio ad SBP < 140 ad DBP < 90 Me Takig medicatio ad SBP 140 ad/ or DBP 90 Not takig medicatio ad SBP 140 ad/or DBP Respodets with treated ad/or cotrolled raised blood pressure Me Takig medicatio ad SBP < 140 ad DBP < 90 Takig medicatio ad SBP 140 ad/ or DBP 90 Not takig medicatio ad SBP 140 ad/or DBP 90 Rural Urba Total

195 Respodets with treated ad/or cotrolled raised blood pressure Takig medicatio ad SBP < 140 ad DBP < 90 Wome Takig medicatio ad SBP 140 ad/or DBP 90 Not takig medicatio ad SBP 140 ad/or DBP Respodets with treated ad/or cotrolled raised blood pressure Wome Takig medicatio ad SBP < 140 ad DBP < 90 Takig medicatio ad SBP 140 ad/or DBP 90 Not takig medicatio ad SBP 140 ad/or DBP 90 Rural Urba Total Respodets with treated ad/or cotrolled raised blood pressure Takig medicatio ad SBP < 140 ad DBP < 90 Both sexes Takig medicatio ad SBP 140 ad/or DBP 90 Not takig medicatio ad SBP 140 ad/or DBP Respodets with treated ad/or cotrolled raised blood pressure Both sexes Takig medicatio ad SBP < 140 ad DBP < 90 Takig medicatio ad SBP 140 ad/or DBP 90 Not takig medicatio ad SBP 140 ad/or DBP 90 Rural Urba Total

196 Mea heart rate Descriptio Mea heart rate (beats per miute) Istrumet questio Readig 1 3 heart rate Mea beats per miute Mea heart rate (beats per miute) Me Wome Both sexes Mea beats per miute Mea beats per miute Height, weight ad body mass idex (BMI) Descriptio Mea height, weight, ad BMI amog all respodets (excludig pregat wome) Istrumet questios For wome: Are you pregat? Height Weight Me Mea height (cm) Mea height (cm) Wome Mea height (cm) Me Mea height (cm) Mea weight (kg) Wome Mea height (cm)

197 Mea BMI (kg/ m 2 ) Mea BMI (kg/m2) Me Wome Both sexes Mea BMI (kg/ m 2 ) Mea BMI (kg/m 2 ) Mea BMI (kg/m2) Me Wome Both sexes Mea BMI (kg/ m 2 ) Mea BMI (kg/ m 2 ) Mea BMI (kg/m 2 ) Rural Urba Total

198 BMI categories Descriptio Percetage of respodets i each BMI category (excludig pregat wome) Istrumet questios For wome: Are you pregat? Height Weight Uderweight < 18.5 BMI classificatios Normal weight Me Overweight Obese Uderweight < 18.5 BMI classificatios Normal weight Wome Overweight Obese Uderweight < 18.5 BMI classificatios Normal weight Both sexes Overweight Obese

199 BMI 25 Descriptio Percetage of respodets classified as overweight (BMI 25) (excludig pregat wome) Istrumet questios For wome: Are you pregat? Height Weight BMI 25 BMI 25 Me Wome Both sexes BMI 25 BMI BMI 25 BMI 25 Me Wome Both sexes BMI 25 BMI 25 Rural Urba Total Waist circumferece Descriptio Mea waist circumferece amog all respodets (excludig pregat wome) Istrumet questios For wome: Are you pregat? Waist circumferece measuremet Me Mea circumferece (cm) Waist circumferece (cm) Wome Mea circumferece (cm)

200 Hip circumferece Descriptio Mea hip circumferece amog all respodets (excludig pregat wome) Istrumet questios For wome: Are you pregat? Hip circumferece measuremet Me Mea circumferece (cm) Hip circumferece (cm) Wome Mea circumferece (cm) Waist / hip ratio Descriptio Mea waist-to-hip ratio amog all respodets (excludig pregat wome) Istrumet questios For wome: Are you pregat? Waist circumferece measuremet Hip circumferece measuremet Me Mea circumferece (cm) Mea waist hip ratio Wome Mea circumferece (cm)

