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Mongolian STEPS survey on the prevalence of noncommunicable disease risk factors 2009

31 décembre 2010 Organisation mondiale de la santé

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MONGOLIAN STEPS SURVEY ON THE PREVALENCE OF NONCOMMUNICABLE DISEASE AND INJURY RISK FACTORS - 2009

WHO Library Cataloguing in Publication Data MONGOLIAN STEPS SURVEY ON THE PREVALENCE OF NONCOMMUNICABLE DISEASE AND INJURY RISK FACTORS-2009 1. Noncommunicable diseases 2. Poverty 3. Developing countries  World Health Organization 2010 All rights reserved The designations employed and the presentation of the material in this publications do not imply the expression of any opinion whatsoever on the World Health Organization concerning the legal status of any country, territory, city or area or of 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 manufactures’ products does not imply that they area endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions expected, the names of proprietary products are distinguished by initial capital letters. The World Health Organization can be obtained from Marketing and Dissemination, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel:+41 22 791 2476; fax: +41 22 791 4857; email: bookorders@who.int) Requests for permission to reproduce WHO publications, in part or in whole, or to translate them-whether for sale or for noncommercial distribution –should be addressed to Publications, at the above address (fax: +41 22 791 4806; email:permissions@who.int). For WHO Western Pacific Regional Publications, request for permission to reproduce should by addressed to Publications Office, World Health Organization, Regional Office for the Western Pacific, P.O.Box 2932, 1000, Manila, Philippines, Fax.No.(632)521-1036, email:publications@wpro.who.int

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

CONTENT 1. TABLES 2. FIGURES 3. GLOSSARY 4. FOREWORD 5. EXECUTIVE SUMMARY CHAPTER 1. RATIONALE o Noncommunicable diseases worldwide and in Mongolia o Prevalence of common modifiable risk factors for NCDs o Survey goal, objectives and importance of the survey 4 6 7 8 15 21 22 23 24 25 26 26 28 29 34 34 34 34 35 36 39 39 42 46 52 55 57 57 60 65 70 73 76 79 79 84 90 90 91 99 100 101 103 Content

CHAPTER 2. SURVEY METHODOLOGY o Survey scope o Survey population and sampling o Training of field researchers in survey methodology o Data collection process o Monitoring of data collection o Data entry and cleaning o Weighting of data o Data analysis

CHAPTER 3. SURVEY RESULTS 3.1 Demographic indicators 3.2 Prevalence of common modifiable risk factors for NCDs o Tobacco use o Alcohol consumption o Fruit and vegetable consumption o Physical activity o Body development and physical fitness 3.3 Prevalence of intermediate risk factors for NCDs o Overweight and obesity o Prevalence central obesity and body fat o Biochemical risk factors for NCDs o Hypertension o Diabetes o Breast and cervical cancer 3.4 Injury and violence o Injury o Violence 3.5 Results of comparative study o Trends in prevalence of common modifiable risk factors for NCDs o Trends in prevalence of intermediate risk factors for NCDs CHAPTER 4. CONCLUSIONS General conclusion REFERENCE ANNEXES

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

TABLES Table 1. Number of urban and rural clusters Table 2. Selected clusters and survey population Table 3. Standard drinks guide Table 4. Level of risk associated with alcohol consumption, by gender Table 5. Reference values for body fat percent Table 6. Category for fitness test assessment Table 7. Biochemical indicators (WHO, 2005) Table 8. Age group and sex of respondents Table 9. Survey sample (ethnicity, settings) Table 10. Mean number of years of education Table 11. Average annual income per adult person (by age) Table 12. Employment status Table 13. Unpaid work and unemployed (by age and gender) Table 14. Percentage of current smokers (by age and gender) Table 15. Smoking status Table 16. Mean age started smoking Table 17. Alcohol consumption status, by age Table 18. Alcohol consumption status, by sex Table 19. Mean number of standard drinks per drinking occasion among current (past 30 days) drinkers Table 20. Category II, III drinking among all respondents, by gender Table 21. Category I, II and III drinking among current (past 30 days) drinkers, by gender Table 22. Five/four or more drinks on a single occasion at least once during the past 30 days among total population Table 23. Mean number of days fruit consumed in a typical week (by gender and locality) Table 24. Mean number of servings of fruit on average per day (by gender and locality) Table 25. Mean number of days vegetables consumed in a typical week (by gender and locality) Table 26. Mean number of servings of vegetables on average per day (by gender and locality) Table 27. Mean number of servings of fruit and/or vegetables on average per day (by gender and locality) Table 28. Number of servings of fruit and/or vegetables on average per day Table 29. Number of servings of fruit and/or vegetables on average per day by locality Table 30. Mean height (cm) Table 31. Mean body weight and height (by locality) Table 32. Mean BMI (kg/m2), by age and gender Table 33. Mean BMI (kg/m2), by locality Table 34. BMI classifications (by gender and locality) Table 35. Mean waist circumference (cm), by gender and age group Table 36. Mean waist circumference (cm), by locality Table 37. Prevalence of central obesity (by age and gender) Table 38. Prevalence of central obesity (by locality) Table 39. Mean body fat % (by age and gender) Table 40. Mean body fat % (by locality) Table 41. Proportion of population with increased body fat, by stratum Table 42. Mean total cholesterol (mmol/L) 27 29 30 30 32 33 33 36 36 37 37 38 38 39 39 40 42 42 43 44 44 44 46 46 47 47 48 49 49 57 57 58 58 60 60 61 61 61 62 62 64 65

Table

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Table 43. Total cholesterol ≥ 5.0 mmol/L or ≥ 190 mg/dl or currently on medication for raised cholesterol Table 44. Percentage with total cholesterol ≥ 6.2 mmol/L or ≥ 240 mg/dl or currently on medication for raised cholesterol Table 45. Mean fasting triglycerides (mmol/L) Table 46. Percentage of respondents with fasting triglycerides ≥ 1.7 mmol/L or ≥ 150 mg/dl Table 47. Percentage of respondents with fasting triglycerides ≥ 2.0 mmol/L or ≥ 180 mg/dl Table 48. Mean blood LDL (mmol/L) cholesterol Table 49. Proportion of population with or at risk of increased blood LDL (≥ 3.0 mmol/L) Table 50. Proportion of population with increased LDL (≥ 4.15 mmol/L) Table 51. Mean blood HDL (mmol/L) cholesterol Table 52. Proportion of population with decreased LDL (mmol/L) Table 53. Mean blood pressure (by gender and locality) Table 54. Percentage with SBP ≥140 and/or DBP ≥ 90 mmHg or currently on medication for raised blood pressure Table 55. Percentage with SBP ≥140 and/or DBP ≥ 90 mmHg or currently on medication for raised blood pressure (by gender and locality) Table 56. Respondents with treated and/or controlled raised blood pressure Table 57. Mean fasting blood glucose (mmol/L), by age and gender Table 58. Mean fasting blood glucose (mmol/L), by locality Table 59. Impaired Fasting Glycaemia (by age group) Table 60. Impaired Fasting Glycaemia (by gender and locality) Table 61. Raised blood glucose or currently on medication for diabetes (by age group) Table 62. Raised blood glucose or currently on medication for diabetes (by gender and locality) Table 63. Percentage who have had a VIA test and PAP SMEAR test ( by age ) Table 64. Cervical cancer screening (by locality) Table 65. Percentage who have had a breast palpation by health care provider, Percentage who have had a mammogram only, Performed self breast exam ( by age ) Table 66. Breast cancer screening (by locality ) Table 67. Self-reported injuries other than traffic (by age and gender) Table 68. Traffic injury ( by age, gender and locality) Table 69. Traffic injuries ( by locality and risk factors) Table 70. Proportion not using seatbelts (by age and gender) Table 71. Violence against women Table 72. Frequency of abuse Table 73. Persentage worrying about their personal and family security because of someone’s anger Table 74. Percentage being abused as child

65 66 66 66 67 67 67 68 68 68 70 70 71 72 73 73 74 74 74 75 76 76

77 77 79 80 81 82 85 86 86 87

Table

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

FIGURES Figure 1. Survey frame, selected clusters Figure 2. Multi-stage cluster sampling units Figure 3. Frequency of smoking Figure 4. Frequency of alcohol consumption in the past 12 months Figure 5. Daily servings of fruits and vegetables Figure 6. Daily servings of fruits and vegetables, by locality Figure 7. Fat intake (by locality) Figure 8. Proportion of population engaged in high levels of physical activity, by age and gender Figure 9. Median duration of daily vigorous activity (by gender, urban/rural and type of setting) Figure 10. Physical fitness (by gender) Figure 11. Physical fitness, males (by age group) Figure 12. Physical fitness, by age group Figure 13. Prevalence of overweight and obesity (by gender) Figure 14. Prevalence of overweight and obesity, by age and gender Figure 15. Proportion with increased body fat content, by age and gender Figure 16. Proportion of population with increased body fat, by age and gender Figure 17. Respondents with treated and/or controlled raised blood pressure Figure 18. Percentage of respondents who were seriously injured other than road traffic crashes8 by age group (N=358) Figure 19. Location of accidental serious injuries among respondents seriously injured, by age group (N=358) Figure 20. Cause of crash among those respondents involved road traffic crash, by age group (N=191) Figure 21. Proportion not using seatbelts (by locality and gender) Figure 22. Prevalence of violence (by age and gender) Figure 23. Use of weapons in violent act Figure 24. Abusers reported by 15-24 year-olds Figure 25. Frequency of child abuse Figure 26. Preferred point of contact, by locality 26 28 40 43 49 50 50 52 54 55 55 56 59 59 63 63 71 79 79 80 81 82 84 84 85 87 88

Figure

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

GLOSSARY

BMI BP DM DBP Dept. PHCPIC Dept. SPP Dept. IME IFG MNMRI MOH NRC RPCMB MCA-M MSc NCD PHI SBP PDA WPRO WC GPD

- Body Mass Index - Blood pressure - Diabetes Mellitus - Diastolic Blood Pressure - Department of Public Health Care Policy Implementation and Coordination of MOH - Department of Strategic Policy Planning of MOH - Department of Information, Monitoring and Evaluation of MOH - Impaired fasting glucose - Mongolian National Medical Research Institute - Ministry of Health - Nutrition Research Center of Public Health Institute - Research and Production Center of Medical Biotechnology in Public Health Institute - Millennium Challenge Account, Mongolia - Master of Health Sciences - Non-communicable diseases - Public Health Institute - Systolic Blood Pressure - Personal Digital Assistant: a handheld PC - Western Pacific Regional Office of WHO - Waist Circumference - General Police Department

Glossary

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

FOREWORD

The National NCD Prevention and Control Programme was adopted in 2005 by the Government of Mongolia and it is being implemented in two phases toward 2013. With the technical assistance of the World Health Organization, the first NCD STEPS survey was conducted in 2005, aimed to establish baseline indicators of the National Programme and of the NCD surveillance system in Mongolia. National Public Health Institute of the Ministry of Health has successfully carried out Mongolian STEPS Survey on the Prevalence of Noncommunicable Diseases and Injury Risk Factors for the second time. The primary objective of the current survey was to provide up-to-date information for assessing the situation of NCD risk factors and injury among Mongolian population. It was also intended to furnish the necessary data for monitoring and evaluating the implementation status of the National Program and to determine the needs for MCA Mongolia Health Project and to contribute to the further planning of the next strategies of the World Health Organization programme. We believe that the STEPS Mongolia 2009 survey results not only generate key information sources, but will also provide researchers and all users with comprehensive data and information on the current situation of NCD risk factors, breast and cervical cancer early detection status, and information of injury and violence among the population. The significance of the survey is to extend NCD risk factor surveillance system in Mongolia and enable data to be incorporated with WHO NCD Global Info Base to obtain internationally comparable trends in NCD risk factors among Mongolian population. These valuable information and facts with evidence provide us to effectively implement public health policies, programmes, and projects. We would like to emphasize that the survey was conducted in accordance with international standards by means of the technical assistance of the World Health Organization, with financial assistance from MCA Mongolia Health Project and effective collaboration of STEPS Coordinating Committee in MOH, the Technical Working Group members and experts of all other participating organizations.

Foreword

MINISTER OF HEALTH

S. LAMBAA

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

PARTICIPATING ORGANIZATIONS:

International Consultants: Leanne Margaret Riley, PhD Head, Surveillance Dept. of Chronic Diseases and Health Promotion, WHO Melanie Cowan, MPH Technical Officer, Surveillance Dept. of Chronic Diseases and Health Promotion, WHO Principal Investigator, Project leader J.Oyunbileg, ScD (Biol), Professor, Academician General Director, Public Health Institute STEPS Coordinating Committee at MOH S.Tugsdelger, MD, MPH, Chairman Director, Dept. Public Health Care Policy Implemetation & Coordination , MOH J.Oyunbileg, ScD (Biol), Professor, Academician Deputy Chairman General Director, Public Health Institute G.Tsetsegdary, MD, PhD, Secretary Senior officer, Dept. Public Health Care Policy Implemetation & Coordination, MOH B.Burmaa, PhD Senior Officer, Dept. Strategic Policy Planning, MOH B.Khongolzul, MD Deputy-Director, Dept . Information Monitoring and Evaluation, MOH P.Enkhtuya, PhD Deputy Director, Public Health Institute I.Bolormaa, PhD Scientific Secretary, Public Health Institute J.Batjargal, MD, PhD Director, Nutrition Research Center, Public Health Institute

Participating organizations

Ministry of Health World Health Organization Millennium Challenge Account –Mongolia Health project Public Health Institute Health Sciences University National Medical Research Institute National Cancer Center Mongolian State Committee of Physical Culture and Sports National Traumotology and Orthopaedic Research Center Child Rights Protection Center City Health Authority Regional Diagnostic and Treatment Centers District and Aimag Health Agencies

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Ts.Enkhjargal, ScD (Biol), Academician Director, Public Health Laboratories, Public Health Institute D.Otgontuya, MD, MSc Researcher, Nutrition Research Center, Public Health Institute B.Munkhbat, PhD, ScD (Biol) Deputy Director, MCA Mongolia Health Project J.Enkhsaikhan, PhD Specialist, MCA Mongolia Health Project Participating organizations J.Tungalag Chairman, Section of the Mongolian Physical Education and Sports Authority D.Narantuya, MD, PhD MD, PhD, Health Sciences University Kh.Altaisaikhan, MD, PhD Deputy President, Mongolian Health Sciences University D.Oyunchimeg, MD Head, Research and Training Unit, National Cancer Research Center B.Bayarmaa, MD, MSc Head, Research and Foreign relation department, National Mental Health Center Kh.Nansalmaa, MD Public Health Specialist, National Traumotology and Orthopaedic Research Center S.Enkhtur Head, Department of Public Relation, National Road Traffic Agency S.Govind, MPH Public Health Specialist, WHO Country Office B.Tsogzolmaa, MSc Programme officer, WHO Country Office Sh.Enkhtsetseg, PhD Programme officer, WHO Country Office

Project team Project coordinator D.Otgontuya, MD, MSc Researcher, Nutrition Research Center, Public Health Institute Survey Team Leaders I.Bolormaa, PhD Scientific Secretary, Public Health Institute Ts. Enkhjargal, ScD (Biol), Academician Director, Public Health Laboratories, Public Health Institut

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Survey team members J.Tungalag Chairman,Section of the Mongolian Physical Education and Sports Authority B. Sodgerel MD, PhD Researcher, National Medical Research Institute N. Bolormaa MD, MSc Researcher, Nutrition Research Center, Public Health Institute U.Tserendolgor MD, ScD, Researcher, Nutrition Research Center, Public Health Institute T. Erdenezul MD, PhD Lecturer, Health Science University B.Undarmaa, PhD Professional officer, National Professional Inspection Agency N.Narantuya, MD, MSc Head of Public Health Management and Coordination Unit, Public Health Institute S.Tsegmed, MSc Researcher, Hygiene and Human Ecology Center, Public Health Institute J.Demberelsuren, MSc Researcher, Medical Research and Training Center, Public Health Institute B.Soninkhuu, MD Head, Public Health Department, City Health Authority B.Davaakhuu Officer, Public Health Department, City Health Authority J.Tsogzolmaa, MD, MSc Professional officer, National Statistical Office D.Erveekhei, MD NCD officer, Regional Diagnostic and Treatment Center, Khovd aimag Ts Ganbat, MD NCD officer, Regional Diagnostic and Treatment Center, Dornod aimag Ts.Battuvshin, MD Head, Central hospital, Orkhon aimag Kh. Bakytjan Senior Officer, Mongolian Physical Education and Sports Authority Ts. Mart Officer, Health Promotion Division, Government Implementation Agency B.Davaadulam. MSc Researcher, Nutrition Research Center, Public Health Institute A.Erdenebat, MD Researcher, Medical Research and Training Center, Public Health Institute Kh.Tserensuren, MSc Researcher, Biotechnology Research, Training and Production Center, Public Health Institute Ts.Tseveensuren, MSc Researcher, Biotechnological Research, Training and Production Center, Public Health Institute

Participating organizations

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

N. Enkhchimeg Officer, National Infectious Disease Research Center J.Javzandolgor Researcher, Medical Research and Training Center, Public Health Institute D.Odjargal Researcher, Researcher at the Toxicology Center, Public Health Institute M.Oyunchimeg Researcher, Ecology & Hygiene Center, Public Health Institute Participating organizations B. Khishigjargal Officer, Health Agency of Sukhbaatar District Sh.Nansalmaa, MD Professional Officer, National Traumotology and Orthopaedic Research Center O.Altansukh Programmist, Medical Research and Training Center, Public Health Institute B. Dulamsuren Researcher, Public Health Laboratory, Public Health Institute Kh.Mandakhtsetsen Researcher, Biotechnological Research, Training and Production Center, Public Health Institute L.Lkhagva Officer,, Biotechnological Research, Training and Production Center, PHI B.Nyamtsetseg Officer, Health Agency of Bayanzurkh district D.Khishigbuyan, MSc Researcher, Public Health Laboratory, Public Health Institute Ch.Batkhuu, MD Physician, State Clinical Hospital II B.Sodnomtseren MSc, Public Health Laboratories, Public Health Institute D.Otgonbayar Researcher, Ecology & Hygiene Center, Public Health Institute L.Altantuya Officer, Biotechnological Research, Training and Production Center, PHI D.Oyunjargal Officer, Public health worker, Bayanzurkh District Health Center A.Ariunzul Professional officer, National Cancer Center

Statistical analysis team Melanie Cowan, MPH Technical Officer, Surveillance Dept. of Chronic Diseases and Health Promotion, WHO D.Otgontuya, MD, MSc Researcher, Nutrition Research Center, Public Health Institute

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

O.Altansukh Programmist, Research, Training and Information Center, PHI S.Tsegmed, MSc Researcher, Hygiene and Human Ecology Center, Public Health Institute

Report compiled by: D.Otgontuya, MD, MSc Researcher, Nutrition Research Center, Public Health Institute I. Bolormaa, PhD Scientific Secretary, Public Health Institute P.Enkhtuya, PhD Deputy Director, Public Health Institute U.Tserendolgor, MD, ScD Researcher, Nutrition Research Center, Public Health Institute J.Tungalag Chairman, Section of the Mongolian Physical Education and Sports Authority Kh. Bakytjan Senior officer, Mongolian Physical Education and Sports Authority Ts. Enkhjargal, ScD (Biol), Academician Director of Public Health Laboratory, Public Health Institute D. Narantuya, MD, PhD Head, Cardiology Department, Medical School, Mongolian Health Sciences University N.Bolormaa, MD, MSc Researcher, Nutrition Research Center, Public Health Institute D.Oyunchimeg, MD, MSc Head, Research and Training Unit, National Cancer Research Center Kh.Altaisaikhan, MD, PhD, Professor Deputy President, Mongolian Health Sciences University J.Erdenezul, MD, PhD Lecturer, Mongolian Health Sciences University Sh. Nansalmaa, MD Professional officer, Injury Rehabilitation Clinical Center B.Badamtsestseg Director, Child Rights Protection Center B.Sukh-Ochir Executive director, Association of Professional Social Workers N. Narantuya, MD, MSc Head, Management and Coordination Unit, Public Health Institute F Maximillian de Courten, Professor Copenhagen School of Global Health, University of Copenhagen, Denmark Cherian Varghese, PhD Technical Officer, Noncommunicable diseases, WPRO, WHO

Participating organizations

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Translated by: S.Tugsdelger, MD, MPH Director, Public Health Care Policy Implementation and Coordination Department, MOH Editors: L.Lkhagva, MD, PhD, DSc, Academician, Professor Director, Drug Research Institute Participating organizations G. Tsetsegdary, MD, PhD Senior Officer, Public Health Care Policy Implementation and Coordination Department, MOH P. Enkhtuya, PhD Deputy Director, Public Health Institute Note: Any comments/suggestion related to this survey will be invaluble in our work and be appreciated to be considered in the future surveys. Therefore, please feel free to send your comments/ suggestions to the following address.

Address: Public Health Institute of the Ministry of Health, Peace Avenue-17, Ulaanbaatar-210349 E-mail: , pubhealth@magicnet.mn] jobileg@magicnet.mn

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

EXECUTIVE SUMMARY The current Survey on the Prevalence of Noncommunicable Diseases (NCD) and Injury Risk Factors was conducted to establish the midterm evaluation of the National Program on NCD Prevention and Control, and to establish baseline data for a health project funded by the Millennium Challenge Account (MCA). The cross-sectional survey used WHO STEPS survey methodology adapted to the countrys specifics. The goal of the survey was to determine the prevalence of risk factors for NCD and injuries using WHO-approved methods, and to inform on NCD and injury control activities. The survey had the following objectives: • • • To determine the prevalence of common modifiable risk factors for NCDs and major causes of injuries To determine the prevalence of hypertension, overweight, obesity, hypercholesterolemia and hyperglycemia To compare the current prevalence of NCD risk factors to that identified in the previous STEPS survey

A total of 5,638 randomly selected 15-64 year-old Mongolian residents of both sexes from 36 soums of 20 aimags and 6 districts of Ulaanbaatar city participated in the survey. The survey data was collected between October 8th and November 2nd 2009 in selected aimags, and between 10th and 25th of December, 2009 in Ulaanbaatar city. The survey data was fully collected using small handheld computers (PDAs). Because the data was comprised of only a sample of the target population, it was necessary to weight the data. Thus, sample weighting and adjustments to correct the differences in the age-sex distribution of the sample compared to the target population were performed. Data analysis was conducted using EPI INFO version 3.5.1 using appropriate methods for the complex sample design of the survey. The prevalence and measures of central tendency of NCD risk factors were estimated. Outcome measures (prevalence and mean variance) and differences between groups (age, gender and urban/ rural groups) were calculated with 95% confidence intervals (95% CI). The survey results showed that in Mongolia 27.6% of the population smoke whereas 48.0% of men and 6.9% of women were current smokers. The vast majority of smokers (87.9%) smoke daily. Nearly one in two persons (42.9%) was exposed to second-hand smoking at home and over a third (35.6%) of the target population was exposed at work on at least one day in the past 7 days, respectively. Current drinking or consumption of alcohol in the past 30 days was reported by 38.6% of all respondents or 49.8% of men and 27.2% of women. On a drinking occasion, the current drinkers consumed 7.7 standard drinks where on average it was 9.2 for men and 5.1 for women. The prevalence of binge drinking (more than 5 drinks on one occasion for men, or more than 4 drinks for women) was 39.7% in men and 15.1% in women, and was thus more than twice as common in males than females. Average daily servings of fruits and vegetables were 1.8, which was 3.2 servings less than the WHO recommendation. 92.3% of the population consumed less than 5 servings of fruits and vegetables daily. Fruit and vegetable consumption in rural areas was significantly lower than in the urban areas. Daily salt intake was 7.3 grams per person with rural residents using on average 1.6 more grams of salt compared to their urban counterparts. 7.5% of the population were not meeting the minimum recommendation for physical activity, which

Executive summary

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

meant nearly 1 in 10 persons was at increased risk for physical inactivity. Urban men were 4 times more likely to fall into the category of low physical activity than rural men, and urban women were twice as likely compared to their rural counterparts. Median duration of time spent in high or moderate levels of physical activity at work was 214.2 minutes, during transport 30.0 minutes and in recreational settings 51.4 minutes, respectively. The mean BMI of study population was 24.6 kg/m2 and it was 24.3 kg/m2 in men and 24.9 kg/m2 in women, respectively. According to BMI risk assessment, 39.8% of the population was overweight and 12.5% was obese. Prevalence of overweight and obesity tended to increase with age, and the proportion of overweight or obese women in all age groups was higher compared to their male counterparts. Prevalence of central obesity (Men: WC≥90cm and Women: WC≥80cm) was 29.1% in men and 55.7% in women. Executive summary Prevalence of high risk cholesterol category or hypercholesterolemia in the population was 25.0 % and prevalence of hypercholesterolemia was 8.5%. Prevalence of high risk triglyceride category or hypertriglyceridemia in the population was 22.4% with significantly higher prevalence in men (29.5%) compared to women (15.4%). The proportion of the population at risk and with increased blood LDL was 42.4% and 20.2%, respectively. The proportion of women at risk or with decreased blood HDL was 2.7 times higher compared to men. Mean systolic blood pressure (SBP) was 129.8 mmHg in men and 121.4 mmHg in their female counterparts, and it was significantly higher in men than in women. Prevalence of hypertension was 27.3%. Men had significantly higher prevalence of hypertension compared to women. There was no significant difference in the prevalence of hypertension between urban and rural populations. Mean fasting blood glucose in the study population was 4.7 mmol/L and there was no difference between men and women. However, the urban population was more likely to have higher mean fasting glucose than the rural population. Prevalence of impaired fasting glycaemia (IFG) was 9.4% in the study population and 11.5% in males, 7.5% in females. Prevalence of diabetes was 6.5% in the study population, 8.9% in males, 4.1% in females. Cervical cancer screening coverage was very low with only 5.2% of female survey respondents reporting VIA and 11.4% - Pap smear testing. Women aged 35-54 had the highest cervical cancer screening coverage, which was consistent with the fact that cervical cancer incidence is highest in this age group. Breast cancer screening was also insufficient with 1 in 3 surveyed women reporting breast self-examination, and only 3.2 and 1.7% undergoing clinical breast examination and mammography, respectively.Cervical and breast cancer screening coverage was similar in urban and rural settings. Prevalence of road traffic injury in the study population was 4.0%. One in four (22.7%) traffic injuries was due to speeding, and nearly 1 in 10 (9.1%) due to drunk driving. Roughly eight in ten drivers and passengers (83.6%) did not use a seatbelt regularly. Prevalence of violent injury was 3.5% in the study population and 4.4% in men and 2.5% in women. Men more likely to fell victim to interpersonal violence, which is mainly because men tended to use physical force in resolving conflicts. On the other hand, among those females involved in violence incidence, 30.4% reported being abused by family or intimate partners and 24.2% were abused by friends. Of the survey respondents, 62.3% were abused as a child. Results of the comparative study (STEPS 2005 vs. 2009) indicated that the prevalence of smoking in the adult population has stayed about the same. Furthermore, women start smoking on average at a younger age. With regards to alcohol consumption, although the percentage drinking alcohol in the past 12 months has decreased, the frequency of drinking shows a slight, but not statistically significant, increasing trend.

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

The comparative analysis revealed that over the past 4 years the average daily servings of fruit (0.8 vs. 0.4) and vegetables (1.6 vs. 1.3) consumed has decreased significantly. At the same time, average daily salt intake decreased. Although there was an increase in the median time spent in physical activity on average per day (181.4 mins vs. 347.1 mins) and in the percentage with high level of physical activity (70.4% vs. 81.8%), no changes were observed in the percentage of the population who were not fulfilling the minimum recommendation for physical activity. The mean body mass index of the adult population increased as well as the prevalence of obesity (by 2.7%), and overweight and obesity (by 8.3%). Mean blood cholesterol and the percentage with or at risk of increased total cholesterol were remained stable. Although the prevalence of hypertension remained unchanged, use of medication for treatment of hypertension and its responsiveness to anti-hypertensive drugs worsened. Mean fasting blood glucose in the adult population and percentage of people with raised blood glucose or on medication for diabetes remained stable. According to the WHO STEPS methodology, combined exposure of 5 common risk factors such as current daily smokers, less than 5 servings of fruits & vegetables per day, low level of activity, overweight (BMI ≥ 25 kg/m2), raised BP (SBP ≥ 140 and/or DBP ≥ 90 mmHg or currently on medication) was used to determine population risk for NCDs. In conclusion, the summary of combined NCD risk factors demonstrates that 1 in 5 (26.4%) Mongolian adults and 1 in 2 (53.8%) adults of 45-64 years of age have three or more common modifiable NCD risk factors. Twice as many young men (aged 15-44 years) than women (26.0% vs. 12.4%) have 3 or more risk factors.

