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Noncommunicable diseases risk behaviours among adults in the South-East Asia Region: findings from STEPS and GATS.

1 août 2016 Organisation mondiale de la santé

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WHO Library Cataloguing-in-Publication data World Health Organization, Regional Office for South-East Asia. Noncommunicable diseases risk behaviours among adults in the South-East Asia Region: findings from STEPS and GATS.

1. Tobacco Use - statistics and numerical data 2. Statistics. 3. Health Status Indicators 4. Smoking 5. Alcohol Drinking. ISBN 978-92-9022-528-7 (NLM classification: WM 290)

© World Health Organization 2016 All rights reserved. Requests for publications, or for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – can be obtained from SEARO Library, World Health Organization, Regional Office for South-East Asia, Indraprastha Estate, Mahatma Gandhi Marg, New Delhi 110 002, India (fax: +91 11 23370197; e-mail: searolibrary@who.int). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. This publication does not necessarily represent the decisions or policies of the World Health Organization. Printed in India.

Contents Acknowledgements.............................................................................iv Message from the Regional Director WHO South-East Asia Region........v Introduction........................................................................................ 1 Country factsheet Bangladesh............................................................................... 3 Bhutan...................................................................................... 7 India.......................................................................................13 Indonesia................................................................................15 Maldives..................................................................................27 Myanmar.................................................................................21 Nepal......................................................................................27 Sri Lanka.................................................................................33 Thailand..................................................................................39 Timor-Leste.............................................................................41

NCD risk behaviours among adults in the South-East Asia Region: Findings from STEPS and GATS | iii

Acknowledgements Under the aegis of Director Thaksaphon Thamarangsi, this report was prepared by the NCD and tobacco surveillance team within the department of Noncommunicable Diseases and Environmental Health. Naveen Agarwal coordinated overall publication work, conceptualization and reporting the survey results and performed all data management; Arpita Mehta led the data collection and validation of results. Contributors to the report were made by Jagdish Kaur, Pyi Pyi Phyo, Anika Singh, Nazneen Anwar, Padmini Angela De Silva, Suvajee Good, Payden, Jayasuriya Navaratne, Gampo Dorji, Patanjali Dev Nayar, Lesley Jayne Onyon, David Sutherland, Puneet Dhingra, Om Prakash and Charu Sharma. We gratefully acknowledge World Health Organization headquarters and the United States Centers for Disease Control and Prevention (CDC) for providing technical and financial support to conduct these surveys in the WHO South-East Asia countries. Sincere thanks to Member States for their assistance to conduct these surveys in their respective countries.

iv | NCD risk behaviours among adults in the South-East Asia Region: Findings from STEPS and GATS

Message from the Regional Director WHO South-East Asia Region Noncommunicable diseases (NCDs) are a major killer in the WHO South-East Asia Region. NCDs claim the lives of an estimated 8.5 million people every year, accounting for 62% of overall deaths and 48% of all premature deaths (deaths before the age of 70 years) in the Region. Prevention and control of NCDs is the major priority to prevent premature deaths and to reduce related health-care costs. Four modifiable lifestyle-related risk behaviours – namely tobacco use, unhealthy diet, insufficient physical activity and harmful use of alcohol are responsible for the majority of NCDs in the WHO South-East Asia Region. There are about 246 million smokers and over 290 million smokeless tobacco users. Of total population, 80% does not consume the recommended five portions of fruits and vegetables a day. In addition, 35–61% of males and 63–89% of females do not engage in vigorous physical activities. The behavioral risk factors described above lead to four metabolic risk factors for NCDs, which are overweight/obesity, high blood pressure, raised blood sugar and abnormal blood lipids – quite prevalent in the populations of our Region. The prevalence of overweight varies from 8% to 30% among men and 8% to 52% among females. Approximately one third of the adult population suffers from hypertension. The prevalence of raised blood sugar in adults aged 25 years and above ranges from 6.6% to 12.2% in the Region. The prevalence of raised cholesterol in the adult population is as high as 50% in some Member States. With an understanding of the raising trends of NCDs, WHO has been monitoring the situation very closely. This publication, ‘Noncommunicable diseases risk behaviours among adults in the South-East Asia Region: Findings from STEPS and GATS’, was developed based on the results of the Global Adult Tobacco Surveys (GATS) and the WHO STEPwise approach to noncommunicable disease risk factor surveillance (STEPS). GATS is a nationally representative household survey on tobacco use while STEPS is the WHO’s recommended tool for surveillance of chronic noncommunicable diseases and risk factors among adults. Both provide an entry point for low- and middle-income countries to get started on surveillance activities on NCDs. The evidence contained in this publication, which includes data on adult health risks, both behavioural and metabolic risk factors, will help inform governments, policy-makers and other stakeholders on how to better prevent and control the NCD epidemic. Alongside renewing political commitment and strengthening alliances, we must increase public awareness on issues related to noncommunicable diseases and the need to avoid risky behaviours that enhance the likelihood of contracting NCDs and leading to premature death. Not only will this ensure physical, mental and social well-being of our people, but will also lead to a more productive workforce and healthier population in the South-East Asia Region.

Dr Poonam Khetrapal Singh Regional Director WHO South-East Asia Region

NCD risk behaviours among adults in the South-East Asia Region: Findings from STEPS and GATS | v

Introduction This publication, entitled ‘Noncommunicable diseases risk behaviours among adults in the South-East Asia Region: Findings from STEPS and GATS’, conveys the most recent quantitative surveillance results focusing on noncommunicable disease (NCDs)-related risk behaviours among adults from the WHO STEPwise approach to NCD risk factor surveillance (STEPS) and tobacco use among adults from the Global Adult Tobacco Survey (GATS) in Member States of the WHO South-East Asia Region. STEPS is a WHO recommended tool for surveillance of risk factors related to NCDs. The survey results provide an entry point for low- and middle-income countries to get started on NCD surveillance activities. It is also designed to help countries build and strengthen their capacity to conduct surveillance. Different countries use different age groups for STEPS, depending on the country context. STEPS is conducted as a sequential process. First, it gathers the information on risk factors with a standard core and expended questions with optional items to gather the information on basic demographic information, tobacco use, alcohol consumption, fruit and vegetable consumption, salt intake, physical activity, history of raised blood pressure, diabetes, raised total cholesterol and cardiovascular disease, life-style advice, cervical cancer screening, mental health, oral health, sexual health, tobacco policy, and violence and injury. Second, it conducts simple physical measurements to measure blood pressure, height and weight, and waist circumference. And third, it collects urine and blood samples for biochemical analysis to measure fasting blood sugar, total cholesterol and urinary sodium and creatinine. This publication contains data from STEPS surveys for Bangladesh (2010) for age group 25 years and above, Bhutan (2014), Sri Lanka (2015) and Timor-Leste (2014) for age group 18–69 years, Malé, Maldives (2011) for age group 15–64 years, Myanmar (2014) for age group 25–64 years and Nepal (2013) for age group 15–69 years. GATS is a component of the Global Tobacco Surveillance System (GTSS), which is a global standard protocol for systematically monitoring adult tobacco use, covering both smoking and smokeless tobacco products, and tracking key tobacco control indicators. GATS is a nationally representative school-based survey of adults, 15 years of age and older, and is designed to produce cross-sectional estimates for each country with the aim of supporting capacity of countries for the designing, implementation and evaluation of tobacco control policies. It is also an important tool to assist countries in supporting WHO MPOWER, a package of six evidence-based demand reduction measures contained in the WHO Framework Convention on Tobacco Control (WHO FCTC). GATS uses a standard core questionnaire with a set of optional questions on tobacco use and key tobacco control indicators that permit adaptation to meet the needs of the country. The GATS interview consists of two parts: the Household Questionnaire (household screening) and the Individual Questionnaire (individual interview); it is conducted using an electronic data collection device. The Household Questionnaire is used to determine if the selected household meets GATS eligibility requirements and to make a list, or roster, of all eligible members of the household. Once the roster of eligible residents of the household is completed, one individual is randomly selected to complete the Individual Questionnaire. The Individual Questionnaire asks questions about background characteristics; tobacco smoking; smokeless tobacco; cessation; secondhand smoke; economics; media; and knowledge, attitudes, and perceptions about tobacco. This publication contains data from GATS for Bangladesh (2009), India (2009–2010), Indonesia (2011) and Thailand (2011) for age group 15 years and older.

NCD risk behaviours among adults in the South-East Asia Region: Findings from STEPS and GATS | 1

This publication contains selected indicators relating to tobacco use and other related risk behaviours of adults in Member States of the WHO South-East Asia Region. The tobacco indicators are taken from GATS or STEPS and other indicators relating to risk behaviours (history– dietary behaviours, physical activity, alcohol use, cervical cancer screening; physical measurements – body mass index, blood pressure, waist circumference; biochemical measurements – fasting blood glucose level, blood glucose level 2 hours after glucose load, total blood cholesterol, urine sodium and urine creatinine) are taken from STEPS. The latest findings from surveys conducted in Member States are presented in the publication. The target audience includes governments, policy-makers, development partners, civil society and nongovernmental organizations, academics, researchers, and other stakeholders who are contributing to health and other related policies and programmes concerning NCDs.

2 | NCD risk behaviours among adults in the South-East Asia Region: Findings from STEPS and GATS

BANGLADESH Total Populationa

161 million

Malesa

41.1 million

Femalesa Aged 25+ years

41.1 million

Aged 25+ years

Tobacco use Overall

Current tobacco users (smoking or/and smokeless)

43%

58% Males

29% Females

Current tobacco smokers

Current smokeless tobacco users

23% 45% 2% Attempt to quit (among current smokers)

27% 63% ...at work place

26% 28%

Exposure to second–hand smoke

45% ...at public places

47% Alcohol use Current alcohol drinkers Binge Drinkers (among current drinkers)

0.9%

67%

NCD risk behaviours among adults in the South-East Asia Region: Findings from STEPS and GATS | 3

BANGLADESH Physical activity Diet

96%

56% Nutrition status

67%

do not consume sufficient fruits and vegetables

Were not engaged in vigorous activities

(ate less than 5 servings on average per day)

Overweight or Obese

13% 22% 18%

Blood pressure Mean BLOOD PRESSURE

121 78 (mmHg) (mmHg)

Systolic Diastolic

119 75 (mmHg) (mmHg)

have raised Blood pressure or currently on medication

Current daily smokers Less than 5 servings of fruits and vegetables per day

28% on raised risk (at least 3 risk factors)

Insufficient physical activity Overweight (BMI ≥ 25 kg/m2) Raised BP (SBP ≥ 140 and/or DBP ≥ 90 mmHg or currently on medication for raised BP)

4 | NCD risk behaviours among adults in the South-East Asia Region: Findings from STEPS and GATS

BANGLADESH Results for adults aged 25+ years (including 95% CI) STEP 1: Tobacco use b Percentage who currently smoke tobacco Percentage who currently smoke tobacco daily Percentage who currently use smokeless tobacco Percentage who currently use smokeless tobacco daily Percentage who currently use tobacco in any form (smoked and/or smokeless) Average age started smoking (years) for daily users Percentage of current smokers smoking manufactured cigarettes Percentage of current smokers smoking bidis Mean number of manufactured cigarettes smoked per day (by smokers of manufactured cigarettes) Percentage of adults exposed to second–hand smoke at work during the past 30 days Percentage of adults exposed to second–hand smoke in public places (in any of these places : government buildings, health care facilities, restaurants, public transportation, etc.) during the past 30 days Percentage of current smokers who have made an attempt to quit in past 12 months Percentage of current smokers advised by a health care provider to quit smoking in past 12 months (21.9–24.2) (19.8–22.0) (25.5–28.9) (22.1–25.3) (41.7–45.0) (18.4–19.2) (13.2–15.2) (10.0–12.4) (4.6–5.6) (59.2–66.7)