201 Biochemical measuremets Mea fastig blood glucose Descriptio Mea fastig blood glucose results, icludig respodets curretly takig medicatio for diabetes (o-fastig recipiets excluded) Istrumet questios Durig the past 12 hours have you had aythig to eat or drik, other tha water? Blood glucose measuremet Mea mmol/l Mea fastig blood glucose (mmol/l) Me Wome Both sexes Mea mmol/l Mea mmol/l

202 Raised blood glucose Descriptio Categorizatio of respodets ito blood glucose level categories ad percetage of respodets curretly takig medicatio for raised blood glucose (o-fastig recipiets excluded) Istrumet questios I the past two weeks, have you take ay medicatio for diabetes prescribed by a doctor or other health worker? Are you curretly takig isuli for diabetes prescribed by a doctor or other health worker? Durig the last 12 hours have you had aythig to eat or drik, other tha water? Blood glucose measuremet Today, have you take isuli or other medicatio that has bee prescribed by a doctor or other health worker? IFG* Me Wome Both sexes % % % Raised blood glucose** or curretly takig medicatio for diabetes Me Wome Both sexes % % % * Impaired fastig glycaemia (IFG) is defied as either: plasma veous value: 6.1mmol/L (110mg/dl) ad < 7.0mmol/L (126mg/dl); or 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) 201

203 Curretly takig medicatio for diabetes Me Wome Both sexes % % % Total cholesterol Descriptio Mea total cholesterol amog all respodets, icludig those curretly takig medicatio for raised cholesterol Istrumet questio Total cholesterol measuremet Mea cholesterol level Mea total cholesterol (mmol/l) Me Wome Both sexes Mea cholesterol level Mea cholesterol level

204 Raised total cholesterol Descriptio Percetage of respodets with raised total cholesterol ad percetage of respodets curretly takig medicatio for raised cholesterol Istrumet questios Total cholesterol measuremet Durig the past two weeks, have you bee treated for raised cholesterol with medicatio prescribed by a doctor or other health worker? Total cholesterol 5.0 mmol/l or curretly takig medicatio for raised cholesterol Me Wome Both sexes % % % Total cholesterol 6.2 mmol/l or curretly takig medicatio for raised cholesterol Me Wome Both sexes % % %

205 High desity lipoprotei (HDL) Descriptio Mea HDL amog all respodets ad percetage of respodets with low HDL Istrumet questio HDL cholesterol measuremet Mea HDL Mea HDL (mmol/l) Me Wome Both sexes Mea HDL Mea HDL Percetage of respodets with HDL < 1.29mmol/L Wome % Percetage of respodets with HDL < 1.03mmol/L Me %

206 Cardiovascular disease (CVD) risk CVD risk of 30% or existig CVD Descriptio Percetage of respodets aged years with a 10-year CVD risk* 30% or with existig CVD Istrumet questios (combied from STEPS 1, 2 ad 3) Geder, age Curret ad former smokig status History of diabetes, CVD SBP measuremets Fastig status, glucose ad total cholesterol measuremets Percetage of respodets with a 10-year CVD risk 30% or with existig CVD Me Wome Both sexes % % % * A 10-year CVD risk of 30% is defied accordig to age, sex, blood pressure, smokig status (curret smokers OR those who stopped smokig less tha 1 year before the assessmet), total cholesterol, ad diabetes (previously diagosed OR a fastig plasma glucose cocetratio > 7.0 mmol/l (126 mg/dl)). 205

207 Drug therapy ad couselig for those with CVD risk 30% or existig CVD Descriptio Percetage of eligible idividuals (defied as those aged years with a 10-year CVD risk* 30%, icludig those with existig CVD) receivig drug therapy ad couselig** (icludig glycaemic cotrol) to prevet heart attacks ad strokes Istrumet questios (combied from STEPS 1, 2 ad 3) Geder, age Curret ad former smokig History of diabetes, CVD Lifestyle advice SBP measuremets Fastig status, glucose ad total cholesterol measuremets Percetage of eligible persos receivig drug therapy ad couselig to prevet heart attacks ad strokes Me Wome Both sexes % % % * A 10-year CVD risk of 30% is defied accordig to age, sex, blood pressure, smokig status (curret smokers OR those who stopped smokig less tha 1 year before the assessmet), total cholesterol, ad diabetes (previously diagosed OR a fastig plasma glucose cocetratio > 7.0 mmol/l (126 mg/dl)). **Couselig is defied as receivig advice from a doctor or other health worker to stop smokig/ usig tobacco products or ot start, to reduce salt i diet, to eat at least five servigs of fruit ad/or vegetables per day, to reduce fat i diet, to start or do more physical activity, to maitai a healthy body weight or to lose weight. 206