Executive summary

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Fact Sheet The STEPS survey of chronic disease risk factors in Mongolia carried out from October to December 2009. Mongolia carried out Step 1, Step 2 and Step 3. Socio demographic and behavioural information was collected in Step 1. Physical measurements such as height, weight and blood pressure were collected in Step 2. Biochemical measurements were collected to assess blood glucose and cholesterol levels in Step 3. The STEPS survey in Mongolia was a population-based survey of adults aged 15-64. A multi-stage cluster sample design was used to produce representative data for that age range in Mongolia. A total of 5438 adults participated in the Mongolia STEPS survey. The overall response rate was 95%. A repeat survey is planned to be conducted in 2013. Results for adults aged 15-64 years (incl. 95% CI) Step 1 Tobacco Use

Both Sexes

Males

Females

Fact Sheet

Percentage who currently smoke tobacco Percentage who currently smoke tobacco daily For those who smoke tobacco daily Average age started smoking (years)

(26.0 – 29.4) (22.9 – 25.7)

27.6% 24.3%

(44.5 – 51.5) (39.9 – 46.0)

48.0% 43.0%

(5.2 – 8.5) (3.8 – 6.7)

6.9% 5.2%

(18.7-19.6) (78.8-90.3) (7.8-9.6)

19.2

(18.2-19.2) (78.3-90.2) (7.9-9.8)

18.7

(21.3-25.1) (72.7-100.0) (5.6-8.4)

23.2

Percentage of daily smokers smoking manufactured cigarettes Mean number of manufactured cigarettes smoked per day (by smokers of manufactured cigarettes) Step 1 Alcohol Consumption 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) Step 1 Fruit and Vegetable Consumption (in a typical week) 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 Step 1 Physical Activity 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

84.6% 8.7

84.3% 8.9

86.9% 7.0

(28.7 – 39.6) (5.7 – 9.1) (34.6 – 42.7) --

34.2% 7.4%

(19.3 – 28.8) (4.4 – 7.7) (44.7 – 54.8)

24.0% 6.0%

(38.1 – 51.0) (6.6 – 11.0) (23.0 – 31.3)

44.5% 8.8%

38.6%

49.8% 39.7%

27.2% 15.1%

(35.0 – 44.4)

(12.4 – 17.7)

(1.0-1.3) (0.3-0.5) (4.3-5.3) (1.2-1.7) (88.7-95.8)

1.2 0.4 4.8 1.4

(0.7-1.2) (0.2-0.5) (4.1-5.2) (1.1-1.6) (89.9-96.9)

1.0 0.3 4.6 1.4

(1.2-1.6) (0.4-0.6) (4.5-5.4) (1.3-1.8) (87.4-94.8)

1.4 0.5 4.9 1.5

92.3%

93.4%

91.1%

(5.2-9.9) (75.7-85.8) (158.6-510.0) (43.3-53.6)

7.5%

(4.7-10.1) (77.7-87.4) (171.4-501.4) (37.3-48.4)

7.4%

(5.3-10.1) (72.9-85.0) (141.4-518.6) (48.5-59.8)

7.7%

80.8% 342.9

82.5% 347.1

78.9% 337.1

48.5%

42.9%

54.2%

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Results for adults aged 15-64 years (incl. 95% CI) Step 2 Physical Measurements 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) who are not currently on medication for raised BP Step 3 Biochemical Measurement Mean fasting blood glucose, including those currently on medication for raised blood glucose (mmol/L) Percentage with impaired fasting glycaemia as defined below: (capillary whole blood value ≥5.6 mmol/L (100 mg/dl) and <6.1 mmol/L (110 mg/dl))

Both Sexes 24.6

Males 24.3

Females 24.9

(24.3-24.9) (37.1-42.5) (10.8-14.3)

(24.0-24.7) (33.0-41.0) (8.7-13.4) (82.2-84.3) (128.4-131.1) (78.7-80.5) (28.2-34.6) (66.6-77.2)

(24.6-25.2) (39.9-45.5) (12.1-16.0) (81.7-83.5) (120.0-122.8) (77.3-78.9) (20.7-25.7) (40.8-51.1)

39.8% 12.5% --

37.0% 11.1% 83.2

42.7% 14.1% 82.6

(124.3-126.9) (78.1-79.6) (24.9-29.8) (56.4-65.8)

125.6 78.9

129.8 79.6

121.4 78.1

27.3% 61.1%

31.4% 71.9%

23.2% 46.0%

(4.6-4.9)

4.7

(4.6-5.0)

4.8

(4.5-4.8)

4.7

(7.4-11.5)

9.4%

(8.5-14.5)

11.5%

(4.5-10.4)

7.5%

Percentage with raised fasting blood glucose as defined below or currently on medication for raised blood glucose (capillary whole blood value ≥ 6.1 mmol/L (110 mg/dl))

(4.5-8.4)

6.5% 4.4

(5.0-12.7)

8.9% 4.5

(2.1-6.2)

4.1% 4.2

Mean total blood cholesterol, including those currently on medication for raised cholesterol (mmol/L) Percentage with raised total cholesterol (≥ 5.0 mmol/L or ≥ 190 mg/dl or currently on medication for raised cholesterol) Summary of combined risk factors · current daily smokers · less than 5 servings of fruits & vegetables per day · low level of activity Percentage with none of the above risk factors Percentage with three or more of the above risk factors, aged 15 to 44 years Percentage with three or more of the above risk factors, aged 45 to 64 years Percentage with three or more of the above risk factors, aged 15 to 64 years

(4.1-4.6)

(4.2-4.7)

(4.0-4.4)

(19.4-30.5)

25.0%

(20.9-33.9)

27.4%

(16.8-28.2)

22.5%

· overweight (BMI ≥ 25 kg/m2) · raised BP (SBP ≥ 140 and/or DBP ≥ 90 mmHg or currently on medication for raised BP) (1.7-4.2) (17.3-21.5) (49.4-58.1) (24.1-28.7)

3.0%

(0.8-3.1) (23.1-28.8) (55.4-67.3) (30.3-35.9)

1.9%

(2.4-5.6) (9.9-14.8) (41.7-50.5) (16.9-21.9)

4.0%

19.4% 53.8% 26.4%

26.0% 61.4% 33.1%

12.4% 46.1% 19.4%

Fact Sheet

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

CHAPTER I RATIONALE

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Noncommunicable diseases worldwide According to the World Health Organization (WHO) noncommunicable diseases (NCDs) such as cardiovascular diseases (CVDs), diabetes, chronic pulmonary diseases and cancers accounted for 60 percent of population mortality globally and 80 percent of mortality in low and middle income countries in 2008 [3]. The WHO estimates that mortality due to smoking could increase twice in low and middle income countries by 2030, reaching 6.8 million deaths, if no effective preventive measures are taken. Similarly, cancer mortality could increase from 7.4 million deaths in 2004 to 11.8 in 2030. However, the experience of a number of countries demonstrates that NCDs can be prevented effectively. There is a growing scientific evidence that if we succeed in controlling common modifiable risk factors leading to NCDs, we can prevent some 80% of cardiovascular disease, 90% of type II diabetes as well as 1/3 of cancers [9].

Chapter I. Rationale

Noncommunicable diseases in Mongolia Mongolia has been undergoing an epidemiological transition since 1990s. As a result, diseases related to lifestyle and health behavior, such as cardiovascular diseases, diabetes, cancer and injuries are growing steadily and have become the leading causes of population mortality. In 2008 the following diseases were the leading causes of death in Mongolia: • • • • • Diseases of circulatory system - 20.54 per 10,000 population Neoplasms - 11.80 per 10,000 population Injury, poisoning and certain other consequences of external causes - 9.33 per 10,000 population Diseases of digestive system - 5.27 per 10,000 population Perinatal conditions - 2.42 per 10,000 population.

Diseases of circulatory system are the leading cause of population morbidity and mortality, and were accounted for every third death in 2008. According to official health statistics, mortality due to the diseases of circulatory system is 22.02 and 18.76 per 10,000 males and females, respectively [1]. Cervical cancer is the second most common cancer diagnosed in women in Mongolia. Between 2000 and 2008 the prevalence of cervical cancer increased from 38.8 to 68.4, the incidence from 6.6 to 15.5, and mortality from 3.4 to 4.0 per 100,000. Until recently, breast cancer was rare in Mongolia. However, its incidence is growing steadily, and currently it is the sixth most common cancer. Between 2000 and 2008 the prevalence of breast cancer rose from 12.5 to 20.6, the incidence from 2.5 to 3.6, and mortality from 0.8 to 1.3 per 100,000. Injury More than 5 million people annually or 16,000 people daily lose their lives due to injuries worldwide. Thousands more are disabled. Injury mortality has increased dramatically in recent years in Mongolia. It was the fifth leading cause of population mortality in 1990, and has risen to the third position since 2000. The main causes of injury mortality are traffic injuries, suicide, homicide and other injuries, which account for 19.7, 16.3, 10.4 and 46.9 percent of mortality, respectively[13]. Violence Studies have been conducted that looked into the forms, prevalence and consequences of gender-

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

based violence, child abuse and violence against the elderly in Mongolia. These studies demonstrate that 1 in every 3 women experience some form of violence, 1 in every 10 women is battered, 1 in every 5 families has abusive relations, half of all children are abused, and 1 in every 4 elderly is a victim of family violence. A number of victims of family violence with moderate to severe injuries registered with a forensic medicine unit has increased 2.5 times over the last few years [12].

Prevalence of common modifiable risk factors for NCDs According to the Mongolian STEPS Survey on the Prevalence of NCD Risk Factors (2005) 24.2 percent of the population were daily smokers, and almost three quarters (72.5%) of the respondents consumed less than 5 servings of fruits and vegetables daily. The prevalence of people who engaged in low levels of physical activity was 23.1 percent or one in five. The survey indicated that 31.6% of the population were overweight or obese (21.8% overweight and 9.8 % obese). The prevalence of high blood pressure was 28.1 percent and the prevalence of diabetes was 8.2%. The current survey was undertaken to identify the prevalence of risk factors for NCDs and injuries, to inform the evaluation of the National Program on NCD Prevention and Control, and to establish baseline data for a health project funded by the Millennium Challenge Account (MCA).

Chapter I. Rationale

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

SURVEY GOAL The goal of the survey was to determine the prevalence of risk factors for NCDs and injuries using WHO-approved methods, and to inform on NCD and injury control activities.

SURVEY OBJECTIVES • • Chapter I. Rationale • To determine the prevalence of common modifiable risk factors for NCDs and major causes of injuries; To determine the prevalence of hypertension, overweight, obesity, hypercholesterolemia and hyperglycemia, and To compare the current prevalence of NCD risk factors to that identified in the previous STEPS survey.

SCIENTIFIC NOVELTY AND IMPORTANCE OF THE SURVEY • The survey will inform the evaluation of the National Program on NCD Prevention and Control, and will establish baseline data for a health project funded by the Millennium Challenge Account (MCA). The use of internationally validated survey methods adapted to the country specifics will contribute to the development of health research and will enable international comparisons. The survey uses WHO STEPS survey methodology, and advanced software, laboratory tests and statistical analysis methods, which will generate reliable information for policymaking and program planning.

• •

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

CHAPTER II SURVEY METHODOLOGY

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

1. Survey scope The current Survey on the Prevalence of NCD and Injury Risk Factors is conducted to inform the mid-term evaluation of the National Program on NCD Prevention and Control, and to establish baseline data for a health project funded by the Millennium Challenge Account. The survey used WHO STEPS survey methodology adapted to the country specifics, and was conducted in the following three steps. Chapter II. Survey methodology 1. STEP 1: Questionnaire survey – information on smoking, alcohol consumption, fruit and vegetable consumption, physical activity, and history of hypertension, diabetes, screening for cervical and breast cancer, injuries and violence, and their causes was collected by using a questionnaire. 2. STEP 2: Physiological measurements – overweight and obesity (body weight and height, waist and hip circumference, and body fat), blood pressure, and physical fitness were measured using specific tests and devices. 3. STEP 3: Laboratory analysis – blood glucose, cholesterol and triglycerides were measured in peripheral (capillary) blood at data collection sites using dry chemical methods, while LDL and HDL were measured in blood serum using wet chemical methods.

2. Survey population and sampling A total of 5,438 randomly selected 15-64 year-old Mongolian residents of both sexes from 36 soums of 20 aimags and 24 khoroos of 6 districts of Ulaanbaatar city participated in the survey(Figure 1). All participants completed STEPS 1 and 2 of the survey except pregnant women, persons with disabilities and bedridden patients, for whom physiological measurements were not performed. Every third person aged 25-64 randomly selected into the study completed STEP 3 or biochemical testing. Response rate of the survey was 95% in both STEP1, 2 and STEP3. Figure 1. Survey frame, selected cluster

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

For calculating the survey sample size, the prevalence of overweight and obesity (P=32.6%) identified during the previous (2005) round of STEP survey was used, assuming 95% confidence interval (Z=1.96), 5% acceptable margin of error, complex sampling design effect coefficient of 1.5, and equal representation of genders in each age group (5 age groups for each gender or a total of 10 groups). This gave a sample size of 4,840 persons, which was further increased by 15% (5,694) to account for contingencies such as non-response or recording error (Formula 1). Sample size calculation formula: e2

n=1.962 0.3(1-0.3) = 322.69 0.0025

2. n x design effect x age-gender factor = 322.7 x 1.5 x 10 = 4840 3. n/ probability of non-response = 4840 / 0.85 = 5694 The survey was designed to cover all geographical areas of Mongolia, and a four-stage cluster sampling process was carried out to randomly select participants from the target population. Given the urban vs. rural differences in lifestyle and disease status, the target population was stratified into urban and rural areas and the sample was drawn proportionally from each based on the target population in each area. Thus, out of the 60 total clusters selected, 28 were urban and 32 were rural. Ulaanbaatar city, Darkhan-Uul and Orkhon aimags represented urban areas, while the rest of aimags and soums represented rural areas (Table 1). Table 1. Number of urban and rural clusters As % of total population 0.48 0.52 1.00

Setting Urban Rural Total

Target population 831802 919417 1751219

Survey population 2733 2961 5694

Number of clusters 28 32 60

Ninety-five participants were selected from each cluster. In the urban areas, khoroos were selected, then family groups, then households. In rural areas, soums were selected, then baghs then households How this selection was proceeded is explained in the following paragraph (Figure 2). A total of 28 khoroos were selected from a list of all khoroos (n=173) in the urban area using probability proportional to size sampling, where the size was 25.5% of the total target population of 851,062 persons aged 15-64 years old. From each selected khoroo, three of the family groups were selected using probability proportional to its total number of households. Within each of the three family groups, 95 households were selected using simple random sampling from updated household registries.

Chapter II. Survey methodology

1. n=Z2 P(1-P)

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Figure 2. Multi-stage cluster sampling units

Chapter II. Survey methodology

Primary unit Secondary unit

Tertiary unit Final unit

For the rural area, 32 of the soums were selected from a list of all soums (n=324) using probability proportional to size sampling, where the size was 23.1% of the total target population of 919,417 persons aged 15-64 years old. From each selected soum, 2 baghs were selected using probability proportional to its total number of households. Within each selected baghs, 95 of the households were selected using simple random sampling from updated household registries (Table 2). From each selected household in urban and rural areas, only one person aged 15-64 years was selected using Kish Method as the last step. Data collection period. The survey data was collected between October 8th and November 2nd in aimags, and between 10th and 25th of December, 2009 in Ulaanbaatar city. Training of field researchers in survey methodology. A seminar on the STEPS Survey on the Prevalence of NCD and Injury Risk Factors was conducted by the Public Health Institute in collaboration with the Ministry of Health, WHO and MCA-supported Health Project on 15th September, 2009. The seminar was attended by more than 50 stakeholders including Ms. Leanne Riley, STEPS Team Leader, WHO HQ, members of the survey coordinating committee, representatives from health research, training, service and sports organizations, international donors and civil society.

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Table 2. Selected clusters and survey population Number of Clusters 24 2 2 28 3 1 2 2 1 2 1 Proportion of participants aged 15-64 years (N, %) 2176 (40.0) 180 (3.3) 190 (3.5) 2546 (46.8) 285 (5.2) 95 (1.7) 190 (3.5) 180 (3.3) 77 (1.4) 184 (3.4) 82 (1.5)

Cities/Aimags Ulaanbaatar Darkhan

Urban

Erdenet Total Arkhangai Bayan-Ulgii Bayankhongor Bulgan Dornogobi Dornod Dundgobi

Pilot test. The trained field researchers carried out a pre-testing comprised of all three steps of the survey in two districts of Ulaanbaatar Zavkhan 2 188 (3.5) city. Over 80 people participated in the preUvurkhangai 2 180 (3.3) testing. The pre-testing started with the data Umnugobi 2 151 (2.8) collection team leaders selecting family groups, Sukhbaatar 1 91 (1.7) households and individuals according to the Selenge 2 177 (3.3) sampling methodology, and disseminating information about the survey to selected Tuv 2 178 (3.3) individuals in collaboration with family Uvs 2 183 (3.4) practitioners and nurses. There were eight Khovd 2 184 (3.4) data collection teams with 5 researchers each. Khuvsgul 3 277 (5.1) Each team collected questionnaire data from Khentii 1 95 (1.7) and performed physiological measurements Gobi-Altai 1 95 (1.7) on 9-10 individuals, and performed laboratory analysis on 3-4 individuals. The pre-testing Total 32 2892 (53.2) was aimed at validating the field researchers’ skills in using survey questionnaires, performing physiological measurements and laboratory tests, and using PDAs. Based on the findings of the pre-testing, hands-on training on physiological measurements was repeated. After re-training, all researchers underwent testing in practical skills. Rural

Data collection process Validated questionnaires of WHO “STEPS Survey on the Prevalence of NCD Risk Factors” and “Community Survey on Injuries and Violence” were translated into Mongolian, adapted to country specifics, back translated into English, reviewed and approved by international and national consultants, and used for the survey data collection.

STEP 1: Questionnaire survey The questionnaire was used to collect data on respondent’s socio-economic status, tobacco use, alcohol consumption, fruit and vegetable consumption, physical activity, and history of hypertension, diabetes, screening for cervical and breast cancer, and injuries and violence, and their causes. Assessing alcohol consumption: Alcohol consumption was assessed using the concept of “standard drinks”. A standard drink is any drink containing 10 grams of pure alcohol (Table 3).

Chapter II. Survey methodology

A training of 50 national researchers was conducted by the survey technical working group in collaboration with the WHO experts on September 16-21, 2009. On the first two days the trainees were exposed to the methods of sampling and obtaining informed consent from selected survey respondents. The core of the training was focused on a survey questionnaire and skills to use Personal Digital Assistants (PDAs) for data entry. The last two days of the training consisted of interactive sessions to introduce data collection methods for Steps 1, 2 and 3 of the survey.

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Researchers used a poster and a guide showing a table with standard drinks depicting 5 types of commonly consumed alcoholic beverages.

Table 3. Standard drinks guide Alcoholic beverages Vodka Wine Beer Home brewed alcohol Mare’s milk Amount 1 glass / 50 ml / 1 glass / 100 ml / 1 bottle / can 330 ml / 1 cup / 100 ml / 1 cup / 250 ml / Pure alcohol content 40% Alc/Vol 12.5% Alc/Vol 4-5% Alc/Vol 15% Alc/Vol 5% Alc/Vol amount 20 g 12.5 g 15 g 15 g 12.5 g Standard drinks 2 1.3 1.5 1.5 1.3

Chapter II. Survey methodology

In the current survey respondents reporting alcohol use within the past 1 month were classified as “current drinkers”. Three risk categories were used to classify respondents who consumed alcohol depending on the average amount of alcohol consumed per day. These categories are defined in the table below (Table 4).

Table 4. Level of risk associated with alcohol consumption, by gender Units are in amount of alcohol consumed on average per day

Gender, content of pure alcohol Male Female

Category I <40 g <20 g

Category II 40-59.9 g 20-39.9 g

Category III >60 g >40 g

Binge drinking was defined as consuming on one occasion 5 or more standard drinks for males and 4 or more standard drinks for females. Assessing fruit and vegetable consumption: In order to assess the diet pattern of the surveyed population, the respondents were asked about frequency of fruit and vegetable consumption, type of oil used in food, and amount of salt consumed daily. Consumption of fruits and vegetables was assessed in terms of “number of servings”, and a serving was equal to 80 g. In order to facilitate data collection, showcards were produced containing 52 photo images of servings of 21 different names of fruits belonging to 14 fruit groups, 19 different names of vegetables belonging to 11 vegetable groups (excluding potato), 11 different names of oil and fats belonging to 6 groups, and 2 types of salt. The showcards were used to collect data on fruit and vegetable consumption on a typical day. In addition, a poster with fruit and vegetable serving guide was used. Salt consumption was assessed by asking for how many days a pack of 500 grams of salt is used in a household, and estimating average daily salt intake by dividing 500 g by a number of days and a number of members in a household. Fat and oil intake was assessed by asking about a type of oil most frequently used for cooking. Assessing physical activity: Physical activity was assessed based on intensity, duration and frequency of physical activity at work, in recreational settings and during transportation using a complex set of 16 questions. Data on the number of days, hours and minutes of physical activity performed at work, transport and recreational settings for at least 10 minutes per day were collected. The complex questionnaire has an advantage of assessing not only the duration, but also the intensity of physical activity. The median time of total physical activity per day spent for work, transport and recreational activities was measured by using the standard metabolic equivalent time, or MET. This unit is used to estimate

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

the amount of oxygen used by a body for a specific type of physical activity. 1 MET unit is the energy (oxygen) used by a body when one sits quietly. The levels of physical activity were classified into high, medium and low as defined below. · High levels of physical activity • Vigorous-intensity activity on at least 3 days achieving a minimum of at least 1,500 METminutes/week OR • 7 or more days of any combination of walking, moderate or vigorous intensity activities achieving a minimum of at least 3,000 MET-minutes per week · Medium levels of physical activity • 3 or more days of vigorous-intensity activity of at least 20 minutes per day OR • 5 or more days of moderate-intensity activity or walking of at least 30 minutes per day OR • 5 or more days of any combination of walking, moderate or vigorous intensity activities achieving a minimum of at least 600 MET-minutes per week · Low levels of physical activity - A person not meeting any of the above mentioned criteria falls into this category. Those individuals who do not meet criteria for moderate or high and achieving at least 600 MET – minutes/week are considered to be “physically inactive”

Assessment of cervical and breast cancer screening status Cervical cancer screening status was assessed by asking about undergoing Visual Inspection with Acetic Acid (VIA) and/or Pap smear. • • VIA is a simple test for the early detection of cervical precancerous lesions and early invasive cancer, which involves naked-eye visual inspection of the uterine cervix, after application of 5% acetic acid and/or of Lugol’s iodine. Pap smear or cytological examination is a medical procedure in which a sample of cells from a woman’s cervix is collected and spread on a microscope slide. The cells are examined under a microscope after staining with Papanicolau dye. This method is important in differential diagnosis of malignant, non-malignant, precancerous and inflammatory lesions. Breast cancer screening status was assessed by asking about breast self-examination. Breast self-examination is a method whereby women examine their breasts monthly one week after their periods.

•

Assessment of violence Interviews with questions on violence including domestic abuse were ensured with confidentiality and an environment conducive to obtain accurate data. Individuals were interviewed in the absence of a potential marital partner and other people around.

STEP 2: Physiological measurements Body weight, height, waist circumference, body fat, blood pressure, physical fitness and body development were measured in all survey participants. Body weight was measured with electronic scales “GIMA” produced in Italy. “GIMA” is a bioimpedance device highly suitable for research purposes, which measures body weight, body fat %, and water, muscle and bone mass with 0.1 % precision. Body height was measured using “Somatometre-Stanley 04-116” device suitable for research

Chapter II. Survey methodology

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

purposes, which has the capacity to measure height up to 2 meters with a precision of a millimeter difference, reading height values in centimeters. Body mass index (BMI) was calculated as a ratio of body weight in kilograms to the square of body height in centimeters. BMI = Body weight (kg) : Body height (cm2) Waist circumference was measured with “GIMA waist meter”, a non-stretch tape with mm precision. Waist circumference was measured by placing a tape measure around bare abdomen just above upper hip bone. The central obesity was defined as men with waist circumference ≥90cm, and the women with ≥80cm according to the suggested interim lower values for Asians by the WHO [5]. Body fat was measured with “GIMA body fat scale”. The device measures body fat % relative to the person’s age, gender, weight and height. Body fat percent was measured in all subjects. Obesity is usually defined as total body fat percentage over 25 in men and about 35 and over in women (Table 5 ). Table 5. Reference values for body fat percent Gender Male Female Body fat percent Low <10.0 <20.0 Normal 10.0 -19.9 20.0-29.9 High 20.0- 24.9 30.0 – 34.9 Very high 25<= 35<=

Chapter II. Survey methodology

Reference: Wardlaw,G.M., Kessel, M. (2000). Perspectives in Nutrition

Blood pressure measurement: Blood pressure was measured three times on the right arm of the survey participants in a sitting position using OMRON Model M5 automatic blood pressure monitor. Mean of three measurements was taken for analysis of blood pressure. The measurements were taken after the participant had rested for 5 minutes. Each measurement was done with 3 minutes resting between the measurements. Percentage of raised blood pressure was defined as follows; • SBP ≥140 and /or DBP ≥90mmHg, or currently on medication for raised blood pressure Percentage of respondents with treated and/or controlled of raised blood pressure among those with raised blood pressure (SBP ≥140 and/or DBP ≥ 90 mmHg) or currently on medication for raised blood pressure was categorized as follows; • • • % On medication and SBP<140 and DBP<90 % On medication and SBP≥140 and/orDBP≥90 % Not on medication and SBP≥140 and/orDBP≥90

Assessment of physical fitness and body development: One in every three survey participants aged 25-64 years were selected to undergo fitness test, which assessed physical fitness by using 5 quality indicators such as strength, speed, flexibility, endurance and balance. The performance criteria in each indicator are different for men and women. • • • • • Strength was measured as a number of push-ups per minute. Speed was measured using 10 sec sprint test. Flexibility was measured using sit and reach test. Balance was measured as a duration, for which a person maintained balance standing on a left leg with a right knee raised, arms sideward, and eyes shut Endurance was measured as the duration of exhalation after deep inhalation.

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Participants were scored in each test and sum of the scores was categorized according to the table below for a final assessment .

Table 6. Category for fitness test assessment Age group 15-24 25-34 35-44 45-54 55-64 À >25 >24 >21 >17 >15 Â 21-24 20-23 17-20 12-16 11-14 Ñ 17-20 16-19 13-16 8-11 6-13 D 13-16 12-15 9-12 4-7 2-5 F <12 <11 <3 <1

STEP 3: Laboratory analysis Laboratory analysis included testing for blood glucose, cholesterol, triglycerides, LDL and HDL. Concentrations of glucose, cholesterol and triglycerides were measured in peripheral (capillary) blood at the data collection site with dry chemical reagent strips using Accutrend GCT (Glucose, Cholesterol, Triglycerides) equipment. Data collection in late autumn resulted in overcooling of the equipment, which jeopardized the sensitivity of the test and required re-validation of the measurements. Re-validation of cholesterol and triglyceride measurements was done with semiautomatic analyzer “Humalyzer 2000” using colorimeter. Validated results were used in the final report. Low density lipoprotein (LDL) and high density lipoprotein (HDL) content was measured in serum with semi-automatic analyzer “Humalyzer 2000” using colorimeter. For testing purposes 7 ml of fasting blood was collected, centrifuged to separate serum, and the tubes with serum were labeled and transported in frozen condition. Laboratory analysis results were assessed according to the category in table 7 [10]. Table 7. Biochemical indicators (WHO, 2005) Biochemical indicators Glucose Cholesterol Triglycerides LDL HDL Normal <5.6 mmol/L <5.0 mmol/L <1.7 mmol/L <3 mmol/L At risk ≥5.6 mmol/L & <6.1 mmol/L ≥ 5.0 mmol/L & <6.2 mmol/L ≥ 1.7 mmol/L & < 2 mmol/L ≥ 3 mmol/L & <4.15 mmol/L Increased ≥6.1 mmol/L or using glucoselowering drugs ≥ 6.2 mmol/L or using cholesterollowering drugs ≥2.0 mmol/L ≥4.15 mmol/L

HDL levels decreased M: >1.03 mmol/L; F: >1.29 mmol/L

Survey data collection in Ulaanbaatar and aimags was done by 7 teams with 5 researchers in each team. Survey teams consisted of a team leader, two interviewers, one person to obtain physical measurements, one laboratory technician and two local assistants. Thus, teams often consisted of 7-8 people each. About 2-3 days prior to the interview process, an information leaflet on the survey goal and objectives, and consent forms were distributed to the members of randomly selected households. Survey participants were invited to selected FGPs in urban areas and soum/bagh hospitals in rural areas for data collection. Those unable to visit selected sites were reached at home for data collection purposes especially in remote rural areas.

Chapter II. Survey methodology

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Monitoring of data collection. Three monitoring teams comprised of two representatives from MOH and PHI had been assigned a task of monitoring the survey data collection in accordance with the Monitoring Guidelines approved by State Secretary of the MOH. The teams monitored the survey data collection process in the field, and provided technical and logistics support to data collection teams. Data collection process in Ulaanbaatar city was monitored by two teams comprised of representatives from the City Health Authority, Deputy Directors of District Health Units and the survey coordinators in accordance with the Monitoring Guidelines approved by Director of the Public Health Institute. Chapter II. Survey methodology Data entry and cleaning: The survey data was fully collected using PDAs. Therefore, data from 35 PDAs used by data collection teams was downloaded directly into a database using the eSTEPS data management software; thus, completing the data entry process. The data copied into eSTEPS questionnaire designer software was converted into EpiData software; thus, allowing an easy conversion of data into other statistical analysis software including SPSS. Each survey respondent had a unique identifier comprised of cluster, family group, bagh and individual ID numbers. The accuracy of coding was established within a week by elucidating any overlaps, omissions and/or wrong coding. Next, the survey data was compiled into a single file, and the accuracy of recording respondents’ age and gender, and other variables was established within a week using range and logical checking. Finally, data checking was also performed by using the analysis code provided by WHO HQ, which includes code to check the data prior to every analysis performed. Weighting of data: Because the data is comprised of only a sample of the target population, it was necessary to weight the data. Thus, sample weighting and adjustments to correct differences in the age-sex distribution of the sample versus the target population were performed. The sample weight for each case in the survey sample accounts for the number of cases it represents in the sampling frame, based on the sample selection procedure. The product of the sample weight and the population adjustment weight was used in all weighted analyses. Data analysis Statistical analysis of the survey data was performed by statistical analysis team of PHI under the guidance of Ms. Melanie Cowan, Technical Officer, Surveillance and Population-Based Prevention Department of Chronic Diseases and Health Promotion, WHO. Data analysis was performed using Epi Info version 3.5.1 using appropriate methods for the complex sample design of the survey. The prevalence and measures of central tendency of NCD risk factors were estimated. Outcome measures (prevalence and mean variance) and differences between groups (age, gender and urban/ rural groups) were calculated with 95% confidence intervals (95% CI). Sampling error, which could potentially affect the accuracy of the results of the current survey, was measured by the standard error of variables. Margins of error in a prevalence and measures of central tendency are represented by numeric values of lower and upper limits of 95% confidence interval. Results of the survey on the prevalence of NCD and injury risk factors such as prevalence and measures of central tendency could be considered representative of the survey population since they were adjusted using population and sample weights. Analysis of comparative study The first Mongolian STEPS Survey on the Prevalence of NCD Risk Factors was conducted in 2005, and established baseline of NCD risk factors using only an adjustment to the 2005 population. The current survey employed both a population adjustment and sample weighting; thus, improving accuracy and representativeness of the survey. However, this difference in data analysis between the two surveys compromises their direct comparability. Therefore, primary data for 2005 and 2009 surveys were adjusted for age group and gender to the 2008 population to allow direct comparison.

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

CHAPTER III SURVEY RESULTS

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

3.1 DEMOGRAPHIC INDICATORS The survey collected information on demographic indicators such as age, gender, education, ethnicity, occupation, household income and marital status of respondents. The survey participants included 5438 respondents aged 15-64 years from 20 aimags and Ulaanbaatar city. Of which, 2217 were males and 3221 were females (Table 8). Table 8. Age group and sex of respondents Chapter III. Survey results Age Group (years) 15-24 25-34 35-44 45-54 55-64 15-64 Men n 403 603 568 420 223 2217 % 44.8 39.5 39.3 40.2 42.6 40.8 n 496 922 876 626 301 3221 Women % 55.2 60.5 60.7 59.8 57.4 59.2 n 899 1525 1444 1046 524 5438 Both Sexes % 16.5 28.0 26.6 19.2 9.6 100

Of a total of 5438 survey respondents, representatives of khalkha and kazak ethnic groups accounted for 82.1 and 2.0%, respectively. In terms of age groups there were 899 person aged 15-24, 1525 persons aged 25-34, 1444 persons aged 35-44, 1046 persons aged 45-54, and 524 persons aged 5564. In terms of locality, 2546 persons were from urban and 2892 persons from rural areas.

Table 9. Survey sample (ethnicity, settings) Demographics Khalkha Ethnicity Kazak Other Urban Setting Rural Total Survey sample n 4460 107 866 2546 2892 5438 % 82.1 2.0 15.9 46.8 53.2

The distribution of the survey respondents in different age, gender and urban/rural groups was comparable to that of the general population, which facilitated stratification by age, gender and locality.

Marital status The majority (74.0%) of the survey respondents were married, 17.3% were single, 4.3% were widowed, 2.6% were divorced, 1.2% had a girlfriend/boyfriend, and 0.6% were separated. Four in five respondents had a sexual partner and the proportion of widowed women was greater by 3.2% compared to men ( Annex I. I-3).

Education level The average number of years spent in school for the survey respondents was 10.4 years with males spending 9.9 years and females 10.8 years in school (Table 10). Among the younger age groups, females tended to have slightly more years of schooling, on average.

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Table 10. Mean number of years of education Age Group (years) 15-24 25-34 35-44 45-54 55-64 15-64 Men n 403 603 568 419 223 2216 Mean 9.6 9.8 10.3 9.6 10.3 9.9 n 496 922 876 626 301 3221 Women Mean 10.6 10.7 11.3 11.0 9.6 10.8 n 899 1525 1444 1045 524 5437 Both Sexes Mean 10.1 10.3 10.9 10.4 9.9 10.4

According to the survey, 1.4% of the population had no formal schooling, 1.8% had incomplete primary schooling (completed the first three grades or were just literate), 9.7% completed primary education, 22.6% had incomplete secondary education, 25.9% completed secondary education, 37.3% completed college/university and 1.3% had postgraduate degree training (Annex I.5). Comparison of education levels by gender demonstrated that males were more likely to have only attained some secondary schooling or less while women were more likely to have completed their secondary education, universities, or postgraduate studies. Comparison of levels of education by age group revealed that 15-24 year-old males (33.3%) were more likely to have incomplete secondary education compared to their female counterparts (27.6%), while the proportion of women with completed college/university training was 2.2-20.7% higher compared to men in all age groups. The above data demonstrates higher rates of discontinuation of formal training by males after graduation from 8th grade, which results in their lower educational attainments compared to women. Household income and employment The household income of the surveyed population was assessed based upon average earnings over the past year. 5298 out of 5438 surveyed participants answered the question “What was your average household income in the last year?” Mean reported household income per year was 3’138’196 tugrigs. Considering that household income consists of joint earnings of working age adults (aged 18 years and above), an average income earned by an adult person per year was 1’281’624.25 tugrigs (Table 11). Table 11. Average annual income per adult person (by age) Age group 15-24 25-34 35-44 45-54 55-64 Total n 840 1495 1419 1026 518 5298 Per adult person (MNT) 1’127’826.8 1’421’754.0 1’434’386.2 1’094’237.1 1’094’709.2 1’283’132.8 95% CI 1’064’210.1 – 1’191’443.6 1’363’689.4 – 1’479’818.7 1’373’701.3 – 1’495’071.0 1’033’084.0 – 1’155’390.3 1’014’456.4 – 1’174’962.0 1’253’928.6 – 1’312’337.0

Of the survey respondents, 57.4% were employed, of whom 44% were males and 55.1% were females.