Overall 23.0%

Males 44.7%

Females 1.5%

(42.5–47.0) (38.5–42.9) (24.2–28.6) (18.7–22.9) (55.9–60.1) (18.1–18.8) (26.3–30.4) (19.2–23.7) (4.7–5.7) (63.7–71.6)

(1.1–2.1) (0.9–1.9) (25.9–30.0) (24.7–28.6) (26.7–30.8) (21.6–31.3)

20.9% 27.2% 23.7% 43.3% 18.8

40.7% 26.4% 20.7% 58.0% 18.4

1.3%

27.9% 26.6% 28.7% 26.5 *

14.1% 11.2 5.1

28.3% 21.4 5.2

(0.7–1.5) (0.2–1.4) (24.1–37.6)

1.1 0.8

63.0% 45.0% 47.3% 52.9%

67.8% 69.4% 47.8% 52.7%

30.4% 20.8% 31.5% *

(43.4–46.5)

(67.0–71.6)

(19.1–22.7)

(43.9–50.8) (47.0–58.6)

(44.4–51.3) (46.8–58.5)

(18.4–48.4)

STEP 1: Alcohol Consumption c Percentage who are lifetime abstainers Percentage who currently drink (drank alcohol in the past 30 days) Percentage who engage in heavy episodic drinking (men who had 5 or more / women who had 4 or more drinks on any day in the past 30 days) (92.4–96.4) (0.8–1.2) (55.9–75.9)

94.4

(90.0–91.8) (1.1–1.9) (55.5–76.2)

99.8

(99.6–99.9)

91.0 ** **

0.9%

1.5%

66.7%

STEP 1: Diet c Mean number of days fruit consumed (in a typical week) Mean number of servings of fruit consumed on average per day (in a typical week) Mean number of days vegetables consumed (in a typical week) Mean number of servings of vegetables consumed on average per day (in a typical week) Percentage who ate less than 5 servings of fruit and/or vegetables on average per day (in a typical week) (1.8–1.9) (1.5–1.8) (6.1–6.1) (2.2–2.4) (95.3–96.1)

1.8 1.7 6.1 2.3

(1.6–1.7) (1.3–1.6) (5.7–5.8) (2.0–2.2) (97.1–98.0)

1.7 1.4 5.7 2.1

(1.9–2.0) (1.7–2.2) (6.4–6.4) (2.3–2.7) (93.4–94.8)

1.9 1.9 6.4 2.5

95.7%

97.6%

94.1%

NCD risk behaviours among adults in the South-East Asia Region: Findings from STEPS and GATS | 5

BANGLADESH Results for adults aged 25+ years (including 95% CI) STEP 1: Physical activity c

Overall 27.0% 52.8% 61.8%

Males 10.5% 74.9% 55.9%

Females 41.3% 33.7% 67.1%

Percentage with low levels of activity (defined as <600 MET–minutes per week)*** Percentage with high levels of activity (defined as ≥3000 MET– minutes per week)*** Percentage not engaging in vigorous activity

(25.9–28.1) (51.4–54.3) (60.7–63.0)

(9.5–11.5) (72.3–77.5) (54.2–57.6)

(39.6–43.1) (32.1–35.4) (65.5–68.6)

STEP 2: Physical measurements c Mean body mass index – BMI (kg/m2) Percentage who are overweight (BMI 25.0–29.9 kg/m2) Percentage who are obese (BMI ≥30 kg/m2) Average waist circumference (cm) Mean systolic blood pressure – SBP (mmHg), among all respondents Mean diastolic blood pressure – DBP (mmHg), among all respondents Percentage with raised BP (SBP ≥140 and/or DBP ≥90 mmHg) Percentage with raised BP (SBP ≥140 and/or DBP ≥90 mmHg an/ or currently on medication for raised BP) Percentage with raised BP (SBP ≥160 and/or DBP ≥100 mmHg) (21.4–21.6) (13.6–15.0) (3.3–4.0) (76.4–76.8) (119.4–120.1) (76.1–76.6) (14.0–15.6) (17.0–18.8) (5.1–6.0)

21.5

(20.8–21.1) (10.2–12.1) (1.8–2.6) (77.4–78.0) (120.7–121.8) (77.2–77.8) (14.4–16.8) (17.2–19.8) (5.3–6.7)

21.0

(21.8–22.1) (15.9–18.0) (4.3–5.5) (75.3–76.0) (118.0–119.0) (75.0–75.7) (13.1–15.3) (16.2–18.5) (4.6–5.8)

22.0

14.3% 3.6% 76.6

11.1% 2.2% 77.7

17.0% 4.9% 75.7

120.0 76.0

121.0 78.0

119.0 75.0

14.8% 17.9% 5.5%

15.6% 18.5% 5.8%

14.2% 17.3% 5.3%

Summary of combined risk factors l Current daily smokers l Insufficient physical activity l Raised BP (SBP ≥ 140 and/or DBP ≥ 90 mmHg or currently on medication for raised BP) Percentage with raised risk (at least three of the risk factors included above), aged 25 to 44 years old Percentage with raised risk (at least three of the risk factors included above), aged 45 to 64 years old Percentage with three or more of the above risk factors, aged 25–64 years old l Less than 5 servings of fruit and vegetables per day l Overweight (BMI ≥ 25 kg/m2)

(19.8–22.2) (37.9–42.1) (27.2–29.4)

21.0% 40.0% 28.3%

(15.3–18.8) (30.5–35.6) (23.2–26.2)

17.0% 33.0% 24.7%

(22.0–25.3) (46.1–53.2) (30.0–33.1)

23.6% 49.5% 31.5%

Technical Notes: a. Population for year 2015 from “UN, World Population Prospects: The 2015 Revision : https://esa.un.org/unpd/wpp/DataQuery/ (accessed on 15 August 2016); b. World Health Organization, Regional Office for South East Asia. Global Adult Tobacco Survey (GATS) Bangladesh report 2009. (aged 15+ years); c. World Health Organization, Regional Office for South East Asia. Noncommunicable disease risk factor survey Bangladesh 2010. * Sample size was less than 25; ** Sample size was less than 50; *** Complete definitions of low and high levels of physical activity and other conditions are specified in the GPAQ Analysis Guide, available at: http://www.who.int/chp/STEPs/GPAQ ;

6 | NCD risk behaviours among adults in the South-East Asia Region: Findings from STEPS and GATS

BHUTAN Total Populationa

776 thousand

Malesa

275 thousand

Femalesa

224thousand

Aged 18–69 years

Tobacco use 25% Overall Current tobacco smokers

Current tobacco users (smoking or/and smokeless)

34% Males

14% Females

Current smokeless tobacco users

11% 3%

20% 21% ...at home

27%

11%

Attempt to quit (among current smokers)

Exposure to second–hand smoke

25% ...at work place

69% Alcohol use Current alcohol drinkers Binge Drinkers (among current drinkers)

42%

22%

NCD risk behaviours among adults in the South-East Asia Region: Findings from STEPS and GATS | 7

BHUTAN Physical activity 35% Nutrition status 28% 128.0 (mmHg)

Diet 66%

67%

do not consume sufficient fruits and vegetables (ate less than 5 servings on average per day)

Were not engaged in vigorous activities

Overweight or Obese

41% 123.8 (mmHg)

Blood pressure Mean BLOOD PRESSURE (including those on medication)

Systolic Diastolic

84.6 (mmHg)

85.4 (mmHg)

HIGH BLOOD PRESSURE or currently on medication

36% have

Mean total

(including those currently on medication for raised cholesterol)

Blood Cholesterol

% with raised fasting

Blood Sugar

144.1 (mg/dl) 64%

148.7 (mg/dl)

6.4%

Current daily smokers Less than 5 servings of fruits and vegetables per day

of women aged 30–49 years who have ever had a screening test for

Cervical Cancer

14% on

Insufficient physical activity Overweight (BMI ≥ 25 kg/m2) Raised BP (SBP ≥ 140 and/or DBP ≥ 90 mmHg or currently on medication for raised BP)

raised risk

(at least 3 risk factors)

8 | NCD risk behaviours among adults in the South-East Asia Region: Findings from STEPS and GATS

BHUTAN Results for adults aged 18–69 years (including 95% CI) STEP 1: Tobacco use b

Overall 7.4% 4.3%

Males 10.8% 6.0%

Females 3.1% 2.1%

Percentage who currently smoke tobacco Percentage who currently smoke tobacco daily Percentage who currently use smokeless tobacco Percentage who currently use smokeless tobacco daily Percentage who currently use tobacco in any form (smoked and/or smokeless) Average age started smoking (years) for daily users Mean duration of smoking among current daily smokers Percentage of adults exposed to second–hand smoke at home during the past 30 days Percentage of adults exposed to second–hand smoke in the closed areas in their workplace during the past 30 days Percentage of current smokers who have tried to quit smoking Percentage of current smokers advised by a health care provider to quit smoking in past 12 months Percentage of daily smokers smoking manufactured cigarettes

(5.8–9.0) (3.3–5.4) (16.5–22.9) (15.3–21.7) (21.4–28.3) (17.5–20.3) (10.8–15.2) (18.0–23.4) (21.5–27.7) (59.8–78.1) (22.6–41.0) (76.3–92.0)

(8.1–13.6) (4.3–7.8) (22.1–31.0) (20.7–29.7) (28.8–38.5) (17.3–20.8) (9.6–14.2) (17.0–24.4) (24.6–33.4) (55.2–76.8) (22.2–44.3) (82.2–98.0)

(2.0–4.2) (1.3–3.0) (8.6–13.5) (7.5–12.4) (10.9–16.4)

19.7% 18.5% 24.8% 18.9 13.0

26.5% 25.2% 33.6% 19.0 11.9

11.0% 9.9%

13.6% * *

20.7% 24.6% 69.0% 31.8% 84.1%

20.7% 29.0% 66.0% 33.2% 90.1%

(17.8–23.6) (15.9–22.3) (68.6–95.7)

20.7% 19.1% 82.1% * *

39.0% 10.8% 42.4% 22.4%

(26.2–35.0) (9.2–14.9) (45.5–54.5) (24.9–33.1)

30.6% 12.1% 50.0% 29.0%

(45.9–53.7) (7.0–11.6) (29.5–36.0) (11.3–16.9)

49.8% 9.3%

32.8% 14.1%

STEP 1: Dietb Mean number of days fruit consumed in a typical week Mean number of servings of fruit consumed on average per day Mean number of days vegetables consumed in a typical week Mean number of servings of vegetables consumed on average per day Percentage who ate less than 5 servings of fruit and/or vegetables on average per day Percentage who always or often add salt or salty sauce to their food before eating or as they are eating Percentage who always or often eat processed foods high in salt (1.5–1.9) (0.6–0.8) (5.4–5.7) (3.4–4.1) (61.7–72.0) (5.4–10.2) (9.3–12.9)

1.7 0.7 5.6 3.8

(1.4–1.8) (0.5–0.8) (5.5–5.8) (3.5–4.4) (58.3–71.2) (4.4–10.5) (8.4–13.6)

1.6 0.7 5.6 4.0

(1.7–2.1) (0.7–0.9) (5.3–5.7) (3.1–3.8) (64.4–74.7) (6.2–10.4) (9.1–13.3)

1.9 0.8 5.5 3.5

66.9% 7.8%

64.8% 7.4%

69.6% 8.3%

11.1%

11.0%

11.2%

NCD risk behaviours among adults in the South-East Asia Region: Findings from STEPS and GATS | 9

BHUTAN Results for adults aged 18–69 years (including 95% CI) STEP 1: Physical activity b

Overall

Males

Females

Percentage with insufficient physical activity (defined as <150 minutes of moderate intensity activity per week,or equivalent)** Median time spent in physical activity on average per day (minutes) (presented with inter–quartile range P25–P75) Mean time spent in physical activity per day (minutes) Percentage not engaging in vigorous activity

(4.7–8.0)

6.4% 330

3.8% (2.5–5.0) 367.1 362.1 (357.3–410.2) (30.3–40.2)