208 Summary of combied risk factors Summary of combied risk factors Descriptio Percetage of respodets with 0, 1 2, or 3 5 of the followig risk factors: Istrumet questios (combied from STEPS 1 ad 2) Curret daily smokig Fewer tha five servigs of fruit ad/or vegetables per day Not meetig WHO recommedatios o physical activity for health (< 150 miutes of moderate activity per week, or equivalet) Overweight or obese (BMI 25 kg/m 2 ) Raised blood pressure (SBP 140 ad/or DBP 90 mmhg or curretly takig medicatio for raised blood pressure) 0 risk factors Summary of combied risk factors Me 1 2 risk factors 3 5 risk factors risk factors Summary of combied risk factors Wome 1 2 risk factors 3 5 risk factors risk factors Summary of combied risk factors Both sexes 1 2 risk factors 3 5 risk factors

209 Health care Health isurace Descriptio Percetage of respodets with health isurace Istrumet questio Do you curretly have health isurace? Percetage with health isurace Me Wome Both sexes % % % Percetage with health isurace Me Wome Both sexes % % % Rural Urba Total

210 Fiacial sources used for health expediture Descriptio Percetage of respodets usig differet fiacial sources for health expediture Istrumet questios Durig the past 12 moths, which of the followig fiacial sources did you use to pay for ay health expediture, such as medicies, cosultatios, treatmet, hospitalizatio or patiet care? Fiacial sources used for health expediture Curret icome Me Savigs Paymet or reimbursemet from health isurace Sold items Fiacial sources used for health expediture Family member or fried outside household Wome Borrowed from someoe other tha family or fried Other

211 N Sold items Fiacial sources used for health expediture Family member or fried outside household Wome Borrowed from someoe other tha family or fried Other Curret icome Fiacial sources used for health expediture Savigs Both sexes Paymet or reimbursemet from health isurace Other Sold items Fiacial sources used for health expediture Family member or fried outside household Both sexes Borrowed from someoe other tha family or fried Other

212 Prevalece of ocommuicable disease (NCD) Descriptio Percetage of respodets who had i the past or curretly have a NCD Istrumet questio Have you ever had or do you curretly have a NCD such as a CVD, icludig heart disease ad stroke, cacer, chroic respiratory disease, or diabetes? Percetage who had i the past or curretly have a NCD Me Wome Both sexes % % % Visits to health care facilities for NCDs Descriptio Percetage of respodets who have ever visited a health care facility due to a NCD, amog those with a NCD Istrumet questio Have you ever had or do you curretly have a NCD such as a CVD, icludig heart disease ad stroke, cacer, chroic respiratory disease, or diabetes? Have you ever visited ay health care facility due to a NCD you have? Please exclude ay hospitalizatio. Percetage who visited a health care facility for a NCD Me Wome Both sexes % % %

213 Travel time to ad from last visit to health care facility Descriptio Mea travel time to a health care facility for the last visit, amog those with a NCD who have ever visited a health care facility Istrumet questio Have you ever had or do you curretly have a NCD such as a CVD, icludig heart disease ad stroke, cacer, chroic respiratory disease, or diabetes? Have you ever visited ay health care facility due to a NCD you have? Please exclude ay hospitalizatio. How much time did you sped travelig the last time you visited a health care facility (takig both ways ito accout)? Mea travel time (miutes) to ad from last visit to health care facility for a NCD Mea miutes Me Wome Both sexes Mea miutes Mea miutes Mea travel time (miutes) to ad from last visit to health care facility for a NCD Me Wome Both sexes Mea miutes Mea miutes Mea miutes Rural Urba Total