Chapter III. Survey results

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

According to the survey results, 21.5% of the population was employed in governmental organizations, 10.6% – in nongovernmental organizations, 20.4% – self-employed, and 47.5% engaged in occasional work. Women were predominantly employed in governmental organizations (22.7%) and men – in private sector (24.9%). Table 12. Employment status Both n 402 603 568 420 223 2216 496 922 876 626 301 3221 5437 % Government employee 7 21.2 24.5 23.1 20.2 19.7 8.1 21.4 32.1 31 7.3 22.8 21.5 % Non-government employee 4.5 15.8 13.9 11.9 5.8 11.5 7.7 13.2 10.6 8.5 4.3 9.9 10.6 % Self-employed 14.7 29.4 32.9 25.2 10.3 24.9 6.7 18.4 24.1 19.6 7 17.3 20.4

Age Group (years)

Chapter III. Survey results

15-24 25-34 men womwn 35-44 45-54 55-64 15-64 15-24 25-34 35-44 45-54 55-64 15-64 Total

The unemployment rate in the survey population was 30.5%, of whom 39.1% were males and 25.3% females. Of the survey respondents, students, homemakers, the retired, the disabled and the able-bodied unemployed accounted for 18.6%, 24.4%, 16.5% and 24.1%, respectively. Gender breakdown of the able-bodied unemployed demonstrated that there were slightly (9.9%) more males than females in this group, while there were more (20%) female homemakers (housewives) than male (Table 13). Table 13. Unpaid work and unemployed (by age and gender) Age group 15-24 25-34 Male 35-44 45-54 55-64 15-64 15-24 25-34 Female 35-44 45-54 55-64 15-64 Total Student % 61.3 6.4 0.6 0 0 20.2 67.8 3.9 1.7 0 0 17.6 18.6 Homemaker % 8.8 16.3 17.2 12.6 3.5 11.6 15.6 53.1 47.8 26.2 4.9 31.6 24.1 Retired % 0 0.5 4.3 15 65.5 13 0.5 0.2 3.1 29.3 87.3 18.7 16.5 Unemployed Able to work Not able to work % % 19.5 2 42.9 40.5 39.5 14.1 30.6 12.5 28.9 30.9 23.8 3.7 20.7 24.4 7.4 11.7 16.2 11.3 8.5 0.5 3 5.8 2.9 2.9 4.6 6.1

n 297 203 163 167 142 972 385 433 291 256 245 1610 2582

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

3.2 PREVALENCE OF COMMON MODIFIABLE RISK FACTORS FOR NCDs

Tobacco use The survey participants were asked questions about current smoking, previous smoking, the age of initiation of smoking, duration of smoking, the quantity of tobacco smoked daily, use of smokeless tobacco, types of tobacco products used, and duration of exposure to second-hand smoke at work and home. The prevalence of smoking in the survey population was 27.7% (95%CI 26.0-29.4) with statistically significantly more males (48.0%) currently smoking as compared to females (6.9%). Among those all, as well as male smokers, the percentage of 15-24 years old smokers was lower compared to other age groups. For female smokers, there was no statistically significant difference in terms of age group (Table 14). Table 14. Percentage of current smokers (by age and gender) Age Group (years) 15-24 25-34 35-44 45-54 55-64 15-64 Men n 403 603 568 420 223 2217 % Current smoker 35.0 55.5 60.4 52.4 47.5 48.0 95% CI 27.3-42.8 50.6-60.4 54.3-66.4 46.0-58.7 39.4-55.6 44.5-51.5 n 496 922 876 626 301 3221 Women % Current smoker 4.0 9.1 7.1 10.9 5.4 6.9 95% CI 1.9-6.0 5.8-12.4 4.5-9.8 7.3-14.4 1.9-8.9 5.2-8.5 n 899 1525 1444 1046 524 5438 Both Sexes % Current smoker 19.9 32.5 33.6 32.3 25.6 27.7 95% CI 15.5-24.2 29.9-35.2 30.5-36.7 28.9-35.8 21.3-29.9 26.0-29.4

In terms of locality, 27.6% of urban (95% CI 24.8-30.3) and 27.8% (95%CI 25.7-29.8) of rural population smoked indicating no statistically significant difference in terms of stratum. With respect to frequency of smoking, 24.3% (95%CI 22.9-25.7) of the respondents were daily smokers, 3.4% (95%CI 2.7-4.0) were non-daily smokers and 72.3% (95%CI 70.6-74.0) responded to never smoke (Table 15). Table 15. Smoking status Age Group (years) 15-24 25-34 35-44 45-54 55-64 15-64 Both Sexes Current smoker 95% CI % Non-daily 95% CI 13.0-19.9 3.4 1.7-5.1 26.7-31.5 26.7-31.8 26.4-33.7 19.7-27.5 22.9-25.7 3.4 4.4 2.3 2.0 3.4 2.3-4.5 2.8-6.0 1.2-3.4 0.7-3.3 2.7-4.0

n 899 1525 1444 1046 524 5438

% Daily 16.4 29.1 29.2 30.0 23.6 24.3

% Does not smoke 80.1 67.5 66.4 67.7 74.4 72.3

95% CI 75.8-84.5 64.8-70.1 63.3-69.5 64.2-71.1 70.1-78.7 70.6-74.0

There were significant differences in frequency of smoking between genders with 43.0% (95% CI 39.9-46.0) of males and 5.2% (95% CI 3.8-6.7) of females smoking daily, and 5.0% (95% CI 4.06.1) of males and 1.6% (95% CI 0.9-2.4) of females smoking non-daily (Figure 3)

Chapter III. Survey results

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Figure 3. Frequency of smoking

43%

5.2%

5% 5%

Chapter III. Survey results

1.6%

Daily Men Women

Non daily

Among current smokers, it was found that 87.9% (95% CI 85.8-90.0) reported to smoke daily. In regard to gender there was no difference in the daily smokers that is, 89.5% (95% CI 87.5-91.4) of t men and 76.3% (95% CI 66.5-86.0) of women smoked daily (Annex I.7). Among smokers, mean age of initiation to smoking was 19.2 years (95% CI 18.7-19.6) and this was differed by sex whereas males started smoking at the age of 18.7 years (95% CI 18.2-19.2) and females started smoking at the age of 23.2 (95% CI 21.3-25.1) years (Table 16). Table 16. Mean age started smoking Age Group (years) 15-24 25-34 35-44 45-54 55-64 15-64 Men n 126 298 305 210 99 1038 Mean age 16.6 18.3 19.4 19.9 23.3 18.7 95% CI 16.0-17.1 17.8-18.9 18.3-20.5 19.0-20.9 21.5-25.0 18.2-19.2 n 12 55 55 51 21 194 Women Mean age 17.5 20.6 25.6 25.9 32.4 23.2 95% CI 15.9-19.1 18.4-22.8 21.6-29.6 22.8-29.1 21.5-43.3 21.3-25.1 n 138 353 360 261 120 1232 Both Sexes Mean age 16.6 18.6 20.0 20.8 24.3 19.2 95% CI 16.1-17.2 18.1-19.1 18.9-21.0 19.8-21.8 22.2-26.4 18.7-19.6

The duration of smoking has implications for health risks associated with tobacco use. The average duration of smoking among smokers was 15.8 years (95% CI 14.9-16.6) with no significant difference between males (16.1 years; 95% CI 15.1-17.0) and females (13.1 years; 95% CI 11.015.2) (Annex I.8). Out of current daily smokers, 84.6% (95% CI 78.8-90.3) used manufactured cigarettes. There was a statistically significant difference in proportion of urban (99.6%; 95% CI 99.1-100.0) and rural (71.0%; 95% CI 61.1-80.8) consumers of manufactured cigarettes (Annex I.9). Mean number of cigarettes smoked per day was 8.7 (95% CI 7.8-9.6) among current daily smokers. Men smoked 8.9 cigarettes (95% CI 7.9- 9.8) daily and women smoked 7.0 cigarettes (95% CI 5.68.4) a day. There was no significant difference in the number of cigarettes smoked daily between genders and age groups.

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Exposure to second-hand smoke at home and work was reported by 42.9% (95% CI 38.4-47.3) and 35.6% (95% CI 31.1-40.1) of the respondents, respectively. In regard to gender, 38.2% (95% CI 32.3-44.1) of males and 47.6% (95% CI 43.3-51.9) of females were exposed to smoking at home. At work place, 43.3% (95% CI 36.7-40.1) of the males and 27.7% (95% CI 24.0-31.3) of the females reported to be exposed, indicating more males had exposure to second-hand smoke than females (Annex I.10, 11).

Conclusions: Chapter III. Survey results 1. In Mongolia 27.6% of the population, or three in every 10 people, and one in every two males, smoked. 2. One in every 4 smokers (24.3%) smoked daily. When stratified by gender, 43.0% of males and 5.2% of females smoked daily. 3. There was no significant difference between genders in duration of smoking and a number of cigarettes smoked daily, which was indicative of high risk of developing NCDs among smokers irrespective of gender. 4. One in two persons was exposed to second-hand smoke at home, and 4 in 10 were exposed at work, which considerably increased the risk of NCDs in the general population.

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Alcohol consumption Alcohol consumption patterns, frequency of drinking and risks associated with alcohol consumption were studied according to gender, age and place of residence of the survey respondents. Of the survey respondents, 34.2% (95% CI28.7-39.6), including 24.0% (95% CI 19.3-28.8) of males and 44.5% (95%CI 38.1-51.0) of females were lifetime abstainers. In addition, 7.4% (95% CI 5.79.1) of the respondents reported no alcohol consumption in the past 12 months, and there was no gender difference with regards to this indicator (Table 17). Table 17. Alcohol consumption status, by age Chapter III. Survey results Both Sexes Age Group (years) % Current drinker (past 30 days) 26.7 47.5 47.7 44.0 33.0 38.6 % Drank in past 12 months, not current 21.4 19.1 19.8 18.8 15.7 19.8 % Past 12 months abstainer 6.7 7.6 7.1 8.4 9.3 7.4

95% CI

% Lifetime abstainer

95% CI

15-24 25-34 35-44 45-54 55-64 15-64

899 1525 1444 1046 524 5438

21.6-31.8 42.1-53.0 42.1-53.3 39.1-48.9 28.0-38.1 34.6-42.7

16.0-26.9 15.7-22.6 15.6-23.9 15.0-22.6 10.4-20.9 16.1-23.5

4.1-9.3 5.7-9.5 4.3-9.9 6.0-10.9 5.9-12.6 5.7-9.1

45.2 25.7 25.4 28.8 42.1 34.2

37.6-52.7 20.1-31.4 19.2-31.7 23.3-34.4 34.1-50.0 28.7-39.6

Of alcohol users, 19.8% (95% CI 16.1-23.5) reported drinking in the past 12 months, and 38.6% (95% CI 34.6-42.7) were current drinkers or reported alcohol use in the past 30 days. There was no gender difference among past 12 month drinkers. In contrast, 49.8% (95% CI 44.7-54.8) of males vs. 27.2% (95% CI 23.0-31.3) of females were current drinkers or reported alcohol use in the past 30 days (Table 18). Table 18. Alcohol consumption status, by sex Current drinker (past 30 days) n Male Female Total 2217 3221 5438 % 49.8 27.2 38.6 95% CI 44.7-54.8 23.0-31.3 34.6-42.7 Drank in past 12 months, not current % 20.1 19.5 19.8 95% CI 15.9-24.4 15.9-23.1 16.1-23.5 Past 12 months abstainer % 6.1 8.8 7.4 95% CI 4.4-7.7 6.6-11.0 5.7-9.1

Gender

Lifetime abstainer % 24 44.5 34.2 95% CI 19.3-28.8 38.1-51.0 28.7-39.6

In terms of the frequency of alcohol use by respondents reporting drinking in the past 12 months, 62.0% (95% CI 55.0-69.0) drank occasionally (less than once per month), 30.8% (95% CI 25.236.2) drank alcohol for 1-3 days a month, 5.9% (95% CI 3.6-8.3) drank 1-4 days a week, 0.7% (95% CI 0.1-1.4) drank 5-6 days a week, and 0.6% (95% CI 0.2-0.9) reported daily consumption of alcohol (Figure. 4).

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Figure 4. Frequency of alcohol consumption in the past 12 months

Analysis of the frequency of alcohol use by gender demonstrated the following: 1. 52.9% (95% CI 44.7-61.2) of males and 75.8% (95% CI 69.8-81.9) of females drank alcohol less than once a month 2. 37.2% (95% CI 30.3-44.0) of males and 21.0% (95% CI 15.9-26.1) of females drank 1-3 days a month, 3. 8.3% (95% CI 4.9-11.7) of males and 2.3% (95% CI 0.9-3.6) of females drank 1-4 days a week, 4. 0.9% (95% CI 0.2-1.6) of males and 0.4% (95% CI 0.0-1.1) of females drank 5-6 days a week, 5. 0.6% (95% CI 0.1-1.1) of males and 0.5% (95% CI 0.0-0.9) of females reported daily consumption of alcohol (Annex I.12-13) In overall, the above data demonstrates higher risk posed by more frequent alcohol consumption in males compared to females. An alcohol consumption pattern was further studied by elucidating the frequency of drinking in the past 30 days and an amount of standard drinks on a drinking occasion. In the past 30 days alcohol users drank on average 3.6 times (95% CI 2.7-4.6), males - 3.8 times (95% CI 2.9-4.8) and females - 3.3 times (95% CI 2.1-4.6). Current drinkers consumed on average 7.7 standard drinks (95% CI 7.1-8.3) on a drinking occasion with males consuming 9.2 standard drinks (95% CI 8.5-9.9) or three times more than recommended consumption limits, and females consuming 5.1 standard drinks (95% CI 4.5-5.6) or twice more than recommended limits. In all age groups men consumed twice more standard drinks on a drinking occasion than women (Table 19). Table 19. Mean number of standard drinks per drinking occasion among current (past 30 days) drinkers Age groups 15-24 25-34 35-44 45-54 55-64 15-64 men n 113 332 296 212 107 1060 Mean 7.3 9.5 10.0 10.0 10.1 9.2 95% CI 6.1-8.5 8.5-10.6 8.9-11.0 8.7-11.4 8.6-11.6 8.5-9.9 n 94 280 274 172 54 874 woman Mean 4.0 5.3 5.9 5.3 4.2 5.1 95% CI 3.0-5.0 4.5-6.1 5.1-6.8 4.5-6.1 3.2-5.2 4.5-5.6 n 207 612 570 384 161 1934 Total Mean 6.0 8.0 8.5 8.4 8.5 7.7 95% CI 5.2-6.9 7.1-8.8 7.6-9.3 7.5-9.4 7.2-9.8 7.1-8.3

Chapter III. Survey results

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

The risk associated with alcohol consumption was assessed in the survey population based on an average number of standard drinks consumed per drinking day. According to the survey results, 1.1% (95% CI 0.4-1.8) of the respondents or 1.5% (95% CI 0.6-2.4) of males and 0.7% (95% CI 0.21.2) of females were at high risk with twice as many men having such a risk compared to women. Medium level risk was found in 1.0% (95% CI 0.5-1.5) of the population or 1.2% (95% CI 0.5-1.8) of males and 0.8% (95% CI 0.3-1.3) of females with no significant difference between genders (Table 20). Table 20. Category II, III drinking among all respondents, by gender Gender Male Female Total Category II n 2164 3212 5376 % 1.2 0.8 1 95% CI 0.5-1.8 0.3-1.3 0.5-1.5 % 1.5 0.7 1.1 Category III 95% CI 0.6-2.4 0.2-1.2 0.4-1.8

Chapter III. Survey results

The risk associated with alcohol consumption was assessed in current drinkers based on the average number of standard drinks consumed per drinking day in the past 30 days. For 94.5% (95% CI 92.196.9) of men and women the risk was low, for 2.4% (95% CI 1.1-3.7) of men and 2.9% (95% CI 1.1-4.6) of women the risk was medium, and for 3.1% (95% CI 1.4-4.7) of men and 2.6% (95% CI 1.0-4.3) of women the risk was high (Table 21, Annex I.14-15). Table 21. Category I, II and III drinking among current (past 30 days) drinkers, by gender Category I Gender n 1125 885 Amount /g/ <40 <20 % 94.5 94.5 95% CI 92.1-96.9 91.6-97.4 Category II Amount /g/ 40-59.9 20-39.9 % 2.4 2.9 95% CI 1.1-3.7 1.1-4.6 Amount /g/ >60 >40 Category III % 3.1 2.6 95% CI 1.4-4.7 1.0-4.3

Male Female

Binge drinking is an important factor which significantly increases risks associated with alcohol consumption. Binge drinking is defined for males as consumption of 5 or more standard drinks on a drinking occasion and for females as consumption of 4 or more standard drinks per occasion. The survey findings demonstrated that among current drinkers, 39.7% (95% CI 35.0-44.4) of men and 15.1% (95% CI 12.4-17.7) of women engaged in binge drinking and it was 2.5 times more common among males compared to females (Table 22). Table 22. Five/four or more drinks on a single occasion at least once during the past 30 days among total population Gender Male Female Number of standard drinks per drinking occasion ≥5 ≥4 n 2217 3221 % 39.7 15.1 95% CI 35.0-44.4 12.4-17.7

Analysis of binge drinking behavior by age revealed that more than half (51.5% and 52%) of 25-44 year-old males and one in five females in the same age group engaged in binge drinking (Annex I.16). In the past 30 days men consumed more than the recommended consumption limits on 2.1 occasions (95% CI 1.7-2.4), and women on 1 occasion (95% CI 0.8-1.1). In addition, the greatest number of standard drinks consumed on a drinking occasion in the past 30 days was 8.8 drinks (95% CI 8.2-

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

9.4) in current drinkers or 10.7 drinks (95% CI 9.8-11.5) in males and 5.5 drinks (95% CI 4.9-6.2) in females (Annex I.17). Conclusions: 1. One third of the population is lifetime alcohol abstainers. Current drinking or consumption of alcohol in the past 30 days was reported by 38.6% of all respondents or 49.8% of men and 27.2% of women. 2. Frequency of alcohol drinking was higher in males compared to females. Chapter III. Survey results 3. On an average drinking occasion, males consumed 9.2 and females consumed 5.1 standard drinks respectively. 4. The prevalence of binge drinking was 39.7% in men and 15.1% in women, and binge drinking was 2.5 times more common in males compared to females.

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Fruit and vegetable consumption Fruit and vegetable consumption of the survey population was assessed using indicators of “frequency of consumption per week” and “average daily consumption”. Frequency of fruit consumption per week The frequency of weekly fruit consumption in the survey population is shown in the table below by gender and locality breakdown (Table 23). Chapter III. Survey results Table 23. Mean number of days fruit consumed in a typical week (by gender and locality) Gender and locality Man Woman Total Urban Rural Total n 2217 3220 5437 2546 2891 5437 Mean 1.0 1.4 1.2 1.5 0.8 1.2 95% CI 0.7-1.2 1.2-1.6 0.9-1.4 1.3-1.7 0.5-1.1 0.9-1.4

Gender

Locality

The survey population consumed fruits 1.2 days (95% CI 0.9-1.4) a week. The corresponding numbers for males and females were 1.0 (95% CI 0.7-1.2) and 1.4 (95% CI 1.2-1.6) days a week, respectively (Annex I.18). With regards to the locality, urban respondents consumed fruits 1.5 days (95%CI 1.3-1.7) and rural respondents – 0.8 days (95% CI 0.5-1.1) a week. Breakdown of data by gender within a locality demonstrated that frequency of weekly fruit consumption was 1.3 days (95% CI 1.0-1.6) for urban men, 0.6 days (95% CI 0.4-0.9) for rural men, 1.7 days (95% CI 1.6-1.9) for urban women and 1 day (95% CI 0.6-1.3) for rural women. Analysis of data by age revealed that the frequency of weekly fruit consumption was 1.4 days for 15-24 year-olds, which was higher compared to other age groups (95% CI 1.1-1.6). Average daily fruit consumption Average daily fruit consumption in the survey population is shown in the table below by gender and locality breakdown (Table 24). Table 24. Mean number of servings of fruit on average per day (by gender and locality) Gender and locality Man Gender Woman Total Urban Locality Rural Total n 2208 3206 5414 2534 2880 5414 Mean 0.3 0.5 0.4 0.5 0.3 0.4 95% CI 0.2-0.5 0.4-0.6 0.3-0.5 0.4-0.7 0.1-0.5 0.3-0.5

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Average daily fruit consumption was 0.4 servings (95% CI 0.3-0.5) in the survey population, or 0.3 servings (95% CI 0.2-0.5) for males and 0.5 servings (95% CI 0.4-0.6) for females. Average daily fruit consumption for women was higher compared to men (Annex I.19). Average daily fruit consumption was 0.5 servings (95% CI 0.4-0.7) for urban and 0.3 servings (95% CI 0.1-0.5) for rural respondents. Average daily fruit consumption was higher in urban population compared to the rural population. There was no statistically significant difference in average daily fruit consumption between age groups. Frequency of vegetable consumption per week Chapter III. Survey results Frequency of weekly vegetable (excluding potato) consumption in the survey population is shown in the table below by gender and locality breakdown (Table 25). Table 25. Mean number of days vegetables consumed in a typical week (by gender and locality) Gender and locality Man Woman Total Urban Rural Total n 2215 3220 5435 2546 2889 5435 Mean 4.6 4.9 4.8 5.8 3.8 4.8 95% CI 4.0-5.2 4.4-5.5 4.2-5.3 5.5-6.1 3.0-4.6 4.2-5.3

Gender

Locality

The survey population consumed vegetables 4.8 days (95% CI, 4.2-5.3) a week. The corresponding numbers for males and females were 4.6 (95% CI 4.0-5.2) and 4.9 (95% CI 4.4-5.5) days a week, respectively (Annex I.20). With regards to the locality, urban respondents consumed vegetables 5.8 days (95% CI 5.5-6.1) and rural respondents – 3.8 days (95% CI 3.0-4.6) a week. Breakdown of data by gender within a locality demonstrated that the frequency of weekly vegetable consumption was 5.8 days (95% CI 5.5-6.1) for urban men, 3.6 days (95% CI 2.8-4.4) for rural men, 5.9 days (95% CI 5.6-6.2) for urban women and 3.9 days (95% CI 3.1-4.7) for rural women. The frequency of weekly vegetable consumption was significantly higher in urban vs. rural population. Mean number of servings of vegetables on average per day Average daily vegetable consumption in the survey population is shown in the table below by gender and locality breakdown. Table 26. Mean number of servings of vegetables on average per day (by gender and locality) Gender and locality Man Woman Gender Total Urban Locality Rural Total n 2204 3207 5411 2534 2877 5411 Mean 1.4 1.6 1.4 1.9 1.0 1.4 95% CI 1.1-1.6 1.2-1.9 1.2-1.7 1.6- 2.2 0.7-1.3 1.2-1.7

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Mean number of servings of vegetables on average per day 1.4 servings (95% CI 1.2-1.7) in the survey population, or 1.4 servings (95% CI 1.1-1.6) for males and 1.6 servings (95% CI 1.2-1.9) for females. Average daily vegetable consumption for women was higher compared to men (Annex I.21). Average daily vegetable consumption was 1.9 servings (95% CI 1.6-2.2) for urban and 1.0 serving (95% CI 0.7-1.3) for rural respondents. Average daily vegetable consumption was higher in urban vs. rural population. Comparison of average daily vegetable consumption between different age groups demonstrated that the 25-34 year age group had the highest consumption of 1.5 servings (95% CI 1.1-1.9) of vegetables a day. Further breakdown by gender within age groups revealed that 25-34 year-old males had the highest consumption of 1.5 servings (95% CI 1.1-1.9) of vegetables a day compared to males in other age groups. Similarly, 15-24 year-old females had the highest consumption of 1.7 servings (95% CI 1.4-2.0) of vegetables a day compared to females in other age groups. Mean number of servings of fruits and vegetables Average daily consumption of fruits and vegetables was 1.8 servings in the survey population, or 1.7 servings (95% CI 1.3-2.0) for males and 2 servings (95% CI 1.6-2.4) for females. Average daily consumption of fruits and vegetables for women was higher compared to men (Table 27, annex I.22). Table 27. Mean number of servings of fruit and/or vegetables on average per day (by gender and locality) Gender and locality Man Woman Total Urban Rural Total n 2217 3219 5436 2545 2891 2217 Mean 1.7 2.0 1.8 2.4 1.3 1.7 95% CI 1.3-2.0 1.6 -2.4 1.5-2.2 2.0-2.8 0.8-1.8 1.3-2.0

Chapter III. Survey results

Gender

Locality

Mean number of servings of fruits and vegetables was 2.4 servings (95% CI 2.0-2.8) for urban and 1.3 servings (95% CI 0.8-1.8) for rural respondents. Average daily fruit and vegetable consumption was higher in urban vs. rural population (Annex II.10-11). Average daily consumption of fruits and vegetables other than potatoes in the survey population by age groups was classified into three categories based on the number of servings consumed and is shown in Figure 5. 33.3% (95% CI 25.9-40.7) of the population did not consume fruits or vegetables at all, 46.5% (95% CI 40.2-52.9) consumed 1-2 servings a day, 12.4% (95% CI 8.9-16.0) - 3-4 servings a day, and only 7.7% (95% CI 4.2-11.3) – 5 or more servings a day. Overall, 92.3% of the population did not consume or consumed less than 5 servings of fruits and vegetables a day (Annex I.25).

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Figure 5. Daily servings of fruits and vegetables 70 60 C onsumption %

58.9

50 40 33.3 30 20 10 0 0 servings <5 servings ≥5 servings 7.7

Among fruit and vegetable consumers, 35-44 year-olds accounted for 36.4% (95% CI 28.0-44.9) and 45-54 year-olds – for 38.1% (95% CI 31.5-44.8), which was significantly higher compared to other age groups. In terms of a number of servings of fruits and vegetables consumed daily, 46.5% (95% CI 40.2-52.9) had 1-2 servings, 12.4% (95% CI 8.9-16.0) had 3-4 servings and 7.7% (95% CI 4.2-11.3) – 5 or more servings daily (Table 28, Annex I.23-24). Table 28. Number of servings of fruit and/or vegetables on average per day Total Age Group (years) 15-24 25-34 35-44 45-54 55-64 15-64 n 898 1524 1444 1046 524 5436 % no fruit and/or vegetables 28.8 34.2 36.4 38.1 34.7 33.3 95% CI

% 1-2 servings 49.7 44.8 44.2 45.6 45.0 46.5

95% CI

% 3-4 servings 12.4 12.9 12.2 10.7 15.3 12.4

95% CI

% ≥5 servings 9.1 8.2 7.2 5.5 5.1 7.7

95% CI

19.8-37.9 25.8-42.6 28.0-44.9 31.5-44.8 26.6-42.8 25.9-40.7

41.1-58.2 37.7-51.8 38.1-50.2 40.0-51.2 37.2-52.8 40.2-52.9

8.2-16.6 8.8-17.0 8.1-16.4 7.2-14.2 9.6-21.0 8.9-16.0

5.0-13.2 3.0-13.3 3.5-10.9 2.7-8.3 0.6-9.5 4.2-11.3

The majority of the respondents consumed 1-2 servings of fruits and vegetables a day. Breakdown by age of respondents who reported consuming 1-2 servings of fruits and vegetables daily demonstrated that 15-24 year-olds were more likely to fall into this category (49.7%; 95% CI 41.1-58.2) compared to other age groups. Average daily consumption of fruits and vegetables according to a number of servings is classified into 3 categories, and a breakdown by locality is shown in Table 29. Table 29. Number of servings of fruit and/or vegetables on average per day by locality Total Locality n 2545 2891 5436 % no fruit and/or vegetables 14.6 51.3 33.3 95% CI 11.2-18.1 38.9-63.7 24.5-42.0 % 1-2 servings 58.1 35.4 46.5 95% CI 49.6-66.7 27.7-43.0 39.6-58.5 % 3-4 servings 15.9 9.1 12.4 95% CI 11.5-20.3 3.8-14.4 8.8-16.0 % ≥5 servings 11.4 4.2 7.7 95% CI 5.5-17.2 0.3-8.2 4.1-11.4

Urban Rural Total

Chapter III. Survey results

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

A third (33.3%; 95% CI 24.5-42.0) of the survey population in total, and 14.6% of urban and 51.3% (95% CI 38.9-63.7) of rural respondents had 0 servings of fruits and vegetables. Of those who reported consuming fruits and vegetables, 46.5% (95% CI 39.6-58.5) consumed 1-2 servings, 12.4% (95% CI 8.8-16.0) - 3-4 servings, and 7.7% (95% CI 4.1-11.4) - 5 or more servings daily. The majority of the survey participants consumed 1-2 servings of fruits and vegetables daily. Figure 6. Daily servings of fruits and vegetables, by locality 80 C onsumption % 70 60 50 40 30 20 10 0 0 servings <5 servings ≥5 servings 14.5 11.4 4.2 51.3 44.5 Urban Rural 74

Chapter III. Survey results

The proportion of respondents reporting consuming 1-2 servings of fruits and vegetables daily was 58.1% (95% CI 49.6-66.7) in urban and 35.4% (95% CI 27.7-43.0) in rural areas. Similarly, those consuming 3-4 servings daily accounted for 15.9% (95% CI 11.5-20.3) of urban and 9.1% (95% CI 3.8-14.4) of rural respondents. Only 11.4% (95% CI 5.5-17.2) of urban and 4.2% (95% CI 0.3-8.2) of rural population consumed 5 or more daily servings of fruits and vegetables. The above data demonstrates significantly higher consumption of fruits and vegetables in urban vs. rural population (Figure 6).

Fat and oil intake When asked about a type of oil used for cooking, 77.1% (95% CI 70.3-83.9) of the survey respondents reported using vegetable oil, 17.1% (95% CI 10.8-23.3) – animal fat, 5.5% (95% CI 3.3-7.8) – other types of fats and oils and 0.3% (95% CI 0.1-0.5) did not use fat or oil for cooking. Figure 7. Fat intake (by locality) 100 90 Consumption % 80 70 60 50 40 30 20 10 0 Us e vegetable oil for c ook ing 2.3 Us e animal fat for c ook ing 94.1

60.7 Urban R ural

31.3

Of male respondents, 73.7% (95% CI 65.9-81.5) used vegetable oil, 20.3% (95% CI 12.8-27.9) – animal fat, 5.5% (95% CI 3.2-7.8) – other oil and 0.4% reported no use of fat or oil in cooking. 94.1% (95% CI 91.5-96.7) of urban and 60.7% (95% CI 48.6-72.7) of rural respondents used vegetable oil. Animal fat use was reported by 2.3% (95% CI 1.3-3.3) or urban vs. 31.3% (95% CI 19.9-42.8) or rural respondents.

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Salt intake Average daily salt intake was 7.3 grams (95% CI 6.9-7.7) per household member. Salt intake was higher in rural (8.1 grams daily, 95% CI 7.5-8.6) vs. urban (6.5 grams daily, 95% CI 6.1-6.9) residents (Annex I.26; II.13) Conclusions 1. Average daily serving of fruits and vegetables was 1.8 in the Mongolian population, which was 3.2 servings less than the WHO recommendation. 2. 92.3% of the Mongolian population consumed less than 5 servings of fruits and vegetables daily. 3. Fruit and vegetable consumption in rural areas was twice lower than in urban areas. 4. Urban residents used predominantly vegetable oil for cooking, while rural residents tended to use animal fat. 5. Daily salt intake was 7.3 grams per person with rural residents using on average 1.6 more grams of salt compared to their urban counterparts.