(6.8–12.4)

9.6%

274.3 377.1 (283.9–332.8) (61.2–70.9)

377.1 (330.0–371.0) (44.6–53.1)

350.5

383.7

308.3

48.8%

35.2%

66.0%

STEP 1: Mental healthb Percentage of respondents who seriously considered attempting suicide in the last 12 months among all respondents Percentage of respondents who have ever attempted suicide among all respondents Percentage of respondents who have ever had anyone in their close family attempt suicide Percentages of respondents who have ever had anyone in their close family die from suicide (1.5–3.2) (0.3–1.0) (1.0–2.0) (1.1–2.5)

2.4 0.6 1.5 1.8

(0.3–1.6) (0.3–1.6) (0.3–1.8) (0.5–2.2)

0.9 0.0 1.1 1.4

(2.5–5.9) (0.6–2.2) (1.2–2.7) (1.2–3.4)

4.2 1.4 2.0 2.3

STEP 1: Cervical cancer screeningb Percentage of women aged 30–49 years who have ever had a screening test for cervical cancer – – (59.0–69.2)

64.1%

STEP 2: Physical measurementsb Mean body mass index – BMI (kg/m2) Percentage who are overweight (BMI ≥25 kg/m2) Percentage who are obese (BMI ≥30 kg/m2) Average waist circumference (cm) Mean systolic blood pressure – SBP (mmHg), including those currently on medication for raised BP Mean diastolic blood pressure – DBP (mmHg), including those currently on medication for raised BP Percentage with raised BP (SBP ≥140 and/or DBP ≥90 mmHg or currently on medication for raised BP) Percentage with raised BP (SBP ≥140 and/or DBP ≥90 mmHg) excluding those on medication for raised BP Percentage with raised BP (SBP ≥160 and/or DBP ≥100 mmHg or currently on medication for raised BP) (23.7–24.2) (23.8–29.6) (5.1–7.4) –

24.0

(23.2–23.9) (19.0–26.7) (2.9–6.0) (81.0–82.9) (126.6–129.4) (83.4–85.9) (31.5–39.6) (29.5–37.6) (10.4–16.2)

23.5

(24.2–24.8) (28.4–35.5) (6.8–10.2) (78.7–80.4) (122.5–125.1) (84.5–86.3) (32.5–39.4) (28.6–35.4) (13.4–18.2)

24.5

26.7% 6.2%

22.8% 4.5% 81.9

31.9% 8.5% 79.5

(125.1–127.2) (84.0–85.9) (32.8–38.6) (30.0–35.8) (12.3–16.5)

126.2 85.0

128.0 84.6

123.8 85.4

35.7% 32.9% 14.4%

35.5% 33.6% 13.3%

35.9% 32.0% 15.8%

10 | NCD risk behaviours among adults in the South-East Asia Region: Findings from STEPS and GATS

BHUTAN Results for adults aged 18–69 years (including 95% CI) STEP 3: Biochemical measurements b

Overall

Males

Females

Mean fasting blood glucose, including those currently on medication for raised blood glucose (mg/dl) Percentage with impaired fasting glycaemia (capillary whole blood value ≥5.6mmol/L(100mg/dl) and <6.1mmol/L(110mg/dl) Percentage with raised fasting blood glucose (capillary whole blood value ≥6.1 mmol/L(110 mg/dl) or currently on medication for raised blood glucose) Mean total blood cholesterol, including those currently on medication for raised cholesterol (mg/dl) Percentage with raised total cholesterol (≥ 5.0mmol/L or ≥190mg/dl or currently on medication for raised cholesterol) Mean intake of salt per day (in grams)

(87.4–90.2) (8.6–12.9) (5.0–7.8) (143.4–148.9) (10.6–14.4) (8.8–9.1)

88.8

(86.9–90.5) (8.2–14.5) (4.6–8.5) (140.3–147.9) (9.1–14.7) (9.4–9.8)

88.7

(87.4–90.4) (7.9–12.0) (4.7–7.9) (146.0–151.4) (11.3–15.3) (7.9–8.2)

88.9

10.7% 6.4%

11.4% 6.5%

10.0% 6.3%

146.1

144.1

148.7

12.5% 9.0

11.9% 9.6

13.3% 8.0

Cardiovascular disease (CVD) riskb Percentage aged 40–69 years with a 10–year CVD risk ≥ 30%, or with existing CVD*** (1.0–2.6)

1.8%

(0.4–2.7)

1.5%

(1.0–3.4)

2.2%

Summary of combined risk factorsb l Current daily smokers l Insufficient physical activity l Raised BP (SBP ≥ 140 and/or DBP ≥ 90 mmHg or currently on medication for raised BP) Percentage with low risk (i.e. none of the risk factors included above) Percentage with raised risk (at least three of the risk factors included above), aged 18–39 years old Percentage with raised risk (at least three of the risk factors included above), aged 40–69 years old Percentage with three or more of the above risk factors, aged 18–69 years old l Less than 5 servings of fruit and vegetables per day l Overweight (BMI ≥ 25 kg/m2)

(10.2–15.2) (8.6–12.8) (15.7–22.2) (11.8–15.3)

12.7% 10.7% 18.9% 13.5%

(11.4–19.2) (6.6–12.5) (10.7–18.1) (8.6–13.7)

15.3% 9.5%

(7.3–11.3) (9.6–15.0) (19.9–29.3) (14.1–19.2)

9.3%

12.3% 24.6% 16.7%

14.4% 11.2%

Technical Notes: a. Population for year 2015 from United Nations. World population prospects: the 2012 revision. New York: Population Division, Department of Economics and Social Affairs, 2015; b. World Health Organization, Regional Office for South East Asia. National survey for noncommunicable disease risk factors and mental health using WHO STEPS approach in Bhutan – 2014 * Sample size was less than 50; ** Complete definitions of low and high levels of physical activity and other conditions are specified in the GPAQ Analysis Guide, available at: http://www.who.int/chp/ steps/GPAQ ; *** A 10–year CVD risk of >30% is defined according to age, sex, blood pressure, smoking status (current smokers OR those who quit smoking less than 1 year before the assessment), total cholesterol, and diabetes (previously diagnosed OR a fasting plasma glucose concentration >7.0mmol/l (126 mg/dl)

NCD risk behaviours among adults in the South-East Asia Region: Findings from STEPS and GATS | 11

INDIA Total Populationa

1311 million

Malesa

480.6 million

Femalesa Aged 15+ years

453 million

Aged 15+ years

Tobacco use Overall

Current tobacco users (smoking or/and smokeless)

35%

48% Males

20% Females

Current tobacco smokers

Current smokeless tobacco users

14% 24% 3% 40% ...at home

26%

33% 18% 30% ...at work place

Exposure to second–hand smoke

Attempt to quit (among current smokers)

Advised by healthcare provider to quit smoking (among current smokers)

38%

46%

NCD risk behaviours among adults in the South-East Asia Region: Findings from STEPS and GATS | 13

INDIA Results for adults aged 15+ years (including 95% CI) Tobacco useb Percentage who currently smoke tobacco Percentage who currently smoke tobacco daily Current any cigarette smokers Percentage who currently use smokeless tobacco Percentage who currently use smokeless tobacco daily Percentage who currently use tobacco in any form (smoked and/or smokeless) Average age started smoking (years) for daily users Percentage of current smokers smoking manufactured cigarettes Mean number of manufactured cigarettes smoked per day (by smokers of manufactured cigarettes) Percentage of adults exposed to second–hand smoke at home during the past 30 days Percentage of adults exposed to second–hand smoke in the closed areas in their workplace during the past 30 days Percentage of current smokers who tried to quit smoking in past 12 months Percentage of current smokers advised by a health care provider to quit smoking in past 12 months (13.4–14.6) (10.2–11.2)

Overall 14.0% 10.7% 5.7% –

Males 24.3% 18.3% 10.3% –

Females 2.9% 2.4% 0.8% –

(23.3–25.3) (17.4–19.3)

(2.6–3.4) (2.1–2.8)

(24.9–26.9) (20.5–22.3) (33.6–35.5) (17.9–18.6) (4.9–5.6) (5.8–6.6) (38.6–41.4) (28.2–31.6) (36.3–40.5) (43.6–49.0)

25.9% 21.4% 34.6% 18.3

(31.6–34.2) (26.2–28.7) 47.9% (46.7–49.1) (18.0–18.7) (9.0–10.3) (5.8–6.5) (39.0–42.3) (30.3–34.2) (36.1–40.5) (44.5–50.1)

32.9% 27.4%

(17.4–19.5) (14.0–15.9) (19.2–21.3) (15.7–18.7) (0.4–0.7) (5.6–8.5) (37.7–40.9) (16.4–22.7) (33.5–44.6) (31.5–46.8)

18.4% 14.9% 20.3% 17.2

18.3

5.2% 6.2

9.6% 6.1

0.5% 7.0

40.0% 29.9% 38.4% 46.3%

40.7% 32.2% 38.3% 47.3%

39.3% 19.4% 38.9% 38.9%

Technical Notes: a. Population for year 2015 from “UN, World Population Prospects: The 2015 Revision : https://esa.un.org/unpd/wpp/DataQuery/ (accessed on 15 August 2016); b. International Institute for Population Sciences (IIPS), Mumbai and Ministry of Health and Family Welfare, Government of India. Global Adult Tobacco Survey (GATS) India 2009–2010.

14 | NCD risk behaviours among adults in the South-East Asia Region: Findings from STEPS and GATS

INDONESIA Total Populationa

257.6 million

Malesa

93.1 million

Femalesa Aged 15+ years

93.1 million

Aged 15+ years

Tobacco use Overall

Current tobacco users (smoking or/and smokeless)

36%

67% Males

5% Females

Current tobacco smokers

Current smokeless tobacco users

35% 67% 3% 78% ...at home

Exposure to second–hand smoke

51% ...at work place

Attempt to quit (among current smokers)

Advised by healthcare provider to quit smoking (among current smokers)

30%

35% NCD risk behaviours among adults in the South-East Asia Region: Findings from STEPS and GATS | 15

INDONESIA Results for adults aged 15+ years (including 95% CI) Tobacco useb Percentage who currently smoke tobacco Percentage who currently smoke tobacco daily Current cigarette smokers (among current tobacco smokers) Percentage who currently use smokeless tobacco Percentage who currently use smokeless tobacco daily Percentage who currently use tobacco in any form (smoked and/or smokeless) Average age started smoking (years) for daily users Percentage of daily smokers smoking manufactured cigarettes(white cigarettes) Percentage of daily smokers smoking Kretek Mean number of manufactured cigarettes smoked per day (by smokers of manufactured cigarettes) Percentage of adults exposed to second–hand smoke at home during the past 30 days Percentage of adults exposed to second–hand smoke in the closed areas in their workplace during the past 30 days Percentage of current smokers who tried to stop smoking in past 12 months Percentage of current smokers advised by a health care provider to stop smoking in past 12 months (33.2–36.4) (27.6–30.9) – (1.4–2.2) (0.9–1.5) (34.4–37.8) (17.3–17.9) – – (12.9–16.5) (75.1–81.4) (45.8–56.8) (26.8–34.2) (29.2–40.5)

Overall 34.8% 29.2%

Males 67.0% 56.7% 67.0% 1.5% 1.1%

Females 2.7% 1.8% 2.7% 2.0% 1.3% 4.5% * (0.0–0.4) (1.7–3.1)

(64.4–69.5) (53.8–59.6) (64.4–69.5) (1.1–2.2) (0.8–1.6) (64.8–69.9) (17.3–17.9) (3.2–5.8) (57.9–63.8) (13.1–16.8) (78.1–84.3) (51.6–64.2) (26.2–33.7) (30.3–41.6)

(2.0–3.5) (1.4–2.4) (2.0–3.5) (1.4–2.7) (0.9–1.8) (3.6–5.6)

