National Survey Zimbabwe Non-Communicable Disease Risk Factors - (ZiNCoDs) Preliminary Report 2005 Using The WHO STEPwise Approach to Surveillance of Non-Communicable Diseases (STEPS) COLLABORATION OF Ministry of Health & Child Welfare University of Zimbabwe World Health Organization United Nations Children’s Fund 1 Zimbabwe NCDs Risk factors Surveillance Report 2005 TABLE OF CONTENTS List of abbreviations.................................................................................................................................8 ACKNOWLEDGEMENTS......................................................................................................................9 AUTHORS .............................................................................................................................................10 Survey Team...........................................................................................................................................11 EXECUTIVE SUMMARY....................................................................................................................12 1.0: INTRODUCTION AND LITERATURE REVIEW .......................................................................14 1.1: Global perspective ................................................................................................................14 1.2 Developing countries ..................................................................................................................14 1.3 Sub-Saharan Africa....................................................................................................................14 1.4 Zimbabwe....................................................................................................................................14 1.4.1: Geographic location........................................................................................................14 1.4.2: Health services delivery..................................................................................................17 1.4.3: Disease Burden...............................................................................................................17 1.4.4: Preliminary survey..........................................................................................................18 1.5: SIGNIFICANCE AND RATIONALE OF SURVEY ................................................................18 2.0: OBJECTIVES OF THE STUDY ...................................................................................................20 2.1: GENERAL OBJECTIVE ....................................................................................................20 2.2: SPECIFIC OBJECTIVES ...................................................................................................20 3.0: METHODOLOGY.....................................................................................................................21 3.1: Design .........................................................................................................................................21 3.2: WHO STEPwise Approach (STEPS) ......................................................................................21 3.3: Adaptation of survey methods and tools.............................................................................22 3.4: Conduct of the survey...........................................................................................................22 3.4.1: National Team ................................................................................................................22 3.4.2: Field Team......................................................................................................................22 3.4.3: Adaptation of survey tools and training manuals............................................................22 3.4.4: Training of Interviewers .................................................................................................22 3.4.5: Pilot test of field procedures ...........................................................................................23 3.4.6: Field Activities ...............................................................................................................23 3.4.7: Survey flow ....................................................................................................................24 3.4.8: Blood Sample Collection................................................................................................25 3.4.8.1: Materials-.......................................................................................................................25 3.4.8.2: Glucose: (dextrose monohydrate)- ................................................................................25 3.4.8.3: Venoject needles- ..........................................................................................................25 3.4.8.4: Venesection/venepuncture- ...........................................................................................25 3.4.8.5: Quality Control of blood Sample Collection-................................................................25 3.4.8.6: Transportation of samples- ................................................................................................26 3.4.8.7: Laboratory Procedures at the Central, Sample Receipt, Recording and Storage-..............26 3.4.8.8: Registration of Samples- ...............................................................................................26 3.4.8.9: Sample Processing and Analysis-......................................................................................26 3.5.0: Nutritional Survey (Food Frequency Questionnaire) And Fortification Rapid Assessment Tool.................................................................................................................................26 3.6.0: Measurements....................................................................................................................27 3.6.1: Step 1: Questionnaire-based assessment:........................................................................27 3.6.2: Step 2: Physical measurements.......................................................................................27 3.6.2.1: Blood pressure ........................................................................................................27 3.6.2.2: Waist Circumference ..............................................................................................27 3.6.2.3: Hip measurement....................................................................................................27 3.6.2.4: Height .....................................................................................................................27 3.6.2.5: Weight ....................................................................................................................27 3.6.3: Step 3: Biochemical assessment .....................................................................................27 3.6.3.1: Glucose Determination ...........................................................................................28 3.6.3.2: Serum Lipids...........................................................................................................28 3.6.3.2.1: Serum cholesterol Kit Ref 467825, Lot T501276..............................................28 3.6.3.2.2: Triglyceride Kit: Ref 445850, Lot T502091.......................................................28 3.6.3.2.3: HDL-cholesterol Kit, Ref 467820, Lot M504237..............................................28 3.6.3.3: LDL-cholesterol......................................................................................................28 3.6.3.4: VLDL-Cholesterol..................................................................................................28 3.7.0: DEFINITIONS..................................................................................................................29 2 Zimbabwe NCDs Risk factors Surveillance Report 2005 3.7.1: Overweight and Obesity .................................................................................................29 3.7.2: Central Obesity...............................................................................................................29 3.7.3: Hypertension...................................................................................................................29 3.7.4: Diabetes and Impaired Glucose Tolerance .....................................................................29 3.7.5: Lipid Profiles ..................................................................................................................30 3.8: SAMPLING...........................................................................................................................31 3.8.1: Sample Size Determination ............................................................................................31 3.9: SAMPLING STRATEGY....................................................................................................31 3.9.1: Sampling of households..................................................................................................32 3.9.2: Sampling within households...........................................................................................32 3.9.3: Informed Consent .................................................................................................................33 4.0: DATA MANAGEMENT ................................................................................................................34