REPUBLIC OF RWANDA MINISTRY OF HEALTH P O BOX 84 KIGALI www.moh.gov.rw Rwanda Non-communicable Diseases Risk Factors Report November 2015 Table of Contents Table of Contents ............................................................................................................................ 3 Table of figures ............................................................................................................................... 6 List of tables .................................................................................................................................... 7 Abbreviations ................................................................................................................................ 10 List of investigators ....................................................................................................................... 11 Executive Summary ...................................................................................................................... 14 Background ............................................................................................................................... 14 Objectives ................................................................................................................................. 14 Results and Conclusions ........................................................................................................... 14 Recommendations..................................................................................................................... 15 1. Introduction ............................................................................................................................ 18 1.1 Background and rationale ............................................................................................... 18 1.2 Rwanda .......................................................................................................................... 18 1.2.1 Geography ............................................................................................................... 18 1.2.2 Population ................................................................................................................ 19 1.2.3 Rwanda’s vision and economy ................................................................................. 19 1.3 Existing information on NCDs in Rwanda ........................................................................ 20 1.4 Risk factors for NCDs in Rwanda .................................................................................... 20 1.5 The 2012-13 NCD STEPs risk factor survey in Rwanda ................................................. 21 1.6 Objectives ....................................................................................................................... 22 2 Methodology .......................................................................................................................... 22 2.1 Approach ........................................................................................................................ 22 2.2 Ethics approval ............................................................................................................... 23 2.3 Participants and sampling ............................................................................................... 23 2.4 Data collection procedures .............................................................................................. 24 2.4.1 Behavioral risk factors (Step 1) ................................................................................ 25 2.4.2 Physical measurements (Step 2) ............................................................................. 25 2.4.3 Biochemical measurements (Step 3) ....................................................................... 25 2.5 Data entry and quality control ......................................................................................... 26 2.6 Data analysis and dissemination ..................................................................................... 26 3 Results ................................................................................................................................... 26 3.1 Response rate and socio-demographic characteristics ................................................... 26 3.2 Behavioral risk factors ..................................................................................................... 29 3 3.2.1 Tobacco use ............................................................................................................ 29 3.2.2 Alcohol consumption ................................................................................................ 33 3.2.3 Diet and eating patterns ........................................................................................... 36 3.2.4 Physical activity ....................................................................................................... 38 3.3 Biological risk factors ...................................................................................................... 41 3.3.1 Blood pressure ......................................................................................................... 41 3.3.2 Diabetes .................................................................................................................. 43 3.3.3 Cholesterol .................................................................................................................... 45 3.3.3 Renal disorder/Albuminuria ...................................................................................... 46 3.3.4 Asthma .................................................................................................................... 47 3.3.5 Overweight and obesity ........................................................................................... 48 3.4 Combined NCD risk factors ............................................................................................. 49 3.5 Injuries ............................................................................................................................ 50 3.6 HIV/AIDS ........................................................................................................................ 53 4 Discussion ............................................................................................................................. 55 4.1 Behavioral risk factors ..................................................................................................... 55 4.1.1 Tobacco use ............................................................................................................ 55 4.1.2 Harmful use of alcohol ............................................................................................. 56 4.1.3 Unhealthy diet .......................................................................................................... 56 4.1.4 Physical inactivity ..................................................................................................... 57 4.2 Biological risk factors ...................................................................................................... 57 4.2.1 Overweight / obesity ................................................................................................ 57 4.2.2 Raised blood pressure ............................................................................................. 58 4.2.3 Raised blood glucose and total cholesterol .............................................................. 58 4.2.4 Asthma .................................................................................................................... 58 4.2.5 Renal disorder/Albuminuria ...................................................................................... 58 4.2.6 People with multiple NCD risk factors ...................................................................... 59 4.3 Other risk factors ............................................................................................................ 59 4.3.1 HIV/AIDS ................................................................................................................. 59 4.3.2 Injuries ..................................................................................................................... 59 4.4 Health system response to blood pressure and diabetes ................................................ 60 4.5 Association between particular risk factors ..................................................................... 60 4.5.1 Risk factors associated with hypertension ................................................................ 60 4.5.2 Association between Alcohol drinking and injury ...................................................... 60 4.6 Conclusion and targets ................................................................................................... 62 4 5 Recommendations ................................................................................................................. 64 References ................................................................................................................................... 66 Appendix 1: Additional tables ................................................................................................... 69 Appendix 2: Rwanda STEPS Survey Questionnaire ................................................................ 93 5 Table of figures Figure 1: Sequential