Chapter III. Survey results

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Physical activity Physical activity was assessed in terms of intensity and duration of activity and compared between different genders, age groups and locality. In terms of intensity, physical activity is classified into high, moderate and low levels. High levels of physical activity. According to the survey results, the prevalence of people engaged in high levels of physical activity was 80.8% with significantly more males (82.5%) engaged in such activities than females (78.9%) (Annex I.27-29). Chapter III. Survey results In terms of age differences, 15-24 year-old men most actively engaged in high level physical activities (85.6%), decreasing with age and reaching the lowest rate in 55-64 year-olds (63.4%). In females, in contrast, the peak was in 35-44 year-olds (83.3%) and the lowest rate – in 55-64 yearolds (73.2%). The findings of the survey demonstrated that in both genders physical activity was at the lowest level in 55-64 year age group, and women lag almost 20 years behind men in terms of reaching the highest level of engagement in high levels of physical activity (Figure 8). Figure 8. Proportion of population engaged in high levels of physical activity, by age and gender 100

85.6

83.6 80.6

83.3 83

proportion %

77.2

80.3 77.2 73.2 63.4

40 15-24 25-34 Men 35-44 45-54 Woman 55-64

In terms of locality, rural respondents (88.1%) were more likely to engage in high levels of physical activity compared to their urban counterparts (73.3%). A similar trend was preserved when stratified by gender, with 75.1% (95% CI 67.1-83.2) of urban men, 89.2% (95% CI 84.3-94.1) of rural men, 71.7% (95% CI 63.1-80.4) of urban women and 87% (95% CI 79.6-94.3) rural women engaging in high levels of physical activity (Annex II.14-16). Moderate levels of physical activity. According to the survey results, the prevalence of people engaged in moderate levels of physical activity was 11.7% (95% CI 8.7-14.7) with significantly more females (13.4%; 95% CI 9.4-17.4) engaged in such activities than males (10%; 95% CI 7.412.7). In terms of age differences, in men in 15-44 year age group moderate levels of physical activity decreased steadily with age (10.3%, 8.5%, and 7.6%) before increasing in 45-65 year age group (11.5%, 18.6%). In females, the peak was in 15-24 year-olds (16%), followed by a decrease to the lowest rate in 35-44 year-olds (10.4%), before steadily increasing in 45-64 year-olds (13.2%, 14.4%). The findings of the survey demonstrated that in both genders moderate levels of physical activity were common in 35-44 year-olds, increasing further in 55-64 year age group.

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

In terms of locality, urban respondents (15.3%, 95% CI 11.2-19.3) were twice more likely to engage in moderate levels of physical activity compared to their rural counterparts (8.2%; 95% CI 4.1-12.3). Low levels of physical activity. Of the survey population, 7.5% belonged to a physically inactive risk group. In males the prevalence of low levels of physical activity was 7.4% (95% CI 4.5-10.3) and in females – 7.7% (95% CI 5.1-10.2). Breakdown by gender and locality revealed that 12% (95% CI 7.3-16.7) of urban men, 3.3% (95% CI 1.4-5.2) of rural men, 10.8% (95% CI 7.1-14.6) of urban women and 4.2% (95% CI 1.6-6.7) of rural women, or 11.4% (95% CI 7.5-15.2) of urban residents and 3.7% (95% CI 1.7-5.8) of rural residents were physically inactive. In other words, one in every 10 urban residents was physically inactive. Chapter III. Survey results Population not engaging in vigorous physical activity Out of the physically active population, 48.5% (95% CI 43.1-53.8) did not engage in vigorous or high and moderate levels of physical activity at work and/or recreational settings. The proportion of men and women not engaging in vigorous activity was 42.9 (95% CI 37.3-48.4) and 54.2% (95% CI 48.2-60.1), respectively. The proportion increased with age irrespective of gender (Annex I.30). In urban areas, the population not engaged in vigorous physical activity at work and in recreational settings was 54.5% (95% CI 48.5-60.6), which was higher than in rural areas (42.4%; 95% CI 34.150.8), (Annex II.17) The proportion of the population engaged in vigorous physical activity at work was 53.4% (95% CI 49.1-57.6), 23.7% (95% CI 20.7-26.7) during transport and 23% (95% CI 20.1-25.8) in recreational settings with no significant differences between genders. The median duration of time spent in vigorous activity was 342.9 minutes (95% CI 158.6-510) a day. For males the median duration was 347.1 minutes (95% CI 171.4-501.4) and for females - 337.1 minutes (95% CI 141.4-518.6). Median minutes spent in vigorous activity was the highest in men and women in 35-44 year age group (385.7 and 364.3 minutes, respectively), and the lowest in 5564 year age group (234.3 minutes for men and 297.1 minutes for women). Thus, the intensity and duration of vigorous physical activity decreased with age (Annex I.31-36). Median duration of daily vigorous physical activity at work was 214.2 minutes (95% CI 25.7-342.9), during transport – 30 minutes (95% CI 11.4-85.7) and in recreational settings – 51.4 minutes (95% CI 4.3-102.9). Gender breakdown of data demonstrated that males spent 225.7 minutes (95% CI 51.4-342.9) at work, 34.3 minutes (95% CI 10-90) during transport and 34.3 minutes (95% CI 0-85.7) in recreational settings engaging in vigorous physical activity. Corresponding numbers for females were 205.7 (95% CI 7.1-342.9), 30 (95% CI 12.9-77.1) and 51.4 (95% CI 11.4-120) minutes, respectively (Figure 9).

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Figure 9. Median duration of daily vigorous activity (by gender, urban/rural and type of setting)

Chapter III. Survey results

Rural respondents spent more time in physical activity than urban respondents. Median duration of daily vigorous activities for urban males was 180 minutes (95% CI 8.6-308.6) at work, 25.7 minutes (95% CI 4.2-60.0) during transport and 25.7 minutes (95% CI 0-64.3) in recreational settings. The corresponding numbers for rural males were 257.1 (95% CI 109.3-360), 60 (95% CI 20-120) and 45 (95% CI 0-120) minutes, respectively; for urban females 171.4 (95% CI 0-300), 21.4 (95% CI 7.1-60.0) and 47.1 (95% CI 8.6-102.9) minutes, respectively; and for rural females 240 (95% CI 85.7-360), 60 (95% CI 21.4-120) and 60 (95% CI 17.1-124.3) minutes, respectively. Conclusions 1. 7.5% of the population were physically inactive, which meant 1 in 10 persons was at increased risk for NCDs. Urban men were 4 times and women two times more at risk compared to their rural counterparts as a result of physical inactivity. 2. Median duration of time spent in high or moderate levels of physical activity during transport (30 min) and in recreational settings (51.4 min) was 4-7 times less than at work (214.2 min). 3. The fact that more than 1 in every 2 persons (53.4%) engaged in vigorous physical activity at work demonstrated that there were opportunities for dissemination of information and knowledge on healthy lifestyle at workplaces. 4. Women lagged almost 20 years behind men in terms of reaching the highest level of engagement in high and moderate levels of physical activity, which could be a reflection of a lack of knowledge on the importance of regular physical activity, and engagement in physical activity only after obesity problem arose.

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Body development and physical fitness Changes in fitness test methodology enabled shortening of the test duration. In the current survey physical fitness was assessed by using 5 quality indicators such as strength, speed, flexibility, endurance and balance. A total of 1949 persons or 37.5% of the survey participants underwent the fitness test.

Figure 10. Physical fitness (by gender)

Physical fitness test results were scored as follows: 27.5% of men and 34.8% of women tested “A- Excellent”, 26.5% of men and 24.9% of women tested “B- Good”, 28% of men and 23.2% of women tested “C- Satisfactory”, 15.7% of men and 13.2% of men tested “D- Below average”, and 2.4% of men and 3.9% of women tested “F- Unsatisfactory” (Figure 10). Figure 11. Physical fitness, males (by age group)

According to the test results, 57.4% of survey respondents or 54% of males and 59.7% of females scored A or B. The rest (42.6% of all respondents, 46.6% of males and 40.3% of females) scored Ñ or lower. The results of the current survey compared to 2005 survey results demonstrated 15% increase in physical fitness of males. Therefore, physical fitness test results were stratified by age for males only and demonstrated in the figure 11 below (Figure 11).

Chapter III. Survey results

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Figure 12. Physical fitness, by age group

Chapter III. Survey results

According to the graph proportion of 15-24 year-old males with “À-Excellent” rating increased by 0.6%, but the proportion with “Â-Good” rating decreased by 9.4% and the proportion with “Ñ” and below rating increased by 17.7% compared to 2005. This is yet another sign of gaps in physical fitness education persisting since 2005 (Figure 12). Conclusions A number of factors contributed to low levels of physical fitness in 15-24 year-old youth, including dissociation between basic education and behavior change communication aimed at promoting the importance of engaging in vigorous physical activity at work, during transport and in recreational settings, and the lack of enabling environment and comprehensive training curricula for physical fitness classes in schools.

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

3.3 PREVALENCE OF INTERMEDIATE RISK FACTORS FOR NCDs Overweight and obesity Overweight and obesity are recognized as intermediate risk factors for NCDs. Trained staff performed anthropological measurements of weight, height and waist circumference in 5314 survey participants aged 15-64 years. Anthropometric measurements were used to calculate Body Mass Index (BMI) and mean waist circumference in order to estimate the prevalence of overweight and obesity by age, gender and locality. Chapter III. Survey results In the male study population mean body weight was 68.3 kg (95% CI 67.2-69.3), and mean height – 167.4 cm (95% CI 166.7-168.0). The corresponding indicators for females were 61.7 kg (95% CI 60.9-62.4) and 157.4 cm (95% CI 156.9-157.9) (Table 30). Table 30. Mean height (cm) Ýðýãòýé Íàñ 15-24 25-34 35-44 45-54 55-64 15-64 Æèí – êã Äóíäàæ 62.9 70.3 72.0 71.9 72.0 68.3 95%CI 61.4-64.5 68.6-71.9 70.0-74.0 70.3-73.6 68.8-75.2 67.2-69.3 ªíäºð - Ñì Äóíäàæ 168.2 168.1 166.8 166.1 163.9 167.4 95%CI 167.2-169.3 167.1-169.2 165.9-167.8 165.1-167.0 162.9-164.8 166.7-168.0 Æèí – êã Äóíäàæ 56.4 62.1 64.9 67.1 66.6 61.7 95%CI 55.0-57.8 61.0-63.1 63.9-66.0 65.7-68.5 65.1-68.1 60.9-62.4 Ýìýãòýé ªíäºð - Ñì Äóíäàæ 158.2 158.2 156.7 156.0 155.1 157.4 95%CI 157.4-159.0 157.5-158.9 155.9-157.6 155.2-156.8 154.0-156.3 156.9-157.9

There were no statistically significant differences in mean body weight and height between urban and rural study participants. For instance, mean body weight in urban males was 69.3 kg (95% CI 67.6-71.0) and in rural males – 67.3 kg (95% CI 66.2-68.5), while corresponding height was 168.5 cm (95% CI 167.7-169.2) in urban males and 166.4 cm (95% CI 165.3-167.4) in rural males (Table 31). Table 31. Mean body weight and height (by locality) Male Locality Urban Rural Total Weight, kg Mean 69.3 67.3 68.3 95%CI 67.6-71.0 66.2-68.5 67.2-69.3 Height, cm Mean 168.5 166.4 167.4 95%CI 167.7-169.2 165.3-167.4 166.7-168.0 Weight, kg Mean 62.1 61.1 61.7 95%CI 61.2-63.1 60.0-62.2 60.9-62.4 Female Height, cm Mean 158.1 156.7 157.4 95%CI 157.3-158.8 155.9-157.4 156.9-157.9

For females, mean body weight was 62.1 kg (95% CI 61.2-63.1) in urban and 61.1 kg (95% CI 60.062.2) in rural areas, the corresponding body height was 158.1 (95% CI 157.3-158.8) and 156.7 (95% CI 155.9-157.4) cm, respectively (Table 31). Mean BMI for 15 – 64 year-old men and women was 24.9 (95% CI 24.6-25.2) and 24.3 (95% CI 24.0-24.7), respectively. There was no statistical difference in mean BMI between genders. In both genders mean BMI had a tendency to increase with age although not statistically significant. However, body weight and mean BMI in 15 – 24 year-olds was statistically significantly lower than in other age groups (Table 32).

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Table 32. Mean BMI (kg/m2), by age and gender Age Group (years) 15-24 25-34 35-44 45-54 55-64 15-64 Men n 400 599 564 412 222 2197 Mean 22.2 24.8 25.8 26.1 26.8 24.3 95% CI 21.7-22.7 24.3-25.3 25.2-26.4 25.5-26.6 25.7-27.9 24.0-24.7 n 473 857 867 620 300 3117 Women* Mean 22.5 24.8 26.4 27.5 27.7 24.9 95% CI 22.0-23.0 24.5-25.2 26.0-26.8 27.0-28.1 27.0-28.3 24.6-25.2 n 873 1456 1431 1032 522 5314 Both Sexes Mean 22.3 24.8 26.1 26.8 27.2 24.6 95% CI 21.9-22.8 24.5-25.2 25.8-26.5 26.3-27.2 26.6-27.9 24.3-24.9

Chapter III. Survey results

* excluding pregnant women There was a statistically significant trend in 15 – 54 year-old women towards increase in mean BMI with age. However, there was no significant difference in mean BMI of 45 – 54 (BMI=27.5; 95% CI 27.0-28.1) and 54 – 64 (BMI=27.7; 95% CI 27.0-28.3) year-old females. There was no significant difference in mean BMI of urban (BMI=24.7; 95% CI 24.3-25.0) vs. rural (BMI=24.6; 95% CI 24.2-24.9) residents aged 15 – 64 years (Table 33). Table 33. Mean BMI (kg/m2), by locality Locality Urban Rural Total Male n 991 1206 2197 Mean 24.4 24.3 24.3 95% CI 23.7-24.9 23.8-24.7 23.9-24.7 n 1508 1609 3117 Female* Mean 24.89 24.90 24.9 95% CI 24.5-25.3 24.4-25.4 24.6-25.2 n 2499 2815 5314 Total Mean 24.7 24.6 24.6 95% CI 24.2-25.0 24.2-24.9 24.3-24.9

* excluding pregnant women There was no significant difference in mean BMI in urban vs. rural areas when stratified by gender. In overall, the survey results on BMI risk categories revealed that 4.5% (95% CI 3.2-5.8) of 15 – 64 year-old survey population was underweight, 55.7% (95% CI 53.1-58.3) - normal, 27.3% (95% CI 25.3-29.2) - overweight, and remaining 12.5% (95% CI 10.8-14.3) - obese (Figure 12, Annex I.3739). The survey results on BMI risk categories demonstrated that 26% (95% CI 23.2-28.7) and 11.1% (95% CI 8.7-13.4) of men were overweight and obese, respectively. The corresponding rates for females were 28.6% (95% CI 26.3-31.0) and 14.1% (95% CI 12.1-16.0). There were no statistically significant differences in the prevalence of overweight and obesity between genders (Figure 13).

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Figure 13. Prevalence of overweight and obesity (by gender)

The prevalence of overweight and obesity (BMI ≥ 25) was 42.7% (95% CI 39.9-45.5) in women and 37% (95% CI 33.0-41.0) in men. Proportion of overweight and obese people in 25–34 year age group was 2.2-2.5 times higher compared to 15 – 24 year age group. For instance, proportion of overweight and obese men aged 25 – 34 years was 40.1%, which was 2.5 times more compared to 15–24 year-old men (15.7%). Similarly, the proportion of overweight and obese women aged 25 – 34 years was 41.4%, which was 2.2 times more compared to 15–24 year-old women (19.1%) (Figure 13). Among people aged 15-44 there was statistically significant direct correlation between the prevalence of obesity and age in both genders. More than a half of population aged 45-64 years was overweight or obese, and there were no significant differences between age groups (Figure 14). Figure 14. Prevalence of overweight and obesity, by age and gender

The prevalence of overweight and obesity was the highest in 45 – 64 year-olds with 55.9 - 60.3% of men and 65.8 – 67.7% of women having BMI ≥25 (Figure 14). There was no significant difference in the prevalence of overweight and obesity between urban and rural population. In particular, 41.1% (95% CI 37.5-44.7) of 15-64 year-old urban population and 38.5% (95% CI 34.7-42.3) of their rural counterparts were overweight or obese.

Chapter III. Survey results

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Table 34. BMI classifications (by gender and locality) Male Urban % 95%CI n 5.2 2.7-7.8 35 55.7 49.4-61.9 684 28.1 24.6-31.7 335 10.9 6.9-14.9 152 Female Urban % 95%CI n 5.1 2.6-7.6 41 51.9 48.5-55.4 762 28.4 24.8-31.8 527 14.6 12.1-17.1 279

BMI Underweight (BMI <18.4) Normal weight (BMI 18.5–24.9) Overweight (BMI 25.0-29.9) Obese (BMI >30.0) BMI n 30 512 315 134

Rural % 95%CI 4.0 2.2-5.8 60.8 56.2-65.4 24.0 20.3-27.8 11.1 8.6-13.7 Rural % 3.7 53.9 29.0 13.4

Chapter III. Survey results

Underweight (BMI <18.4) Normal weight (BMI 18.5–24.9) Overweight (BMI 25.0-29.9) Obese (BMI >30.0)

n 48 679 496 285

95%CI 2.3-5.0 50.0-57.8 25.8-32.1 10.5-16.4

There were no statistically significant differences in the prevalence of overweight and obesity detected between urban and rural residents when stratified by gender. The prevalence of overweight and obesity in 15–64 year-old males was 39.1% (95% CI 33.0-45.2) in urban and 35.2% (95% CI 30.2-40.1) in rural settings (Table 34).

Mean waist circumference and prevalence of central obesity Mean waist circumference and prevalence of central obesity were measured in order to estimate risk for developing cardiovascular diseases in the study population. Mean waist circumference was 83.2 cm (95% CI 82.2-84.3) in men aged 15 – 64 years, and 82.6 cm (95% CI 81.7-83.5) in their female counterparts with no significant difference between the two. Mean waist circumference had a tendency to increase with age although not statistically significant (Table 35). Table 35. Mean waist circumference (cm) Age Group (yaers) 15-24 25-34 35-44 45-54 55-64 15-64 Male n 402 600 567 416 223 2208 Mean 76.5 83.9 88.3 88.9 91.8 83.2 95% CI 75.2-77.8 82.4-85.4 86.3-90.3 87.1-90.6 88.3-95.3 82.2-84.3 n 475 859 868 622 300 3124 Female* Mean 75.7 82.9 86.5 89.5 91.3 82.6 95% CI 74.4-77.1 81.7-84.1 85.5-87.5 88.0-91.0 89.9-92.8 81.7-83.5

* excluding pregnant women

Mean waist circumference was significantly higher in 25 – 34 year-olds (83.9 cm /95% CI 82.4-85.4/ in males and 82.9 cm /95% CI 81.7-84.1/ in females) compared to 15 -24 year-olds (Table 36). Comparison of mean waist circumference between urban and rural population revealed no significant difference (Table 36).

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Table 36. Mean waist circumference (cm)’ Age Group (yaers) Urban Rural Total Male n 992 1216 2208 Mean 83.5 83.0 83.2 95% CI 81.8-85.2 81.7-84.3 82.2-84.3 n 1511 1613 3124 Female* Mean 81.7 83.5 82.6 95% CI 80.5-82.9 82.1-84.9 81.7-83.5

* excluding pregnant women Chapter III. Survey results

Mean waist circumference was 83.5 cm (95% CI 81.8-85.2) in urban men, 81.7 cm (95% CI 80.582.9) in urban women, 83 cm (95% CI 81.7-84.3) in rural men and 83.5 cm (95% CI 82.1-84.9) in rural women. The prevalence of central obesity was estimated using waist circumference measurements. Waist circumference equal to or greater than 90 cm in men and 80 cm in women is an indicator of central obesity. The prevalence of central obesity was 29.1% (95% CI 25.8-32.4) in 15-64 year-old men and 55.7% (95% CI 52.3-59.0) in their female counterparts. Increase in the prevalence of central obesity with age was prominent in 15–44 year age group and the trend was statistically significant. Central obesity was generally common in people older than 35 irrespective of gender. Three in four women aged 35–54 years and 8 in 10 women aged 55 – 64 years were centrally obese. Of men aged 55–64, one in two men had central obesity (Table 37). Table 37. Prevalence of central obesity (by age and gender) Age Group (yaers) 15-24 25-34 35-44 45-54 55-64 15-64 Male (waist circumference ≥ 90 ñì) n 402 600 567 416 223 2208 % 10.4 29.5 43.4 45.4 55.9 29.1 95% CI 6.3-14.6 24.7-34.4 37.0-49.8 39.2-51.6 44.5-67.3 25.8-32.4 Female (waist circumference ≥ 80 ñì) n 475 859 868 622 300 3124 % 31.3 59.4 71.4 76.1 80.6 55.7 95% CI 25.8-36.9 54.7-64.1 68.0-74.8 70.8-81.4 74.9-86.2 52.3-59.0

No significant differences were detected in the prevalence of central obesity by urban/rural locality. Table 38. Prevalence of central obesity (by locality) Locality Urban Rural Total Male (waist circumference ≥ 90 ñì) n 992 1216 2208 % 31.7 26.9 29.1 95% CI 26.6-36.8 22.9-30.9 25.8-32.4 Female (waist circumference ≥ 80 ñì) n 1511 1613 3124 % 53.1 58.6 55.7 95% CI 48.8-57.4 53.5-63.6 52.3-59.1

The prevalence of central obesity was 31.7% (95% CI 26.6-36.8) in urban men, 53.1% (95% CI 48.8-57.4) in urban women, 26.9% (95% CI 22.9-30.9) in rural men and 58.6% (95% CI 53.5-63.6) in rural women.

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Body fat In this survey, body fat % was measured in 5215 participants (2167 males and 3048 females) by using “GIMA” bioimpedance device. Mean body fat of men aged 15 – 64 years was above the reference value or 22.2% (95% CI 21.423.0), while for women was within normal range or 29.3% (95% CI 28.5-30.2) (Table 39). Men aged 25 and above, and women aged 35 and above had mean body fat content above reference values, i.e. were obese. In 45–64 age group one in four men and one in three women had increased body fat content, i.e. were obese (Table 39). Chapter III. Survey results Table 39. Mean body fat % (by age and gender) Age Group (yaers) 15-24 25-34 35-44 45-54 55-64 15-64 Male N 391 592 558 408 218 2167 Mean 17.9 22.3 25.1 26.6 28.2 22.2 95%CI 16.7-19.2 20.8-23.7 23.9-26.4 25.5-27.7 26.6-29.7 21.4-23.0 N 464 842 846 607 289 3048 Female* Mean 24.3 28.7 32.4 35.0 37.2 29.3 95%CI 23.3-25.3 27.7-29.6 31.6-33.1 33.9-36.2 34.5-39.8 28.5-30.2

There was no significant difference in mean body fat % between urban and rural survey participants (Table 40). Table 40. Mean body fat % (by locality) Male N 958 1209 2167 Mean 21.6 22.7 22.2 95%CI 20.6-22.6 21.6-23.9 21.4-23.0 N 1447 1601 3048 Female* Mean 29.4 29.3 29.3 95%CI 28.3-30.6 28.1-30.4 28.5-30.2

Locality Urban Rural Total

Mean body fat % was 21.6% (95% CI 20.6-22.6) in urban men, 29.4% (95% CI 28.3-30.6) in urban women, 22.7% (95% CI 21.6-23.9) in rural men and 29.3% (95% CI 28.1-30.4) in rural women (Table 40). The survey results demonstrated that the proportion of men with high and very high body fat content was relatively higher compared to women. Prevalence of increased body fat content was 28.2% (95% CI 16.0-20.4) in men and 17.8% (95% CI 15.6-19.9) in women (Figure 14).

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Figure 15. Proportion with increased body fat content, by age and gender

Analysis of data on the prevalence of very high body fat content by age and gender revealed that body fat content directly correlated with age. In particular, the proportion of women with very high content of body fat increased with age, and the trend was statistically significant. Body fat % in 15 – 34 year-old men increased with age, and more than a half of men aged 35 – 64 years had very high body fat % (Figure 15). Proportion of men with very high body fat % (i.e. obesity) was 34% (95% CI 29.9-38.1), and the proportion of their female counterparts was 25.2% (95% CI 22.1-28.2) (Figure 16). Figure 16. Proportion of population with increased body fat, by age and gender

Proportion of men with very high body fat % was relatively higher compared to their female counterparts. It was 3.8 and 4.3% higher in men aged 45–54 and 55–64 than in women of the same age. No significant difference was detected in the prevalence of very high body fat content or obesity in 15–64 year-old men vs. their female counterparts.

Chapter III. Survey results

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Table 41. Proportion of population with increased body fat, by stratum Body fat category N % 958 1209 2167 1447 1601 3048 6.5 3.2 4.6 15.2 14.1 14.7 Small 95%CI 3.0-10.0 1.5-4.8 2.7-6.6 10.0-20.4 9.7-18.5 11.2-18.1 % 41.6 44.4 43.2 41.1 43.8 42.4 Normal 95%CI Male Urban Rural Total 34.1-49.1 38.7-50.2 38.5-47.9 Female Urban Rural Total 37.9-44.4 39.9-47.7 39.8-45.0 16.8 18.7 17.8 13.7-20.0 16.0-21.5 15.6-19.9 26.9 23.4 25.2 22.7-31.1 19.3-27.4 22.1-28.2 17.6 18.7 18.2 14.1-21.2 15.8-21.5 16.0-20.4 34.3 33.8 34.0 28.8-39.8 27.9-39.6 29.9-38.1 % High 95%CI % Very high 95%CI

Áàéð øèë

Chapter III. Survey results

The proportion of men with very high body fat was 34.3% (95% CI 28.8-39.8) in urban and 33.8% (95% CI 27.9-39.6) in rural areas. Similarly, the prevalence of very high body fat or obesity in 15–64 year-old women was not significantly different in urban vs. rural areas or 26.9% (95% CI 22.7-31.1) and 23.4% (95% CI 19.3-27.4), respectively. Conclusions 1. Mean body weight and height of Mongolian men was 68.3 kg and 167.4 cm, respectively. For women, mean body weight was 61.7kg and height was 157. cm. 2. Mean BMI was 24.3 in men and 24.9 in women. According to BMI risk assessment 39.8% of population was overweight or obese, with 27.3% overweight and 12.5% obese. 3. Prevalence of overweight and obesity tended to increase with age, and the proportion of overweight or obese women in all age groups was higher compared to their male counterparts. 4. Prevalence of central obesity was 29.1% in 15–64 year-old men and 55.7% in women; Seven in ten women above the age of 35 were centrally obese. 5. Body fat % was high or very high in 43% of men and 52.2% of women. Body fat % tended to increase with age irrespective of gen

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Biochemical risk factors for NCDs One in three survey participants were tested for blood glucose and cholesterol, and additionally for triglycerides, LDL and HDL. Results of the assessment of blood glucose are presented in “Diabetes” part of the report. Therefore, in the current section only results of blood lipid testing are discussed. Blood cholesterol Chapter III. Survey results Survey participants receiving cholesterol-lowering treatment were not excluded from blood cholesterol testing. Mean blood cholesterol of the surveyed population was 4.4 mmol/L, and stratification by gender showed no significant difference (4.5 mmol/L in men vs. 4.2 mmol/L in women) (Table 42). Mean blood cholesterol levels tended to increase with age in both sexes, however the difference was not statistically significant. Table 42. Mean total cholesterol (mmol/L) Age Group (years) 25-34 35-44 45-54 55-64 25-64 Men n 193 193 136 84 606 Mean 4.4 4.4 4.6 4.7 4.5 95% CI 4.1-4.7 4.0-4.7 4.3-5.0 4.2-5.3 4.2-4.7 n 272 304 232 124 932 Women Mean 4.2 4.1 4.4 4.4 4.2 95% CI 3.8-4.6 4.0-4.3 4.1-4.7 4.0-4.8 4.0-4.4 n 465 497 368 208 1538 Both Sexes Mean 4.3 4.3 4.5 4.6 4.4 95% CI 4.0-4.6 4.0-4.5 4.2-4.8 4.1-5.0 4.1-4.6

The proportion of the population with or at risk of increased blood cholesterol (≥5.0 mmol/L) was 25.0% (95% CI 19.4-30.5), and no significant gender difference was observed with the prevalence of 22.5 (95% CI 16.8-28.2) in women and 27.4% (95% 20.9-33.9) in men. The prevalence of elevated blood cholesterol was likely to increase with age. Table 43. Total cholesterol ≥ 5.0 mmol/L or ≥ 190 mg/dl or currently on medication for raised cholesterol Age Group (years) 25-34 35-44 45-54 55-64 25-64 Men n 193 193 136 84 606 % 21.2 27.9 33.6 36.0 27.4 95% CI 14.6-27.7 19.4-36.5 22.0-45.2 19.6-52.3 20.9-33.9 n 272 304 232 124 932 Women % 20.6 18.5 27.9 29.1 22.5 95% CI 12.0-29.1 12.8-24.3 18.6-37.2 19.0-39.1 16.8-28.2 n 465 497 368 208 1538 Both Sexes % 20.9 23.2 30.8 32.3 25.0 95% CI 14.4-27.4 16.9-29.5 21.9-39.7 20.9-43.6 19.4-30.5

The proportion of the population with increased blood cholesterol (≥6.2 mmol/L) was 8.5% (95% CI 5.4-11.6) in the study population, and no gender difference was observed. The prevalence of elevated blood cholesterol was the highest in men of 55-64 years, although the difference was not statistically significant different from other age groups.

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Table 44. Percentage with total cholesterol ≥ 6.2 mmol/L or ≥ 240 mg/dl or currently on medication for raised cholesterol Age Group (years) 25-34 35-44 45-54 55-64 Men n 193 193 136 84 606 % 7.4 8.2 13.4 19.6 10.2 95% CI 2.9-11.9 2.6-13.8 3.6-23.2 4.8-34.4 5.9-14.4 n 272 304 232 124 932 Women % 8.9 4.0 6.7 8.1 6.8 95% CI 1.6-16.1 1.9-6.2 3.1-10.4 3.4-12.7 3.4-10.2 n 465 497 368 208 1538 Both Sexes % 8.1 6.1 10.1 13.4 8.5 95% CI 3.4-12.9 3.0-9.2 4.3-15.9 5.3-21.6 5.4-11.6

Chapter III. Survey results

25-64

Triglycerides Blood triglyceride level is one of the risk factors for cardiovascular diseases and diabetes. Mean blood triglyceride level in the study population was 1.3 mmol/L (95% CI 1.2-1.4). Men had significantly higher mean blood triglyceride level (1.5 mmol/L) compared to women (1.1 mmol/L). There was no significant differences in the mean triglyceride level in regard to age (Table 45). Table 45. Mean fasting triglycerides (mmol/L) Age Group (years) 25-34 35-44 45-54 55-64 25-64 Men n 185 185 129 83 582 Mean 1.5 1.6 1.7 1.3 1.5 95% CI 1.3-1.6 1.3-1.8 1.1-2.2 1.1-1.5 1.4-1.7 n 260 298 221 120 899 Women Mean 1.1 1.1 1.2 1.2 1.1 95% CI 1.0-1.2 1.0-1.2 1.0-1.5 1.0-1.3 1.1-1.2 n 445 483 350 203 1481 Both Sexes Mean 1.3 1.3 1.4 1.2 1.3 95% CI 1.1-1.4 1.2-1.5 1.1-1.8 1.1-1.3 1.2-1.4

The proportion of the population with or at risk of increased blood triglyceride level (≥1.7 mmol/L) was 22.4% (95% CI 18.4-26.3), and the risk was significantly higher in men 29.5% (95% CI 23.735.3) than in women 15.4% (11.8-19.0). There was no statistically significant difference in the proportion with regard to age. Table 46. Percentage of respondents with fasting triglycerides ≥ 1.7 mmol/L or ≥ 150 mg/dl Age Group (years) 25-34 35-44 45-54 55-64 25-64 Men n 185 185 129 83 582 % 27.1 35.5 27.8 24.0 29.5 95% CI 19.3-35.0 27.0-44.1 14.7-41.0 12.0-36.0 23.7-35.3 n 260 298 221 120 899 Women % 14.2 15.4 18.6 13.0 15.4 95% CI 9.4-19.0 9.8-21.0 11.4-25.7 6.0-19.9 11.8-19.0 n 445 483 350 203 1481 Both Sexes % 20.8 25.2 23.2 18.1 22.4 95% CI 15.9-25.7 19.1-31.3 14.3-32.0 12.6-23.6 18.4-26.3

The proportion of the population with increased blood triglycerides was 16.4% (95% CI 12.820.0) in the study population, and the prevalence was higher in males 23.6% (95% CI 17.5-29.7) compared to females 9.4% (95% CI 6.9-11.8). The proportion of the population with increased blood triglycerides was not different in regard to age.

