2014-12-31-世界卫生组织-2015_STEPS_Fact_sheet_Iraq_152页_3mb

Descriptive Summary:

A Detailed Report from Iraq's 2015 National STEPS Survey

1. Epidemiological Status:

   • Noncommunicable Diseases (NCDs): Represent a major public health challenge in Iraq, contributing to 50% of mortality.
   • Risk Factors: High prevalence found for tobacco use (20.7%), physical inactivity (over half of population), unhealthy diet (low fruit/veg intake, high salt, processed foods), and NCDs like hypertension (17-35%, doubled in those >40), diabetes (7-14%), and hypercholesterolemia (up to 39%).
   • Health Indicators: Similar or higher rates initially found for hypertension, diabetes, and hypercholesterolemia compared to the global baseline (likely due to WHO-STEPS adopting 2000 NCD targets as baseline).
   • Mental Health: High rates of self-reported mental ill-health (12.4%) and violence exposure (also high). Only a small fraction seeks care due to barriers like cost and stigma.
   • Screening: Opportunities exist for strengthening (mammograms, Pap smears, vision screening).

2. Methodology:

   • Design: Large-scale, national, representative, three-step survey (behavioural, physical, biochemical), using probability multi-stage cluster sampling.
   • Response: Excellent overall response rate (98.8%, 98.6%, 93.5% for Steps 1, 2, 3).
   • Location: 15 governorates surveyed due to displacement issues.

3. Risk Factor Domains (Key Findings):

   • Tobacco: High prevalence among men (38%), early initiation, SHS exposure high in homes (55.8%), workplaces (61%), and only 20% quit. Iraq's smoking rates are half the global average.
   • Alcohol: Mostly men, low overall, with drinking initiation mainly in young adulthood.
   • Diet: Inadequate fruit/veg consumption (<5 servings/day in 79%), general overestimation of salt intake, high processed food consumption, high vegetable oil use.

• Physical Inactivity: Over two-thirds (males: 76%, females: 61%) do not meet WHO recommendations.
  * Obesity: High rates (overweight/obesity: 64-65%, obesity: 31-35%), worse in rural areas and women. Sex gap widens post-40.
  * Hypertension: High prevalence (35.6%), poor control rate (7.9%), only doubled over 9 years compared to global baseline. Alarmingly few seek counseling.
  * Diabetes/Hyperglycemia: High prevalence (13.9%), poorly managed in many cases (few have check-ups). Perception is less than measured prevalence.
  * Hypercholesterolemia: High prevalence (37.8%), linked to income (lower-income more likely affected).
  * Physical Activity: Mostly work-related, regardless of age/disability.

4 Socio-Economic & Other Hazards:
* High unemployment (>70% not economically active). Low income makes NCD risk worse.
* High perceived violence (12.4%).

5. Epidemiological Trend (vs global baseline):

   • Slight improvements seen in smoking prevalence (21.5%), hypertension (33.1%), hypercholesterolemia (34.9%).
   • Increases seen in hyperglycemia (8.9%), overweight/obesity (5.7-16.0 p.p.).

6. Methodological Aspect:

   • Fairly valid and reliable.
   • Strong collaboration between government (Ministry of Health, Central Statistical Organization) and WHO.

7. Limitations/Challenges Encountered:

   • Dodging displacement areas, funding issues, rumors spread during data collection. But survey maintained high response rates ultimately.

Conclusion/Synthesis:

Iraq faces a significant, rising burden of NCDs, strongly driven by modifiable behavioral risks, obesity, and inadequate physical activity. Social determinants of health significantly influence the distribution of these risks and outcomes. The 2015 STEPS survey provides a comprehensive baseline for monitoring progress.

• Cross-agency and inter-sectoral commitment is needed to tackle NCDs.
• Investment in PHC, data utilization, and behavioral interventions is critical.
• Improving equity (socio-economic gradient, urban-rural disparities, sex differences) must be prioritized.
• Consistent funding and partnership with WHO are essential.
  The high prevalence of key behavioral risks like tobacco use and physical inactivity, alongside poor NCD control, require urgent, sustained action by national authorities and international partners.