A province-based surveillance system for the risk factors of non-communicable diseases: A prototype for integration of risk factor surveillance into primary healthcare systems of developing countries

Objectives: To establish a surveillance system for risk factors of non-communicable diseases, develop a valid tool and methodology for surveillance surveys, and build capacity in 41 provincial surveillance sites to design and conduct the surveys and provide provincially interpretable baseline data. Study design: Population-based national study. Methods: The World Health Organization's STEPwise approach to non-communicable disease surveillance was adapted to design a national risk factor surveillance model. The first national population-based and cross-sectional study was conducted in 2005 in 41 universities of medical sciences in all 30 provinces of Iran. This involved multi-stage cluster sampling from 25-64 year-old Iranians and non-institutionalized populations. A national technical unit at the Ministry of Health and Medical Education supervised all study processes including data management and analysis. Results: From the national results, the survey estimated that the prevalence of daily current smoking was 17.9%. Of the target population, 5% consumed at least five combined servings of fruit and vegetables per day. The median daily time spent undertaking transport-related physical activity (43.8 min) was significantly higher than the median time spent on work-related physical activity (27.5 min) or recreational physical activity (28.6 min). Overall, 54.7% of the target population were overweight or obese, and waist circumference was greater among women than men. The prevalence of hypertension was 23.8%, with a higher prevalence among women than men. In addition, 6% of the target population had a high fasting blood glucose (>= 126 mg/dl), and 45.1% had a total cholesterol level of at least 200 mg/dl. Conclusion: Integration of province-based surveillance activities into the Iranian primary healthcare system is feasible. Provincial reports could provide a baseline picture of the Most important risk factors for non-communicable diseases. There are several important risks with a prominent burden that may cause a progressive epidemic of major non-communicable diseases in the future in the absence of quality interventions. (C) 2009 Published by Elsevier Ltd on behalf of The Royal Society for Public Health.