2006-12-31-世界卫生组织-2007_STEPS_Country_Report_Botswana_142页_6mb

Summary of the Botswana STEPS Survey on Chronic Disease Risk Factors (2007)

Core Content

The Botswana STEPS survey, conducted in 2007 using the WHO STEPwise approach, aimed to identify chronic disease risk factors in the adult population (aged 25-64) to support the development of effective public health strategies. The survey focused on key risk factors including tobacco use, alcohol consumption, physical inactivity, poor diet, overweight, and raised blood pressure. It was carried out in 8 selected districts with a high response rate of 4003 participants, employing a multi-stage cluster sample design to ensure representativeness.

Main Risk Factors and Findings

• Tobacco Use: 19.7% of the population currently smokes. Males start smoking at an earlier age (21.8 years) compared to females (31.8 years).
• Alcohol Consumption: 54.1% of males and 51.8% of females engaged in binge drinking in the previous week.
• Diet: The population consumes an average of only 1.0 serving of fruit and 3.4 servings of vegetables per day. 96.6% of respondents eat less than 5 servings of fruits and/or vegetables daily.
• Physical Activity: 34.7% of the population has low levels of physical activity. 72.7% of both sexes are not engaged in vigorous physical activity, with significantly higher inactivity in females.
• Overweight: 38.6% of the total population is overweight (BMI ≥25 kg/m²), with a significantly higher prevalence in women (53.4%) than in men (22.1%).
• Raised Blood Pressure: 33.1% of the population has raised blood pressure (SBP ≥140 mmHg and/or DBP ≥90 mmHg or on BP medication), with a higher prevalence in women (37.0%) than in men (28.8%).

Combined Risk Factors

Respondents with at least three of the following risk factors were identified as having a higher risk of developing non-communicable diseases (NCDs):

• Currently daily smokers

• Less than 5 servings of fruits and/or vegetables per day

• Low level of physical activity

• Overweight (BMI ≥25 kg/m²)

• Raised blood pressure (SBP ≥140 mmHg and/or DBP ≥90 mmHg or on BP medication)

• Only 1.2% of the population had none of these risk factors, while 34.5% had at least three.

Additional Key Findings

• Waist-Hip Ratio: A predictive index for cardiovascular issues. Normal ranges are <1.0 for men and <0.8 for women.
• Health Services Utilization: Chronic diseases like diabetes have shown an increasing trend, particularly in the female population.
• Public Health Implications: The survey highlights the need for integrated preventive measures, policy guidelines, and public health interventions to address lifestyle-related NCDs.

Methodology

• Sampling Frame: Based on the 2001 population census from the Central Statistical Office (CSO).
• Strata: The country was divided into urban and rural areas.
• Cluster Selection: Villages with populations ≥5000 were selected to facilitate resource allocation and ensure a representative sample.
• Data Collection: A multi-stage cluster sampling method was used, with interviews conducted using the WHO STEP 1 questionnaire and physical measurements using STEP 2 tools.
• Tools and Training: Interviewers were trained in Setswana and English to ensure effective communication. The survey was conducted in collaboration with the Ministry of Local Government and various health and administrative bodies.

Acknowledgements

The survey was a collaborative effort involving the Ministry of Health, WHO experts, local health workers, and community members. Special thanks were given to the enumerators and support staff who played a crucial role in data collection, and to the participants for their time and cooperation.

Recommendations

• Develop national policy guidelines for the prevention and control of NCDs.
• Implement public health measures targeting the identified risk factors.
• Increase awareness and education on healthy lifestyles.
• Promote physical activity and balanced diets.
• Improve access to healthcare services and ensure proper management of NCDs.
• Encourage the use of traditional and modern methods for blood pressure and diabetes management.

Conclusion

The Botswana STEPS survey provided critical baseline data on chronic disease risk factors, revealing alarming trends in smoking, alcohol use, poor diet, and physical inactivity. The survey also highlighted the disproportionately high rates of overweight and raised blood pressure among women. These findings are essential for formulating effective strategies to combat NCDs and improve public health outcomes in Botswana.