REPUBLIC OF THE MARSHALL ISLANDS NCD Risk Factors STEPS Report 2002 Printed in Suva, Fiji December 2007 Survey sites: Majuro atoll Kwajalein atoll Wotje atoll Jaluit atoll Arno atoll Kili island 2 ACKNOWLEDGEMENT The hard work of various people and organsations who took part in the design, field work, data entry, analysis and reporting of the NCD STEPS is hereby acknowledged: STEPS project committee, World Health Organization, Fiji School of Medicine, Menzies Center, AusAID and community of RMI at large. STEPS project committee: Ms. Justina R. Langidrik - Secretary of Health- MOH Ms. Julia M. Alfred (STEPS Project Manager - MOH) Dr. Kennar Briand (Director of Public Health- MOH) Mr. Arata Nathan (Director of Outer Islands Health Care System) Dr. Robyn McIntyre (Physician- 177 Health Care Program) Mr. Duncan Banda (Statistician- UNV) Ms. Florina Nathan (Supervisor of PH Nursing, MOH) Mr. Kam Wase (Director of Human Services & Health Promotion- MOH) Mr. Paul Lalita (Director of Laboratory Services- MOH) Ms. Sala Elbourne, (Microbiologist, MOH) Mr. Kumi Hanerg (Director of Vital Statistics- MOH) Dr. Kyaw Tut (Director of Dental Services, MOH) Mrs. Ione Debrum (NCD coordinator) World Health Organisation: Dr. Temo K Waqanivalu, WHO South Pacific Ms Leanne Riley, WHO HQ Mr. Shalvindra Raj, WHO South Pacific Fiji School of Medicine: Dr. Jan Pryor (Director Research) Ms. Monica Fong Ms. Shakila Naidu (NCD Research Assistant) Ms. Vizo Halavatau (NCD Research Assistant) Menzies Center: Dr. Leigh Blizzard - Senior Research Biostatistician Dr. Robert Granger Contributors: Dr Philayrath Phongsavan (reviewer), Mr. Russell Edwards (Assistant Secretary for Primary Health Care- MOH), Mr. Sandy Alfred (Assistant Secretary for Majuro Hospital Services- MOH), Mr. Dwight Heine (Assistant Secretary for Finance & Personnel- MOH), Ms. Irene Paul (Assistant Secretary for Kwajalein Health Care Services- MOH), Mr. Wilbur Heine (Assistant Secretary for Health Planning & Statistics- MOH), Ms. Edlen Anzures (Health Planning & Statistics, MOH), Ms. Deborah Atwood (Manager, 177 Health Care Program- MOH) AusAID Community participation: (for NCD STEPS Training) Marshall Islands Visitor’s Authority (MIVA) RRE Pacific Pure Water Pacific Diabetes Today Resource Center Papa Ola Lokahi, Honolulu, Hawaii 3 CONTENTS 1 FOREWORD......................................................................................................................... 8 2 EXECUTIVE SUMMARY..................................................................................................... 10 3 INTRODUCTION................................................................................................................. 12 3.1 BACKGROUND INFORMATION ..................................................................................... 12 3.1.1 Geography.............................................................................................. 12 3.1.2 Population .............................................................................................. 12 3.1.3 Economy ................................................................................................ 12 3.1.4 Government............................................................................................ 13 3.1.6 Burden of NCDs in RMI............................................................................ 13 3.1.7 NCD Prevention and Control Services....................................................... 14 3.2 RATIONALE .................................................................................................................... 14 3.3 DEVELOPING WHO STEPS IN RMI ................................................................................. 15 3.4 PURPOSE....................................................................................................................... 16 3.5 OBJECTIVES................................................................................................................... 16 4 METHODOLOGY................................................................................................................ 17 4.1 SCOPE..................................................................................................................... 17 4.2 SAMPLING ................................................................................................................ 17 4.2.1 Selection of households: .......................................................................... 18 4.3 DATA COLLECTION PROCEDURE...................................................................................... 19 4.3.1 STEP 1 – Behavioral Risk Factors ............................................................ 19 4.3.2 STEP 2 – Physical Measurements ............................................................ 19 4.3.3 STEP 3 – Biochemical Measurements....................................................... 20 4.4 DATA ENTRY AND PROCESSING....................................................................................... 20 4.5 DATA ANALYSIS.............................................................................................................. 20 5 RESULTS ........................................................................................................................... 21 5.1 DESCRIPTION OF THE SAMPLE ................................................................................... 21 5.1.1 Survey Sample Characteristics................................................................. 21 5.1.2 Level of Education................................................................................... 22 5.1.3 Main Employment.................................................................................... 23 5.2 BEHAVIOURAL MEASURES............................................................................................... 24 5.2.1 Tobacco Use .......................................................................................... 24 5.2.2 Betel nut use........................................................................................... 26 5.2.3 Alcohol Consumption............................................................................... 26 5.2.4 Diet........................................................................................................ 28 5.2.5 Physical Activity ...................................................................................... 30 5.3 PHYSICAL MEASURES ..................................................................................................... 33 5.3.1 Body Mass Index..................................................................................... 33 5.3.2 Waist Circumference ............................................................................... 35 5.3.3 Blood Pressure ....................................................................................... 35 5.4 BIOCHEMICAL MEASURES ............................................................................................... 38 5.4.1 Fasting Blood Glucose............................................................................. 38 5.4.2 Blood Lipids (Total Cholesterol, Triglyceride, HDL, LDL) ............................. 39 5.4.3 Haemoglobin .......................................................................................... 42 5.5 COMBINED RISK FACTORS .............................................................................................. 44 6 CONCLUSIONS.................................................................................................................. 46 4 7 RECOMMENDATIONS ....................................................................................................... 47 8 LIMITATIONS AND LESSONS LEARNT............................................................................ 47 9 GLOSSARY ........................................................................................................................ 49 10 REFERENCES.................................................................................................................... 50 11 APPENDIX.......................................................................................................................... 51 11.1 APPENDIX 1: RMI PROJECT TEAM MEMBERS ................................................................ 51 11.2 APPENDIX 2: DETAILED RESULTS ................................................................................ 52 A. DEMOGRAPHIC INFORMATION ............................................................................... 52 B. TOBACCO USE ..................................................................................................... 52 C. BETEL NUT USE................................................................................................... 54 D. ALCOHOL CONSUMPTION...................................................................................... 54 E. DIET.................................................................................................................... 56 F. PHYSICAL ACTIVITY .............................................................................................. 57 G. MEDICAL HISTORY: HIGH BLOOD PRESSURE ......................................................... 59 H. MEDICAL HISTORY: DIABETES............................................................................... 60 I. PHYSICAL MEASURES ........................................................................................... 62 J. BIOCHEMICAL MEASURES ....................................................................................