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Table 47. Percentage of respondents with fasting triglycerides ≥ 2.0 mmol/L or ≥ 180 mg/dl Age Group (years) 25-34 35-44 45-54 55-64 25-64 Men n 185 185 129 83 582 % 20.2 28.9 24.9 17.8 23.6 95% CI 12.4-27.9 20.0-37.8 11.9-37.8 5.6-29.9 17.5-29.7 n 260 298 221 120 899 Women % 6.9 9.8 13.1 9.2 9.4 95% CI 3.5-10.2 5.9-13.7 6.7-19.4 3.5-14.9 6.9-11.8 n 445 483 350 203 1481 Both Sexes % 13.7 19.1 18.9 13.2 16.4 95% CI 9.3-18.0 13.2-25.0 10.5-27.3 7.6-18.9 12.8-20.0

Blood levels of low density lipoprotein (LDL) Mean blood LDL was 3.4 mmol/L (95% CI 3.2-3.5) in the study population, and there were no significant differences with regards to age and gender. Table 48. Mean blood LDL (mmol/L) Age Group (years) 25-34 35-44 45-54 55-64 Total Men N 201 204 146 89 640 % 3.3 3.3 3.6 3.5 3.4 95% CI 3.1-3.5 3.1-3.5 3.3-3.9 3.1-3.8 3.2-3.6 N 279 326 235 126 966 Women % 3.2 3.3 3.6 3.5 3.4 95% CI 3.1-3.4 3.1-3.4 3.4-3.8 3.2-3.7 3.2-3.5 N 480 530 381 215 1606 Both Sexes % 3.3 3.3 3.6 3.5 3.4 95% CI 3.1-3.4 3.1-3.5 3.4-3.8 3.3-3.7 3.2-3.5

The proportion of the population at risk or with increased blood LDL (≥3.0 mmol/L) was 62.6% (95% CI 57.3-67.8), and no statistically significant differences were detected between different age and gender groups. Table 49. Proportion of population with or at risk of increased blood LDL (≥ 3.0 mmol/L) Age Group (years) 25-34 35-44 45-54 55-64 Total Men N 201 204 146 89 640 % 58.8 64.3 66.6 69.3 63.3 95% CI 47.3-70.3 56.3-72.3 56.4-76.9 58.4-80.3 56.9-69.6 N 279 326 235 126 966 Women % 59.3 55.3 72.2 69.3 61.9 95% CI 51.2-67.4 47.0-63.5 65.2-79.1 57.7-80.9 55.9-67.8 N 480 530 381 215 1606 Both Sexes % 59.0 59.7 69.3 69.3 62.6 95% CI 51.9-66.2 52.9-66.5 62.1-76.4 61.3-77.3 57.3-67.8

The prevalence of elevated blood LDL (≥4.15 mmol/L) was 20.2% (95% CI 15.4-25.0) in the study population. No significant difference was observed between men and women. The prevalence was the highest (28.6%) in 45-54 year age group, and the lowest (18.1%) in 25-34 year age group.

Chapter III. Survey results

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Table 50. Proportion of population with increased LDL (≥ 4.15 mmol/L) Age Group (years) 25-34 35-44 45-54 55-64 Total Men N 201 204 146 89 640 % 22.2 13.4 30.7 23.7 21.6 95% CI 14.4-30.0 6.3-20.6 19.3-42.1 10.8-36.6 15.4-27.8 N 279 326 235 126 966 Women % 13.7 17.0 26.3 26.1 18.8 95% CI 7.9-19.5 11.5-22.4 19.0-33.6 16.5-35.7 14.4-23.2 N 480 530 381 215 1606 Both Sexes % 18.1 15.2 28.6 25.0 20.2 95% CI 12.2-24.0 10.2-20.3 20.1-37.0 18.1-31.9 15.4-25.0

Chapter III. Survey results

Blood levels of high density lipoprotein (HDL) Mean blood HDL was 1.5 mmol/L (95%CI 1.5-1.6) in the study population, and there were no significant differences with regards to age and gender. Table 51. Mean blood HDL (mmol/L) Age Group (years) 25-34 35-44 45-54 55-64 Total Men N 200 200 143 88 631 % 1.6 1.5 1.5 1.5 1.5 95% CI 1.4-1.7 1.4-1.6 1.4-1.6 1.4-1.7 1.4-1.6 N 272 320 233 126 951 Women % 1.6 1.6 1.6 1.5 1.6 95% CI 1.5-1.7 1.4-1.7 1.5-1.7 1.4-1.7 1.5-1.7 N 472 520 376 214 1582 Both Sexes % 1.6 1.5 1.6 1.5 1.5 95% CI 1.5-1.7 1.4-1.7 1.5-1.7 1.4-1.7 1.5-1.6

Blood HDL level below 1.03 mmol/L in men and below 1.29 mmol/L in women is a risk factor for NCDs, and the prevalence of decreased blood HDL was significantly higher in women (31.7%; 95% CI 23.4-40.0) compared to men (11.6%; 95% CI 7.2-16.1). Table 52. Proportion of population with decreased LDL (mmol/L) Age Group (years) 25-34 35-44 45-54 55-64 Total Men (<1.03 mmol/L) N 200 200 143 88 631 % 14.9 14.2 4.4 7.9 11.6 95% CI 6.4-23.4 7.7-20.6 1.0-7.8 0.8-14.9 7.2-16.1 N 272 320 233 126 951 Woman (<1.29 mmol/L) % 29.9 30.6 33.0 37.9 31.7 95% CI 20.0-39.8 20.9-40.2 22.8-43.1 22.9-52.9 23.4-40.0

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Conclusions 1. The prevalence of the high risk cholesterol category or hypercholesterolemia in the population was 25% and the prevalence of hypercholesterolemia was 8.5%. 2. The prevalence of the high risk triglyceride category or hypertriglyceridemia in the population was 22.4% with significantly higher prevalence in men (29.5%) compared to women (15.4%). 3. Increased blood level of LDL is a risk factor for cardiovascular diseases, and the proportion of population at risk or with increased blood LDL was 62.7% Chapter III. Survey results 4. The proportion of women at risk or with decreased blood HDL cholesterol was 31.7% and it was 11.6% in men.

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Hypertension Hypertension as a risk factor for NCDs was assessed using questionnaire and physical measurements. Mean blood pressure Mean systolic blood pressure (SBP) was 125.6 mmHg (95% CI 124.3-127.0) in the study population in general, and 129.8 mmHg (95% CI 128.4-131.1) in men and 121.4 mmHg (95% CI 120.0-122.9) in women. Mean SBP was higher in men compared to women. Mean diastolic blood pressure (DBP) was 78.9 mmHg (95% CI 78.1-79.6) in the study population in general, and 79.6 mmHg (95% CI 78.7-80.5) in men and 78.1 mmHg (95% CI 77.3-78.9) in women. No significant difference was detected between genders (Table 53). In urban participants mean SBP was 124.7 mmHg (95% CI 122.9-126.6) and mean DBP was 78.6 mmHg (95% CI 77.4-79.9), while in rural participants the corresponding means were 126.5 mmHg (95% CI 124.8-128.3) and 79.1 mmHg (95% CI 78.3-79.9). The difference in SBP and DBP between urban and rural participants was not statistically significant (Table 53). Table 53. Mean blood pressure (by gender and locality) Systolic blood pressure, mmHg n Mean 95% CI 2209 129.8 128.4-131.1 3192 121.4 120.0-122.9 5401 125.6 124.3-127.0 2524 124.7 122.9-126.6 2877 126.5 124.8-128.3 Diastolic blood pressure, mmHg n Mean 95% CI 2209 79.6 78.7-80.5 3192 78.1 77.3-78.9 5401 78.9 78.1-79.6 2524 78.6 77.4-79.9 2877 79.1 78.3-79.9

Chapter III. Survey results

Gender Locality

Male Female Total Urban Rural

Hypertension The prevalence of hypertension was 27.3% (95% CI 24.9-29.8) in the study population, 31.5% (95% CI 28.3-34.7) in men and 23.2% (95% CI 20.7-25.7) in women. The prevalence of hypertension in men was higher than in women. The prevalence of hypertension increased with age. In men it was 54.9% in 45-54 year age group, 71.3% in 55-64 year age group, and was similar in 25-34 (29.1%; 95% CI 24.5-33.7) and 35-44 (35%; 95% CI 29.9-40.2) year-olds. In women, the prevalence increased with age, and reached 52.1% in 45-54 year age group and 66% in 55-64 year age group (Table 54). Table 54. Percentage with SBP ≥140 and/or DBP ≥ 90 mmHg or currently on medication for raised blood pressure Age Group (years) 15-24 25-34 35-44 45-54 55-64 15-64 Men n 403 601 564 418 223 2209 % 15.5 29.1 35.0 54.9 71.3 31.5 95% CI 9.7-21.3 24.5-33.7 29.9-40.2 49.1-60.7 65.7-77.0 28.3-34.7 n 494 921 869 624 297 3205 Women % 6.6 14.0 31.4 52.1 61.0 23.2 95% CI 3.7-9.4 10.0-18.0 27.2-35.6 47.0-57.1 54.6-67.3 20.7-25.7 n 897 1522 1433 1042 520 5414 Both Sexes % 11.2 21.6 33.2 53.5 66.0 27.4 95% CI 7.7-14.7 17.9-25.4 29.6-36.9 49.6-57.4 61.8-70.2 25.0-29.8

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

The prevalence of hypertension was 25.3% (95% CI 21.8-28.8) in urban and 29.3% (95% CI 26.132.6) in rural settings with no significant differences between genders when stratified by locality (Table 55). Table 55. Percentage with SBP ≥140 and/or DBP ≥ 90 mmHg or currently on medication for raised blood pressure (by gender and locality) Gender Male Female Total Urban n 990 1540 2530 % 30.7 20.4 25.3 95% CI 26.0-35.3 17.1-23.7 21.8-28.8 n 1219 1665 2884 Rural % 32 26.2 29.3 95% CI 27.6-36.5 22.5-29.9 26.1-32.6 n 2209 3205 5414 Total % 31.4 23.2 27.3 95% CI 28.2-34.6 24.9-29.8

Out of those with hypertension, 63.7% (95%CI 59.8-67.6) were newly diagnosed. In regard to gender, 74.3% (95%CI 69.7-78.9) of males and 48.7% (95%CI 44.0-53.4) of females were diagnosed newly. Among those diagnosed previously, 19.8% (95%CI 44.0-53.4) were taking medicine for raised blood pressure but uncontrolled, 11.8% reported to be controlled by medicine and 4.7% did not use any medicine (Figure 17). Figure 17 Respondents with treated and/or controlled raised blood pressure

Treatment and follow-up of hypertension Of those with hypertension, 61.1% (95% CI 56.4-65.8) were not on anti-hypertensive medication, 25.6% (95% CI 22.1-29.2) were on anti-hypertensive medication, but still had high blood pressure or did not monitor it, and only 13.3% were successfully controlled with medication (Table 56). Analysis of hypertension control by gender demonstrated that 71.9% (95% CI 66.6-77.2) of hypertensive men and 46.0% (95% CI 40.8-51.1) of hypertensive women were not on medication. Out of those successfully controlled with anti-hypertensive drugs, 21.4% (95% CI 17.6-25.1) were women and 7.5% (95% CI 4.3-10.7) were men. Prevalence of uncontrolled hypertension was high in both men and women.

Chapter III. Survey results

20.6-25.8

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Table 56. Respondents with treated and/or controlled raised blood pressure On medication and SBP<140 and DBP<90 n 810 931 1741 789 952 % 7.5 21.4 13.3 12.5 13.9 95% CI 4.3-10.7 17.6-25.1 10.7-15.8 9.2-15.7 10.1-17.8 On medication and SBP≥140 and/ orDBP≥90 % 20.6 32.7 25.6 27.6 24 95% CI 16.5-24.7 28.2-37.2 22.1-29.2 23.5-31.6 18.5-29.5 Not on medication and SBP≥140 and/ orDBP≥90 % 71.9 46.0 61.1 60 62.1 95% CI 66.6-77.2 40.8-51.1 56.4-65.8 55.0-64.9 54.6-69.6

Gender Locality

Chapter III. Survey results

Male Female Total Urban Rural

Blood pressure measurement status 42.6% (95% CI 39.7-45.4) of the study population had never had their blood pressure measured. Of them, 50.5% (95% CI 47.2-53.7) were males and 34.5% (95% CI 31.0-37.9) were females. out of those who had blood pressure measurements, 37.3% (95 %CI 34.5-40.2) had never been previously diagnosed with hypertension, 3.7% (95% CI 2.8-4.6) had been diagnosed more than 12 months ago, and 16.4% (95% CI 14.8-17.9) – within past 12 months (Annex I.43-45). Non-medication treatment of hypertension The study participants who had previously been diagnosed with hypertension were asked whether they had received non-medication treatment such as special dieting, and advice to lose weight, stop smoking and engage in physical activity. Out of those who received counseling from medical practitioners, 44.1% (95% CI 38.2-49.9) were advised to limit salt intake, 28.7% (95% CI 22.5-34.9) – to control excess weight, 17.6% (95% CI 13.521.8) – to quit smoking, 44.2% (95% CI 37.8-50.7) – to engage in physical activity. The above data suggested that non-medication treatment options were under-utilized, medical practitioners did not provide sufficient counseling on weight loss and smoking cessation, and patients largely ignored such treatment options. Only 8% of study participants with hypertension sought traditional medicine services with no significant difference between gender and age groups (Annex I.46-50) Conclusions: 1. Mean SBP was 129.8 mmHg in 15-64 year-old Mongolian men and 121.4 mmHg in their female counterparts, and it was significantly higher in men than in women. 2. Prevalence of hypertension among Mongolian aged 15-64 years was 27.3%. Men had significantly higher prevalence of hypertension compared to women. 3. There was no significant difference in the prevalence of hypertension between urban and rural population. 4. Women were more likely to monitor their blood pressure compared to men. 5. Non-medication treatment options were underutilized, medical practitioners did not provide sufficient counseling on weight loss and smoking cessation, and patients largely ignored such treatment options. 6. Medicinal treatment of people with hypertension was insufficient or ineffective, and the prevalence of uncontrolled hypertension was high irrespective of gender.

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Diabetes The prevalence of diabetes was defined in accordance with widely used traditional epidemiological classification of diabetes, according to which participants with fasting blood glucose less than 6.1 mmol/L who had previously been diagnosed with diabetes, but were not taking anti-diabetes medication were included in a normal group, and participants with fasting blood glucose between 5.6-6.1 mmol/L were included into a group of people with impaired fasting glucose (IFG). Blood glucose Chapter III. Survey results Mean fasting blood glucose was 4.7 mmol/L (95% Cl 4.6-4.9) in 25-64 year-old study population, 4.8 mmol/L (95% Cl 4.6-5.0) in men and 4.7 mmol/L (95% Cl 4.5-4.8) in women. Although mean blood glucose appeared to be higher in men than in women, especially in 45-54 year-olds, the difference was not statistically significant (Table 57). Table 57. Mean fasting blood glucose (mmol/L), by age and gender Age 25-34 35-44 45-54 55-64 25-64 Male N 180 178 131 84 573 Mean 4.8 4.8 5.1 4.7 4.8 95% CI 4.6-5.0 4.5-5.1 4.6-5.5 4.4-5.1 4.6-5.0 N 263 300 220 113 896 Female Mean 4.6 4.7 4.7 4.8 4.7 95% CI 4.4-4.7 4.4-4.9 4.5-5.0 4.5-5.1 4.5-4.8 N 443 478 351 197 1469 Total Mean 4.7 4.7 4.9 4.8 4.7 95% CI 4.5-4.8 4.5-4.9 4.5-5.1 4.6-4.9 4.6-5.2

Test results of 1470 tested participants were stratified by locality, and the stratification demonstrated that mean fasting blood glucose was 4.9 mmol/L (95% Cl 4.7-5.2) in urban and 4.6 mmol/L (95% Cl 4.4-4.7) in rural study population. A total of 573 men were tested, and mean fasting glucose was 5.1 mmol/L (95% Cl 4.7-5.4) in rural and 4.6 mmol/L (95% Cl 4.4-4.8) in urban men. For 897 women tested, mean fasting glucose was 4.8 mmol/L (95% Cl 4.6-5.0) in urban and 4.5 mmol/L (95% Cl 4.3-4.7) in rural settings (Table 58). Table 58. Mean fasting blood glucose (mmol/L), by locality Locality Urban Rural Total Male n 287 286 573 Mean 5.1 4.6 4.8 95% CI 4.7-5.4 4.4-4.8 4.6-5.0 n 440 457 897 Female Mean 4.8 4.5 4.7 95% CI 4.6-5.0 4.3-4.7 4.5-4.8 n 727 743 1470 Total Mean 4.9 4.6 4.7 95% CI 4.7-5.2 4.4-4.7 4.6-4.9

Impaired fasting glucose (IFG): 9.5% (95% Cl 7.4-11.5) of the study population had impaired fasting glucose. IFG was detected in 11.5% (95% Cl 8.5-14.5) of men and 7.5% (95% Cl 4.5-10.4) of women. Analysis of IFG data by age demonstrated that its prevalence was the highest in 35-44 year-old men (14.5%; 95% Cl 8.6-20.3) and 55-64 year-old women (14%; 95% Cl 2.2-25.7) (Table 59).

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Table 59. Impaired Fasting Glycaemia (by age group) Age 25-34 35-44 45-54 55-64 25-64 Male n 180 178 132 84 574 % 11.5 14.5 8.3 9.6 11.5 95% CI 6.1-16.9 8.6-20.3 2.5-14.2 2.9-16.3 8.5-14.5 n 263 300 221 113 897 Female % 3.0 8.2 8.9 18.0 7.5 95% CI 0.7-5.4 4.6-11.8 4.6-13.2 0.0-38.3 4.5-10.4 n 443 478 353 197 1471 Total % 7.2 11.2 8.6 14.0 9.5 95% CI 4.3-10.1 7.5-14.9 4.8-12.4 2.2-25.7 7.4-11.5

Chapter III. Survey results

Test results of 1472 tested participants were stratified by locality, and the stratification demonstrated that prevalence of IFG (capillary whole blood glucose levels between 5.6-6.1 mmol/L) was 11.7% (95% Cl 8.6-14.8) in urban, which was higher than 7.3% (95% Cl 4.8-9.7) in rural population. A total of 574 men were tested, and the prevalence of IFG was 13.2% (95% Cl 9.2-17.3) in urban and 9.8% (95% Cl 5.4-14.3) in rural men. For 898 women tested, the prevalence of IFG was 10.3% (95% Cl 5.4-15.1) in urban and 4.7% (95% Cl 2.5-7.0) in rural settings (Table 60). Table 60. Impaired Fasting Glycaemia (by gender and locality) Locality Male n 288 286 574 % 13.2 9.8 11.5 95% CI 9.2-17.3 5.4-14.3 8.5-14.5 n 440 458 898 Female % 10.3 4.7 7.5 95% CI 5.4-15.1 2.5-7.0 4.5-10.5 n 728 744 1472 Total % 11.7 7.3 9.5 95% CI 8.6-14.8 4.8-9.7 7.3-11.6

Urban Rural Total

Raised blood glucose Prevalence of diabetes was 6.5% (95% Cl 4.5-8.4) in the study population. The prevalence was 8.9% (95% Cl 5.0-12.7) in men and 4.1% (95% Cl 2.0-6.2) in women. The difference between genders was not statistically significant. Table 61. Raised blood glucose or currently on medication for diabetes (by age group) Age 25-34 35-44 45-54 55-64 25-64 Male n 180 178 132 84 574 % 5.1 6.9 17.4 9.7 8.9 95% CI 1.5-8.8 2.9-10.9 5.2-29.5 2.1-17.3 5.0-12.7 n 263 300 221 113 897 Female % 3.2 5.3 4.3 3.3 4.1 95% CI 0.6-5.9 2.0-8.6 0.9-7.8 0.0-7.0 2.0-6.2 n 443 478 353 197 1471 Total % 4.2 6.1 10.9 6.4 6.5 95% CI 1.9-6.5 3.6-8.6 4.5-17.3 2.5-10.3 4.5-8.4

Prevalence of diabetes was 8.9% (95% Cl 5.8-12.0) in urban study participants, which was higher than 4.1% (95% Cl 2.0-6.1) of their rural counterparts. When stratified by gender, 14.2% (95% Cl 7.4-21.0) of urban men, 3.8% (95% Cl 1.3-6.2) of rural men, 3.9% (95% Cl 1.0-6.9) of urban women and 4.3% (95% Cl 1.5-7.2) or rural women had diabetes (Table 62).

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Table 62. Raised blood glucose or currently on medication for diabetes (by gender and locality) Locality Urban Rural Total Male n 288 286 574 % 14.2 3.8 8.9 95% CI 7.4-21.0 1.3-6.2 4.8-12.9 n 440 458 898 Female % 3.9 4.3 4.1 95% CI 1.0-6.9 1.5-7.2 2.1-6.2 n 728 744 1472 Total % 8.9 4.1 6.5 95% CI 5.8-12.0 2.0-6.1 4.4-8.5

Diagnosis of diabetes and blood glucose testing A total of 5438 people (2217 males and 3221 females) participated in a questionnaire survey. Of them, 85.2% (95% Cl 83.5-86.9) had never had blood glucose testing, 12.3% (95% Cl 10.8-13.7) had testing but were not diagnosed with diabetes, 0.9% (95% Cl 0.6-1.2) had no blood glucose testing in the past 12 months, and 1.7% (95% Cl 1.3-2.1) were tested in the past 12 months. Among men, 88.2% (95% Cl 86.2-90.1) had never had blood glucose testing, 9.5% (95% Cl 7.8-11.3) had testing but were not diagnosed with diabetes, 0.6% (95% Cl 0.3-0.9) had no blood glucose testing in the past 12 months, and 1.7% (95% Cl 1.0-2.5) were tested in the past 12 months. Among women, 82.1% (95% Cl 80.0-84.3) had never had blood glucose testing, 15.1% (95% Cl 13.2-16.9) had testing but were not diagnosed with diabetes, 1.2% (95% Cl 0.7-1.7) had no blood glucose testing in the past 12 months, and 1.6% (95% Cl 1.2-2.0) were tested in the past 12 months. In terms of age difference, 15-24 year-olds were most likely not to have blood glucose testing (92.4%, 95% Cl 90.594.3), while 45-54 year-olds were most likely to have blood glucose testing in the past 12 months (3.4%, 95% Cl 2.2-4.6) (Annex I.51-53). Treatment of diabetes A total of 170 study participants were asked whether they received diabetes treatment or counseling, which revealed that 16.7% (95% Cl 10.0-23.5) were taking diabetes drugs (males: 16.3%, 95% Cl 4.7-27.9; females: 17.1%, 95% Cl 8.7-25.4), and 9.9% (95% Cl 3.4-16.3) were on insulin treatment (males: 14%, 95% Cl 1.3-26.7; females: 6.3%, 95% Cl 1.9-10.8), (Annex I.54-55). The following proportion of the study participants reported receiving counseling: on diet – 45.4% (95% Cl 32.6-58.1) (males: 51.6%, 95% Cl 32.9-70.4; females: 40%, 95%Cl 27.0-53.0), on weight loss – 36.1% (95% Cl 24.5-47.7) (males: 29.4%, 95% Cl 13.4-45.5; females: 41.8%, 95% Cl 27.656), on smoking cessation – 23.3% (95% Cl 12.1-34.5) (males: 38.0%, 95% Cl 18.0-58.0; females: 10.8%, 95% Cl 4.3-17.3), on increasing the level of physical activity – 52.4% (95% Cl 40.8-63.9) (males: 59.0%, 44.4-73.5; females: 46.7%, 95% Cl 33.6-59.9), (Annex I.56-59). Conclusions 1. Mean fasting blood glucose was 4.7 mmol/L in the study population, 4.8 mmol/L in males, 4.7 mmol/L in females, 4.9 mmol/L in urban and 4.6 mmol/L in rural population. 2. Prevalence of IFG was 9.5% in the study population, 11.5% in males, 7.5% in females, 11.7% in urban and 7.3% in rural population. 3. Prevalence of diabetes was 6.5% in the study population, 8.9% in males, 4.1% in females, 8.9% in urban and 4.1% in rural population. Chapter III. Survey results

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Breast and Cervical cancer Cervical cancer The survey participants were asked whether they had Visual Inspection with Acetic Acid (VIA) and/or Pap smear for early detection of cervical cancer, and at what time interval they had repeated screening if any (Table 63). Table 63. Percentage who have had a VIA test and PAP SMEAR test ( by age ) Chapter III. Survey results Test Age 15-24 25-34 35-44 VIA 45-54 55-64 15-64 15-24 25-34 Pap smear 35-44 45-54 55-64 15-64 n 471 855 827 569 277 2999 470 860 823 570 276 2999 % had exam 0.9 4.0 10.3 9.6 8.1 5.2 2.2 10.6 19.9 21.5 19.3 11.4 95%CI 0.0-1.8 2.3-5.6 7.5-13.1 6.3-12.8 4.4-11.8 4.2-6.1 0.6-3.9 7.5-13.6 16.2-23.7 17.9-25.0 13.3-25.3 9.9-13.0 % has not had exam 99.1 96.0 89.7 90.4 91.9 94.8 97.8 89.4 80.1 78.5 80.7 88.6 95%CI 98.2-100.0 94.4-97.7 86.9-92.5 87.2-93.7 88.2-95.6 93.9-95.8 96.1-99.4 86.4-92.5 76.3-83.8 75.0-82.1 74.7-86.7 87.0-90.1

Cervical cancer screening coverage was very low with only 5.2% (95% CI 4.2-6.1) of surveyed women having had VIA and 11.4% (95% CI 9.9-13.0) – Pap smear. Analysis of data by age groups demonstrated that 35-54 year-old women were most likely to undergo screening. For instance, 10.3% (95% CI 7.5-13.1) of 35-44 year-old and 9.6% (95% CI 6.3-12.8) of 45-54 year-old women had VIA, while the corresponding numbers for Pap smear testing were 19.9 (95% CI 16.2-23.7) and 21.5 (95% CI 17.9-25.0) % (Table 64). Table 64. Cervical cancer screening (by locality) Test VIA Locality Urban Rural Total Urban Pap smear Rural Total Urban Total Rural Total n 1465 1534 2999 1466 1533 2999 1476 1545 3,021 % screened 4,8 5,5 5,2 13,1 9,6 11,4 15.8 12.9 14.4 95%CI 3,4-6,3 4,3-6,7 4,2-6,1 10,7-15,6 7,9-11,2 9,9-13,0 13.1-18.5 10.7-15.2 12.6-16.3 % unscreened 95,2 94,5 94,8 86,9 90,4 88,6 84.2 87.1 85.6 95%CI 93,7-96,6 93,3-95,7 93,9-95,8 84,4-89,3 88,8-92,1 87,0-90,1 81.5-86.9 84.8-89.3 83.7-87.4

Of female survey respondents, 14.4% (95% CI 12.6-16.3) underwent cervical cancer screening, and there was no significant difference between urban and rural women. VIA was performed on 4.8% (95% CI 3.4-6.3) of urban and 5.5% (95% CI 4.3-6.7) of rural women, while significantly more urban women (13.1%; 95% CI 10.7-15.6) had Pap smear testing compared to rural women (9.6%;

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

95% CI 7.9-11.2). The finding that 85.6% (95% CI 83.7-87.4) of women had never had cervical cancer screening demonstrated significant gaps in the screening program (Table 64). Breast cancer The survey participants were asked about breast self-examination, clinical breast examination or mammography, and at what time interval they had repeated screening if any. Breast cancer screening coverage was very low with only 36.3% (95% CI 31.1-41.6) of respondents reporting breast self-examination, 3.2% (95% CI 2.0-4.3) – clinical breast examination by a medical practitioner and 1.7% (95% CI 1.7-2.3) – mammography (Table 65). Table 65. Percentage who have had a breast palpation by health care provider, Percentage who have had a mammogram only, Performed self breast exam ( by age ) Test Age group 15-24 25-34 35-44 45-54 55-64 15-64 15-24 25-34 35-44 45-54 55-64 15-64 15-24 25-34 35-44 45-54 55-64 15-64 n 425 738 701 509 258 2631 426 737 701 511 258 2633 474 873 840 587 286 3060 % screened 1.9 3.3 4.3 4.0 4.7 3.2 0.4 2.4 2.8 2.3 2.6 1.7 28.2 40.1 44.4 43.2 28.5 36.3 95%CI 0.3-3.5 1.8-4.8 2.4-6.1 2.2-5.9 1.7-7.7 2.0-4.3 0.0-1.0 0.9-3.8 1.3-4.2 1.0-3.6 0.5-4.7 1.2-2.3 21.2-35.2 34.5-45.6 37.4-51.3 35.8-50.6 21.1-35.8 31.1-41.6 % unscreened 98.1 96.7 95.7 96.0 95.3 96.8 99.6 97.6 97.2 97.7 97.4 98.3 71.8 59.9 55.6 56.8 71.5 63.7 95%CI 96.5-99.7 95.2-98.2 93.9-97.6 94.1-97.8 92.3-98.3 95.7-98.0 99.0-100.0 96.2-99.1 95.8-98.7 96.4-99.0 95.3-99.5 97.7-98.8 64.8-78.8 54.4-65.5 48.7-62.6 49.4-64.2 64.2-78.9 58.4-69.0

Clinical examination

Mammography

Selfexamination

Clinical breast examination was the most common in 35-44 (4.3%; 95% CI 2.4-6.1) and 55-64 (4.7%; 95% CI 1.7-7.7) year age group, and mammography – in 35-54 year age group (2.8%; 95% CI 1.3-4.2). The screening coverage increased with age. Significantly more women had clinical breast examination (3.2%; 95% CI 2.0-4.3) compared to mammography (1.7%; 95% CI 1.2-2.3) (Table 65). There was no difference in proportion of women using breast self-examination, while clinical breast examination and mammography were significantly more common in urban vs. rural areas (Table 66). Table 66. Breast cancer screening (by locality ) Test Clinical examination Locality Urban Rural Total Urban Rural Total Urban Rural Total n 1287 1344 2631 1288 1345 2633 1494 1566 3060 % screened 3.9 2.3 3.2 2.1 1.3 1.7 39.3 33.0 36.3 95%CI 1.9-5.9 1.5-3.2 2.0-4.3 1.2-2.9 0.8-1.9 1.2-2.3 31.1-47.5 27.0-38.9 31.0-41.6 % unscreened 96.1 97.7 96.8 97.9 98.7 98.3 60.7 67.0 63.7 95%CI 94.1-98.1 96.8-98.5 95.7-98.0 97.1-98.8 98.1-99.2 97.7-98.8 52.5-68.9 61.1-73.0 58.4-69.0

Mammography

Self-examination

Chapter III. Survey results

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Conclusions 1. Cervical cancers screening coverage was very low with only 5.2% of female survey respondents reporting VIA and 11.4% - Pap smear testing. 2. Women aged 35-54 had the highest cervical cancer screening coverage, which was consistent with the fact that cervical cancer incidence was the highest in this age group. 3. Breast cancer screening was also insufficient with 1 in 3 surveyed women reporting breast self-examination, and only 3.2 and 1.7% undergoing clinical breast examination and mammography, respectively. Chapter III. Survey results 4. Cervical and breast cancer screening coverage was similar in urban and rural settings. Discussion 1. There were significant gaps in cervical cancers screening in Mongolia with only 5.2% of female survey respondents reporting VIA and 11.4% - Pap smear testing, which meant that 94.8 and 88.6% of women did not have VIA and Pap smear, respectively. 2. Women aged 35-54 years were most likely to have VIA (10.3 and 9.6) or Pap smear (19.9 and 21.5). The incidence of cervical cancer was also the highest in this age group, which could mean that these tests were performed not as a screening, but rather diagnostic test. 3. More than 80% of cervical cancer cases are from developing countries with no comprehensive cancer screening program (1). In South East Asia cervical cancer rates are high in Mongolia and Korea, moderate in Japan and low in China. Mongolia has the lowest breast cancer rates in the region (2). Screening coverage data is important in planning cervical and breast cancer prevention, screening and treatment activities. 4. Breast cancer screening was also insufficient as demonstrated by the fact that 3.2% of surveyed women had clinical breast examination and 1.7% had mammographic examination.

