2003-12-31-世界卫生组织-2004_STEPS_Country_report_Tonga_118页_1mb

Kingdom of Tonga NCD Risk Factors STEPS Report Summary

Core Content

The Kingdom of Tonga NCD Risk Factors STEPS Report is a national survey conducted in 2004 to assess the prevalence of non-communicable diseases (NCDs) and their associated risk factors among adults aged 15–64 years. It was a collaborative effort between the Ministry of Health, Kingdom of Tonga and the World Health Organization (WHO), supported financially by AusAID and NZAID.

The report follows the WHO STEPwise Approach to NCD risk factor surveillance, which includes three steps:

• Step 1: Behavioral risk factors (e.g., tobacco use, alcohol consumption, diet, and physical activity)
• Step 2: Physical risk factors (e.g., overweight, obesity, and waist circumference)
• Step 3: Biochemical risk factors (e.g., blood pressure, blood glucose, and cholesterol)

The survey collected data from 1250 households, with one adult per household randomly selected to participate. The response rate was 80%, and the sample was 57.8% female, with 30.8% in the 35–44 age group.

Main Findings

Tobacco Use

• 31.0% of the population aged 15–64 smoked.
• 46.2% of men vs. 16.3% of women smoked.
• 27.6% were daily smokers, with 41.9% of men and 13.8% of women.
• The mean age of smoking initiation was 18.2 years, with men starting at 17.5 years and women at 20.3 years.
• 84.0% of daily smokers used manufactured cigarettes.
• 29.8% of the 25–64 age group smoked, with 46.2% of men and 14.3% of women.

Alcohol Consumption

• 13.4% of the population aged 15–64 consumed alcohol in the past 12 months.
• 22.2% of men vs. 4.8% of women consumed alcohol.
• 21.7% of the 15–24 age group were current drinkers, with 37.9% of men and 5.2% of women.
• 8.9% of the 25–64 age group consumed alcohol, with 13.6% of men and 4.6% of women.

Fruit and Vegetable Intake

• 92.8% of the population consumed less than five combined servings of fruits and vegetables per day.
• The mean number of days per week of combined fruit and vegetable consumption was 4.2 days.
• On days when both were consumed, the mean combined servings were 2.4 serves.
• Similar patterns were observed in the 25–64 age group, with 92.2% consuming less than five servings.

Physical Activity

• 43.9% of the population had a low level of total physical activity (<600 MET-minutes per week).
• 54.8% of women vs. 32.4% of men had low physical activity.
• Work-related physical activity was the largest contributor (81.3 minutes/day for 15–64 years), followed by transport (33.8 minutes/day) and recreation/leisure (15.6 minutes/day).
• 189.2 minutes/day for men and 91.5 minutes/day for women across all domains.

Overweight and Obesity

• 92.1% of the population aged 25–64 was overweight (BMI ≥25 kg/m²).
• 68.7% were obese (BMI ≥30 kg/m²).
• 7.7% had a normal BMI (18.5–24.9 kg/m²).
• Men had a higher BMI than women, and waist circumference was also higher in men, exceeding the cardiovascular disease risk threshold (102 cm) in all age groups except the youngest.

Blood Pressure and Hypertension

• 23.1% of the population had hypertension (SBP ≥140 mmHg or DBP ≥90 mmHg or on medication).
• 26.5% of men vs. 19.9% of women had hypertension.

Blood Glucose and Diabetes

• 16.4% of the population had raised blood glucose (fasting glucose ≥6.1 mmol/L or on medication).
• No significant gender difference in raised blood glucose levels.
• The highest prevalence was in the 45–54 and 55–64 age groups for women (32.8% and 35.3% respectively).

Blood Cholesterol

• 49.7% of the population had raised blood cholesterol (≥5.0 mmol/L or ≥190 mg/dl).
• Men had a significantly higher prevalence (66.1%) than women (34.2%).
• Prevalence increased with age in both genders.

Combined Risk Factors

• 60.7% of the population was at high risk of NCDs (3–5 risk factors).
• 39.2% were at moderate risk (1–2 risk factors).
• High risk was equally distributed between men and women.
• 58.1% of the population aged 25–44 years was at high risk.

Key Recommendations

Surveillance and Information Needs

• Establish a systematic and planned STEPS data collection system with a skilled workforce.
• Include additional questions in the questionnaire to address salt consumption and mental health.
• Present 15–64 and 25–64 age group data in future reports to better understand youth and adolescent risk factors.
• Set national targets and indicators for NCD prevention and control.
• Participate in cross-country comparisons of STEPS findings in the Pacific island countries and areas (PICs).
• Conduct data comparison over time after the second round of the STEPS survey.

Policy, Organizational, and Environmental Factors

• Implement the WHO Framework Convention on Tobacco Control, including smoke-free environments and tobacco taxation.
• Limit marketing and advertising of unhealthy foods and drinks.
• Support the importation of healthy foods and improve the availability and affordability of fruits and vegetables.
• Develop policies to promote physical activity-friendly environments, such as walking paths, open green spaces, and workplace programs.
• Encourage setting-based policies in workplaces, churches, and schools to promote healthy lifestyles.
• Strengthen the health system by investing in skilled workforce, financial coverage, essential drugs, and affordable NCD management technologies.

Knowledge and Awareness of NCD Risk Factors

• Implement comprehensive anti-smoking programs, especially targeting adolescents and youths.
• Launch smoking cessation programs for all age groups.
• Develop public health programs to reduce harmful alcohol consumption through social marketing and mass communication.
• Promote recommended fruit and vegetable consumption via public health initiatives.
• Raise awareness about high-fat, high-salt, and high-sugar foods through mass communication campaigns.
• Create culturally appropriate programs to encourage daily physical activity.
• Conduct public awareness campaigns on the importance of regular screening and monitoring of blood pressure, blood sugar, and cholesterol.
• Develop a community-based outreach care system for individuals with diagnosed NCDs.

Conclusion

The report highlights that NCDs are a major public health concern in Tonga, with very high rates of overweight, obesity, and raised cholesterol, along with moderate levels of tobacco and alcohol use. It provides scientific data to support the development of NCD prevention and control strategies, emphasizing the need for policy interventions, environmental changes, and community-based programs to address these issues effectively.

This report is a milestone in Tonga's efforts to combat the NCD epidemic, and it serves as a baseline for future monitoring and evaluation. The findings underscore the urgency of addressing modifiable risk factors through coordinated actions at the national and local levels.