2005-12-31-世界卫生组织-2004-2006_STEPS_Country_report_Kiribati_111页_1mb

Kiribati NCD Risk Factors STEPS Report Summary

Core Content

The Kiribati NCD Risk Factors STEPS Report is a national survey conducted from May 2004 to September 2006, covering South Tarawa and four outer islands (Butaritari, Makin, Onotoa, Beru). It was a collaborative effort between the Kiribati Ministry of Health and Medical Services (MHMS), the World Health Organization (WHO), the Fiji School of Medicine, and the Centre for Physical Activity and Health, University of Sydney, supported financially by AusAID, NZAID, and WHO. The report provides a comprehensive overview of the prevalence of noncommunicable diseases (NCDs) and their associated risk factors among the adult population of Kiribati, with a focus on those aged 25–64 years.

Main Objectives

• To document the prevalence of key NCDs and their major modifiable risk factors among adults.
• To assess the magnitude of these risk factors.
• To compare NCDs and their risk factors across different age groups and genders.

Key Risk Factors

1. Behavioural Risk Factors

• Tobacco Use: 61.3% of the population were current smokers, with men (75.7%) significantly more likely to smoke than women (48.3%). 59.0% smoked daily, with men smoking more frequently than women.
• Alcohol Consumption: 25.5% of adults consumed alcohol in the past 12 months. Men (46.9%) were much more likely to drink than women (6.1%). 71.8% of male current drinkers engaged in binge drinking (5 or more standard drinks per day).
• Kava Use: 23.2% of the population had ever tried kava. Men (43.7%) were more likely to consume it than women (4.6%).
• Fruit and Vegetable Intake: 99.3% of the population consumed less than five combined servings per day, far below the recommended level. On average, fruits and vegetables were consumed 1.5 and 1.9 days per week, respectively.
• Physical Activity: 50.1% of the population had low levels of physical activity (<600 METminutes per week). Women (57.3%) were more likely to be physically inactive than men (41.8%). Men had higher levels of high-intensity physical activity (>1500 METminutes per week), with 30.1% of men and 16.6% of women in this category. Most physical activity was work-related, followed by transport-related activities.

2. Physical Risk Factors

• Overweight and Obesity: 81.5% of the population were overweight (BMI ≥ 25 kg/m²), and 50.6% were obese (BMI ≥ 30 kg/m²). Among women, 84.6% were overweight, with 58.9% being obese. Among men, 78.2% were overweight, with 41.7% being obese.
• Waist Circumference: Women had a significantly higher mean waist circumference (97.3 cm) than men (94.2 cm), with all age groups of women exceeding the 80 cm cutoff for increased cardiovascular disease risk.
• Hypertension: 17.3% of the population had hypertension (SBP ≥ 140 mmHg or DBP ≥ 90 mmHg or on medication). The condition was more common in men than women, and increased with age.

3. Biochemical Risk Factors

• Diabetes: 28.1% of the population aged 25–64 years had diabetes (fasting glucose ≥ 6.1 mmol/L or on medication). Men had a slightly higher prevalence (29.6%) than women (26.7%).
• High Blood Cholesterol: 27.7% of the population had elevated total blood cholesterol (≥5.0 mmol/L or ≥190 mg/dl). Women had a higher prevalence (30.6%) than men (23.8%).

Combined Risk Factors

The report classifies individuals into three risk categories based on the number of risk factors they have:

• Low Risk: 0.1% of the population had no risk factors.
• Moderate Risk: 25.4% had 1–2 risk factors.
• High Risk: 74.6% had 3–5 risk factors.

The highest risk was observed in the 45–64 years age group, with 80.4% of men and 77.7% of women classified as high risk. This highlights the urgent need for targeted interventions among middle-aged and older adults.

Key Findings

• High prevalence of NCDs and their risk factors among the adult population.
• Tobacco and alcohol use are widespread, with men being more affected.
• Poor diet and low physical activity are major contributors to NCD risk.
• Obesity and hypertension are prevalent, especially among women.
• Diabetes is a significant public health issue, with nearly 30% of the population affected.

Recommendations

Policy, Organizational and Environmental Factors

• Increase resources to implement the WHO Framework Convention on Tobacco Control.
• Generate resources for national health institutions.
• Develop policies to support healthy food imports and improve availability of fruits and vegetables.
• Create physical activity-friendly environments.
• Strengthen the healthcare system for early detection and management of chronic diseases.
• Establish sustainable government funding and health infrastructure to support NCD strategies.
• Develop NCD coalitions and partnerships such as the Kiribati NCD Working Committee and National Food and Nutrition Committee.

Addressing NCD Behavioural Risk Factors

• Launch comprehensive anti-smoking campaigns targeting all age groups and both genders.
• Implement smoking cessation programs.
• Promote health campaigns to reduce alcohol and kava consumption, especially binge drinking among men.
• Encourage recommended fruit and vegetable intake and raise awareness about the risks of high-fat, high-salt, and high-sugar diets.
• Develop cultural-appropriate programs to promote incidental and moderate-intensity physical activity, especially among women.
• Emphasize reducing the five critical NCD risk factors through public health programs.

Establishing a Coordinated NCD Management System

• Increase public awareness of the importance of regular monitoring and screening of blood pressure, cholesterol, and blood sugar.
• Strengthen coordinated care and management for individuals with chronic conditions.
• Develop integrated care systems across primary and clinical care providers.
• Support patient self-management and self-monitoring of conditions, medications, and lifestyle changes.

Maintaining Quality Surveillance and Public Health Information

• Ensure strong leadership and political and financial commitments to maintain a systematic and rigorous approach to national STEPS data collection.
• Build capacity in the workforce, infrastructure, and financial systems to support ongoing surveillance.
• Evolve the system into a robust STEPS surveillance framework.

Conclusion

The Kiribati STEPS survey marks a significant milestone in addressing the growing NCD epidemic. It provides scientifically sound data for policy-making and program development, emphasizing the need for primary and secondary prevention strategies. The report outlines a clear pathway for improving public health outcomes through policy reform, behavioral change, and system strengthening.