1.7% 1.2%

36.1% 17.6

67.4% 17.6

4.3% 60.9 15.0

0.1% 2.3% *

14.7

78.4% 51.3% 30.4% 34.6%

81.4% 58.0% 29.8% 35.7%

(71.7–78.9) (35.4–47.5) (35.9–53.7) (5.6–27.2)

75.4% 41.4% 44.6% 13.0%

Technical Notes: a. United Nations. World population prospects: the 2012 revision. New York: Population Division, Department of Economics and Social Affairs, 2015; b. World Health Organization, Regional Office for South East Asia. Global Adult Tobacco Survey (GATS): Indonesia Report 2011 * Sample size was less than 25;

16 | NCD risk behaviours among adults in the South-East Asia Region: Findings from STEPS and GATS

MALDIVES Total Populationa

362 thousand

Malesa

123 thousand

Femalesa

125 thousand

Aged 15–64 years

Tobacco use Overall

Current tobacco users (smoking or/and smokeless)

20%

36% Males

4% Females

Current tobacco smokers

Current smokeless tobacco users

19% 35% 3% Attempt to quit (among current smokers)

Exposure to second–hand smoke

25% ...at home

17% ...at work place

39% Alcohol use Current alcohol drinkers

1.6% 0.2%

of male current drinkers are Binge drinkers

0.9%

NCD risk behaviours among adults in the South-East Asia Region: Findings from STEPS and GATS | 17

MALDIVES Physical activity Diet

94%

59% Nutrition status

88%

do not consume sufficient fruits and vegetables

Were not engaged in vigorous activities

(ate less than 5 servings on average per day)

Overweight or Obese

41% 57% 17%

Blood pressure Mean BLOOD PRESSURE (including those on medication)

122.8 76.5 (mmHg) (mmHg)

Systolic Diastolic

116.7 74.5 (mmHg) (mmHg)

have raised Blood pressure or currently on medication

Current daily smokers Less than 5 servings of fruits and vegetables per day

40% on raised risk (at least 3 risk factors)

Insufficient physical activity Overweight (BMI ≥ 25 kg/m2) Raised BP (SBP ≥ 140 and/or DBP ≥ 90 mmHg or currently on medication for raised BP)

18 | NCD risk behaviours among adults in the South-East Asia Region: Findings from STEPS and GATS

MALDIVES Results for adults aged 15–64 years (including 95% CI) STEP 1: Tobacco useb Percentage who currently smoke tobacco Percentage who currently smoke tobacco daily Percentage who currently use smokeless tobacco Percentage who currently use smokeless tobacco daily Percentage who currently use tobacco in any form (smoked and/or smokeless) Percentage of current smokers who have tried to quit smoking Percentage of current smokers advised by a health care provider to quit smoking in past 12 months Percentage of adults exposed to second–hand smoke at home during the past 30 days Percentage of adults exposed to second–hand smoke in the closed areas in their workplace during the past 30 days Average age started smoking (years) for daily users Percentage of daily smokers smoking manufactured cigarettes Mean number of manufactured cigarettes smoked per day (by smokers of manufactured cigarettes) (16.7–20.9) (13.5–17.5) (1.9–3.4) (1.1–2.2) (17.7–22.1) (31.8–46.3) (22.3–44.9)

Overall 18.8% 15.5% 2.6% 1.6%

Males 34.7% 29.1% 3.9%

Females 3.4% 2.2%

(30.8–38.5) (25.5–32.8) (2.5–5.4) (1.2–3.2) (32.1–39.9) (30.9–46.4) (22.2–46.8)

(2.3–4.5) (1.4–3.0) (0.8–2.0) (0.6–1.6) (3.2–5.6) (35.8–77.0)

1.4% 1.1%

2.2%

19.9%

36.0%

4.4%

39.0% 33.6% 25.3% –

38.6% 34.5% 27.2% –

43.6% * 23.4% –

(13.6–20.7) (17.2–18.5) (90.8–96.9) (12.7–15.3)

17.1% 17.8

(15.5–25.1) (17.1–18.5) (92.9–98.9) (12.9–15.7)

20.3% 17.8

(6.5–16.2)

11.4% * * *

93.9% 14.0

95.9% 14.3

STEP 1: Alcohol consumptionb Percentage who are lifetime abstainers Percentage who are past 12 month abstainers Percentage who currently drink (drank alcohol in the past 30 days) Percentage who engage in heavy episodic drinking (men who had 5 or more / women who had 4 or more drinks on any day in the past 30 days) (95.1–97.3) (0.9–2.4) (0.3–1.4) –

96.2% 1.7%

(90.7–95.0) (1.7–4.7) (0.6–2.6) (0.1–1.6)

92.9% 3.2%

(99.1–100.0) (0.0–0.4) (0.0–0.6)

99.5% 0.2% 0.2% 0%

0.9%

1.6% 0.9%

3.3 1.0 3.8 1.0

(3.1–3.5) (0.9–1.2) (3.5–4.0) (0.9–1.1) (90.5–94.8)

3.3 1.1 3.7 1.1

(3.2–3.5) (0.8–1.0) (3.7–4.1) (0.8–1.1) (93.1–96.1)

3.4 0.9 3.9 0.9

93.6%

92.6%

94.6%

NCD risk behaviours among adults in the South-East Asia Region: Findings from STEPS and GATS | 19

MALDIVES Results for adults aged 15–64 years (including 95% CI) STEP 1: Physical activity b

Overall 45.9% 33.5% 34.3

Males 39.1% 46.1% 60.0

Females 52.4% 21.5% 21.4

Percentage with low levels of activity (defined as <600 MET–minutes per week)** Percentage with high levels of activity (defined as ≥3000 MET– minutes per week)** Median time spent in physical activity on average per day (minutes) (presented with inter–quartile range) Percentage not engaging in vigorous activity

(43.2–48.7) (30.9–36.1) (0.0–120.0) (71.4–76.3)

(35.1–43.2) (41.9–50.3) (0.0–180.0) (54.6–62.9)

(48.9–55.9) (18.7–24.4) (0.0–68.6) (85.8–90.5)

73.8%

58.8%

88.1%

STEP 2: Physical measurementsb Mean body mass index – BMI (kg/m2) Percentage who are overweight (BMI ≥25 kg/m2) Percentage who are obese (BMI ≥30 kg/m2) Average waist circumference (cm) Mean systolic blood pressure – SBP (mmHg) (including those currently on medication for raised BP) Mean diastolic blood pressure – DBP (mmHg) (including those currently on medication for raised BP) Percentage with raised BP (SBP ≥140 and/or DBP ≥90 mmHg or currently on medication for raised BP) Percentage with raised BP (SBP ≥140 and/or DBP ≥90 mmHg) excluding those on medication for raised BP (23.4–23.9) (34.6–39.6) (9.9–13.1) – (118.9–120.5) (74.9–76.1) (14.8–18.4) (13.0–16.4)

23.7

(22.8–23.6) (28.3–35.8) (6.4–10.8) (78.0–80.2) (121.6–124.0) (75.5–77.4) (16.0–22.1) (14.4–20.3)

23.2

(23.8–24.6) (38.9–45.7) (12.3–16.7) (78.0–79.9) (115.6–117.7) (73.7–75.3) (12.4–16.3) (10.3–13.9)

24.2

37.1% 11.5%

32.0% 8.6% 79.1

42.3% 14.5% 78.9

119.7 75.5

122.8 76.5

116.7 74.5

16.6% 14.7%

19.0% 17.3%

14.3% 12.1%

Summary of combined risk factors l Current daily smokers l Insufficient physical activity l Raised BP (SBP ≥ 140 and/or DBP ≥ 90 mmHg or currently on medication for raised BP) Percentage with low risk (i.e. none of the risk factors included above) Percentage with raised risk (at least three of the risk factors included above), aged 25 to 44 years old Percentage with raised risk (at least three of the risk factors included above), aged 45 to 64 years old Percentage with three or more of the above risk factors, aged 25–64 years old l Less than 5 servings of fruit and vegetables per day l Overweight (BMI ≥ 25 kg/m2)

(0.4–1.8) (30.1–38.2) (48.9–59.8) (36.2–42.9)

1.1%

(0.0–2.0) (31.3–45.0) (42.9–60.5) (36.3–47.4)

0.9%

(0.5–2.3) (25.8–34.4) (51.0–63.4) (33.5–40.8)

1.4%

34.2% 54.3% 39.5%

38.1% 51.7% 41.8%

30.1% 57.2% 37.1%

Technical Notes: a. Population for year 2015 from “UN, World Population Prospects: The 2015 Revision : https://esa.un.org/unpd/wpp/DataQuery/ (accessed on 15 August 2016); b. World Health Organization. WHO STEPS survey on risk factors for noncommunicable diseases Maldives (Malé), 2011 * Sample size was less than 50; ** Complete definitions of low and high levels of physical activity and other conditions are specified in the GPAQ Analysis Guide, available at: http://www.who.int/chp/ steps/GAPQ

20 | NCD risk behaviours among adults in the South-East Asia Region: Findings from STEPS and GATS

MYANMAR Total Populationa

53.9 million

Malesa

12.8 million

Femalesa

13.7 million

Aged 25–64 years

Tobacco use 54% Overall Current tobacco smokers

Current tobacco users (smoking or/and smokeless)

80% Males

29% Females

Current smokeless tobacco users

26%

44% 8%

43% 39% ...at home

62%

24%

Attempt to quit (among current smokers)

Exposure to second–hand smoke

28% ...at work place

44% Alcohol use Current alcohol drinkers Binge Drinkers (among current drinkers)

20%

10%

NCD risk behaviours among adults in the South-East Asia Region: Findings from STEPS and GATS | 21

MYANMAR Physical activity 61% Nutrition status 17% 126 81

Diet 88%

87%

do not consume sufficient fruits and vegetables (ate less than 5 servings on average per day)

Were not engaged in vigorous activities

Overweight or Obese

39% 124 81 HIGH BLOOD PRESSURE or currently on medication

Blood pressure Mean BLOOD PRESSURE (including those on medication) (mmHg) (mmHg)

26% have

Systolic Diastolic

(mmHg) (mmHg)

(including those currently on medication for raised cholesterol)

Mean total

Blood Cholesterol

% with raised fasting

Blood Sugar

173 (mg/dl)

184 (mg/dl)

5.9%

of women aged 30–49 years who have ever had a screening test for

Current daily smokers Less than 5 servings of fruits and vegetables per day

Cervical Cancer

20% on

Insufficient physical activity Overweight (BMI ≥ 25 kg/m2) Raised BP (SBP ≥ 140 and/or DBP ≥ 90 mmHg or currently on medication for raised BP)

raised risk

(at least 3 risk factors)

22 | NCD risk behaviours among adults in the South-East Asia Region: Findings from STEPS and GATS

MYANMAR Results for adults aged 25–64 years (including 95% CI) STEP 1: Tobacco useb Percentage who currently smoke tobacco Percentage who currently smoke tobacco daily Percentage who currently use smokeless tobacco Percentage who currently use smokeless tobacco daily Percentage of current tobacco users Mean Duration of smoking among daily smokers Percentage of current smokers who have tried to quit smoking Percentage of current smokers advised by a health care provider to quit smoking in past 12 months Percentage of adults exposed to second–hand smoke at home during the past 30 days Percentage of adults exposed to second–hand smoke in the closed areas in their workplace during the past 30 days Average age started smoking (years) for daily users Percentage of daily smokers smoking manufactured cigarettes Percentage of current smokers smoking manufactured cigarettes Mean number of manufactured cigarettes smoked per day (by smokers of manufactured cigarettes) (23.8–28.4) (18.2–23.3) (39.2–47.1) (27.0–33.6) (50.4–58.4) (22.7–25.7) (37.7–49.6) (27.0–39.9) (35.7–42.5) (20.9–34.2) (19.2–20.4) (21.6–34.5) (26.7–39.3) (1.0–2.0)

