2009-12-31-世界卫生组织-2010_STEPS_Country_report_Cambodia_192页_4mb

Summary of the STEPS Survey on Non-Communicable Disease Risk Factors in Cambodia

Core Content

The STEPS Survey conducted in Cambodia in 2010 is a comprehensive, nationwide cross-sectional study aimed at assessing the prevalence of non-communicable disease (NCD) risk factors using the WHO STEPwise approach to Surveillance (STEPS) methodology. The survey was carried out by the University of Health Sciences (UHS) and the Preventive Medicine Department of the Ministry of Health (PMD/MoH), with support from the World Health Organization (WHO).

Main Objectives

• To estimate the prevalence of NCD risk factors among the Cambodian population.
• To establish baseline data for the prevention and control of NCDs.
• To compare NCD risk factor prevalence across urban and rural areas, gender, and age groups.

Key Findings

Tobacco Use

• 29.4% of respondents were current tobacco smokers (daily and non-daily).
• 37.0% were current tobacco users (including both smoking and smokeless).
• 55.2% were exposed to environmental tobacco smoke (ETS) in the past 7 days.
• 26.4% were daily smokers and 33.7% were daily users of tobacco.
• Men were more likely to smoke and use tobacco daily than women.
• Rural respondents had a higher likelihood of daily tobacco use than urban ones.

Alcohol Consumption

• 26.5% of respondents were lifetime alcohol abstainers.
• 10.0% were past 12 months abstainers.
• 53.5% were current drinkers in the past 30 days.
• 26.4% of men and 10.0% of women were heavy episodic drinkers in the past 30 days.
• Men were approximately 10 times more likely to engage in heavy episodic drinking than women.

Diet and Eating Patterns

• 84.3% of respondents consumed less than five servings of fruit and/or vegetables per day, placing them at increased risk for NCDs.
• The proportion of low fruit and vegetable consumption was similar between men and women but 10% higher in rural areas.
• 70% of households used vegetable oil for meal preparation, with slightly higher usage in urban areas.

Physical Activity

• 76.1% of respondents engaged in high levels of physical activity.
• The median time spent in total physical activity was 4 hours and 4 minutes per day.
• 4h17min in rural areas vs. 3h36min in urban areas.
• 33.7% of respondents were classified as doing no physical activity.
• Activities contributing to physical activity were more common in rural areas.

Physical Measurements

• 15.4% of respondents were overweight (BMI ≥25 and <30 kg/m²).
• 1.9% were obese (BMI ≥30 kg/m²).
• Overweight and obesity rates were twice higher among women than men.
• These rates increased with age.

Blood Pressure and Diabetes

• 11.2% of respondents had hypertension (SBP ≥140 and/or DBP ≥90 mmHg).
• 2.9% had diabetes.
• 1.4% had impaired fasting glycaemia.
• Urban areas had higher prevalence of diabetes than rural areas (5.6% vs. 2.3%).
• 20.7% had raised total cholesterol.

Combined Risk Factors

• 82.4% of respondents had one to two risk factors for NCDs.
• 10.2% had three or more risk factors.
• Men were 2.2 times more likely than women to have three or more risk factors.
• Urban respondents were 1.7 times more likely than rural ones to have three or more risk factors.
• The proportion of respondents with multiple risk factors increased with age.

Methodology

Survey Design

• Conducted in three steps: face-to-face interview, physical measurements, and biochemical measurements.
• Multi-stage cluster sampling was used to select 5,643 participants.
• A non-response rate of 20% was considered in the sampling design.
• The survey covered all geographical areas of Cambodia.

Sampling

• 180 clusters were selected, with 34 urban and 146 rural clusters.
• Clusters were selected using a systematic random sampling method.
• Each cluster included communes (Khum) in rural areas and sangkats (Khan) in urban areas.
• Households were randomly selected, and all members aged 25-64 were invited to participate.

Training

• Two training workshops were conducted for field investigators and supervisors.
• The first was in September 2009, and the second in January 2010.
• Training covered WHO STEPwise methodology, data collection, physical measurements, and biochemical testing.
• Field supervisors were selected from PMD/MoH and UHS-C, with data management handled by UHS-C staff.

Data Collection

• Conducted by 8 teams over 3 months (February to April 2010).
• Group One collected data for Step 1 (behavioral risk factors).
• Group Two collected data for Step 2 (physical measurements) and Step 3 (biochemical measurements).
• Each interview lasted 30 minutes on average.
• Show cards were used to illustrate standard drink quantities and serving sizes.

Conclusion and Recommendations

The survey identified a high prevalence of key NCD risk factors such as tobacco use, alcohol consumption, low fruit and vegetable intake, and lack of physical activity in Cambodia.

Despite relatively low rates of diabetes and hypertension, the overall burden of NCD risk factors is significant, particularly in urban areas and among men.

The Ministry of Health is urged to scale up interventions that promote healthier lifestyles, especially among high-risk populations. The findings can serve as a baseline for future policy development and monitoring efforts.

The WHO STEPS methodology is recommended for ongoing surveillance of NCD risk factors, and the results can be used to strengthen the existing health information system in Cambodia.