National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor-Leste, 2014

Abstract

Timor-Leste, as a newly independent country, is currently confronted with challenges of high prevalence and incidence of communicable diseases and neglected tropical diseases. However, noncommunicable diseases (‎NCD)‎ such as cardiovascular diseases, hypertension, cholesterol, stroke, diabetes, chronic respiratory disease, cancer and kidney diseases etc. are also on the rise and becoming major health challenges for the Timorese national health system. This is the report of the first Timor-Leste NCD survey using WHO STEPS approach, jointly conducted by the Ministry of Health and Universidade Nacional Timor-Lorosae with technical support from the World Health Organization during July–December 2014. The purpose of this survey is to provide the baseline assessment of the key risk factors of NCD and among Timorese adults, to help develop a comprehensive national programme and set targets on NCD and injury prevention and control in Timor-Leste. A cross-sectional study survey was implemented using WHO STEPS methodology. The survey included males and females aged 18–69 years old, residing in Timor-Leste. Sample size calculation used an expected risk factor prevalence of 50%, absolute precision of 5%, alpha error of 5% and design effect of 1.5. A multistage complex sample design was used to produce representative data. Probability proportional to size sampling was used to select 150 enumeration areas (‎EA)‎ from total 1827 EA in all 13 districts. Systematic random sampling was used to then select 18 households from each of the selected EA. From each selected household, one eligible individual was selected by KISH method. The data collection instruments consisted of three steps: Step one (‎interviews)‎, Step two (‎physical measurements)‎ and Step three (‎biochemical measurements)‎. The survey team was composed of one principal investigator, supported by four co-investigators, 12 supervisors, 21 enumerators and one administrative officer. Data weighting and analysis was conducted in accordance with STEPs survey using Microsoft Excel, access and EpiInfo version 3.5.4 Software. In total, 320 items of questionnaire were analysed. The survey included 2609 adults [‎1083 (‎41.5%)‎ males and 1526 (‎58.5%)‎ females]‎ and brought the overall response rate to 96.3%. Out of the sample population, 882 (‎34.4%)‎ of the sample had no formal education or schooling and 2055(‎78.9%)‎ currently married. The findings indicate that more than half (‎56%)‎ of adults used some form of tobacco product, and tobacco use was much higher among men (‎70.6%)‎ as compared to women (‎28.9%)‎. Among respondents, 48.6% smoked and 19.8% used smokeless tobacco products. More men (‎69.5%)‎ than women (‎9.6%)‎ smoked tobacco; more women (‎26.8%)‎ than men (‎16.1%)‎ used smokeless tobacco products. Nearly nine in 10 adults were exposed to secondhand smoke in homes; more than half of adults (‎51%)‎ were exposed to secondhand smoke in work places. Respondents started smoking very young, with mean age of starting smoking being 16.4 years.