Overall

Males

Females

26.1%

(40.8–46.7) (30.5–37.5) (58.3–66.1) (40.9–48.1) (77.1–82.4) (21.7–25.0) (35.2–48.7) (23.6–36.9) (27.5–36.8) (23.5–40.1) (18.7–19.8) (26.2–40.7) (31.6–45.3) (1.3–2.4)

43.8%

(6.4–10.3) (5.6–9.3) (19.5–28.7) (12.8–19.4) (23.9–34.2) (26.4–30.0) (46.4–58.6) (39.3–56.8) (42.5–49.5) (17.5–29.6) (20.7–23.9) (1.1–5.9) (1.9–7.2) (0.0–0.2)

8.4%

20.7%

34.0%

7.4%

43.2% 30.3% 54.4% 24.2

62.2% 44.5% 79.8% 23.3

24.1% 16.1% 29.1% 28.2

43.7% 33.5% 39.1% 27.5% 19.8

42.0% 30.2% 32.1% 31.8% 19.3

52.5% 48.1% 46.0% 23.6% 22.3

28.1%

33.4%

3.5%

33.0% 1.5

38.4% 1.9

4.6% 0.1

68.8% 5.7%

(36.7–47.0) (8.0–12.0) (33.9–42.2) (17.2–23.3)

41.9% 10.0% 38.1%

(94.2–97.5) (0.8–2.2) (0.7–2.3) (0.1–0.5)

95.8% 1.5%

19.8%

1.5%

10.3%

20.3%

0.3%

NCD risk behaviours among adults in the South-East Asia Region: Findings from STEPS and GATS | 23

MYANMAR Results for adults aged 25–64 years (including 95% CI) STEP 1: Dietb Mean number of days fruit consumed in a typical week (2.2–2.7)

Overall

Males

Females

2.5 0.7 5.5 2.1

(2.0–2.6)

2.3 0.7 5.4 2.2

(2.3–2.9)

2.6 0.7 5.6 2.0

Mean number of servings of fruit consumed on average per day

(0.6–0.8)

Mean number of days vegetables consumed in a typical week

(5.2–5.8)

(5.0–5.7)

(5.4–5.8)

Mean number of servings of vegetables consumed on average per day

(1.9–2.2)

(2.0–2.4)

(1.9–2.1)

Percentage who ate less than 5 servings of fruit and/or vegetables on average per day

(84.1–89.0)

86.6%

(82.0–88.3)

85.2%

(85.8–90.1)

87.9%

STEP 1: Physical activityb Percentage with insufficient physical activity (defined as <150 minutes of moderate intensity activity per week,or equivalent) Median time spent in physical activity on average per day (minutes) (presented with inter–quartile range) Percentage not engaging in vigorous activity (12.9–18.4)

15.7% 214

(9.7–15.3)

12.5% 274

(15.8–21.9)

18.8% 177

(57–416)

(86–454)

(30–360)

(69.5–79.5)

74.5%

(54.9–67.4)

61.1%

(83.8–92.1)

87.9%

STEP 1: Cervical Cancer Screeningb Percentage of women aged 30–49 years who have ever had a screening test for cervical cancer – – (2.7–6.0)

4.4%

STEP 2: Physical measurementsb Mean body mass index – BMI (kg/m2) (22.0–22.6)

22.3

(21.2–21.8)

21.5

(22.8–23.5)

23.2

Percentage who are overweight (BMI ≥25 kg/m2)

(19.3–25.4)

22.4% 5.5%

(11.5–16.7)

14.1% 2.6% 77.3 126 81

(27.5–34.1)

30.8% 8.4% 76.9 124 81

Percentage who are obese (BMI ≥30 kg/m2)

(4.2–6.7) –

(1.8–3.5)

(6.6–10.1)

Average waist circumference (cm) Mean systolic blood pressure – SBP (mmHg), including those currently on medication for raised BP Mean diastolic blood pressure – DBP (mmHg), including those currently on medication for raised BP Percentage with raised BP (SBP ≥140 and/or DBP ≥90 mmHg or currently on medication for raised BP) Percentage with raised BP (SBP ≥140 and/or DBP ≥90 mmHg) who are not currently on medication for raised BP

(76.0–78.6)

(75.7–78.1)

(123–126)

125 81

(124–128)

(122–126)

(80–82)

(80–83)

(23.2–29.5)

26.4% 90.8%

(20.1–29.3)

24.7% 93.2%

(24.8–31.3)

28.0% 88.7%

(87.3–94.3)

(90.1–96.3)

(84.5–92.9)

24 | NCD risk behaviours among adults in the South-East Asia Region: Findings from STEPS and GATS

MYANMAR Results for adults aged 25–64 years (including 95% CI) STEP 3: Biochemical measurementsb Mean fasting blood glucose, including those currently on medication for raised blood glucose (mg/dl) Percentage with impaired fasting glycaemia (plasma equivalent value of capillary whole blood ≥6.1 mmol/L(110 mg/dl) and <7.0 mmol/L(126 mg/dl) Mean 2–hour glucose value after glucose load(mg) Percentage with impaired glucose tolerance(2–hour plasma equivalent value of capillary whole blood after glucose load ≥7.8 mmol/L(140 mg/dl) and <11.1 mmol/L(200 mg/dl) Percentage with raised fasting blood glucose (plasma equivalent glucose value of capillary whole blood ≥7.0 mmol/L (126 mg/dl) Percentage with raised fasting blood glucose or raised 2–hour blood glucose as defined below or currently on medication for raised blood glucose (raised fasting blood glucose=plasma equivalent glucose value of capillary whole blood ≥7.0 mmol/L (126 mg/dl) raised 2–hour blood glucose=plasma equivalent glucose value of capillary whole blood ≥11.1 mmol/L (200mg/dl) Mean total blood cholesterol, including those currently on medication for raised cholesterol (mg/dl) Percentage with raised total cholesterol (≥ 5.0 mmol/L or 190mg/dl or currently on medication for raised cholesterol) (90–94) (2.8–4.5) (120–130) (16.5–23.0) (4.6–7.2)

Overall

Males

Females

(89–93) (2.8–5.3) (114–124) (12.2–18.9) (3.4–6.1)

(91–95) (2.6–3.9) (126–135) (20.0–28.3) (5.5–8.5)

3.6% 125

4.0% 119

3.2% 131

19.5% 5.9%

15.2% 4.7%

23.9% 7.0%

(8.3–13.1)

10.5%

(6.9–11.8)

9.1%

(9.6–14.6)

11.8%

(175–182) (32.2–41.2)

178

(169–177) (26.5–35.4)

173

(180–188) (37.7–47.2)

184

36.7%

30.9%

42.5%

Cardiovascular disease (CVD) riskb Percentage aged 40–64 years with a 10–year CVD risk ≥ 30%, or with existing CVD** (9.9–14.3)

12.1%

(6.2–10.7)

8.5%

(13.1–18.3)

15.7%

Summary of combined risk factorsb l Current daily smokers l Insufficient physical activity l Raised BP (SBP ≥ 140 and/or DBP ≥ 90 mmHg or currently on medication for raised BP) Percentage with low risk (i.e. none of the risk factors included above) Percentage with raised risk (at least three of the risk factors included above), aged 25 to 44 years old Percentage with raised risk (at least three of the risk factors included above), aged 45 to 64 years old Percentage with three or more of the above risk factors, aged 25–64 years old l Less than 5 servings of fruit and vegetables per day l Overweight (BMI ≥ 25 kg/m2)

(4.7–7.6) (12.1–17.2) (24.3–30.8) (16.9–22.2)

6.2%

(4.6–8.6) (10.2–17.1) (20.8–30.9) (14.4–22.3)

6.6%

(4.2–7.3) (13.0–18.5) (25.3–33.7) (18.1–23.6)

5.7%

14.6% 27.5% 19.6%

13.6% 25.9% 18.3%

15.7% 29.3% 20.9%

Technical Notes: a. Population for year 2015 from “UN, World Population Prospects: The 2015 Revision : https://esa.un.org/unpd/wpp/DataQuery/ (accessed on 15 August 2016); b. Ministry of Health. Report on national survey of diabetes mellitus and risk factors for noncommunicable diseases in Myanmar (2014). * Sample size was less than 50; ** A 10–year CVD risk of >30% is defined according to age, sex, blood pressure, smoking status (current smokers OR those who quit smoking less than 1 year before the assessment), total cholesterol, and diabetes (previously diagnosed OR a fasting plasma glucose concentration >7.0mmol/l (126 mg/dl)

NCD risk behaviours among adults in the South-East Asia Region: Findings from STEPS and GATS | 25

NEPAL Total Populationa

28.5 million

Malesa

8.6 million

Femalesa

9.7 million

Aged 15–69 years

Tobacco use 31% Overall Current tobacco smokers

Current tobacco users (smoking or/and smokeless)

48% Males

14% Females

Current smokeless tobacco users

19%

27% 10%

18% 36% ...at home

31%

Attempt to quit (among current smokers)

Exposure to second–hand smoke

37% ...at work place

26% Alcohol use Current alcohol drinkers Binge Drinkers (among current drinkers)

17% 19% 3% NCD risk behaviours among adults in the South-East Asia Region: Findings from STEPS and GATS | 27

NEPAL Physical activity 44% Nutrition status 21% 131.1 (mmHg)

Diet 63%

99%

do not consume sufficient fruits and vegetables (ate less than 5 servings on average per day)

Were not engaged in vigorous activities

Overweight or Obese

22% 123.9 (mmHg)

Blood pressure Mean BLOOD PRESSURE (including those on medication)

Systolic Diastolic

81.2 (mmHg)

78.5 (mmHg)

HIGH BLOOD PRESSURE or currently on medication

26% have

(including those currently on medication for raised cholesterol)

Mean total

Blood Cholesterol

% with raised fasting

Blood Sugar

163.4 (mg/dl)

161.2 (mg/dl)

3.6%

Current daily smokers Less than 5 servings of fruits and vegetables per day Insufficient physical activity

15% on raised risk (at least 3 risk factors)

Overweight (BMI ≥ 25 kg/m2) Raised BP (SBP ≥ 140 and/or DBP ≥ 90 mmHg or currently on medication for raised BP)

28 | NCD risk behaviours among adults in the South-East Asia Region: Findings from STEPS and GATS

NEPAL Results for adults aged 15–69 years (including 95% CI) STEP 1: Tobacco useb Percentage who currently smoke tobacco (16.5–20.5)

Overall

Males

Females

18.5% 15.8% 17.8%

(23.7–30.4)

27.0% 22.2% 31.3%

(8.7–11.9)

10.3% 9.6% 4.8%

Percentage who currently smoke tobacco daily

(13.8–17.7)

(18.9–25.4)

(8.1–11.2)

Percentage who currently use smokeless tobacco

(15.8–19.8)

(27.4–35.2)

(3.7–5.9)

Percentage who currently use smokeless tobacco daily

(14.4–18.2)

16.3%

(25.0–32.0)

28.5% 48.1% 18.5

(3.5–5.5)

4.5%

Percentage who currently use tobacco in any form (smoked and/or smokeless)

(28.3–33.2)

30.8% 18.2

(43.7–52.4)

(12.3–15.9)

14.1% 17.6

Average age started smoking (years) for daily users

(17.7–18.7)

(17.8–19.1)

(16.9–18.4)

Percentage of daily smokers smoking manufactured cigarettes

(80.2–89.4)

84.8% 86.1% 6.2

(85.0–94.9)

89.9% 90.7% 6.6

(66.3–80.6)

73.5% 74.3% 5.1

Percentage of current smokers smoking manufactured cigarettes Mean number of manufactured cigarettes smoked per day (by smokers of manufactured cigarettes) Current daily tobacco users

(81.9–90.2)

(86.4–95.0)

(67.5–81.1)

(5.5–6.8)

(5.8–7.4)

(4.4–5.8)

(25.3–30.1)

27.7% 36.1% 37.2% 26.0% 22.3%

(38.5–47.0)