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

3.4 INJURY AND VIOLENCE History of previous injuries and knowledge on injury prevention was assessed in the current study. Injuries other than traffic History of previous injuries other than traffic (including falls, burns, cuts, frostbites, poisoning and other injuries), which required medical attention was studied and compared between different gender, age groups and locality. Chapter III. Survey results Proportion of self-reported injuries, which required medical attention was 8% (95% CI 6.8-9.2), and men were 1.7 times more likely to report having an injury (10.1%; 95% CI 8.3-11.8) compared to women (5.9%; 95% CI 4.6-7.10) (Table 67). Table 67. Self-reported injuries other than traffic (by age and gender) Male Age 15-24 25-34 35-44 45-54 55-64 15-64 n 403 603 567 420 223 2216 % 11.5 10.9 8.2 9.4 5.7 10.1 95% CI 7.3-15.7 7.5-14.3 5.9-10.5 5.9-13.0 1.7-9.7 8.3-11.8 n 495 921 874 625 301 3,216 Female % 6.1 3.9 6.7 6.5 8.1 5.9 95% CI 3.1-9.1 2.3-5.5 4.8-8.5 3.8-9.3 4.7-11.5 4.6-7.1 n 898 1524 1441 1045 524 5432 Total % 8.9 7.4 7.4 8.0 7.0 8.0 95% CI 6.1-11.7 5.4-9.4 5.9-9.0 5.4-10.7 4.3-9.6 6.8-9.2

Breakdown by the type of injury demonstrated that falls were reported most commonly occuring irrespective of gender or in 56.5% (95% CI 47.5-65.5) of cases, blunt force trauma was reported in 17.4% (95% CI 11.2-22.9), other injuries – in 12.4% (95% CI 7.9-16.9), and cuts – in 8.2% (95%CI 2.7-13.6) (Figure 18, Annex I.60-62). Breakdown by age demonstrated that 8.9% (95% CI 6.1-11.7) of cases were 15-24 year-olds, of whom 11.5% (95% CI 7.3-15.7) were males and 8.1% (95% CI 4.7-11.5) were females. Rate of falls increased with age. For instance, 59.9% (95% CI 43.4-76.3) of 35-44 year-olds reported falls, and the rate increased to 81.3% (95% CI 67.7-94.8) in 55-64 year-olds. In contrast, blunt force trauma was more common in younger, working-age persons: 18.6% (95% CI 9.4-27.7) in 25-34 year age group and 18.5% (95% CI 6.4-30.6) in 15-24 year age group. Figure 18. Percentage of respondents who were seriously injured other than road traffic crashes8 by age group (N=358)

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

There were no differences between gender with regards to the place of injury: 36.5% (95% CI 30.842.2) were injured outside/on streets, 23.3% (95% CI 18.6-30.0) at home, 20.4% (95% CI 13.7-27.2) – at school/workplace, 10.3% (95% CI 5.7-14.9) – in other places, and 7.2% (95% CI 2.6-11.9) – in sports facilities (Figure 19, Annex I.63-65). When stratified by age, 24.6% (95% CI 11.7-37.6) of 15-24 year-olds were injured at school/ workplace and 10% (95% CI 1.3-20.0) in sports facilities. In contrast, 50.4% (95% CI 27.1-73.7) of 55-64 year-olds were in injured outside/on streets. Figure 19. Location of accidental serious injuries among respondents seriously injured, by age group (N=358) Chapter III. Survey results

Out of 15-24 year-old males, 14.9% (95% CI 1.4-28.4) were injured while engaging in sports/ physical activity, and 32.5% (95% CI 7.7-57.3) of their female counterparts were injured at school/ workplace. Traffic injury History of traffic injury was assessed by asking whether a respondent had been involved in traffic injury in the past 12 months, about a type of injury, factors causing the injury, place of injury, use of a seatbelt and a helmet, a number of hours driving per day, and drunk driving. Prevalence of self-reported traffic injuries in the past 12 months was 4% (95% CI 3.1-4.8). Traffic injuries were 2.7 times more common in men (5.8%; 95% CI 4.3-7.3) compared to women (2.1%; 95% CI 1.4-2.7) (Table 67). Traffic injuries were the most common in 25-34 year-olds (6.0%; 95% CI 4.1-8.0) with the prevalence of 9.7% (95% CI 6.2-13.3) in men and 2.3% (95% CI 1.3-3.3) in women. Table 68. Traffic injury ( by age, gender and locality) Male n 15-24 25-34 35-44 403 603 568 % 4.1 9.7 7.2 95% CI 1.8-6.4 6.2-13.3 4.2-10.2 n Age group 495 921 875 2.5 2.3 2.0 1.1-4.0 1.3-3.3 0.9-3.1 898 1524 1443 3.3 6.0 4.6 1.9-4.7 4.1-8.0 3.0-6.2 Female % 95% CI n Total % 95% CI

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

45-54 55-64 15-64 Urban Rural Total

420 223 2217 996 1221 2217

3.2 2.3 5.8 5.6 6.0 5.8

1.3-5.1 0.2-4.5 4.3-7.3 3.3-7.8 3.9-8.1 4.3-7.3

625 301 3,217 Locality 1547 1670 3217

1.4 0.5 2.1 1.8 2.4 2.1

0.5-2.3 0.0-1.3 1.4-2.7 0.9-2.7 1.5-3.3 1.4-2.7

1045 524 5434 2543 2891 5434

2.3 1.4 4.0 3.6 4.3 4.0

1.3-3.4 0.2-2.6 3.1-4.8 2.5-4.7 3.1-5.6 3.1-4.8

The main causes of traffic injury were speeding (22.7%; 95% CI 15.7-29.7) and drunk driving (9.1%; 95% CI 3.8-14.3) with no significant differences between genders (Figure 20, Annex I. 6668). In 53.9%, traffic injury was caused by driving faulty cars, violating rules and regulations of transporting passengers, crossing stoplight, violating traffic rules by pedestrians and not using seatbelts. External factors (e.g. slippery roads, weather conditions, unsafe road conditions, poor road side lighting) were responsible for 8.5% of traffic injuries. Figure 20. Cause of crash among those respondents involved road traffic crash, by age group (N=191)

In terms of urban/rural differences, in urban areas 24% (95% CI 16.2-31.8) were caused by speeding and 7.4% (95% CI 0.3-14.5) – by drunk driving, while in rural areas the corresponding rates were 21.6 (95% CI 10.8-32.4) and 10.4 (95% CI 3.1-17.8)%, respectively. Table 69. Traffic injuries ( by locality and risk factors) Violation of traffic rules by pedestrians % 1.4 1.1 1.2 95% CI 0.0-3.4 0.0-3.2 0.0-2.7

Drunk driving Locality Urban Rural Total n 82 109 191 % 7.4 10.4 9.1 95% CI 0.3-14.5 3.1-17.8 3.9-14.3

Fatigue / disease % 6.6 2.9 4.6 95% CI 0.8-12.5 0.0-6.8 1.1-8.0 % 24.0 21.6 22.7

Speeding 95% CI 16.2-31.8 10.8-32.4 15.7-29.6

External factors % 8.4 8.7 8.5 95% CI 1.7-15.0 4.1-13.2 4.6-12.5 % 52.2 55.3 53.9

Other 95% CI 37.9-66.6 42.9-67.8 44.5-63.3

Chapter III. Survey results

Although traffic injuries were common in rural areas (4.3%; 95% CI 3.1-4.8) the difference was not statistically significant.

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Analysis of traffic injury risk factors by age and gender demonstrated that 13.5% (95% CI 0.0-27.3) of 25-34 year-old males were injured as a result of drunk driving, while 33.0% (95% CI 17.6-48.4) of 35-44 year-olds and 35.4% (95% CI 0.0-71.2) of 45-54 year-olds were injured due to speeding. Among females, 18.8% (95% CI 0.0-41.2) of 15-24 year-olds were injured as a result of drunk driving, while 30.3% (95% CI 6.6-53.9) of 25-34 year-olds and 39.3% (95% CI 0.0-100.0) of 55-64 year-olds were injured due to speeding. When asked about seatbelt use, 83.6% (95% CI 81.2-86.0) overall, or 78.6% (95% CI 75.5-81.7) of men and 88.9% (95% CI 86.4-91.5) of women did not use seatbelt every time they drove or rode in a car (Table 70). Chapter III. Survey results Table 70. Proportion not using seatbelts (by age and gender) Male Age group 15-24 25-34 35-44 45-54 55-64 15-64 n 306 493 467 324 165 1755 % 84.5 76.4 71.0 75.4 87.5 78.6 95% CI 77.8-91.2 72.4-80.5 65.0-77.0 68.1-82.7 81.7-93.3 75.5-81.7 n 370 673 650 470 202 2365 Female % 90.9 86.6 88.4 88.5 88.9 88.9 95% CI 86.9-95.0 83.0-90.1 85.1-91.8 84.7-92.2 83.6-94.3 86.4-91.5 n 676 1166 1117 794 367 4120 Total % 87.7 81.2 79.4 81.7 88.2 83.6 95% CI 82.8-92.5 78.0-84.4 76.1-82.7 77.7-85.7 83.9-92.6 81.2-86.0

When stratified by locality, 78% (95% CI 73.6-82.3) of urban and 90.6% (95% CI 87.8-93.3) of rural population did not use seatbelts regularly. Non-compliance with seatbelt use regulation was 69.6% (95% CI 64.7-74.6) in urban men and 88.3% (95% CI 84.8-91.7) in their rural counterparts (Figure 21). Figure 21. Proportion not using seatbelts (by locality and gender)

When asked about helmet use when riding a bicycle or motorcycle, 95.6% (95% CI 94.0-97.2) did not use helmets regularly, and no significant difference between genders was observed. When asked about average number of hours a day spent driving, men responded they spent 2.9 (95% CI 2.5-3.4) and women - 0.7 (95% CI 0.4-1.0) hours a day driving. Of the respondents, 35-44 yearold males spent most or 3.5 hours (95% CI 2.9-4.1) behind the wheel.

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Conclusions 1. Prevalence of injuries other than traffic was 8%, and the leading types of injuries were falls (56.5%) and blunt force trauma (17.4%). 2. Men were 1.7 times more likely to have a history of injuries, and it was the most common in 15-24 year-old males, 25-34 year-old females, and 55-64 year-olds of both sexes. 3. In terms of place of injury, one in three was injured in streets, one in five – at home or school/workplace. 4. Prevalence of traffic injury in the study population was 4%. 6. Eight in ten drivers and passengers did not use seatbelt regularly. 7. Use of helmets when riding a bicycle or a motorcycle was almost inexistent in both genders. Chapter III. Survey results 5. One in five traffic injuries was due to speeding, and 1 in 10 – due to drunk driving.

Discussion 1. Worldwide 16,000 persons a day or 5 million people annually die due to traffic injuries. This accounts for 9.8% of mortality and 12.3% of morbidity in the world (WHO, 2004). 2. In recent years, injuries have increased in Mongolia, becoming the third leading cause of population mortality and the fifth leading cause of morbidity, and the numbers are growing. 3. According to “Report on Injuries in Mongolia, 2003-2004”, the likelihood of men vs. women getting injured in traffic accident was 3.3 times more according to health statistics, 2.7 times more according to the police data, and 2.8 times more according to the results of the study. 4. The current survey data suggested speeding was the leading cause of traffic injury. Low levels of seatbelt and helmet use detected by the current survey are in agreement with the data from the National Traumatology and Orthopedic Research Center (NTORC), according to which 31% of emergency cases have brain injury. 5. According to the results of the current survey, injuries occurred most commonly outside/ in streets and at home, which was consistent with the fact that the majority of injury cases were traffic injuries, falls and domestic interpersonal violence. 6. There was a fair chance that the survey population, and women and the elderly in particular, under-reported violence. Therefore, interpersonal violence could be under reported in cases of sharp and blunt force trauma, which were the 4th and 2nd most common injury excluding traffic injury. The findings of the current survey demonstrate that traffic injuries and falls were the most common types of injury in the population. This is in agreement with NTORC data on traffic injuries, falls and interpersonal violence being the leading causes of injury mortality, morbidity and hospitalization.

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Violence In the current study violence was assessed as a health risk factor and a source of stress. Special attention was given to child abuse and services for violence victims. Violence as a health risk factor In the past 12 months, 3.5% (95% CI 2.6-4.3) of the study population were victims of violence and received medical care. In particular, 4.4% (95% CI 2.9-5.9) of men and 2.5% (95% CI 1.8-3.2) of women were subject to violence (Figure 22, Annex I.69). Chapter III. Survey results Figure 22. Prevalence of violence (by age and gender)

Use of a weapon was reported by 24% (95% CI 11.6-36.5) of men and 17.8% (95% CI 4.3-31.2) of women (Figure 23). Although use of a weapon was reported by fewer women compared to men, the former were more likely to be injured as a result of physical abuse (such as hitting, slamming, pushing and kicking). Figure 23. Use of weapons in violent act

One in two males and one in five females were victimized with weapons and received bodily injury. This demonstrated high risks to personal health and community wellbeing associated with violence.

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Of males, 49.9% (95% CI 38.0-61.7) were abused by friends and acquaintances and 36.5% (95% CI 24.6-48.4) – by strangers. The main reported cause of violence among men was a difference in opinions in 89.4% of cases, and one in every nine men tended to use physical force in resolving conflict. In terms of age, 89.9% of 15-24 year-old males, 60.8% of females were physically abused by their acquaintances or strangers (Figure 24), which demonstrated widespread peer pressure among adolescents and youth. It should be noted that this rate decreased with age. Figure 24. Abusers reported by 15-24 year-olds Chapter III. Survey results Men tended to be victimized in social settings other than household. Among those involved in a violent incident, female victims of violence reported being abused by family or intimate partners in 30.4% of cases, by strangers in 26.9% and by friends in 24.2% of cases (Table 71, Annex I.70-72). Table 71. Violence against women %intimate partner % official or legal authorities % offspring, relatives n 95% CI 95% CI 95% CI % strangers Age Group % friends 95% CI 95% CI 15-24 25-34 35-44 45-54 55-64 15-64 10 18 26 9 2 65 30.9 39.0 34.1 0.0 0.0 30.4 0.0-67.3 15.3-62.6 19.2-48.9 0.0-0.0 0.0-0.0 13.9-46.8 8.3 23.8 20.6 17.6 0.0 17.1 0.0-25.4 7.3-40.3 4.1-37.0 0.0-38.8 0.0-0.0 8.4-25.8 38.4 9.2 5.7 73.2 77.7 24.2 0.6-76.2 0.0-21.9 0.0-13.3 47.1-99.2 27.7-100.0 7.9-40.4 22.4 28.1 39.7 0.0 0.0 26.9 0.0-56.2 10.8-45.3 21.9-57.6 0.0-0.0 0.0-0.0 13.6-40.2 0.0 0.0 0.0 9.3 0.0 0.9 0.0-0.0 0.0-0.0 0.0-0.0 0.0-28.5 0.0-0.0 0.0-2.7

Women were abused by someone close in 21.6% (95% CI 10.1-33.1) of cases in urban and 40.1% (95% CI 10.6-69.6) of cases in rural areas, and by a stranger in 41.5% (95% CI 22.4-60.6) of cases in urban and 10.6% (95% CI 0.7-21.9) in rural areas. This demonstrated that in urban settings, strangers tended to abuse women, and in rural settings this was someone close. 3.5% (95% CI 2.6-4.4) of the survey respondents sought medical care as a result of abuse. Out of them, 96.5% responded they were abused regularly. This was a clear indication that family violence was common in the Mongolian society, tended to recur and worsen, and had negative health impacts.

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Table 72. Frequency of abuse Age group 15-24 25-34 35-44 45-54 n 895 1522 1440 1042 522 5421 0.1 0.0-0.3 % never 0.2 0.0 0.2 95% CI 0.0-0.5 0.0-0.1 0.0-0.5 % rarely 3.6 2.9 3.9 2.2 1.7 3.2 95% CI 2.0-5.3 1.8-4.1 2.6-5.2 1.1-3.3 0.2-3.2 2.4-4.0 0.1 0.2 0.3 0.4 0.1 0.0-0.2 0.0-0.5 0.0-0.6 0.0-1.1 0.0-0.2 % sometimes 95% CI % often 96.2 96.9 95.6 97.6 97.9 96.5 95% CI 94.4-97.9 95.8-98.0 94.3-96.9 96.3-98.8 96.3-99.6 95.7-97.4

Chapter III. Survey results

55-64 Total

Urban vs. rural comparisons revealed that perpetrators were friends and acquaintances in 38.2% (21.7-54.7) of cases in urban and 43.2% (30.6-55.8) of cases in rural areas, while strangers were responsible for 43.4% (29.4-57.4) of cases in urban and 24.2% (13.5-34.9) of cases in rural areas. According to the current survey, one in every 200 people lived in an abusive family. Violence and stress One in five respondents or 19.3% (95% CI 16.9-21.7) of the study population reported worrying about their personal and family security because of someone’s anger, threat or maltreatment in the past 12 months. Of them, 48.4% (95% CI 43.4-53.4) were anxious because of family members, 31.1% (95% I 25.8-36.5 because of friends, 9.2% (95% CI 6.4-12.0) because of coworkers, 9.7% (95% CI 7.5-11.9) because of strangers. This supported the view that negative family and workplace atmosphere triggered stress and interfered with healthy and peaceful living and working. There were no significant differences between urban and rural respondents, which indicated widespread stress in the society. Table 73. Percentage worrying about their personal and family security because of someone’s anger Age group 15-24 25-34 35-44 45-54 55-64 15-64 Male n 402 602 567 420 223 2214 % 16.7 16.8 16.8 12.5 9.0 15.7 95% CI 12.3-21.1 12.6-21.0 12.4-21.2 9.1-15.9 5.0-13.0 13.1-18.2 n 495 921 876 625 301 3218 Female % 22.3 24.1 25.6 20.9 18.3 22.9 95% CI 17.2-27.5 20.4-27.8 21.3-29.9 16.5-25.2 12.9-23.6 19.9-26.0 n 897 1,523 1,443 1,045 524 5432 Total % 19.4 20.4 21.2 16.5 13.8 19.3 95% CI 16.1-22.8 17.3-23.5 17.5-25.0 13.5-19.5 10.5-17.2 16.8-21.7

Child abuse 66.7% (95% CI 60.2-73.2) of the surveyed males and 57.9% (95% CI 51.6-64.2) of females reported being physically abused (slammed, beaten, kicked, etc) by a family member as a child. No significant difference was observed between age groups with 59.6 – 65.7% of 15-64 year-olds reporting abuse as a child (Table 74).

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Table 74. Percentage being abused as child

Age group 15-24 25-34 35-44 45-54 55-64 15-64

Males n 397 586 561 399 216 2159 % 64.9 70.7 64.5 68.4 65.0 66.7 95% CI 57.1-72.8 63.6-77.7 56.5-72.5 60.8-76.1 54.2-75.9 60.2-73.2 n 492 902 862 608 284 3148

Females % 59.9 60.6 55.1 53.5 54.5 57.9 95% CI 51.3-68.5 53.8-67.5 48.2-61.9 46.7-60.3 44.4-64.6 51.6-64.2 n 889 1,488 1,423 1,007 500 5307

Total % 62.5 65.7 59.8 61.1 59.6 62.3 95% CI 55.1-69.8 59.1-72.3 53.0-66.5 50.4-68.8 56.3-68.4 54.5-67.8

The data suggested high prevalence of child abuse in the Mongolian society due to a tendency to view physical abuse as means of disciplining a child (Figure 25). Figure 25. Frequency of child abuse 50 45 40 Proportion % 35 30 25 20 15 10 5 0 0.5 0.2 0.4 Never 19.9 15.7 11.5 3.9 1.2 2.6 42.1 37.7 33.3 42.3

45 43.7

Rarely

Monthly

Weekly

Almost daily

Men

Women

Total

Of those abused as a child, 43.7% (95% CI 39.3-48.1) reported being abused almost on daily basis although did not mention anything about requiring medical attention as a result of abuse. The data suggested that child abuse was common and used as a punishment for wrongdoing, and remained undisclosed unless serious danger to health and life of a child occurred. Services for violence victims The survey respondents unanimously agreed that a victim should tell someone about abuse and seek support and care. Almost half (49.4%) of the respondents preferred to disclose the information to the police, 34.5% - to family members, 9.1% - to friends, 4.6% to local officials, 1.8% - to health professionals and 0.6% - to teachers. Comparisons between different localities demonstrated that 57.7% of urban and 48% of rural respondents preferred seeking help from the police (Figure 26).

Chapter III. Survey results

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Figure 26. Preferred point of contact, by locality 60 50

53.4 45.5 35.133.9

Proportion %

40 30 20 10 0 Police Local oﬃcer 8 0.9 1.1 2.6 Yealth professional

9.4 8.9 0.1 1.1 Family mamber Friend Teacher

Chapter III. Survey results

Urban

Rural

There was a general preference for the police and legal institutions to seek help in violence cases. However, a certain proportion of the respondents preferred to seek help from local officials, health professionals and school teachers, who have legal obligation to protect citizen’s health and wellbeing. Therefore, the above professionals need to be trained in recognizing signs of violence, reporting abuse, collecting evidence and referring to appropriate services. 40% of the respondents preferred to seek support from family and friends. However, this might provoke further violence, and therefore, needs to be addressed in public educational campaigns. Younger (15-24 years old) males sought support from the police in 39.6% (95% CI 32.3-46.9) of cases, which increased with age, while seeking support from family (37.6%; 95% CI 31.6-43.6) and friends (15.4%; 95% CI 10.5-20.3) decreased. The above dynamics could be due to increased family violence towards older men. Conclusions 1. Men compared to women were more likely to fall victims of interpersonal violence, which was mainly because men tended to use physical force in resolving conflict. 2. Peer pressure was common among 15-24 year-olds of both genders. 3. Family violence was common, and the majority of its victims were women. One in seven women was a subject to domestic violence, and one in every 200 people lived in an abusive family. 4. Although public awareness about forms of violence and its recurrent character improved, victims of violence only sought medical care when were injured and their health and lives were in danger. 5. In crowded urban areas there was a greater chance to be abused by a stranger. 6. Stress caused by family aggression threatens safety of workplace, and vice versa. 7. Of the survey respondents, 62.3% were abused as a child. Children are physically abused for wrongdoing, and parents lack skills to effectively communicate with their children. 8. Child abuse mainly remains undisclosed unless serious danger to health and life of a child

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

occurs. 9. 40% of the respondents preferred to seek support from family and friends. However, this might provoke further violence, and therefore, needs to be addressed in public educational campaigns.

Recommendations 1. To plan and implement a communication strategy to improve knowledge of local officials, health professionals and school teachers about violence within the framework of the National Program on Prevention of Family Violence. 2. To establish one stop service centers for violence victims at the Regional Diagnostic and Treatment Centers within the framework of the National Program on Prevention of Injury and Violence. 3. To improve public services for rural population and to support activities of joint teams. 4. To instill a social attitude of intolerance towards violence, promote civil participation and reporting of violence. 5. To support communication campaign focusing on specifics of physical and mental development of children to prevent child abuse

Chapter III. Survey results

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

3.5 RESULTS OF COMPARATIVE STUDY One of the objectives of the current survey was to generate data for mid-term evaluation of the National Program on Prevention and Control of NCDs. Therefore, the results of the current survey were compared to the 2005 survey on NCD risk factors. For comparison purposes, data from the two surveys were weighted using age and gender distribution of the population of Mongolia in 2008, and standardized rates were compared.

1. Trend in prevalence of common modifiable risk factors for NCDs Chapter III. Survey results Tobacco use Standardized prevalence of smoking in the 15-64 year-old population was 27.5% in 2009, which was slightly higher than the corresponding rate in 2005 (26.6%) although not statistically significant. In terms of gender, smoking rates remained stable in men (48.7% and 49.4%), whereas proportion of smoking women 5.9% (95%CI 4.3-7.5) was likely to increase over the years by 7.0% (95CI 4.37.5), however, the difference was not statistically significant (Comparison result I). Similarly, there was no significant difference in the percentage of current daily smokers between the two surveys (23.3% vs. 24.1%). Average age of smoking initiation was 19.3 in 2009, comparatively younger than in 2005 (20.1 years). In regard to gender, there was no difference in the age of starting smoking among men. However, for the women the age starting smoking decreased by 3.7 years – whereas women started smoking at 24.0 (95%CI 22.3-25.7) years in 2009 compared to the age of 27.7 (95%CI 25.8-29.7) years in 2005 (Comparison result II, III). Alcohol consumption Slightly different indicators of risk associated with alcohol consumption were used in 2009 compared to 2005. Therefore, direct comparison between the two surveys was problematic. According to the 2009 survey, the percentage who drank alcohol in the past 12 months was 58.5%, which was significantly lower than 66.9% in 2005. The percentage of men who drank in the past 12 months remained the same in men over the years, whereas in women this percentage decreased from 58.7% (95%CI 55.0-62.3) to 47.3% (95%CI 42.3-52.2). The percentage of people who drank alcohol at least five days weekly in the past 12 months increased to 0.8% (95%CI 0.3–1.2) in 2009 compared to 0.6% (95%CI 0.4–0.9) in the previous survey. However, the difference was not statistically significant in terms of general population or by gender (Comparison result II, III). Fruit and vegetable consumption According to the 2005 survey, the mean number of days fruits were consumed in a typical week was 1.8 days (95% CI 1.7-1.9), which decreased to 1.2 (95% CI 1.0-1.3) in 2009. In regard to gender, mean number of days fruits were consumed in a typical week decreased by 0.4 days in men and 0.7 days in women. The mean number of servings of fruit consumed on average per day was halved from 0.8 (95% CI 0.7-0.8) to 0.4 servings (95%CI 0.3-0.5) between the two surveys. The decrease was noticed both in men and in women – that is decreased from 0.6 servings to 0.3 and from 0.9 to 0.5 servings of fruits, respectively. Similarly, the mean number of days vegetables were consumed in a typical week was decreased from 5.7 (95%CI 5.6-5.8) to 4.7 (95%CI 4.3-5.0) days, and the mean number of servings of vegetables were consumed on average per day decreased from 1.6 (95% CI 1.6-1.7) to 1.3 (95% CI 1.1-1.5)

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

servings. In regard to gender, the mean number of days vegetables were consumed was decreased by 1 day both in men and women. The mean number of servings of vegetables were consumed on average per day was decreased significantly in men from 1.6 (95CI 1.6-1.7) to 1.3 (95CI 1.1-1.5) servings (Comparison result II, III). Decline in fruit and vegetable consumption could be in part due to exclusion of potato consumption from the assessment of vegetable consumption in 2009 and proceedings of late autumn field work compared to the previous survey. Physical activity Chapter III. Survey results The previous survey data was re-analyzed to adjust for changes in methodology and indicators used in the assessment of physical activity. According to the results of a comparative study, the percentage with a low level of physical activity remained almost unchanged between 2005 (7.4%) and 2009 (7.2%). The percentage did not differ in respect to gender. In contrast, there was a statistically significant increase in the percentage with high levels of physical activity from 70.4% in the previous survey to 81.8% in 2009. The increase was observed in both men (74.3%-82.5%) and women (67.2%-81.1%) over the years from 2005 to 2009. The finding of increased percentage with high levels of physical activity was also supported by an increase in median time spent in physical activity on average per day (181.4 vs. 342.8 METminutes). Out of those physically active, the percentage engaging in vigorous activity decreased from 58.9% in 2005 to 45.5% in 2009. In regard to gender, the percentage engaging in vigorous activity decreased by 11.6% in men (51.5%-39.9%) and 13.1% in women (65.2%-52.1%) over the years between 2005 and 2009 (Comparison result II, III).

2. Trends in prevalence of intermediate risk factors for NCDs Overweight and obesity Mean body mass index in the study population increased significantly from 23.9 kg/m2 in 2005 to 24.7 kg/m2 in 2009. There was a significant increase in the mean BMI in men from 23.3 (95CI 23.023.5) kg/m2 to 24.3 (95CI 23.0-23.5) kg/m2 and it was remained stable in women. The prevalence of overweight and obesity increased from 32.4% (95% CI 30.3-34.4) to 40.7% (95% CI 38.4-42.9), with the prevalence of obesity only increasing from 10.2% (95% CI 9.0-11.4) to 12.9% (95% CI 11.6-14.2). Both indicators showed a significant increased trend in men over the years, while remaining stable in women (Comparison result II, III). Hypertension There was no statistically significant difference in mean systolic blood pressure in the study population in 2005 (124.6 mmHg) and 2009 (125.9 mmHg). However, mean diastolic blood pressure increased from 76.9 to 78.9 mmHg. The mean diastolic blood pressure increased by 2.8 mmHg in men and in women remained the same. The prevalence of hypertension remained almost unchanged between 2005 (28.5%; 95% CI 26.130.8) and 2009 (27.8%; 95% CI 25.7-29.9). In regard to gender, there was no statistically significant difference between men and women in the prevalence of hypertension. However, there was a statistically significant increase in the percentage with raised blood pressure who are not currently

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

on medication for raised blood pressure from 50.4% in 2005 to 62.7% in 2009. The comparative study demonstrated that effective medicinal management of hypertension worsened (Comparison result II, III). Diabetes There was a slight decrease in mean fasting blood glucose between the two surveys (4.9 vs.4.7 mmol/L) although not statistically significant. The mean fasting blood glucose was not different in men and women over the years. Similarly, no significant difference was observed in the prevalence of population with impaired fasting glucose (10.3% in 2005 vs. 9.3% in 2009). Thus, there was no significant difference in the percentage of people with raised blood glucose or on medication for diabetes between the two surveys (10.0% in 2005 vs. 6.6% in 2009). No statistically significant differences in these indicators were observed in terms of gender (Comparison result II, III). Blood lipids Mean blood cholesterol was 4.7 mmol/L (95% CI 4.7-4.8) among the population in 2005 and it became 4.3 mmol/l (95% CI (4.2-4.5) in 2009 showing a decrease. However, there was no significant difference in the percentage with or at risk of increased total cholesterol between the study population in 2005 (23.9%; 95% CI20.5-27.3) and 2009 (26.2%; 95% CI (20.5-31.9). The percentage with or at risk of increased total cholesterol was not different between men and women of the two study populations (Comparison result II, III). Conclusion 1. The prevalence of smoking in the adult population has no tendency to decrease. Furthermore, women started smoking at a younger age. With regards to alcohol consumption, although the percentage of people that drank alcohol in the past 12 months decreased, the frequency of drinking has a tendency to increase. 2. Average daily fruit consumption was halved and vegetable consumption decreased by 20 % in the past four years. At the same time, average daily salt intake decreased. Although there was an increase in median time spent in physical activity on average per day and in the percentage of people with high level of physical activity, no changes were observed in the percentage of physically inactive. 3. The mean Body Mass Index of the adult population increased as well as the prevalence of obesity (by 2.7%), and overweight and obesity (by 8.3%). The percentage with or at risk of increased total cholesterol remained stable over the years with 23.9% (95%CI 20.527.3) and 26.2% (20.5-31.9) respectively. 4. Although the prevalence of hypertension remained unchanged, use of medication for treatment of hypertension and its responsiveness to anti-hypertensive drugs worsened. 5. Mean fasting blood glucose in the Mongolian adult population remained stable, and there was also no statistically significant change in the percentage of people with impaired fasting glucose or with raised blood glucose or on medication for diabetes.

