PREVALENCE OF NONCOMMUNICABLE DISEASE RISK FACTORS IN THE REPUBLIC OF MOLDOVA STEPS 2013 PREVALENCE OF NONCOMMUNICABLE DISEASE RISK FACTORS IN THE REPUBLIC OF MOLDOVA STEPS 2013 2014 MINISTERUL SĂNĂTĂȚII AL REPUBLICII MOLDOVA KEYWORDS CHRONIC DISEASE - prevention and control HEALTH POLICY HEALTH PROMOTION PHYSICAL ACTIVITY RISK FACTORS Address requests about publications of the WHO Regional Office for Europe to: Publications WHO Regional Office for Europe UN City, Marmorvej 51 DK-2100 Copenhagen Ø, Denmark Tel.: +45 45 33 70 00; Fax: +45 45 33 70 01 Alternatively, complete an online request form for documentation, health information, or for permission to quote or translate, on the Regional Office web site (http://www.euro.who.int/ pubrequest). © World Health Organization 2014 All rights reserved. The Regional Offi ce for Europe of the World Health Organization welcomes requests for permission to reproduce or trans- late its publications, in part or in full. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specifi c companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either express or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. The views expressed by authors, editors, or expert groups do not necessarily represent the decisions or the stated policy of the World Health Organization. PREVALENCE OF NONCOMMUNICABLE DISEASE RISK FACTORS 2 IN THE REPUBLIC OF MOLDOVASTEPS 2013 CONTENTS GLOSSARY ........................................................................................................................5 FOREWORD .......................................................................................................................6 ACKNOWLEDGEMENTS .....................................................................................................8 LIST OF CONTRIBUTORS ...................................................................................................9 EXECUTIVE SUMMARY ......................................................................................................11 BACKGROUND ..................................................................................................................13 NONCOMMUNICABLE DISEASE (NCDS) WORLDWIDE .......................................................................................... 13 NCDS IN THE REPUBLIC OF MOLDOVA ........................................................................................................... 14 PREVALENCE OF NCD RISK FACTORS IN THE REPUBLIC OF MOLDOVA .................................................................. 15 SURVEY GOAL AND OBJECTIVES ......................................................................................16 SURVEY GOAL .............................................................................................................................................. 16 SURVEY OBJECTIVES ...................................................................................................................................... 16 RATIONALE FOR THE SURVEY .......................................................................................................................... 16 SURVEY METHODOLOGY ..................................................................................................17 SURVEY DESIGN ........................................................................................................................................... 17 SURVEY POPULATION AND SAMPLING ............................................................................................................... 17 ETHICAL CONSIDERATION ...............................................................................................................................19 DATA COLLECTION PROCESS ........................................................................................................................... 20 SURVEY RESULTS ..............................................................................................................27 DEMOGRAPHIC INDICATORS ........................................................................................................................... 27 TOBACCO USE .............................................................................................................................................. 30 ALCOHOL CONSUMPTION ...............................................................................................................................36 DIET .......................................................................................................................................................... 42 PREVALENCE OF NONCOMMUNICABLE DISEASE RISK FACTORS IN THE REPUBLIC OF MOLDOVASTEPS 2013 3 PHYSICAL ACTIVITY ....................................................................................................................................... 52 HISTORY OF RAISED BLOOD PRESSURE.............................................................................................................. 56 HISTORY OF DIABETES ................................................................................................................................... 58 HISTORY OF RAISED CHOLESTEROL .................................................................................................................. 60 CVD HISTORY ............................................................................................................................................. 62 LIFESTYLE ADVICE ........................................................................................................................................ 63 CERVICAL CANCER SCREENING ........................................................................................................................ 64 PHYSICAL MEASUREMENTS ............................................................................................................................. 66 BIOCHEMICAL MEASUREMENTS ........................................................................................................................ 71 CVD RISK .................................................................................................................................................. 75 SUMMARY OF COMBINED RISK FACTORS ............................................................................................................ 77 HEALTH CARE .............................................................................................................................................. 78 RECAP AND CONCLUSIONS ...........................................................................................86 REFERENCES .................................................................................................................87 ANNEX 1 WHO STEPS SURVEY 2013 FACT SHEET .........................................................89 ANNEX 2 WHO STEPS INSTRUMENT FOR CHRONIC DISEASE RISK FACTOR SURVEILLANCE (SURVEY INFORMATION QUESTIONNAIRE) ..................................................................92 ANNEX 3 WHO STEPS SURVEY 2013 DATA BOOK ..........................................................111 PREVALENCE OF NONCOMMUNICABLE DISEASE RISK FACTORS 4 IN THE REPUBLIC OF MOLDOVASTEPS 2013 GLOSSARY BMI body mass index CI confidence interval CVD cardiovascular disease DALY disability-adjusted life year DBP diastolic blood pressure GPAQ General Physical Activity Questionnaire IFG impaired fasting glycaemia HDL high-density lipoprotein HPV human papillomavirus MET metabolic equivalent MICS Multiple Indicator Cluster Surveys n number of respondents NCD noncommunicable disease PDA personal digital assistant PSU primary sampling unit SSU secondary sampling unit SBP systolic blood pressure STEPS WHO STEP-wise approach to surveillance VIA visual inspection with acetic acid WHR waist–hip ratio PREVALENCE OF NONCOMMUNICABLE DISEASE RISK FACTORS IN THE REPUBLIC OF MOLDOVASTEPS 2013 5 FOREWORD Noncommunicable diseases are the leading cause of death at global, regional and national levels. Six out of 10 deaths at global level and eight out of 10 deaths in the WHO European Region are caused by noncommunicable diseases. The noncommunicable disease death rates in the Republic of Moldova are similar to those of the WHO European Region. Prevalence of this group of diseases in the country is also very high; more than half of the population suffer from noncommunicable diseases, including cardiovascular diseases, cancer, chronic respiratory diseases, digestive diseases and diabetes. The burden of noncommunicable