42.7% 37.3% 43.4% 27.4% 23.0%

(11.5–14.9)

13.2% 35.0% 31.3% 22.5% 20.5%

Percentage of adults exposed to second–hand smoke at home during the past 30 days Percentage of adults exposed to second–hand smoke in the closed areas in their workplace during the past 30 days Percentage of current smokers who tried to quit smoking in past 12 months Percentage of current smokers advised by a health care provider to quit smoking in past 12 months

(33.0–39.2)

(33.0–41.6)

(31.8–38.2)

(33.9–40.5)

(38.8–47.9)

(28.0–34.6)

(20.5–31.5)

(20.5–34.2)

(16.0–28.9)

(16.9–27.7)

(16.2–29.7)

(12.8–28.2)

STEP 1: Alcohol consumptionb Percentage who are lifetime abstainers (70.7–76.3)

73.5% 4.5%

(53.5–62.6)

58.0% 6.8%

(85.9–90.7)

88.3% 2.3% 7.1%

Percentage who are past 12 month abstainers

(3.6–5.4)

(5.2–8.5)

(1.6–3.0)

Percentage who currently drink (drank alcohol in the past 30 days) Percentage who engage in heavy episodic drinking (men who had 5 or more / women who had 4 or more drinks on any day in the past 30 days)

(15.0–19.7) –

17.4%

(24.3–31.8)

28.0%

(5.2–9.0)

(15.3–21.9)

18.6%

(2.0–3.8)

2.9%

NCD risk behaviours among adults in the South-East Asia Region: Findings from STEPS and GATS | 29

NEPAL Results for adults aged 15–69 years (including 95% CI) STEP 1: Dietb Mean number of days fruit consumed in a typical week Mean number of servings of fruit consumed on average per day Mean number of days vegetables consumed in a typical week Mean number of servings of vegetables consumed on average per day Percentage who ate less than 5 servings of fruit and/or vegetables on average per day Percentage who always or often add salt or salty sauce to their food before eating or as they are eating Percentage who always or often eat processed foods high in salt (1.8–2.1) (0.4–0.5) (4.6–4.9) (1.3–1.4) (98.4–99.4) (3.7–5.8) (9.5–13.4)

Overall

Males

Females

1.9 0.5 4.8 1.4

(1.8–2.2) (0.4–0.6) (4.6–5.0) (1.3–1.5) (98.1–99.6) (2.4–5.6) (10.6–16.6)

2.0 0.5 4.8 1.4

(1.7–2.1) (0.4–0.5) (4.6–4.9) (1.3–1.4) (98.3–99.5) (4.2–6.7) (7.4–11.4)

1.9 0.5 4.8 1.3

98.9% 4.7%

98.9% 4.0%

98.9% 5.5% 9.4%

11.5%

13.6%

STEP 1: Physical activityb Percentage with low levels of activity (defined as <600 MET–minutes per week)** Percentage with high levels of activity (defined as ≥3000 MET– minutes per week)** Median time spent in physical activity on average per day (minutes) (presented with inter–quartile range) Percentage not engaging in vigorous activity (2.6–4.3) (83.0–87.0) (143.6–360.0) (50.1–57.1)

3.5%

(3.1–5.9) (80.7–86.4) (135.0–381.4) (39.1–47.9)

4.5%

(1.8–3.0) (84.2–88.4) (150.0–360.0) (59.4–67.2)

2.4%

85.0% 240.0

83.6% 242.1

86.3% 240.0

53.6%

43.5%

63.3%

STEP 2: Physical measurementsb Mean body mass index – BMI (kg/m2) Percentage who are overweight (BMI 25.0– –29.9 kg/m2) Percentage who are obese (BMI ≥30 kg/m2) Average waist circumference (cm) Mean systolic blood pressure – SBP (mmHg), including those currently on medication for raised BP Mean diastolic blood pressure – DBP (mmHg), including those currently on medication for raised BP Percentage with raised BP (SBP ≥140 and/or DBP ≥90 mmHg or currently on medication for raised BP) Percentage with raised BP (SBP ≥140 and/or DBP ≥90 mmHg) excluding those on medication for raised BP (22.2–22.6) (15.8–19.5) (3.1–4.8) –

22.4

(22.1–22.7) (15.2–20.8) (2.0–4.3) (79.0–80.7) (129.9–132.3) (80.2–82.2) (27.7–34.5) (25.3–32.1)

22.4

(22.2–22.7) (15.4–19.2) (3.7–5.9) (76.0–77.5) (122.8–124.9) (77.8–79.1) (18.5–22.7) (16.4–20.5)

22.4

17.7% 4.0%

18.0% 3.1% 79.8

17.3% 4.8% 76.7

(126.5–128.3) (79.2–80.4) (23.5–27.9) (21.3–25.6)

127.4 79.8

131.1 81.2

123.9 78.5

25.7% 23.4%

31.1% 28.7%

20.6% 18.5%

30 | NCD risk behaviours among adults in the South-East Asia Region: Findings from STEPS and GATS

NEPAL Results for adults aged 15–69 years (including 95% CI) STEP 3: Biochemical measurementsb Mean fasting blood glucose, including those currently on medication for raised blood glucose (mg/dl) Percentage with impaired fasting glycaemia (plasma venous value ≥110 mg/dl and < 126 mg/dl) Percentage with raised fasting blood glucose (plasma venous value ≥126 mg/dl or currently on medication for raised blood glucose) Mean total blood cholesterol, including those currently on medication for raised cholesterol (mg/dl) Percentage with raised total cholesterol (≥ 190 mg/dl or currently on medication for raised cholesterol) (90.0–92.9)

Overall

Males

Females

91.5

(91.2–95.6)

93.4

(88.3–91.0)

89.7

(3.0–5.2)

4.1% 3.6%

(3.4–6.7)

5.1% 4.6%

(2.2–4.1)

3.2%

(2.9–4.4)

(3.4–5.7)

(1.9–3.6)

2.7%

(159.7–164.9)

162.3

(159.7–167.0)

163.4

(158.6–163.8)

161.2

(20.5–24.9)

22.7%

(21.3–27.7)

24.5%

(18.7–23.3)

21.0%

Summary of combined risk factorsb l Current daily smokers l Insufficient physical activity l Raised BP (SBP ≥ 140 and/or DBP ≥ 90 mmHg or currently on medication for raised BP) Percentage with low risk (i.e. none of the risk factors included above) Percentage with raised risk (at least three of the risk factors included above), aged 15 to 44 years old Percentage with raised risk (at least three of the risk factors included above), aged 45 to 69 years old Percentage with three or more of the above risk factors, aged 15–69 years old l Less than 5 servings of fruit and vegetables per day l Overweight (BMI ≥ 25 kg/m2)

(0.1–0.7)

0.4%

(0.0–0.2)

0.1%

(0.2–1.2)

0.7%

(8.2–11.5)

9.8%

(10.7–16.3)

13.5% 33.5% 19.0%

(5.0–7.6)

6.3%

(26.4–32.7)

29.5% 15.1%

(29.1–37.9)

(21.8–29.2)

25.5% 11.4%

(13.5–16.8)

(16.5–21.5)

(9.8–13.0)

Technical Notes: a. Population for year 2015 from “UN, World Population Prospects: The 2015 Revision : https://esa.un.org/unpd/wpp/DataQuery/ (accessed on 15 August 2016); b. Aryal, KK, et al Noncommunicable disease risk factors: STEPS survey Nepal 2013. Kathmandu: Nepal Health Research Council * Sample size was less than 50; ** Complete definitions of low and high levels of physical activity and other conditions are specified in the GPAQ Analysis Guide, available at: http://www.who.int/chp/ steps/GPAQ

NCD risk behaviours among adults in the South-East Asia Region: Findings from STEPS and GATS | 31

SRI LANKA Total Populationa

21.6 million

Malesa

6.7 million

Femalesa

7.2 million

Aged 18–69 years

Tobacco use 26% Overall Current tobacco smokers

Current tobacco users (smoking or/and smokeless)

46% Males

5% Females

Current smokeless tobacco users

15% 16% Attempt to quit (among current smokers)

26%

Exposure to second–hand smoke

24% ...at home

24% ...at work place

52% Alcohol use Current alcohol drinkers Binge Drinkers (among current drinkers)

18%

NCD risk behaviours among adults in the South-East Asia Region: Findings from STEPS and GATS | 33

SRI LANKA Physical activity 58% Nutrition status 25% 126.8 (mmHg)

Diet 89%

73%

do not consume sufficient fruits and vegetables (ate less than 5 servings on average per day)

Were not engaged in vigorous activities

Overweight or Obese

34% 123.4 (mmHg)

Blood pressure Mean BLOOD PRESSURE (including those on medication)

Systolic Diastolic

80.5 (mmHg)

80.4 (mmHg)

HIGH BLOOD PRESSURE or currently on medication

26% have

(including those currently on medication for raised cholesterol)

Mean total

Blood Cholesterol

% with raised fasting

Blood Sugar

146.8 (mg/dl) 25%

157.8 (mg/dl)

7.4%

Current daily smokers Less than 5 servings of fruits and vegetables per day

of women aged 30–49 years who have ever had a screening test for

Cervical Cancer

18% on

Insufficient physical activity Overweight (BMI ≥ 25 kg/m2) Raised BP (SBP ≥ 140 and/or DBP ≥ 90 mmHg or currently on medication for raised BP)

raised risk

(at least 3 risk factors)

34 | NCD risk behaviours among adults in the South-East Asia Region: Findings from STEPS and GATS

SRI LANKA Results for adults aged 18–69 years (including 95% CI) STEP 1: Tobacco useb Percentage who currently smoke tobacco Percentage who currently smoke tobacco daily Percentage who currently smoke cigarettes Percentage who currently smoke cigarettes daily Percentage who currently use smokeless tobacco Percentage who currently use smokeless tobacco daily Percentage who currently use tobacco Percentage who currently use tobacco daily Average age started smoking (years) for daily users Percentage of daily smokers smoking manufactured cigarettes Average number of cigarettes smoked per day (among daily cigarette smokers) Percentage of adults exposed to second–hand smoke at home during the past 30 days Percentage of adults exposed to second–hand smoke in the closed areas in their workplace during the past 30 days Percentage of current smokers who have tried to quit smoking Percentage of current smokers advised by a health care provider to quit smoking in past 12 months 15.0% (13.6–16.4) 10.2% (9.1–11.3) 15.7% (13.7–17.6) 7.9% (6.9–9.0) 15.8% (14.3–17.4) 11.7% (10.4–12.9) 25.8% (24.1–27.6) 20.0% (18.5–21.5) 20.6 (20.1–21.1) 82.4% (78.6–86.2) 5.1 (4.3–5.9) 23.5% (21.5–25.5) 24.1% (21.4–26.8) 51.8% (46.9–56.7) 35.0% (30.0–40.1) 29.4% (26.8–31.9) 19.9% (17.8–22.0) 24.5% (22.0–27.1) 12.4% (11.1–13.7) 26.0% (23.3–28.8) 18.9% (16.7–21.2) 45.7% (42.7–48.6) 35.3% (32.6–38.0) 20.5 (20.0–20.9) 82.9% (79.1–86.7) 5.1 (4.3–5.9) 25.2% (22.5–28.0) 36.1% (32.2–39.9) 51.8% (46.9–56.8) 35.2% (30.1–40.2) * * * * 5.3% (4.3–6.3) 4.1% (3.3–5.0) 5.3% (4.3–6.3) 4.1% (3.3–5.0) * * * 21.6% (19.3–23.9) 11.1% (8.7–13.6) * *

