2010-12-31-世界卫生组织-2011_STEPS_Country_Report_Zanzibar_115页_3mb

Executive Summary of the Zanzibar National Non-Communicable Disease Risk Factor Survey 2011

The Zanzibar National Non-Communicable Disease Risk Factor Survey, conducted in 2011, was the first comprehensive population-based study of its kind in Zanzibar. It assessed risk factors for non-communicable diseases (NCDs) such as cardiovascular diseases, diabetes, cancer, and chronic obstructive pulmonary disease using the WHO STEPS (Stepwise Approach to Surveillance of NCD risk factors) methodology. This report summarizes key findings from the survey, focusing on socio-demographics, behavioral risk factors, physiological measures, and mental health.

Methodology

• Survey Design: A multi-stage cluster sampling approach with stratification was employed, covering 10 districts. A total of 2772 households were targeted, with 2723 (98.2%) enrolled. Data were collected via a structured questionnaire, physical measurements (anthropometry), and biochemical tests (fasting blood glucose, cholesterol, triglycerides). Ethical clearance was obtained from Zanzibar Medical Research Ethical Committee, and informed consent was secured from all participants.
• Sample Size: Estimated at 2800 participants, with adjustments for non-response; 2638 adults aged 25-64 years completed the core survey.
• Measures: Included tobacco use, alcohol consumption, dietary habits, physical activity, blood pressure, body mass index (BMI), fasting glucose, and a mental health module (GHQ-12).
• Duration: Fieldwork ran from June 15 to July 14, 2011, with data analysis guided by WHO standards.

Key Findings

1. Prevalence of NCDs and Risk Factors:

   • Hypertension: Affecting 33% of the surveyed population (higher in men), with only one-third receiving treatment.
   • Diabetes: Found in 3.7% (mostly older adults), with low awareness and treatment rates.
   • Obesity and Overweight: 14.3% obese (BMI >30), with higher rates among women and urban residents.
   • Tobacco Use: Low prevalence (7.3% current smokers), predominantly among men; smokeless tobacco use was equal by gender but underestimated.
   • Alcohol Use: Very low (1.7% current drinkers), with cultural and religious influences in Zanzibar (predominantly Islamic).
   • Diet: Fruit and vegetable intake was low (mean servings/day ≈ 1.7), with 97.9% consuming less than 5 servings daily.
   • Physical Activity: High levels overall, driven by work and active transport, but associated with injuries.

2. Anthropometric and Biochemical Risk:

   • BMI and Waist Circumference: Indicated metabolic risks; WHR (waist-to-hip ratio) was a better predictor than BMI, showing 73% of women at substantial risk.
   • Blood Glucose and Lipids: Elevated fasting glucose (2.8% IFG and 3.7% DM), and high cholesterol (24.4% prevalence), though results varied by stratum.

3. Mental Health and Injuries:

   • Anxiety/Depression: Approximately 6.8% showed potential mental illness.
   • Injuries: 4.5% involved road traffic accidents, and 9.9% suffered other injuries; only a small portion used protective behaviors like seat belts or helmets.

Conclusions and Recommendations

The survey revealed that Zanzibar is at an early but significant stage of the NCD epidemic, with high levels of behavioral risk factors and intermediate risks like hypertension and obesity, while disease prevalence appears moderate. Key recommendations include:

• Strengthening NCD surveillance through routine data and population-based surveys.
• Implementing prevention programs focusing on tobacco control, dietary improvements, and physical activity promotion.
• Enhancing primary healthcare to manage NCDs, including mental health services, and reducing out-of-pocket expenses for treatments.
• Engaging multiple sectors (health, education, private industry) to foster supportive policies, such as taxation on unhealthy foods or reduced tobacco sales.
• Raising public awareness and community mobilization through culturally appropriate education.

This survey provides robust evidence for tailored interventions and policy changes, addressing Zanzibar's unique context and contributing to global NCD control efforts.