214 Waitig time at last visit to a health care facility Descriptio Mea waitig time at a health care facility at the last visit, amog respodets with a NCD who have ever visited a health care facility Istrumet questio Have you ever had or do you curretly have a NCD such as a CVD, icludig heart disease ad stroke, cacer, chroic respiratory disease, or diabetes? Have you ever visited ay health care facility due to a NCD you have? Please exclude ay hospitalizatio. How log was the waitig time before your appoitmet started whe you last visited a health care facility? Mea waitig time (miutes) at last visit to health care facility for a NCD Mea miutes Me Wome Both sexes Mea miutes Mea miutes Visits to health care facilities for NCDs i the past 30 days Descriptio Percetage of respodets who have visited a health care facility due to a NCD durig the past 30 days, amog those with a NCD Istrumet questio Have you ever had or do you curretly have a ocommuicable disease (NCD) such as a CVD icludig heart disease ad stroke, cacer, chroic respiratory disease, or diabetes? Durig the past 30 days, have you visited ay health care facility due to a NCD you have? Please exclude ay hospitalizatio. Percetage who visited a health care facility for a NCD i the past 30 days Me Wome Both sexes % % %

215 Visits to specific health care facilities i the past 30 days Descriptio Mea umber of visits to specific health care facilities durig the past 30 days amog respodets with a NCD that have visited a health care facility durig the past 30 days Istrumet questios Have you ever had or do you curretly have a NCD such as a CVD, icludig heart disease ad stroke, cacer, chroic respiratory disease, or diabetes? Durig the past 30 days, have you visited ay health care facility due to a NCD you have? Please exclude ay hospitalizatio. Durig the past 30 days, how may times have you visited a health care facility due to a NCD you have? Mea umber of visits to specific health care facilities i the past 30 days Mea o. of visits to a health cetre Me Mea o. of visits to a public hospital Mea o. of visits to a private hospital * * deotes data ot available. Mea umber of visits to specific health care facilities i the past 30 days Mea o. of visits to a health cetre Wome Mea o. of visits to a public hospital Mea o. of visits to a private hospital

216 Mea umber of visits to specific health care facilities i the past 30 days Mea o. of visits to a health cetre Both sexes Mea o. of visits to a public hospital Mea o. of visits to a private hospital Spedig o health care visits i last 30 days Descriptio Mea amout spet [local currecy] by respodets o specific health care costs ad i total for all visits i the past 30 days to a health care facility due to a NCD, amog those with NCDs who have visited a health care facility for a NCD i the past 30 days Istrumet questios Have you ever had or do you curretly have a NCD such as a CVD, icludig heart disease ad stroke, cacer, chroic respiratory disease, or diabetes? Durig the past 30 days, have you visited ay health care facility due to a NCD? Please exclude ay hospitalizatio. Durig the past 30 days, takig all your visits to health care facilities due to a NCD ito accout, how much did you pay yourself for these visits i total? Mea MDL spet o visits to health care facilities for NCDs Mea MDL Me Wome Both sexes Mea MDL Mea MDL Provider s fees Medicie Tests Trasport Other expeses Total

217 Spedig o health care ot related to ay visit to health care facilities i the past 30 days Descriptio Mea amout spet by respodets o health care ot related to ay visit to a health care facility or hospital durig the past 30 days Istrumet questio Have you ever had or do you curretly have a NCD such as a CVD, icludig heart disease ad stroke, cacer, chroic respiratory disease, or diabetes? Durig the past 30 days, how much did you pay from your ow fuds for health care ot related to ay visit of a health care facility or hospital, such as routie medicatio? Mea MDL spet o health care ot related to a visit to a health care facility or hospital Me Wome Both sexes Mea MDL Mea MDL Mea MDL Total Hospitalizatio i the past 12 moths due to a NCD Descriptio Percetage of respodets havig bee hospitalized due to a NCD durig the past 12 moths, amog those with a NCD Istrumet questio Have you ever had or do you curretly have a NCD such as a CVD, icludig heart disease ad stroke, cacer, chroic respiratory disease, or diabetes? Durig the past 12 moths, have you bee hospitalized due to a NCD? Percetage with a NCD who were hospitalized as a result of that NCD Me Wome Both sexes Hospitalized Hospitalized Hospitalized