Chapter III. Survey results

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Comparison result I

Mongolia STEPS Surveys 2005 & 2009 (Population weighted only) The STEPS survey of chronic disease risk factors in Mongolia carried in 2005 and 2009. Both surveys were population-based surveys of adults aged 15-64. A multi-stage cluster sample design was used each time to produce representative data for that age range in Mongolia. A total of 3,411 adults participated in 2005 and 5,438 adults participated in 2009. First 2 columns display 2 survey results with population adjustment weights using the 2008 population figures in both survey data. 2005 (N=3411) 26.6% 23.3% 2009 (N=5438) 27.5% 24.1%

Results for adults aged 15-64 years (incl. 95% CI) Step 1 Tobacco Use Percentage who currently smoke tobacco Percentage who currently smoke tobacco daily For those who smoke tobacco daily Average age started smoking (years) Percentage of daily smokers smoking manufactured cigarettes Mean number of manufactured cigarettes smoked per day (by smokers of manufactured cigarettes) Step 1 Alcohol Consumption Percentage who drank alcohol in the past 12 months Percentage who drank on 5 or more days per week in the past 12 months Percentage who drank less than once a month in the past 12 months Step 1 Fruit and Vegetable Consumption (in a typical week) 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 Step 1 Physical Activity 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

(23.8 – 29.4) (20.8 – 25.8)

(26.0 – 29.0) (22.9 – 25.4)

(87.9 – 93.0) (10.8 – 11.7)

90.5% 11.3

(80.7 – 90.5) (8.1 – 9.5)

85.6% 8.8

(64.2 – 69.5) (0.4 – 0.9) (35.0 – 39.7)

66.9% 0.6%

(54.2 – 62.7) (0.3 – 1.2) (32.5 – 40.9)

58.5% 0.8%

37.3%

36.7%

(1.7 – 1.9) (0.7 – 0.8) (5.6 – 5.8) (1.6 – 1.7) (89.8 – 92.5)

1.8 0.8 5.7 1.6

(1.0 – 1.3) (0.3 – 0.5) (4.3 – 5.0) (1.1 – 1.5) (90.7 – 94.0)

1.2 0.4 4.7 1.3

91.1%

92.3%

(6.0 – 8.8) (67.5 – 73.4) (85.7 – 330.0) (52.3 – 65.6)

7.4%

(5.1 – 9.9) (77.0 – 86.6) (162.9 – 507.1) (41.3 – 51.2)

7.5%

70.4% 181.4

81.8% 347.1

58.9%

46.2%

(19.6 – 20.6)

20.1

(18.9 – 19.6)

19.3

Chapter III. Survey results

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

2005

2009

(23.7-24.1) (30.3-34.4) (9.0-11.4) (123.8-125.5) (76.4-77.4)

23.9

(24.5-24.9) (38.4-42.9) (11.6-14.2) (124.7-127.1) (78.2-79.7)

24.7

32.4% 10.2% 124.6 76.9

40.7% 12.9% 125.9 78.9

Chapter III. Survey results

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 Step 3 Biochemical Measurement Mean fasting blood glucose, including those currently on medication for raised blood glucose (mmol/L) Percentage with impaired fasting glycaemia as defined below capillary whole blood value ≥5.6 mmol/L (100 mg/dl) and <6.1 mmol/L (110 mgdl) Percentage with raised fasting blood glucose as defined below or currently on medication for raised blood glucose capillary whole blood value ≥ 6.1 mmol/L (110 mg/dl) Mean total blood cholesterol, including those currently on medication for raised cholesterol (mmol/L) Percentage with raised total cholesterol (≥ 5.0 mmol/L or ≥ 190 mg/dl or currently on medication for raised cholesterol) Summary of combined risk factors · · · current daily smokers less than 5 servings of fruits & vegetables per day low level of activity · ·

(26.1-30.8)

28.5% 50.4%

(25.7-29.9)

27.8% 62.7%

(45.1-55.8)

(58.4-67.0)

(4.8-5.0)

4.9

(4.6-4.9)

4.7

(7.9-12.6)

10.3%

(7.4-11.1)

9.3%

(7.7-12.3)

10.0%

(4.8-8.3)

6.6%

(4.7-4.8)

4.7

(4.2-4.5)

4.3

(20.5-27.3)

23.9%

(20.5.4-31.9)

26.2%

overweight (BMI ≥ 25 kg/m2) raised BP (SBP ≥ 140 and/or DBP ≥ 90 mmHg or currently on medication for raised BP) (2.6-4.3)

Percentage with none of the above risk factors Percentage with three or more of the above risk factors, aged 15 to 44 years Percentage with three or more of the above risk factors, aged 45 to 64 years Percentage with three or more of the above risk factors, aged 15 to 64 years

3.4%

(1.5-3.6)

2.5%

(13.9-17.7)

15.8% 53.0% 23.8%

(18.3-21.9)

20.1% 52.4% 27.0%

(49.6-56.5)

(48.7-56.0)

(21.7-25.9)

(25.0-28.9)

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Comparison result II

Mongolia STEPS Surveys 2005 The STEPS survey of chronic disease risk factors in Mongolia carried in 2005. Mongolia carried out Step 1, Step 2 and Step 3. Socio demographic and behavioral information was collected in Step 1. Physical measurements such as height, weight and blood pressure were collected in Step 2. Biochemical measurements were collected to assess blood glucose and cholesterol levels in Step 3. The STEPS survey in Mongolia was a population-based survey of adults aged 15-64. A multi-stage cluster sample design was used each time to produce representative data for that age range in Mongolia. A total of 3,411 adults participated in the Mongolia STEPS survey. A repeat survey was carried out in 2009. Results for adults aged 15-64 years (incl. 95% CI) Step 1 Tobacco Use Percentage who currently smoke tobacco Percentage who currently smoke tobacco daily For those who smoke tobacco daily Average age started smoking (years) Step 1 Alcohol Consumption Percentage who drank alcohol in the past 12 months Percentage who drank on 5 or more days per week in the past 12 months Percentage who drank less than once a month in the past 12 months Step 1 Fruit and Vegetable Consumption (in a typical week) 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 Step 1 Physical Activity Percentage with low levels of activity (defined as < 600 METminutes per week)* Percentage with high levels of activity (defined as ≥ 3000 METminutes per week)* Median time spent in physical activity on average per day (minutes) (presented with inter-quartile range) Percentage not engaging in vigorous activity 7.4% (6.0 – 8.8)

Both Sexes

Males

Females

26.6% (23.8 – 29.4)

48.7% (45.2 – 52.2)

5.9% (4.3 – 7.5)

23.3% (20.8 – 25.8)

43.4% (40.1 – 46.7)

4.5% (3.2 – 5.8)

20.1 (19.6 – 20.6)

19.2 (18.8 – 19.7)

27.7 (25.8 -29.7)

66.9% (64.2 – 69.5)

75.7% (72.8 – 78.5)

58.7% (55.0-62.3)

0.6% (0.4 – 0.9)

1.1% (0.6 – 1.6)

0.2% (0.0 – 0.4)

37.3% (35.0 – 39.7)

31.2% (28.7 – 33.8)

41.1% (40.1 – 46.0)

1.8 (1.7 – 1.9)

1.4 (1.3 – 1.6)

2.1 (2.0-2.3)

0.8 (0.7 – 0.8)

0.6 (0.5 – 0.7)

0.9 (0.8-1.0)

5.7 (5.6 – 5.8)

5.6 (5.4 – 5.7)

5.8 (5.6-5.9)

1.6 (1.6 – 1.7)

1.6 (1.5-1.7)

91.1% (89.8 – 92.5)

92.3% (90.7 – 94.0)

90.0% (88.3-91.8)

7.0% (5.3 – 8.8)

7.7% (5.9-9.4)

70.4% (67.5 – 73.4) (85.7 – 330.0) (52.3 – 65.6)

74.3% (71.2 – 77.4) (98.5 – 360.0) (44.5 – 58.6)

67.2% (63.6-70.8) (77.1-310.4) (58.4-72.0)

181.4

205.7

175.7

58.9%

51.5%

65.2%

Chapter III. Survey results

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Results for adults aged 15-64 years (incl. 95% CI) Step 2 Physical Measurements Mean body mass index - BMI (kg/m2) Percentage who are overweight (BMI ≥ 25 kg/m2) Percentage who are obese (BMI ≥ 30 kg/m2) 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 Step 3 Biochemical Measurement Mean fasting blood glucose, including those currently on medication for raised blood glucose (mmol/L) Percentage with impaired fasting glycaemia as defined below capillary whole blood value ≥5.6 mmol/L (100 mg/dl) and <6.1 mmol/L (110 mg/dl) Percentage with raised fasting blood glucose as defined below or currently on medication for raised blood glucose - capillary whole blood value ≥ 6.1 mmol/L (110 mg/dl) Mean total blood cholesterol, including those currently on medication for raised cholesterol (mmol/L) Percentage with raised total cholesterol (≥ 5.0 mmol/L or ≥ 190 mg/dl or currently on medication for raised cholesterol)

Both Sexes 23.9 (23.7-24.1)

Men 23.3 (23.0-23.5)

Women

24.5 (24.3-24.8)

32.4% (30.3-34.4)

25.6% (23.4-27.9)

38.8% (35.9-41.6)

10.2% (9.0-11.4)

7.3% (5.9-8.6)

13.0% (11.2-14.8)

124.6 (123.8-125.5)

128.2 (127.3-129.2)

121.3 (120.1-122.4)

Chapter III. Survey results

76.9 (76.4-77.4)

76.9 (76.2-77.7)

76.8 (76.1-77.6)

28.5% (26.1-30.8)

30.1% (27.4-32.8)

27.0% (23.5-30.5)

50.4 (45.1-55.8)

66.2% (59.8-72.6)

34.0% (27.8-40.2)

(4.8-5.0)

4.9

(5.0-5.2)

5.1

(4.6-4.8)

4.7

(7.9-12.6)

10.3%

(9.6-18.0)

13.8%

(4.6-9.3)

7.0%

(7.7-12.3)

10.0% 4.7

(9.5-17.0)

13.3% 4.7

(4.9-9.0)

7.0% 4.7

(4.7-4.8)

(20.5-27.3)

23.9%

(18.1-28.8)

23.5%

(19.2-29.7)

24.4%

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Comparison result III

MONGOLIA STEPS SURVEY 2009 (population weighted results for comparison) The STEPS survey of chronic disease risk factors in Mongolia carried in 2009. Mongolia carried out Step 1, Step 2 and Step 3. The STEPS survey in Mongolia was a population-based survey of adults aged 15-64. A multi-stage cluster sample design was used each time to produce representative data for that age range in Mongolia. A total of 5438 adults participated in the Mongolia STEPS survey. The results below showed are population weighted only with comparison to STEPS 2005. Step 1 Tobacco Use Percentage who currently smoke tobacco Percentage who currently smoke tobacco daily For those who smoke tobacco daily Average age started smoking (years) Step 1 Alcohol Consumption Percentage who drank alcohol in the past 12 months Percentage who drank on 5 or more days per week in the past 12 months Percentage who drank less than once a month in the past 12 months Step 1 Fruit and Vegetable Consumption (in a typical week) 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 Step 1 Physical Activity Percentage with low levels of activity (defined as < 600 METminutes 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 Step 2 Physical Measurements Mean body mass index - BMI (kg/m2) 24.7 (24.5-24.9)

27.5% (26.0 – 29.0)

49.4% (46.2 – 52.6)

7.0% (5.4 – 8.6)

24.1% (22.9 – 25.4)

44.3% (41.5 – 47.1)

5.3% (3.8 – 6.8)

19.3 (18.9 – 19.6)

18.7 (18.3 – 19.0)

24 (22.3 -25.7)

58.5% (54.2 – 62.7)

70.4% (66.5 – 74.4)

47.3% (42.3-52.2)

0.8% (0.3 –1.2)

1.2% (0.5 – 2.0)

0.4% (0.0 – 0.7)

36.7% (32.5 – 40.9)

37.0% (32.3 – 41.6)

36.4% (31.8 – 40.9)

1.2 (1.0 – 1.3)

1 (0.8 – 1.1)

1.4 (1.2-1.6)

0.4 (0.3 – 0.5)

0.3 (0.2 – 0.4)

0.5 (0.4-0.6)

4.7 (4.3 – 5.0)

4.6 (4.2 – 5.0)

4.7 (4.4-5.1)

1.3 (1.1 – 1.5)

1.3 (1.1-1.6)

92.3% (90.7 – 94.0)

93.8% (91.0 – 96.7)

92.7% (89.8-95.5)

7.5% (5.1 – 9.9)

7.4% (5.0 – 9.8)

7.6% (4.9-10.3)

81.80% (77.0 – 86.6)

82.50% (77.8 – 87.3)

81.10% (75.9-86.4)

347.1 (162.8 – 507.1)

343.6 (165.7 – 504.3)

347.1 (160.0-510.0)

46.2% (41.3 – 51.2)

39.9% (34.8 – 45.0)

52.1% (46.5-57.7)

24.3 (24.0-24.6)

25.1 (24.8-25.3)

Chapter III. Survey results

Results for adults aged 15-64 years (incl. 95% CI)

Both Sexes

Males

Females

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Percentage who are overweight (BMI ≥ 25 kg/m2) Percentage who are obese (BMI ≥ 30 kg/m2) 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 Step 3 Biochemical Measurement Mean fasting blood glucose, including those currently on medication for raised blood glucose (mmol/L) Percentage with impaired fasting glycaemia as defined below - capillary whole blood value ≥5.6 mmol/L (100 mg/dl) and <6.1 mmol/L (110 mg/dl) Percentage with raised fasting blood glucose as defined below or currently on medication for raised blood glucose - capillary whole blood value ≥ 6.1 mmol/L (110 mg/dl) Mean total blood cholesterol, including those currently on medication for raised cholesterol (mmol/L) Percentage with raised total cholesterol (≥ 5.0 mmol/L or ≥ 190 mg/dl or currently on medication for raised cholesterol)

40.7% (38.4-42.9)

37.0% (34.0-40.1)

44.2% (41.8-46.5)

12.9% (11.6-14.2)

10.8% (9.2-12.5)

14.8% (13.2-16.5)

125.9 (124.7-127.1)

130.0 (128.7-131.3)

122.0 (120.7-123.3)

78.9 (78.2-79.7)

79.7 (78.9-80.5)

78.3 (77.5-79.1)

27.8% (25.7-29.9)

31.6% (28.9-34.4)

24.2% (21.9-26.4)

Chapter III. Survey results

62.7% (58.4-67.0)

74.4% (69.6-79.3)

48.1% (43..4-52.7)

4.9 (4.8-5.0)

5.1 (5.0-5.2)

4.7 (4.6-4.8)

9.3% (7.5-11.1)

12.9% (9.9-15.9)

5.9% (4.4-7.5)

6.6% (4.8-8.3)

8.8% (6.0-11.7)

4.5% (2.7-6.2)

4.3 (4.2-4.5)

4.5 (4.2-4.7)

4.2 (4.1-4.4)

26.2% (20.5-31.9)

29.4% (22.5-36.3)

23.2% (17.8-28.6)

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

CHAPTER IV CONCLUSIONS

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

GENERAL CONCLUSIONS 1. The current survey on the prevalence of NCD and injury risk factors was conducted using internationally validated survey methodology with external technical support based on local capacity and effective collaboration between different stakeholders. Its findings will be used for mid-term evaluation of the National Program on NCD Prevention and Control, and will serve as a baseline for a health project funded by the Millennium Challenge Account-Mongolia. 2. According to the survey, 24.3% of the Mongolian adult population are current daily smokers, 92.3% consume less than 5 servings of fruits and vegetables a day, 7.5% are physically inactive, 39.8% are overweight or obese, and 27.3% have hypertension. General conclusions 3. High prevalence of NCD risk factors in an adult population is demonstrated by the fact that 9.5% of the population have hyperglycemia, 8.5% – elevated total cholesterol, 16.4% - hypertriglyceridemia, and 20.2% – increased low density lipoprotein. 4. The summary of combined NCD risk factors demonstrates that 1 in 5 (26.4%) Mongolian adults and 1 in 2 (53.8%) adults above 45 years of age have three or more common modifiable NCD risk factors. Twice as many young men compared to women and more than a half (61.4%) of men above 45 years old have high risk of NCDs. 5. In general, smoking, physical inactivity, hypertension, prevalence of latent diabetes and hypercholesterolemia remained stable, while fruit and vegetable consumption decreased, and prevalence of obesity increased in the past 4 years. 6. One in three adult women practiced breast self-examination, and only 3.2% had clinical breast examination, 5.2% had VIA and 11.4% – Pap smear, which demonstrated low coverage of breast and cervical cancer screening. 7. Prevalence of traffic injury was 4%, and it was caused by speeding in 1 of 5 and drunk driving in 1 of 10 cases. Violence was quite common in the Mongolian society, becoming one of the priority public health issues. 8. The survey results support the need for scaling-up of NCD prevention activities and urgent national implementation of effective preventive and control measures.

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REFERENCES 1. Ministry of Health, National Center for Health Development, 2008. Annual Health Report, p 7. 2. Mongolian STEPS Survey on the Prevalence of Noncommunicable Disease Risk Factors 2006. WHO, MOH, Public Health Insitiute, 2007 3. Nonvommunicable Diseases, Poverty and the Development Agenda, Discussion paper, “World health Organization” ECOSOC High-level Segment: WHO, July 2009. 4. Indicators to determine the prevalence of physical fitness and development of the Mongolia population (7-64 years). State Committee of Physical Education and Sports, Ulaanbaatar, 2005. 5. Western Pacific Region (WPRO). 2000. The Asia Pacific Perspective: Redefining Obesity and it’s treatment, WHO Interim Report on Obesity: World Health Organization, Australia. References 6. World Health Organization, 2000. International guide for monitoring alcohol consumption and related harm. Department of mental health and Substance Dependence, NCD and MHC,WHO. pp.193.

7. World Health Organization, 1999. Definition, diagnosis and classification of diabetes mellitus and its complications. Report of a WHO Consultation. 8. World Health Organization, 2002. World Health Report 2002: Reducing risks, promoting healthy life. 9. World Health Organization, 2005. Preventing chronic diseases: a vital investment, WHO Global Report.

10. World Health Organization, 2005. WHOSTEPSSurveillanceManual:The WHO STEPwise approach to chronic disease risk factor surveillance. Geneva, World Health Organization 11. WPRO TFI Fact Sheet, http://www.wpro.who.int/sites/tfi/fact_sheets/, http://www.who. int/ tobacco/resources/publications/tobacco_atlas/en/ 12. “Gender related violence and child abuse status in Mongolia” baseline survey, MOH, WHO and Child Protection Center, 2007 13. Traumatologic Injury in Mongolia, Survey Report WHO, MOH, National Traumatology and Orthopaedic Research Center, 2006

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DETAILED RESULTS

ANNEX I

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SOCIODEMOGRAPHIC STATUS Table 1. Marital status

Age Group (years) 15-24 25-34 35-44 45-54 55-64 15-64

Men n 403 603 568 420 223 2217 % Never married 76.4 15.8 4 3.6 1.3 20 % Currently married 22.8 80.8 90.7 90 91.5 75.6 % Separated 0.2 0.2 0.4 1.2 0.4 0.5 % Divorced 0 1.3 3.2 2.6 0.9 1.8 % Widowed 0 0 0.5 1.9 5.8 1.1 % Cohabiting 0.5 2 1.2 0.7 0 1.1

Table 2. Marital status

Annex I

Age Group (years) 15-24 25-34 35-44 45-54 55-64 15-64

Women n 496 922 876 626 301 3221 % Never married 66.3 10.8 4.2 2.9 2 15.2 % Currently married 28.6 82.8 84.7 80.8 64.8 72.9 % Separated 1.6 0.9 0.8 0.2 0.3 0.8 % Divorced 1 2 5 5 1.7 3.2 % Widowed 0.6 1.1 4.3 10.7 31.2 6.6 % Cohabiting 1.8 2.5 0.9 0.5 0 1.3

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Table 3. Marital status

Age Group (years) 15-24 25-34 35-44 45-54 55-64 15-64

Both Sexes n 899 1525 1444 1046 524 5438 % Never married 70.9 12.8 4.2 3.2 1.7 17.2 % Currently married 26 82 87 84.5 76.1 74 % Separated 1 0.6 0.6 0.6 0.4 0.6 % Divorced 0.6 1.7 4.3 4 1.3 2.6 % Widowed 0.3 0.7 2.8 7.2 20.4 4.3 % Cohabiting 1.2 2.3 1 0.6 0 1.2

Table 4. Highest level of education Both Sexes Age Group (years) 15-24 25-34 35-44 45-54 55-64 15-64 % No formal schooling 2.1 1.6 0.9 0.9 1.7 1.4 % Less than primary school 2.7 2.4 0.7 1.5 2.5 1.8 % Primary school completed 8 12.4 4.2 9.9 20.6 9.8 % Secondary school completed 30.6 21.4 21.8 23.2 16.4 22.9 % High school completed 34.5 25.5 29.4 22.1 14.1 26.3 % College/ University completed 3.7 7.7 22.6 25.3 23.3 15.9 % Post graduate degree completed 18.4 29 20.4 17 21.4 21.9

887 1506 1420 1035 519 5367

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

TOBACCO USE Table 5. Smoking status Age Group (years) 15-24 25-34 35-44 45-54 55-64 15-64 Men n 403 603 568 420 223 2217 % Daily 30.2 50.1 53.2 49.6 43.6 43.0 Current smoker 95% CI % Non-daily 23.7-36.6 45.6-54.7 48.0-58.5 43.2-56.0 35.8-51.5 39.9-46.0 4.8 5.4 7.1 2.7 3.9 5.0 95% CI 2.5-7.2 3.5-7.3 4.0-10.2 1.0-4.4 1.3-6.4 4.0-6.1 % Does not smoke 65.0 44.5 39.6 47.6 52.5 52.0 95% CI 57.2-72.7 39.6-49.4 33.6-45.7 41.3-54.0 44.4-60.6 48.5-55.5

Table 6. Smoking status Age Group (years) 15-24 25-34 35-44 45-54 55-64 15-64 Women % Daily 2.0 7.7 5.5 9.0 5.1 5.2 95% CI 0.3-3.6 0.5-2.3 0.6-2.7 0.6-3.2 0.0-0.8 0.9-2.4 Current smoker 95% CI % Non-daily 0.8-3.3 4.3-11.0 3.3-7.7 5.5-12.5 1.7-8.5 3.8-6.7 1.9 1.4 1.7 1.9 0.3 1.6 % Does not smoke 96.0 90.9 92.9 89.1 94.6 93.1

496 922 876 626 301 3221

94.0-98.1 87.6-94.2 90.2-95.5 85.6-92.7 91.1-98.1 91.5-94.8

Table 7. Current daily smokers among smokers Age Group (years) 15-24 25-34 35-44 45-54 55-64 15-64 Men n 147 338 336 225 108 1154 % Daily smokers 86.2 90.3 88.2 94.8 91.9 89.5 95% CI 80.9-91.4 87.1-93.6 83.6-92.8 91.5-98.1 86.7-97.0 87.6-91.4 n 21 72 71 63 22 249 Women % Daily smokers 51.6 84.5 76.8 82.8 94.9 76.3 95% CI 24.1-79.1 73.3-95.6 64.9-88.6 70.7-94.9 85.1-100.0 66.5-86.0 n 168 410 407 288 130 1403 Both Sexes % Daily smokers 82.8 89.5 87.0 92.9 92.2 87.9 95% CI 76.1-89.5 86.3-92.7 82.8-91.2 89.3-96.4 87.7-96.8 85.8-90.0

Table 8. Mean duration of smoking Age Group (years) 15-24 25-34 35-44 45-54 55-64 15-64 Men n 126 298 305 210 99 1038 Mean duration 4.5 11.6 19.9 28.8 35.4 16.1 95% CI 3.8-5.3 11.0-12.1 18.8-21.0 27.7-29.9 33.6-37.2 15.1-17.0 n 12 55 55 51 21 194 Women Mean duration 3.2 8.2 14.2 21.9 25.8 13.1 95% CI 0.9-5.4 6.1-10.3 10.0-18.4 18.9-24.9 15.5-36.0 11.0-15.2 n 138 353 360 261 120 1232 Both Sexes Mean duration 4.5 11.1 19.4 27.8 34.3 15.8 95% CI 3.8-5.1 10.5-11.7 18.4-20.4 26.7-28.9 32.1-36.4 14.9-16.6

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95% CI

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Table 9. Manufactured cigarette smokers among daily smokers Men Age Group (years) % Manufactured cigarette smoker 91.8 87.0 80.4 73.8 83.9 84.3 Women % Manufactured cigarette smoker 100.0 85.5 89.1 84.2 68.9 86.9 Both Sexes % Manufactured cigarette smoker 92.3 86.8 81.2 75.3 82.3 84.6

95% CI

15-24 25-34 35-44 45-54 55-64 15-64

126 302 306 210 99 1043

85.3-98.3 80.4-93.6 70.9-89.9 63.4-84.2 75.2-92.7 78.3-90.2

12 55 56 51 21 195

100.0-100.0 64.3-100.0 74.0-100.0 67.5-100.0 34.2-100.0 72.7-100.0

138 357 362 261 120 1238

86.2-98.5 79.7-93.9 72.7-89.8 65.7-84.9 72.5-92.0 78.8-90.3

Table 10. Exposed to ETS in home on 1 or more of the past 7 days

Annex I

Age Group (years) 15-24 25-34 35-44 45-54 55-64 15-64

Men n 403 603 568 420 223 2217 % Exposed 41.3 36.3 34.6 40.5 32.5 38.2 95% CI 32.9-49.7 28.6-44.0 27.6-41.6 31.8-49.3 24.8-40.2 32.3-44.1 n 496 922 876 626 301 3221

Women % Exposed 48.5 48.6 48.4 46.3 39.9 47.6 95% CI 41.1-55.8 43.3-54.0 43.5-53.2 40.4-52.1 32.3-47.4 43.3-51.9 n 899 1525 1444 1046 524 5438

Both Sexes % Exposed 44.8 42.4 41.5 43.3 36.3 42.9 95% CI 37.8-51.9 37.7-47.2 36.6-46.5 37.5-49.1 30.3-42.4 38.4-47.3

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Table 11. Exposed to ETS in the workplace on 1 or more of the past 7 days Age Group (years) 15-24 25-34 35-44 45-54 55-64 15-64 Men n 390 581 549 409 215 2144 % Exposed 38.8 49.3 46.6 45.6 30.7 43.3 95% CI 31.0-46.7 40.0-58.6 38.6-54.6 37.7-53.5 22.3-39.1 36.7-49.9 n 481 886 839 608 285 3099 Women % Exposed 25.8 30.2 29.9 28.3 20.7 27.7 95% CI 20.2-31.3 24.4-36.0 25.6-34.3 22.7-33.9 15.3-26.1 24.0-31.3 n 871 1467 1388 1017 500 5243 Both Sexes % Exposed 32.4 39.9 38.3 37.2 25.5 35.6 95% CI 27.1-37.8 34.0-45.8 33.1-43.4 31.5-43.0 19.6-31.5 31.1-40.1

ALCOHOL USE Table 12. Frequency of alcohol consumption in the past 12 months Men Age Group (years) % Daily 0.3 0.7 0.4 1.9 0.0 0.6 95% CI 0.0-0.8 0.0-1.6 0.0-0.8 0.1-3.7 0.0-0.0 0.1-1.1 % 5-6 days p. week 0.0 2.1 0.1 1.8 0.6 0.9 % 1-4 days p. week 4.7 11.8 10.9 5.8 6.9 8.3 % 1-3 days p. month 23.8 40.2 44.7 43.5 44.1 37.2 % < once a month 71.2 45.3 43.9 47.0 48.4 52.9

95% CI

15-24 25-34 35-44 45-54 55-64 15-64

218 489 458 311 157 1633

0.0-0.0 0.2-3.9 0.0-0.4 0.0-3.8 0.0-1.6 0.2-1.6

0.0-9.5 6.4-17.1 6.8-15.0 2.0-9.6 2.2-11.6 4.9-11.7

14.8-32.8 32.6-47.8 37.5-51.9 33.9-53.2 34.8-53.3 30.3-44.0

61.2-81.1 36.0-54.6 34.6-53.2 37.7-56.3 39.7-57.1 44.7-61.2

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Table 13. Frequency of alcohol consumption in the past 12 months Women Age Group (years) 15-24 25-34 35-44 45-54 55-64 15-64 % Daily 0.0 0.4 0.6 1.4 0.0 0.5 95% CI 0.0-0.0 0.0-1.0 0.0-1.3 0.0-3.8 0.0-0.0 0.0-0.9 % 5-6 days p. week 0.0 0.7 1.0 0.0 0.0 0.4 95% CI 0.0-0.0 0.0-2.0 0.0-2.4 0.0-0.0 0.0-0.0 0.0-1.1 % 1-4 days p. week 1.6 3.4 2.1 1.9 2.2 2.3 % 1-3 days p. month 18.9 22.6 23.3 20.6 15.8 21.0 % < once a month 79.5 73.0 73.0 76.0 82.0 75.8

95% CI

196 484 481 307 105 1573

0.0-3.5 1.1-5.6 0.2-4.0 0.0-4.0 0.0-5.2 0.9-3.6

10.6-27.2 16.1-29.1 18.3-28.4 13.5-27.8 6.9-24.6 15.9-26.1

70.1-88.9 65.4-80.6 66.7-79.2 67.7-84.4 72.5-91.5 69.8-81.9

Table 14. Category I, II and III drinking among current (past 30 days) drinkers Age Group (years) 15-24 25-34 35-44 45-54 55-64 15-64 Men n 118 354 315 223 115 1125 % Category III 0.9 5.2 2.1 4.6 1.2 3.1 95% CI 0.0-2.6 1.9-8.6 0.1-4.1 1.3-7.9 0.0-3.1 1.4-4.7 % Category II 2.8 4.1 1.3 1.5 0.0 2.4 95% CI 0.0-6.0 1.5-6.6 0.0-2.7 0.0-3.1 0.0-0.0 1.1-3.7 % Category I 96.3 90.7 96.6 93.9 98.8 94.5 95% CI 92.8-99.9 86.3-95.1 94.2-98.9 90.1-97.6 96.9-100.0 92.1-96.9

Table 15. Category I, II and III drinking among current (past 30 days) drinkers Age Group (years) 15-24 25-34 35-44 45-54 55-64 15-64 Women n 95 285 277 174 54 885 % Category III 2.0 3.5 2.6 2.4 1.8 2.6 95% CI 0.0-4.7 0.0-7.9 0.5-4.6 0.0-5.2 0.0-5.0 1.0-4.3 % Category II 2.3 2.4 3.8 3.5 1.4 2.9 95% CI 0.0-5.6 0.0-5.1 1.1-6.6 0.5-6.4 0.0-4.1 1.1-4.6 % Category I 95.7 94.1 93.6 94.1 96.9 94.5 95% CI 91.1-100.0 88.3-99.8 89.8-97.3 90.0-98.3 92.9-100.0 91.6-97.4

Table 16. Five/four or more drinks on a single occasion at least once during the past 30 days among total population Age Group (years) 15-24 25-34 35-44 45-54 55-64 15-64 Men n 403 603 568 420 223 2217 % ≥ 5 drinks 23.4 51.5 52.0 45.3 39.2 39.7 95% CI 17.5-29.3 44.3-58.7 44.2-59.8 39.8-50.8 32.0-46.3 35.0-44.4 n 496 922 876 626 301 3221 Women % ≥ 4drinks 10.1 18.7 20.5 17.6 7.6 15.1 95% CI 7.4-12.7 14.1-23.2 15.2-25.7 12.9-22.2 3.0-12.3 12.4-17.7