Overall

Males

Females

STEP 1: Alcohol consumptionb Percentage who are lifetime abstainers Percentage who are past 12 month abstainers Percentage who currently drink (drank alcohol in the past 30 days) Percentage who engage in heavy episodic drinking (6 or more drinks on any day in the past 30 days) 67.9% (66.0–69.8) 5.8% (4.6–6.8) 17.9% (16.5–19.4) 8.6% (7.4–9.7) 40.2% (37.0–43.4) 9.7% (7.9–11.4) 34.8% (32.0–37.6) 16.8% (14.5–19.0) 96.5% (95.5–97.4) 1.8% (1.2–2.3) 0.5% (0.2–0.8) *

NCD risk behaviours among adults in the South-East Asia Region: Findings from STEPS and GATS | 35

SRI LANKA Results for adults aged 18–69 years (including 95% CI) STEP 1: Dietb Mean number of days fruit consumed Mean number of servings of fruit consumed on average per day Mean number of days vegetables consumed Mean number of servings of vegetables consumed on average per day Percentage who ate less than 5 servings of fruit and/or vegetables on average per day Percentage who always or often add salt or salty sauce to their food before eating or as they are eating Percentage who always or often eat processed foods high in salt 3.6 (3.5–3.7) 1.3 (1.2–1.4) 6.6 (6.5–6.6) 3.0 (2.8–3.2) 72.5% (69.7–75.4) 21.8% (18.7–25.0) 26.6% (23.9–29.3) 3.5 (3.4–3.6) 1.3 (1.2–1.5) 6.5 (6.5–6.6) 3.0 (2.8–3.2) 73.1% (69.7–76.5) 21.8% (18.3–25.4) 28.3% (25.0–31.7) 3.8 (3.7–3.9) 1.3 (1.2–1.4) 6.6 (6.6–6.7) 3.1 (2.9–3.3) 72.0% (68.8–75.1) 21.8% (18.3–25.2) 24.8% (21.9–27.6)

Overall

Males

Females

STEP 1: Physical activityb Percentage with low levels of activity (defined as <150 minutes of moderate–intensity activity per week,or equivalent)** Median time spent in physical activity on average per day (minutes) (presented with inter–quartile range) Percentage not engaging in vigorous activity 30.4% (27.9–32.8) 77.1 (12.8–240.0) 73.6% (71.6–75.6) 22.5% (19.4–25.6) 124.3 (25.71–336.4) 58.3% (55.1–61.5) 38.4% (35.5–41.4) 42.8 (4.3–150.0) 89.2% (87.5–90.8)

STEP 1: Cervical cancer screeningb Percentage of women aged 30–49 years who have ever had a screening test for cervical cancer – – 24.5% (21.8–27.3)

STEP 2: Physical measurementsb Mean body mass index – BMI (kg/m2) Percentage who are overweight (BMI 25.0–29.9 kg/m2) Percentage who are obese (BMI ≥30 kg/m2) Average waist circumference (cm) Mean systolic blood pressure – SBP (mmHg), including those currently on medication for raised BP Mean diastolic blood pressure – DBP (mmHg), including those currently on medication for raised BP Percentage with raised BP (SBP ≥140 and/or DBP ≥90 mmHg or currently on medication for raised BP) Percentage with raised BP (SBP ≥140 and/or DBP ≥90 mmHg) excluding those on medication for raised BP 22.9 (22.7–23.1) 23.4% (21.9–24.9) 5.9% (5.1–6.7) – 125.1 (124.4–125.8) 80.5 (80.0–81.0) 26.1% (24.4–27.7) 21.0% (19.5–22.6) 22.4 (22.2–22.7) 21.0% (18.7–23.3) 3.5% (2.5–4.5) 82.3 (81.5–83.2) 126.8 (125.9–127.7) 80.5 (79.8–81.1) 25.4% (23.0–27.9) 21.9% (19.5–24.2) 23.5 (23.2–23.7) 26.0% (24.1–27.8) 8.4% (7.2–9.6) 82.1 (81.3–82.9) 123.4 (122.4–124.4) 80.4 (79.8–81.1) 26.7% (24.7–28.6) 20.2% (18.3–22.0)

36 | NCD risk behaviours among adults in the South-East Asia Region: Findings from STEPS and GATS

SRI LANKA Results for adults aged 18–69 years (including 95% CI) STEP 3: Biochemical measurementsb Mean fasting blood glucose, including those currently on medication for raised blood glucose (mg/dl) Percentage with impaired fasting glycaemia (plasma venous value ≥110 mg/dl and < 126 mg/dl) Percentage with raised fasting blood glucose (plasma venous value ≥126 mg/dl or currently on medication for raised blood glucose) Mean total blood cholesterol, including those currently on medication for raised cholesterol (mg/dl) Percentage with raised total cholesterol (≥ 190 mg/dl or currently on medication for raised cholesterol) 81.6 (79.8–83.5) 3.8% (3.1–4.5) 7.4% (6.4–8.5) 152.2 (149.5–154.9) 23.7% (21.7–25.7) 81.9 (79.6–84.2) 4.4% (3.2–5.5) 7.3% (5.9–8.7) 146.8 (143.6–150.0) 19.1% (16.5–21.6) 81.4 (79.3–83.5) 3.2% (2.4–4.0) 7.6% (6.4–8.8) 157.8 (154.7–160.9) 28.4% (26.0–30.9)

Overall

Males

Females

Cardiovascular disease (CVD) riskb Percentage aged 40–69 years with a 10–year CVD risk ≥ 30%, or with existing CVD*** 9.1% (7.8–10.4) 8.9% (6.9–10.9) 9.3% (7.6–11.1)

Summary of combined risk factorsb l Current daily smokers l Insufficient physical activity l Raised BP (SBP ≥ 140 and/or DBP ≥ 90 mmHg or currently on medication for raised BP) Percentage with low risk (i.e. none of the risk factors included above) Percentage with raised risk (at least three of the risk factors included above), aged 18 to 44 years old Percentage with raised risk (at least three of the risk factors included above), aged 45 to 69 years old Percentage with three or more of the above risk factors, aged 18–69 years old l Less than 5 servings of fruit and vegetables per day l Overweight (BMI ≥ 25 kg/m2) 8.2% (6.8–9.6) 12.5% (10.9–14.1) 27.8% (25.5–30.0) 18.3% (16.8–19.7) 7.6% (5.9–9.4) 12.1% (9.6–14.5) 24.0% (20.8–27.2) 16.4% (14.3–18.5) 8.8% (7.1–10.5) 13.0% (10.9–15.0) 31.4% (28.5–34.3) 20.2% (18.4–22.1)

Technical Notes: a. Population for year 2015 from United Nations. World population prospects: the 2012 revision. New York: Population Division, Department of Economics and Social Affairs, 2015; b. STEPS survey Sri Lanka 2015, Noncommunicable disease risk factor survey Sri Lanka 2015 * Sample size was less than 50; ** Complete definitions of low and high levels of physical activity and other conditions are specified in the GPAQ Analysis Guide, available at: http://www.who.int/chp/ steps/GPAQ; *** A 10–year CVD risk of >30% is defined according to age, sex, blood pressure, smoking status (current smokers OR those who quit smoking less than 1 year before the assessment), total cholesterol, and diabetes (previously diagnosed OR a fasting plasma glucose concentration >7.0mmol/l (126 mg/dl)

NCD risk behaviours among adults in the South-East Asia Region: Findings from STEPS and GATS | 37

THAILAND Total Populationa

68 million

Malesa

27.3 million

Femalesa Aged 15+ years

28.6 million

Aged 15+ years

Tobacco use Overall

Current tobacco users (smoking or/and smokeless)

27%

47% Males

8% Females

Current tobacco smokers

Current smokeless tobacco users

24% 47% 3% 36% ...at home

Exposure to second–hand smoke

31% ...at work place

Attempt to quit (among current smokers)

Advised by healthcare provider to quit smoking (among current smokers)

37%

56%

NCD risk behaviours among adults in the South-East Asia Region: Findings from STEPS and GATS | 39

THAILAND Results for adults aged 15+ years (including 95% CI) Tobacco useb Percentage who currently smoke tobacco Percentage who currently smoke tobacco daily Current cigarette smokers (among current tobacco smokers) Percentage who currently use smokeless tobacco Percentage who currently use smokeless tobacco daily Percentage who currently use tobacco in any form (smoked and/or smokeless) Average age started smoking (years) for daily users Percentage of current smokers smoking manufactured cigarettes Mean number of manufactured cigarettes smoked per day (by smokers of manufactured cigarettes) Percentage of adults exposed to second–hand smoke at home during the past 30 days Percentage of adults exposed to second–hand smoke in the closed areas in their workplace during the past 30 days Percentage of current smokers who tried to stop smoking in past 12 months Percentage of current smokers advised by a health care provider to stop smoking in past 12 months (22.8–25.1) (20.4–22.6) (14.3–16.2) (2.8–3.7) (2.5–3.4) (25.7–28.1) (17.1–17.7) (14.3–16.2) (12.0–12.9) (34.3–37.7) (28.1–32.9) (34.0–39.4) (52.0–59.5)

Overall 24.0% 21.5% 15.2% 3.2% 2.9%

Males 46.6% 42.0% 30.1% 1.1% 0.7%

Females 2.6% 2.1% 1.1% 5.2% 5.0% 7.6% 19.0

(44.7–48.4) (40.2–43.9) (28.4–31.9) (0.8–1.5) (0.5–1.0) (45.3–49.1) (17.0–17.7) (28.4–31.9) (12.2–13.1) (37.7–42.1) (33.9–40.3) (33.7–39.3) (51.9–59.9)

(2.2–3.1) (1.8–2.5) (0.9–1.4) (4.5–6.1) (4.3–5.8) (6.8–8.6) (17.7–20.2) (0.9–1.4) (8.2–10.4) (30.5–34.2) (20.4–25.5) (32.4–46.9) (44.6–64.0)

26.9% 17.4

47.2% 17.3

15.2% 12.5

30.1% 12.6

1.1% 9.3

36.0% 30.5% 36.7% 55.8%

39.9% 37.1% 36.5% 55.9%

32.3% 22.8% 39.4% 54.5%

40 | NCD risk behaviours among adults in the South-East Asia Region: Findings from STEPS and GATS

TIMOR-LESTE Total Populationa

1173 thousand

Malesa

267 thousand

Femalesa

258 thousand

Aged 18–69 years

Tobacco use 56% Overall Current tobacco smokers

Current tobacco users (smoking or/and smokeless)

71% Males

29% Females

Current smokeless tobacco users

49%

70% 10%

20% 92% ...at home

16%

27%

Attempt to quit (among current smokers)

Exposure to second–hand smoke

51% ...at work place

23% Alcohol use Current alcohol drinkers Binge Drinkers (among current drinkers)

29%

15%

NCD risk behaviours among adults in the South-East Asia Region: Findings from STEPS and GATS | 41

TIMOR-LESTE Physical activity 40% Nutrition status 9% 133.1 (mmHg)

Diet 73%

78%

do not consume sufficient fruits and vegetables (ate less than 5 servings on average per day)

Were not engaged in vigorous activities

Overweight or Obese

16% 121.4 (mmHg)

Blood pressure Mean BLOOD PRESSURE (including those on medication)

Systolic Diastolic

83.5 (mmHg)

82.4 (mmHg)

HIGH BLOOD PRESSURE or currently on treatment

39% have

(including those currently on medication for raised cholesterol)

Mean total

Blood Cholesterol

% with raised fasting

Blood Sugar

143.7 (mg/dl)

160.7 (mg/dl)

1.5%

of women aged 30–49 years who have ever had a screening test for

Current daily smokers Less than 5 servings of fruits and vegetables per day

Cervical Cancer

19% on

Insufficient physical activity Overweight (BMI ≥ 25 kg/m2) Raised BP (SBP ≥ 140 and/or DBP ≥ 90 mmHg or currently on medication for raised BP)

raised risk

(at least 3 risk factors)

42 | NCD risk behaviours among adults in the South-East Asia Region: Findings from STEPS and GATS