218 Number of days hospitalized due to a NCD Descriptio Mea umber of days i hospital amog respodets that have bee hospitalized due to a NCD durig the past 12 moths Istrumet questio Have you ever had or do you curretly have a NCD such as a CVD, icludig heart disease ad stroke, cacer, chroic respiratory disease, or diabetes? Durig the past 12 moths, have you bee hospitalized due to a NCD? Durig the past 12 moths, how may days have you bee hospitalized due to a NCD? Mea umber of days hospitalized due to a NCD Me Wome Both sexes Mea o. of days Mea o. of days Mea o. of days Spedig o hospitalizatios i the past 12 moths Descriptio Mea amout spet [local currecy] by respodets o specific health care costs ad i total durig the past 12 moths for hospitalizatios due to a NCD, amog those with a NCD that have visited a hospital durig the past 12 moths Istrumet questios Have you ever had or do you curretly have a NCD such as a CVD, icludig heart disease ad stroke, cacer, chroic respiratory disease, or diabetes? Durig the past 12 moths, have you bee hospitalized due to a NCD? Durig the past 12 moths, takig all your visits to a hospital due to a NCD ito accout, how much did you pay from your ow fuds for these visits i total? Mea MDL Mea MDL spet o hospitalizatios due to NCDs Me Wome Both sexes Mea MDL Mea MDL Provider s fees Medicie Tests Trasport Other expeses Total

219 Home care for NCDs Descriptio Percetage of respodets receivig home care from a family member or fried durig the past 30 days due to a NCD, amog those with a NCD Istrumet questio Have you ever had or do you curretly have a NCD such as a CVD, icludig heart disease ad stroke, cacer, chroic respiratory disease, or diabetes? Durig the past 30 days, has a family member or fried provided care for you at home due to your NCD? Percetage with a NCD that received home care Me Wome Both sexes Received home care Received home care Received home care Hours per week spet givig home care Descriptio Mea time spet per week durig the past 30 days by a family member or fried to provide care for a respodet with a NCD, amog those with a NCD Istrumet questio Have you ever had or do you curretly have a NCD such as a CVD, icludig heart disease ad stroke, cacer, chroic respiratory disease, or diabetes? Durig the past 30 days, has a family member or fried provided care for you at home due to your NCD? Durig the past 30 days, how may hours per week has this perso/have these people provided care for you? Mea time (i hours) spet givig home care for a NCD Me Wome Both sexes Mea hours Mea hours Mea hours Rural Urba Total

220 Missig activities due to NCD Descriptio Percetage of respodets who missed their usual activity i the past 30 days due to a NCD, amog those with a NCD Istrumet questio Have you ever had or do you curretly have a NCD such as a CVD, icludig heart disease ad stroke, cacer, chroic respiratory disease, or diabetes? Durig the past 30 days, have you missed ay of your usual activity (work, work at home, study) due to a NCD? Percetage havig missed usual activity due to a NCD Me Wome Both sexes % % % Mea days of usual activity missed due to NCD Descriptio Mea umber of days of usual activity missed due to a NCD amog those with a NCD Istrumet questio Have you ever had or do you curretly have a NCD such as a CVD, icludig heart disease ad stroke, cacer, chroic respiratory disease, or diabetes? Durig the past 30 days, have you missed ay of your usual activity (work, work at home, study) due to a NCD? Durig the past 30 days, how may days of your usual activity have you missed due to a NCD? N Mea umber of days of usual activity missed due to a NCD Mea o. of days Me Wome Both sexes N Mea o. of days N Mea o. of days * * * * deotes data ot available. 219

221 The WHO Regioal Office for Europe The World Health Orgaizatio (WHO) is a specialized agecy of the Uited Natios created i 1948 with the primary resposibility for iteratioal health matters ad public health. The WHO Regioal Office for Europe is oe of six regioal offices throughout the world, each with its ow programme geared to the particular health coditios of the coutries it serves. Member States Albaia Adorra Armeia Austria Azerbaija Belarus Belgium Bosia ad Herzegovia Bulgaria Croatia Cyprus Czech Republic Demark Estoia Filad Frace Georgia Germay Greece Hugary Icelad Irelad Israel Italy Kazakhsta Kyrgyzsta Latvia Lithuaia Luxembourg Malta Moaco Moteegro Netherlads Norway Polad Portugal Republic of Moldova Romaia Russia Federatio Sa Mario Serbia Slovakia Sloveia Spai Swede Switzerlad Tajikista The former Yugoslav Republic of Macedoia Turkey Turkmeista Ukraie Uited Kigdom Uzbekista World Health Orgaizatio Regioal Office for Europe UN City, Marmorvej 51, DK-2100 Copehage Ø, Demark Tel.: Fax: cotact@euro.who.it Website: Origial: ENGLISH