2004-12-31-世界卫生组织-2005_STEPS_Country_report_Tokelau_73页_8mb

Summary of Tokelau NCD Risk Factors STEPS Report

Core Content

The Tokelau NCD Risk Factors STEPS Report (2005) is a comprehensive assessment of noncommunicable diseases (NCDs) and their associated risk factors among the population aged 15–64 years. The survey was conducted using the WHO STEPwise Approach, a standardized method for collecting, analyzing, and disseminating data on NCD risk factors. The report highlights the significant burden of NCDs in Tokelau and emphasizes the need for integrated and multi-sectoral strategies to address these issues.

Main Objectives

• To investigate and document the prevalence of key NCDs in Tokelau.
• To better understand major modifiable risk factors for common NCDs (e.g., smoking, alcohol use, poor diet, physical inactivity, obesity, hypertension, raised blood glucose, and cholesterol).
• To examine these risk factors across different age, gender, ethnic, and local strata.

Methodology

The survey used a cross-sectional design and included:

1. Behavioral Risk Factors: Interviews on smoking, alcohol use, and diet.
2. Physical Measurements: Height, weight, and waist circumference.
3. Biochemical Measurements: Blood pressure, fasting blood glucose, and total cholesterol.

• The survey had a 98% response rate, with all 586 participants completing all three STEPS.
• Data was validated through double data entry and weighted to account for 2% non-response.
• 95% confidence intervals (CIs) were essentially zero due to the high response rate, indicating precise population measures.

Key Findings

Behavioral Risk Factors

• 73.3% of respondents reported smoking tobacco in the past 12 months.
• 59.3% smoked daily, with the highest prevalence among females aged 35–44 and males aged 15–24.
• Nukunonu had the highest percentage of daily smokers.
• 97.1% of males and 90.4% of females consumed alcohol in the past 12 months.
• 60% of current drinkers consumed more than 6 standard drinks per day.
• 37.5% of males and 20% of females reported binge drinking in the past week.
• Females consumed more fruit and vegetables than males, but 92.3% of the population consumed less than five combined servings per day.
• Nukunonu had the highest fruit and vegetable consumption.

Physical Activity

• 41.2% of the population were classified as physically inactive (<600 METminutes/week).
• Males engaged in more vigorous physical activity than females.
• 74.6% of total physical activity occurred in the work setting, while 10.1% occurred in leisure.

Physical Risk Factors

• 86.2% of the population were overweight or obese, with 63.4% being obese.
• Females had a higher mean BMI (33.2 kg/m²) than males (31.5 kg/m²).
• Hypertension prevalence was 13.6%, with a higher rate in females (13.9%) than males (13.2%).
• Nukunonu had the highest prevalence of hypertension.

Biochemical Risk Factors

• 33.6% of the population had diabetes, with males (35.2%) having a higher prevalence than females (32.2%).
• 35.6% of participants had raised cholesterol levels, with a higher prevalence among females (37%) and those aged 45–54 in both genders.
• Blood pressure and blood glucose were also found to be elevated in significant proportions of the population.

Combined Risk Factors

• 0% of the population aged 25–64 had no risk factors.
• 68.6% of the population aged 25–64 had raised risk (i.e., at least three of the five risk factors).
• 70.2% of the population aged 25–44 was also at raised risk.
• Females had a higher risk profile than males across all age groups.

Key Risk Factors Identified

Main Viewpoints

• NCDs are a major public health challenge in Tokelau, with high prevalence rates of diabetes, hypertension, and obesity.
• Lifestyle factors such as tobacco and alcohol use, poor diet, and physical inactivity are significant contributors to the NCD burden.
• Gender differences were observed, with females more likely to be affected by NCDs and their risk factors.
• Nukunonu had the highest rates of smoking, alcohol consumption, and fruit and vegetable intake.
• Integrated strategies are needed to address the multi-faceted nature of NCD risk factors.

Key Recommendations

• Implement aggressive lifestyle modification programs to reduce smoking, alcohol use, and improve diet and physical activity.
• Focus on early detection and management of diabetes and hypertension.
• Promote community-based interventions that combine medical and behavioral approaches.
• Develop national strategies with multi-sectoral involvement to tackle the NCD epidemic.
• Continue NCD risk factor surveillance using the WHO STEPwise methodology.

Collaborative Efforts

The report was a collaborative effort between:

• Tokelau Department of Health (DOH)
• World Health Organization (WHO)
• Fiji School of Medicine (FSM)
• Supported by AusAID

Key contributors included:

• Dr Tekaai Nelesone (DOH)
• Dr Jan Pryor (FSM)
• Dr Li Dan (WHO, Suva)
• Dr Kevin Palmer (WHO Representative for Tokelau)
• Dr Gauden Galea (WHO, Geneva)
• Dr Philayrath Phongsavan (University of Sydney)

Conclusion

The Tokelau NCD STEPS survey provides crucial baseline data on the prevalence of NCDs and their risk factors. It highlights the urgent need for action to reduce these risk factors and prevent the further spread of NCDs. The report underscores the importance of a community-based, multi-sectoral approach to tackle the complex and interlinked risk factors that contribute to the NCD burden in Tokelau.