TIMOR-LESTE Results for adults aged 18–69 years (including 95% CI) STEP 1: Tobacco useb Percentage who currently smoke tobacco 48.6% (38.4–58.7) 35.0% (29.8–40.3) 94.8% (88.0–100.0) 19.8% (16.3–23.4) 13.8% (10.4–17.2) 56.1% (53.3–58.8) 37.9% (35.4–40.4) 16.4 (15.2–17.6) 94.5% (87.7–100.0) 12.1 (8.6–15.7) 92.1% (83.6–100.0) 51.0% (33.8–68.2) 23.0% (13.1–33.0) 22.5% (7.6–37.4) 69.5% (67.0–72.0) 49.6% (46.3–53.0) 95.2% (88.9–100.0) 16.1% (14.0–18.2) 14.0% (9.6–18.4) 70.6% (68.9–72.4) 50.1% (46.2–54.1) 16.3 (15.3–17.3) 94.6% (88.0–100.0) 12.9 (8.9–17.0) 94.6% (87.8–100.0) 38.9% (13.9–63.9) 19.1% (7.3–31.0) 22.4% (8.7–36.1) 9.6% (5.8–13.4) 7.8% (2.8–12.8) 89.3% (76.4–100.0) 26.8% (17.9–35.6) 13.4% (11.4–15.4) 28.9% (18.6–39.2) 15.1% (13.3–16.9) 17.6 (13.8–21.5) 93.0% (82.5–100.0) 2.9 (1.6–4.2) 87.4% (78.3–96.5) 74.4% (62.6–86.2) 75.2% (47.3–100.0) 23.3% (0.0–51.8)

Overall

Males

Females

Percentage who currently smoke tobacco daily

Current cigarette smokers (among current tobacco smokers)

Percentage who currently use smokeless tobacco

Percentage who currently use smokeless tobacco daily

Percentage who currently use tobacco in any form (smoked and/or smokeless)

Current daily tobacco users

Average age started smoking (years) for daily users

Percentage of daily smokers smoking manufactured cigarettes

Mean number of manufactured cigarettes smoked per day (by smokers of manufactured cigarettes)

STEP 1: Alcohol consumptionb Percentage who are lifetime abstainers 57.7% (53.7–61.8) 5.5% (4.8–6.1) 28.6% (20.3–36.9) 14.5% (12.7–16.4) 39.4% (37.2–41.6) 6.9% (6.2–7.6) 42.8% (37.1–48.6) 21.8% (20.1–23.4) 92.1% (86.3–97.9) 2.8% (0.6–5.1) 2.0% (0.5–3.6) 1.0% (0.1–1.9)

Percentage who are past 12 month abstainers

Percentage who currently drink (drank alcohol in the past 30 days) Percentage who engage in heavy episodic drinking (6 or more drinks on any day in the past 30 days)

NCD risk behaviours among adults in the South-East Asia Region: Findings from STEPS and GATS | 43

TIMOR-LESTE Results for adults aged 18–69 years (including 95% CI) STEP 1: Dietb Mean number of days fruit consumed in a typical week Mean number of servings of fruit consumed on average per day Mean number of days vegetables consumed in a typical week Mean number of servings of vegetables consumed on average per day Percentage who ate less than 5 servings of fruit and/or vegetables on average per day Percentage who always or often add salt or salty sauce to their food before eating or as they are eating Percentage who always or often eat processed foods high in salt 2.3 (1.8–2.8) 0.9 (0.6–1.2) 6.7 (6.3–7.0) 5.0 (3.1–7.0) 77.5% (73.0–82.0) 78.0% (70.2–85.8) 12.9% (10.9–14.8) 2.2 (1.9–2.5) 1.0 (0.7–1.2) 6.7 (6.3–7.1) 6.3 (3.8–8.9) 70.7% (64.1–77.4) 74.7% (67.0–82.5) 15.8% (12.2–19.4) 2.6 (1.5–3.7) 0.9 (0.5–1.2) 6.6 (6.3–6.9) 2.8 (2.5–3.0) 90.4% (82.9–97.8) 84.1% (79.2–89.0) 7.3% (1.8–12.9)

Overall

Males

Females

STEP 1: Physical activityb Percentage with insuffiicent physical activity (defined as<150 minutes of moderate–intensity activity per week,or equivalent) Median time spent in physical activity on average per day (minutes) (presented with inter–quartile range) Percentage not engaging in vigorous activity 16.7% (7.8–25.6) 85.7 (34.3–199.3) 52.4% (50.6–54.1) 12.8% (7.6–18.0) 154.3 (34.3–248.6) 39.9% (38.0–41.9) 23.3% (10.9–35.7) 47.1 (21.4–102.9) 73.3% (64.0–82.6)

STEP 1: Violence and injuryb Percentage of respondents who have been involved in a road traffic crash during the past 12 months Percentage of respondents seriously injured as a result of road traffic crash among those involved in a road traffic crash in the past 12 months Percentage of respondents injured in a non–road traffic related accident that required medical attention in the past 12 months Percentage of respondents who were seriously injured other than road traffic crashes (due to fall) in the past 12 months Percentage of respondents who have driven a motorized vehicle after having had 2 or more alcoholic drinks in the past 30 days Percentage of respondents who rode in a motorized vehicle where the driver has had 2 or more alcoholic drinks in the past 30 days Percentage of respondents involved in a violent incident during the past 12 months resulting in an injury 3.0 (0.0–6.3) 49.6 (36.2–62.9) 2.5 (0.0–5.3) 62.5 (50.9–74.2) 9.6 (8.2–11.0) 7.5 (5.2–9.7) 1.0 (0.0–2.1) 3.6 (0.0–8.3) 46.9 (31.0–62.8) 2.4 (0.0–5.4) 72.3 (55.8–88.8) 14.8 (12.6–16.9) 12.5 (9.4–15.7) 1.1 (0.0–2.7) 1.9 (0.4–3.4) 59.0 (40.6–77.5) 2.8 (0.6–5.1) 47.1 (32.9–61.2) 2.5 (0.0–5.1) 0.5 (0.0–1.2) 0.7 (0.0–1.5)

STEP 1: Cervical cancer screeningb Percentage of women aged 30–49 years who have ever had a screening test for cervical cancer – – 1.1% (0.0–2.3)

STEP 2: Physical measurementsb Mean body mass index – BMI (kg/m2) Percentage who are overweight (BMI 25.0–29.9 kg/m2) 21.2 (21.0–21.5) 10.3% (8.8–11.9) 21.3 (20.9–21.8) 7.5% (6.4–8.6) 21.0 (20.7–21.3) 15.4% (10.2–20.6)

44 | NCD risk behaviours among adults in the South-East Asia Region: Findings from STEPS and GATS

TIMOR-LESTE Results for adults aged 18–69 years (including 95% CI) Percentage who are obese (BMI ≥30 kg/m2) Average waist circumference (cm) Mean systolic blood pressure – SBP (mmHg), including those currently on medication for raised BP Mean diastolic blood pressure – DBP (mmHg), including those currently on medication for raised BP Percentage with raised BP (SBP ≥140 and/or DBP ≥90 mmHg or currently on medication for raised BP) Percentage with raised BP (SBP ≥140 and/or DBP ≥90 mmHg) excluding those on medication for raised BP

Overall 0.9% (0.0–1.8) – 129.0 (123.7–134.4) 83.1 (80.4–85.8) 39.3% (23.2–55.4) 38.6% (21.7–55.6)

Males 0.7% (0.0–1.5) 71.3 (68.0–74.7) 133.1 (126.9–139.2) 83.5 (80.7–86.2) 45.3% (27.3–63.3) 44.8% (26.1–63.6)

Females 1.3% (0.2–2.4) 77.4 (75.7–79.0) 121.4 (120.7–122.2) 82.4 (80.1–84.7) 28.0% (21.5–34.5) 26.9% (19.6–34.3)

STEP 3: Biochemical measurementsb Mean fasting blood glucose, including those currently on medication for raised blood glucose (mg/dl) Percentage with impaired fasting glycaemia (capillary whole blood value ≥5.6mmol/L(100mg/dl) and <6.1mmol/L (110mg/dl) Percentage with raised fasting blood glucose (capillary whole blood value ≥6.1 mmol/L (110 mg/dl) or currently on medication for raised blood glucose) Mean total blood cholesterol, including those currently on medication for raised cholesterol (mg/dl) Percentage with raised total cholesterol (≥ 5.0mmol/L or ≥190mg/dl or currently on medication for raised cholesterol) 77.6 (75.8–79.4) 4.1% (2.2–6.1) 1.5% (0.0–3.2) 149.9 (144.7–155.1) 21.0% (11.4–30.6) 79.7 (76.7–82.6) 5.7% (3.0–8.5) 1.5% (0.0–3.5) 143.7 (139.7–147.8) 18.5% (9.8–27.2) 74.0 (71.4–76.6) 1.2% (0.2–2.2) 1.6% (0.3–2.9) 160.7 (147.7–173.7) 25.5% (12.0–39.0)

Cardiovascular disease (CVD) riskb Percentage aged 40–69 years with a 10–year CVD risk ≥ 30%, or with existing CVD** 1.4% (0.0–2.9) 0.9% (0.0–2.2) 2.9% (1.5–4.1)

Summary of combined risk factorsb l Current daily smokers l Insufficient physical activity l Raised BP (SBP ≥ 140 and/or DBP ≥ 90 mmHg or currently on medication for raised BP) Percentage with low risk (i.e. none of the risk factors included above) Percentage with raised risk (at least three of the risk factors included above), aged 18 to 44 years old Percentage with raised risk (at least three of the risk factors included above), aged 45 to 69 years old Percentage with three or more of the above risk factors, aged 18–69 years old l Less than 5 servings of fruit and vegetables per day l Overweight (BMI ≥ 25 kg/m2)

7.8% (6.4–9.3) 16.3% (13.5–19.1) 28.2% (22.8–33.5) 19.4% (16.1–22.7)

10.1% (6.7–13.4) 16.0% (14.2–17.8) 32.0% (29.6–34.3) 21.1% (19.0–23.3)

4.2% (0.6–7.9) 16.7% (11.3–22.1) 16.1% (12.1–20.1) 16.6% (12.0–21.3)

Technical Notes: a. Population for year 2015 from United Nations. World population prospects: the 2012 revision. New York: Population Division, Department of Economics and Social Affairs, 2015; b. World Health Organization, Regional Office for South East Asia. National survey for noncommunicable disease risk factors and injuries using WHO STEPS approach in Timor–Leste 2014 * Sample size was less than 50; ** A 10–year CVD risk of >30% is defined according to age, sex, blood pressure, smoking status (current smokers OR those who quit smoking less than 1 year before the assessment), total cholesterol, and diabetes (previously diagnosed OR a fasting plasma glucose concentration >7.0mmol/l (126 mg/dl)

NCD risk behaviours among adults in the South-East Asia Region: Findings from STEPS and GATS | 45

This publication, entitled 'NCD risk behaviours among adults in the South-East Asia Region: Findings from STEPS and GATS', conveys the most recent quantitative surveillance results focusing on noncommunicable disease (NCDs)-related risk behaviours among adults from the WHO STEPwise approach to NCD risk factor surveillance (STEPS) and tobacco use among adults from the Global Adult Tobacco Survey (GATS) in Member States of the WHO South-East Asia Region. This publication contains selected indicators relating to tobacco use and other related risk behaviours of adults in Member States of the WHO South-East Asia Region. The tobacco indicators are taken from GATS or STEPS and other indicators relating to risk behaviours (history– dietary behaviours, physical activity, alcohol use, cervical cancer screening; physical measurements – body mass index, blood pressure, waist circumference; biochemical measurements – fasting blood glucose level, blood glucose level 2 hours after glucose load, total blood cholesterol, urine sodium and urine creatinine) are taken from STEPS. The latest ﬁndings from surveys conducted in Member States are presented in the publication.

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Informations clés

Organisation Organisation mondiale de la santé (OMS)

Type de document Publications

Date d'adoption 1 août 2016

Source Organisation mondiale de la santé