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Table 17. Mean maximum number of drinks consumed on one occasion in the past 30 days Age Group (years) 15-24 25-34 35-44 45-54 55-64 15-64 Men n 118 343 306 220 110 1097 Mean maximum number 8.6 11.4 10.9 11.9 11.1 10.7 95% CI 7.3-10.0 10.2-12.7 9.7-12.1 10.3-13.4 9.5-12.7 9.8-11.5 n 95 285 277 176 55 888 Women Mean maximum number 4.1 5.7 6.3 6.4 6.5 5.5 95% CI 3.1-5.0 4.6-6.7 5.5-7.1 5.2-7.6 3.7-9.2 4.9-6.2 n 213 628 583 396 165 1985 Both Sexes Mean maximum number 6.9 9.3 9.2 10.0 9.8 8.8 95% CI 6.1-7.7 8.2-10.4 8.2-10.1 8.9-11.1 8.4-11.2 8.2-9.4

DIET Table 18. Mean number of days fruit consumed in a typical week Men n 403 603 568 420 223 2217 Mean number of days 1.2 0.9 1.0 0.6 0.7 1.0 95% CI 0.8-1.5 0.6-1.1 0.7-1.3 0.4-0.8 0.5-0.9 0.7-1.2 n 496 922 876 626 300 3220

Annex I

Age Group (years) 15-24

Women Mean number of days 1.6 1.4 1.3 1.1 1.0 1.4

95% CI 1.3-1.8 1.1-1.6 1.0-1.6 0.9-1.3 0.8-1.2 1.2-1.6

n 899 1525 1444 1046 523 5437

Both Sexes Mean 95% number CI of days 1.4 1.1-1.6 1.1 1.2 0.9 0.8 1.2 0.9-1.4 0.9-1.4 0.7-1.0 0.7-1.0 1.0-1.3

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25-34 35-44 45-54 55-64 15-64

Table 19. Mean number of servings of fruit on average per day Age Group (years) 15-24 25-34 35-44 45-54 55-64 15-64 Men n 403 598 564 420 223 2208 Mean number of servings 0.5 0.3 0.3 0.2 0.2 0.3 95% CI 0.2-0.7 0.2-0.4 0.2-0.4 0.1-0.3 0.1-0.3 0.2-0.5 n 493 918 872 625 298 3206 Women Mean number of servings 0.5 0.5 0.4 0.3 0.3 0.5 95% CI 0.4-0.7 0.3-0.7 0.3-0.6 0.3-0.4 0.2-0.4 0.4-0.6 n 896 1516 1436 1045 521 5414 Both Sexes Mean number of servings 0.5 0.4 0.4 0.3 0.3 0.4 95% CI 0.3-0.7 0.2-0.5 0.3-0.5 0.2-0.3 0.2-0.3 0.3-0.5

Table 20. Mean number of days vegetables consumed in a typical week Age Group (years) 15-24 25-34 35-44 45-54 55-64 15-64 Men n 403 603 567 420 222 2215 Mean number of days 4.7 4.7 4.4 4.4 4.8 4.6 95% CI 4.1-5.4 4.1-5.3 3.8-5.0 3.8-4.9 4.2-5.4 4.1-5.2 n 496 921 876 626 301 3220 Women Mean number of days 5.2 4.7 4.9 4.6 4.9 4.9 95% CI 4.8-5.7 4.2-5.3 4.4-5.5 4.2-5.0 4.3-5.4 4.5-5.4 n 899 1524 1443 1046 523 5435 Both Sexes Mean number of days 5.0 4.7 4.7 4.5 4.8 4.8 95% CI 4.4-5.5 4.2-5.3 4.1-5.2 4.1-4.9 4.3-5.4 4.3-5.3

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Table 21. Mean number of servings of vegetables on average per day Age Group (years) 15-24 25-34 35-44 45-54 55-64 15-64 Men n 400 600 565 417 222 2204 Mean number of servings 1.3 1.5 1.3 1.3 1.3 1.4 95% CI 1.1-1.6 1.1-1.9 1.1-1.5 1.1-1.5 1.0-1.5 1.1-1.6 n 494 916 871 626 300 3207 Women Mean number of servings 1.7 1.5 1.5 1.3 1.6 1.5 95% CI 1.4-2.0 1.1-1.9 1.1-1.9 1.1-1.5 1.2-2.0 1.3-1.8 n 894 1516 1436 1043 522 5411 Both Sexes Mean number of servings 1.5 1.5 1.4 1.3 1.4 1.4 95% CI 1.2-1.7 1.1-1.9 1.1-1.7 1.1-1.5 1.1-1.8 1.2-1.7

Table 22. Mean number of servings of fruit and/or vegetables on average per day Age Group (years) 15-24 25-34 35-44 45-54 55-64 15-64 Men n 403 603 568 420 223 2217 Mean number of servings 1.8 1.7 1.6 1.5 1.5 1.7 95% CI 1.4-2.2 1.3-2.2 1.3-1.9 1.2-1.7 1.2-1.8 1.4-2.0 n 495 921 876 626 301 3219 Women Mean number of servings 2.2 2.0 1.9 1.7 1.9 2.0 95% CI 1.8-2.6 1.5-2.5 1.5-2.4 1.4-1.9 1.5-2.3 1.6-2.4 n 898 1524 1444 1046 524 5436 Both Sexes Mean number of servings 2.0 1.9 1.8 1.6 1.7 1.8 95% CI 1.6-2.4 1.4-2.3 1.4-2.1 1.3-1.8 1.4-2.1 1.5-2.2

Table 23. Number of servings of fruit and/or vegetables on average per day Age Group (years) 15-24 25-34 35-44 45-54 55-64 15-64 Men n 403 603 568 420 223 2217 % no fruit and/or vegetables 34.0 34.8 39.2 41.2 34.5 36.3 95% CI 22.5-45.4 25.6-44.1 29.7-48.8 32.4-50.0 24.8-44.3 27.9-44.7 % 1-2 servings 48.3 44.7 42.8 44.1 50.5 45.9 95% CI 38.0-58.6 36.2-53.2 35.6-50.0 36.7-51.5 40.5-60.6 38.9-53.0 % 3-4 servings 9.5 12.9 13.4 9.3 12.3 11.2 95% CI 5.2-13.8 7.9-17.9 8.0-18.7 4.9-13.7 6.6-18.1 7.4-15.0 % ≥5 servings 8.2 7.6 4.6 5.4 2.6 6.6 95% CI 3.5-13.0 2.1-13.0 1.9-7.3 2.1-8.8 0.0-6.2 3.1-10.1

Table 24. Number of servings of fruit and/or vegetables on average per day Women Age Group (years) 15-24 25-34 35-44 45-54 55-64 15-64 n 495 921 876 626 301 3219 % no fruit and/or vegetables 23.5 33.5 33.7 34.8 34.8 30.2 95% CI 15.9-31.0 25.0-42.0 24.9-42.4 29.1-40.6 26.1-43.6 23.5-36.9 % 1-2 servings 51.1 44.8 45.5 47.3 39.8 47.2 95% CI 42.6-59.6 38.3-51.4 39.3-51.7 41.0-53.6 31.5-48.2 41.0-53.4 % 3-4 servings 15.4 12.9 11.1 12.2 18.0 13.7 95% CI 9.5-21.4 8.8-16.9 7.6-14.6 7.9-16.6 8.4-27.7 9.8-17.6 % ≥5 servings 10.0 8.8 9.8 5.6 7.3 8.9 95% CI 5.9-14.2 3.5-14.2 4.7-14.8 2.1-9.1 1.7-12.9 5.2-12.6

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Table 25. Less than five servings of fruit and/or vegetables on average per day Men Age Group (years) 15-24 25-34 35-44 45-54 55-64 15-64 n 403 603 568 420 223 2217 % < five servings per day 91.8 92.4 95.4 94.6 97.4 93.4 95% CI 87.0-96.5 87.0-97.9 92.7-98.1 91.2-97.9 93.8-100.0 89.9-96.9 n 495 921 876 626 301 3219 Women % < five servings per day 90.0 91.2 90.2 94.4 92.7 91.1 95% CI 85.8-94.1 85.8-96.5 85.2-95.3 90.9-97.9 87.1-98.3 87.4-94.8 n 898 1524 1444 1046 524 5436 Both Sexes % < five servings per day 90.9 91.8 92.8 94.5 94.9 92.3 95% CI 86.8-95.0 86.7-97.0 89.1-96.5 91.7-97.3 90.5-99.4 88.7-95.8

Table 26. Mean salt intake per day Age Group (years) 15-24 25-34 35-44 45-54 55-64 15-64 Men n 338 516 486 352 189 1881 Mean number of servings 6.9 7.6 7.1 7.5 8.9 7.3 95% CI 6.3-7.5 7.0-8.2 6.5-7.6 6.8-8.1 7.5-10.2 6.9-7.7 n 460 884 840 599 289 3072 Women Mean number of servings 6.7 7.5 7.1 7.6 9.5 7.3 95% CI 6.1-7.3 7.0-8.0 6.7-7.6 7.0-8.2 8.4-10.7 6.9-7.7 n 798 1400 1326 951 478 4953 Both Sexes Mean number of servings 6.8 7.6 7.1 7.5 9.2 7.3 95% CI 6.3-7.3 7.1-8.0 6.7-7.5 7.0-8.1 8.4-10.1 6.9-7.7

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PHYSICAL ACTIVITY Table 27. Level of total physical activity Age Group (years) 15-24 25-34 35-44 45-54 55-64 15-64 Men n 394 588 541 400 216 2139 % Low 4.1 7.9 9.3 8.2 18.0 7.4 95% CI 0.9-7.3 5.2-10.5 5.7-13.0 4.8-11.6 8.5-27.5 4.7-10.1 % Moderate 10.3 8.5 7.6 11.5 18.6 10.0 95% CI 6.2-14.5 5.9-11.1 4.5-10.8 5.7-17.3 12.2-25.0 7.4-12.7 % High 85.6 83.6 83.0 80.3 63.4 82.5 95% CI 79.0-92.2 79.1-88.2 77.6-88.4 73.8-86.7 52.0-74.9 77.7-87.4

Table 28. Level of total physical activity Women Age Group (years) 15-24 25-34 35-44 45-54 55-64 15-64 n 490 907 845 613 293 3148 % Low 6.8 7.7 6.3 9.6 12.5 7.7 95% CI 4.2-9.4 4.5-10.9 3.3-9.3 5.6-13.5 8.4-16.5 5.3-10.1 % Moderate 16.0 11.8 10.4 13.2 14.4 13.4 95% CI 10.5-21.4 6.5-17.0 6.6-14.2 8.5-18.0 7.9-20.9 9.4-17.4 % High 77.2 80.6 83.3 77.2 73.2 78.9 95% CI 70.1-84.4 72.7-88.4 77.4-89.1 70.8-83.6 64.5-81.8 72.9-85.0

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Table 29. Level of total physical activity Age Group (years) 15-24 25-34 35-44 45-54 55-64 15-64 Both Sexes n 884 1495 1386 1013 509 5287 % Low 5.4 7.8 7.8 8.9 15.1 7.5 95% CI 2.9-7.9 5.2-10.3 5.1-10.6 5.7-12.1 9.7-20.6 5.2-9.9 % Moderate 13.1 10.1 9.0 12.4 16.4 11.7 95% CI 8.9-17.3 6.5-13.8 6.2-11.9 8.3-16.4 11.0-21.8 8.7-14.7 % High 81.5 82.1 83.1 78.8 68.5 80.8 95% CI 75.6-87.4 76.4-87.9 78.4-87.9 73.4-84.1 59.7-77.3 75.7-85.8

Table 30. No vigorous physical activity Age Group (years) 15-24 25-34 35-44 45-54 55-64 15-64 Men n 394 588 541 400 216 2139 % no vigorous activity 31.4 45.2 48.5 50.3 68.5 42.9 95% CI 23.7-39.1 37.9-52.4 40.8-56.2 42.9-57.8 59.2-77.8 37.3-48.4 n 490 907 845 613 293 3148 Women % no vigorous activity 50.4 54.4 51.1 59.5 72.1 54.2 95% CI 43.1-57.8 46.7-62.0 44.4-57.7 51.7-67.2 65.9-78.4 48.5-59.8 n 884 1495 1386 1013 509 5287 Both Sexes % no vigorous activity 40.7 49.7 49.8 54.8 70.4 48.5 95% CI 34.3-47.2 43.5-56.0 43.9-55.8 48.4-61.2 64.4-76.4 43.3-53.6

Table 31. Mean minutes of work-related physical activity on average per day Age Group (years) 15-24 25-34 35-44 45-54 55-64 15-64 Men n 394 588 541 400 216 2139 Mean minutes 227.3 238.8 250.1 218.3 156.2 228.8 95% CI 199.0-255.6 205.8-271.8 222.5-277.7 182.5-254.1 117.1-195.3 203.8-253.9 n 490 907 845 613 293 3148 Women Mean minutes 196.5 236.6 235.0 209.9 163.6 213.3 95% CI 166.2-226.8 194.8-278.5 205.2-264.7 181.4-238.5 135.2-192.1 184.9-241.8 n 884 1495 1386 1013 509 5287 Both Sexes Mean minutes 212.2 237.7 242.4 214.2 160.1 221.1 95% CI 185.6-238.8 203.0-272.5 217.7-267.2 185.4-243.0 129.3-190.8 195.7-246.5

Table 32. Mean minutes of transport-related physical activity on average per day Age Group (years) 15-24 25-34 35-44 45-54 55-64 15-64 Men n 394 588 541 400 216 2139 Mean minutes 66.2 56.9 65.2 64.8 52.4 62.8 95% CI 56.6-75.8 47.2-66.6 54.4-76.1 55.3-74.3 44.0-60.8 55.8-69.7 n 490 907 845 613 293 3148 Women Mean minutes 54.9 64.5 64.6 60.9 69.6 60.9 95% CI 44.2-65.6 49.7-79.3 55.9-73.3 48.9-72.9 56.7-82.5 51.2-70.6 n 884 1495 1386 1013 509 5287 Both Sexes Mean minutes 60.6 60.7 64.9 62.9 61.3 61.8 95% CI 51.4-69.9 50.2-71.2 56.7-73.1 54.2-71.6 52.5-70.1 54.0-69.6

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Table 33. Mean minutes of recreation-related physical activity on average per day Age Group (years) 15-24 25-34 35-44 45-54 55-64 15-64 Men n 394 588 541 400 216 2139 Mean minutes 76.0 67.3 75.2 67.9 66.3 72.0 95% CI 53.3-98.6 46.8-87.9 52.7-97.7 49.2-86.6 42.3-90.2 54.2-89.9 n 490 907 845 613 293 3148 Women Mean minutes 77.9 93.9 91.1 82.3 83.9 85.4 95% CI 63.5-92.4 77.3-110.6 75.8-106.4 65.6-99.1 58.4-109.4 72.7-98.0 n 884 1495 1386 1013 509 5287 Both Sexes Mean minutes 76.9 80.6 83.2 75.0 75.4 78.7 95% CI 60.7-93.2 62.4-98.8 65.3-101.2 59.4-90.6 53.3-97.5 63.8-93.5

Table 34. Median minutes of work-related physical activity on average per day Age Group (years) Men n 394 588 541 400 216 2139 Median minutes 231.4 235.7 251.4 200.0 77.1 225.7 Inter-quartile range (P25-P75) 68.7-330 60-360 77.1-251.4 17.1-342.9 0-300 51.4-342.9 n 490 907 845 613 293 3148 Women Median minutes 188.6 214.3 240.0 214.3 120.0 205.7 Inter-quartile range (P25-P75) 6.4-300 14.3-360 50-342.9 0-342.9 0-300 7.1-342.9 n 884 1495 1386 1013 509 5287 Both Sexes Median minutes 311.4 360.0 360.0 342.9 300.0 342.9 Inter-quartile range (P25-P75) 34.3-311.4 34.3-360 60-360 15-342.9 0-300 25.7-342.9

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Table 35. Median minutes of transport-related physical activity on average per day Men Age Group (years) 15-24 25-34 35-44 45-54 55-64 15-64 n 394 588 541 400 216 2139 Median minutes 42.9 30.0 30.0 38.6 30.0 34.3 Inter-quartile range (P25-P75) 17.1-100 7.1-85.7 0-100 8.6-100 12.9-60 10-90 n 490 907 845 613 293 3148 Women Median minutes 28.6 30.0 34.3 34.3 30.0 30.0 Inter-quartile range (P25-P75) 14.3-64.3 8.6-85.7 14.3-85.7 12.9-77.1 8.6-90 12.9-77.1 n 884 1495 1386 1013 509 5287 Both Sexes Median minutes 34.3 30.0 30.0 35.0 30.0 30.0 Inter-quartile range (P25-P75) 14.3-85.7 8.6-85.7 8.6-90 11.4-90 8.6-85.7 11.4-85.7

Table 36. Median minutes of recreation-related physical activity on average per day Men Age Group (years) 15-24 25-34 35-44 45-54 55-64 15-64 n 394 588 541 400 216 2139 Median minutes 51.4 25.7 34.3 30.0 17.1 34.3 Inter-quartile range (P25-P75) 8.6-90 0-77.1 0-90 0-85.7 0-72.9 0-85.7 n 490 907 845 613 293 3148 Women Median minutes 51.4 60.0 60.0 51.4 38.6 51.4 Inter-quartile range (P25-P75) 8.6-111.4 17.1-120 17.1-120 8.6-120 0-120 11.4-120 n 884 1495 1386 1013 509 5287 Both Sexes Median minutes 51.4 42.9 51.4 42.9 25.7 51.4 Inter-quartile range (P25-P75) 8.6-102.9 5.7-115.7 8.6-120 0-94.3 0-85.7 4.3-102.9

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

PHYSICAL MEASUREMENT Table 37. BMI classifications Men Age Group (years) 15-24 25-34 35-44 45-54 55-64 15-64 % Underweight <18.5 10.0 1.4 2.4 0.8 0.4 4.6 % Normal weight 18.5-24.9 74.3 58.6 45.2 43.3 39.4 58.4 % BMI 25.0-29.9 13.2 29.3 35.0 38.4 31.0 26.0 % Obese ≥30.0 2.4 10.7 17.3 17.5 29.3 11.1

95% CI

400 599 564 412 222 2197

6.1-13.9 0.4-2.3 0.8-4.1 0.0-1.7 0.0-1.1 3.0-6.1

68.8-79.8 53.4-63.8 38.8-51.7 36.4-50.1 29.0-49.7 54.5-62.3

8.3-18.2 25.5-33.2 30.1-39.9 32.4-44.5 23.9-38.1 23.2-28.7

0.6-4.3 6.6-14.8 12.6-21.9 12.7-22.3 19.2-39.3 8.7-13.4

Table 38. BMI classifications Women Age Group (years) 15-24 25-34 35-44 45-54 55-64 15-64 % Underweight <18.5 8.9 3.8 0.9 0.7 1.2 4.4 % Normal weight 18.5-24.9 72.0 53.3 40.6 31.6 33.0 52.9 % BMI 25.0-29.9 15.2 30.6 39.5 39.6 36.2 28.6 % Obese ≥30.0 3.9 12.2 18.9 28.1 29.5 14.1

95% CI 5.212.6 2.1-5.5 0.2-1.6 0.0-1.5 0.0-2.8 2.9-5.9

95% CI

473 857 867 620 300 3117

67.5-76.5 48.6-58.1 37.0-44.2 27.4-35.8 26.8-39.2 50.2-55.5

11.3-19.2 26.3-35.0 36.0-43.1 35.2-44.0 30.1-42.4 26.3-31.0

1.8-5.9 9.1-15.3 15.7-22.1 23.3-32.8 23.1-36.0 12.1-16.0

Table 39. BMI classifications Both Sexes Age Group (years) 15-24 25-34 35-44 45-54 55-64 15-64 n 873 1456 1431 1032 522 5314 % Underweight <18.5 9.5 2.5 1.7 0.8 0.8 4.5 95% CI 6.4-12.5 1.5-3.6 0.7-2.6 0.1-1.4 0.0-1.7 3.2-5.8 % Normal weight 18.5-24.9 73.2 56.1 42.9 37.6 36.1 55.7 95% CI 69.6-76.9 52.3-59.8 39.2-46.7 33.0-42.2 29.6-42.5 53.1-58.3 % BMI 25.0-29.9 14.2 30.0 37.3 39.0 33.7 27.3 95% CI 11.1-17.3 26.6-33.3 34.2-40.3 35.5-42.5 29.0-38.4 25.3-29.2 % Obese ≥30.0 3.1 11.4 18.1 22.6 29.4 12.5 95% CI 1.8-4.4 8.8-14.1 15.2-21.0 19.1-26.1 23.6-35.2 10.8-14.3

RAISED BLOOD PRESSURE Table 40. SBP ≥140 and/or DBP ≥ 90 mmHg, excluding those on medication for raised blood pressure Age Group (years) 15-24 25-34 35-44 45-54 55-64 15-64 Men n 388 581 522 339 160 1990 % 12.4 26.1 29.1 41.9 59.0 24.8 95% CI 6.9-17.9 21.3-31.0 24.5-33.6 36.1-47.8 50.5-67.6 21.6-28.1 n 483 873 737 432 173 2698 Women % 4.3 9.0 18.0 30.0 33.0 12.1 95% CI 2.3-6.3 6.5-11.4 14.8-21.2 24.1-35.8 24.9-41.1 10.4-13.9 n 871 1454 1259 771 333 4688 Both Sexes % 8.4 17.7 23.8 36.6 46.8 18.7 95% CI 5.1-11.7 14.4-20.9 20.7-26.8 32.6-40.6 40.4-53.1 16.5-20.9

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Table 41. SBP ≥160 and/or DBP ≥ 100 mmHg, excluding those on medication for raised blood pressure Age Group (years) 15-24 25-34 35-44 45-54 55-64 15-64 Men n 388 581 522 339 160 1990 % 1.3 5.2 7.6 13.7 24.7 6.1 95% CI 0.0-2.9 2.7-7.7 4.7-10.5 8.7-18.6 15.7-33.7 4.6-7.6 n 483 873 737 432 173 2698 Women % 0.4 1.4 4.1 9.1 12.6 2.8 95% CI 0.0-0.9 0.4-2.3 2.4-5.8 5.5-12.7 6.0-19.1 2.1-3.6 n 871 1454 1259 771 333 4688 Both Sexes % 0.8 3.3 5.9 11.6 19.0 4.5 95% CI 0.0-1.8 1.8-4.8 4.0-7.8 8.5-14.7 12.7-25.2 3.5-5.5

Table 42. SBP ≥160 and/or DBP ≥ 100 mmHg or currently on medication for raised blood pressure Age Group (years) 15-24 Men n 403 601 564 418 223 2209 % 4.8 9.1 15.4 32.9 47.3 14.5 95% CI 1.5-8.1 6.1-12.1 11.3-19.5 26.1-39.6 40.4-54.1 12.1-16.8 n 494 921 869 624 297 3205 Women % 2.8 6.8 19.8 37.8 49.0 15.0 95% CI 0.6-5.0 3.7-10.0 16.3-23.3 32.6-42.9 43.2-54.8 13.0-17.0 n 897 1522 1433 1042 520 5414 Both Sexes % 3.8 7.9 17.6 35.2 48.2 14.7 95% CI 1.8-5.9 5.2-10.7 14.7-20.5 30.8-39.7 43.2-53.2 12.9-16.6

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Table 43. Blood pressure measurement and diagnosis Men Age Group (years) % measured, not diagnosed 24.9 33.4 40.2 37.2 34.2 32.2 % diagnosed, but not within past 12 months 1.0 2.8 6.0 4.0 5.3 3.1 % diagnosed within past 12 months 4.9 10.7 15.3 30.0 44.8 14.3

% Never measured

95% CI

15-24 25-34 35-44 45-54 55-64 15-64

403 603 568 420 223 2217

69.3 53.1 38.5 28.8 15.7 50.5

62.9-75.6 48.1-58.1 33.4-43.7 22.4-35.2 10.5-21.0 47.2-53.7

18.3-31.4 28.5-38.4 35.4-45.0 31.4-42.9 28.3-40.0 29.1-35.3

0.0-2.1 0.6-5.0 3.4-8.6 2.2-5.8 0.9-9.8 2.2-4.0

1.5-8.3 7.5-13.9 11.4-19.2 23.9-36.1 36.7-52.8 12.1-16.5

Table 44. Blood pressure measurement and diagnosis Women Age Group (years) % measured, not diagnosed 34.5 55.7 48.0 37.5 34.5 42.7 % diagnosed, but not within past 12 months 1.7 5.1 5.4 6.3 8.8 4.3 % diagnosed within past 12 months 5.1 10.9 25.0 43.0 48.2 18.5

% Never measured

95% CI

15-24 25-34 35-44 45-54 55-64 15-64

496 922 876 626 301 3221

58.7 28.4 21.7 13.2 8.5 34.5

52.6-64.9 23.4-33.4 18.0-25.4 9.6-16.7 5.0-12.1 31.0-37.9

29.0-40.0 49.7-61.6 41.8-54.1 33.0-42.1 28.7-40.2 39.0-46.3

0.1-3.2 3.1-7.1 3.5-7.3 3.2-9.3 4.1-13.4 3.0-5.6

2.8-7.3 8.7-13.1 20.3-29.6 38.1-47.9 42.3-54.1 16.7-20.4

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Table 45. Blood pressure measurement and diagnosis Both sexes Age Group (years) % measured, not diagnosed 29.6 44.5 44.1 37.3 34.3 37.4 % diagnosed, but not within past 12 months 1.3 3.9 5.7 5.1 7.1 3.7 % diagnosed within past 12 months 5.0 10.8 20.1 36.3 46.6 16.4

% Never measured

95% CI

15-24 25-34 35-44 45-54 55-64 15-64

899 1525 1444 1046 524 5438

64.1 40.9 30.1 21.3 12.0 42.6

58.7-69.6 37.3-44.4 26.6-33.5 17.5-25.1 9.0-15.0 39.7-45.4

24.2-34.9 40.9-48.0 39.9-48.3 33.4-41.2 29.9-38.7 34.5-40.2

0.1-2.5 2.5-5.4 4.0-7.4 3.3-6.9 3.6-10.7 2.8-4.6

2.7-7.2 8.7-12.8 17.4-22.8 32.7-39.9 41.6-51.5 14.8-17.9

Table 46. Advised by doctor or health worker to reduce salt intake among those previously diagnosed Age Group (years) 15-24 25-34 35-44 45-54 55-64 15-64 Men n 23 75 110 138 104 450 % 44.7 33.2 34.7 47.4 51.9 42.2 95% CI 25.0-64.5 18.9-47.4 22.0-47.4 35.9-58.8 39.5-64.4 34.6-49.8 n 38 146 256 314 174 928 Women % 20.4 37.7 44.8 54.1 54.8 45.5 95% CI 7.0-33.8 29.5-45.9 36.3-53.3 44.5-63.8 43.6-66.0 39.3-51.7 n 61 221 366 452 278 1378 Both Sexes % 32.0 35.6 40.7 51.3 53.5 44.1 95% CI 17.1-46.9 26.8-44.4 31.7-49.7 43.1-59.4 44.5-62.5 38.2-49.9

Table 47. Advised by doctor or health worker to lose weight among those previously diagnosed Age Group (years) 15-24 25-34 35-44 45-54 55-64 15-64 Men n 15-24 25-34 35-44 45-54 55-64 TOTAL % 23 75 110 138 104 450 95% CI 5.7 15.2 33.0 30.1 40.6 26.9 n 38 146 256 314 174 928 Women % 8.4 23.8 34.2 37.7 30.5 30.1 95% CI 0.0-18.9 14.8-32.7 27.7-40.7 27.7-47.7 21.3-39.6 24.2-36.1 n 61 221 366 452 278 1378 Both Sexes % 7.1 19.8 33.7 34.5 35.0 28.7 95% CI 0.0-15.6 12.1-27.6 27.2-40.3 25.7-43.2 26.7-43.3 22.5-34.9

Table 48. Advised by doctor or health worker to stop smoking among those previously diagnosed Age Group (years) 15-24 25-34 35-44 45-54 55-64 15-64 Men n 15-24 25-34 35-44 45-54 55-64 TOTAL % 23 75 110 138 104 450 95% CI 17.8 27.5 27.4 29.6 38.1 28.7 n 38 146 256 314 174 928 Women % 1.4 9.9 7.5 12.0 9.9 9.0 95% CI 0.0-4.2 3.1-16.7 3.5-11.5 6.1-17.9 3.7-16.1 5.3-12.7 n 61 221 366 452 278 1378 Both Sexes % 9.2 18.1 15.6 19.5 22.5 17.6 95% CI 1.0-17.4 10.0-26.1 10.7-20.6 13.1-26.0 15.9-29.1 13.5-21.8

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Table 49. Advised by doctor or health worker to start or do more exercise among those previously diagnosed Age Group (years) 15-24 25-34 35-44 45-54 55-64 15-64 Men n 15-24 25-34 35-44 45-54 55-64 TOTAL % 23 75 110 138 104 450 95% CI 55.2 38.9 48.9 43.3 52.6 46.9 n 38 146 256 314 174 928 Women % 17.6 29.8 52.1 48.8 42.5 42.2 95% CI 3.4-31.8 21.8-37.8 41.5-62.8 39.9-57.7 32.1-52.9 35.6-48.8 n 61 221 366 452 278 1378 Both Sexes % 35.5 34.0 50.8 46.4 47.0 44.2 95% CI 15.6-55.5 24.3-43.7 42.5-59.1 37.8-55.0 38.0-56.1 37.8-50.7

Table 50. Currently taking blood pressure drugs prescribed by doctor or health worker among those diagnosed Age Group (years) Men n 23 75 110 138 104 450 % taking meds 25.4 16.0 21.5 48.7 46.4 33.0 95% CI 10.6-40.2 7.6-24.4 11.6-31.5 37.2-60.2 31.9-61.0 27.9-38.1 n 38 146 256 314 174 928 Women % taking meds 23.6 14.5 45.1 52.9 57.9 42.2 95% CI 2.2-45.0 5.5-23.6 37.3-53.0 46.0-59.7 49.3-66.5 37.0-47.4 n 61 221 366 452 278 1378 Both Sexes % taking meds 24.5 15.2 35.5 51.1 52.8 38.2 95% CI 9.9-39.0 9.8-20.6 29.2-41.7 44.6-57.6 43.4-62.1 34.5-41.8

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DIABETES Table 51. Blood sugar measurement and diagnosis Men Age Group (years) % measured, not diagnosed 5.7 8.8 12.8 13.2 15.6 9.5 % diagnosed, but not within past 12 months 0.0 0.6 1.1 1.2 1.0 0.6 % diagnosed within past 12 months 0.9 1.3 3.1 3.1 1.0 1.7

% Never measured

95% CI

15-24 25-34 35-44 45-54 55-64 15-64

403 603 568 420 223 2217

93.3 89.2 83.1 82.5 82.4 88.2

90.6-96.0 86.5-92.0 79.0-87.1 78.2-86.8 75.7-89.1 86.2-90.1

3.2-8.2 6.3-11.4 9.8-15.8 9.6-16.8 8.9-22.4 7.8-11.3

0.0-0.0 0.0-1.3 0.2-2.0 0.0-2.6 0.0-2.2 0.3-0.9

0.0-2.2 0.4-2.2 1.2-5.0 1.3-4.9 0.0-2.2 1.0-2.5

Table 52. Blood sugar measurement and diagnosis Women Age Group (years) % measured, not diagnosed 8.1 14.0 17.2 26.9 25.6 15.1 % diagnosed, but not within past 12 months 0.6 0.9 1.2 1.9 4.5 1.2 % diagnosed within past 12 months 0.0 1.7 2.6 3.7 2.2 1.6

% Never measured

95% CI

15-24 25-34 35-44 45-54 55-64 15-64

496 922 876 626 301 3221

91.4 83.5 79.0 67.4 67.6 82.1

88.4-94.4 80.0-87.0 75.1-83.0 60.9-74.0 61.6-73.6 80.0-84.3

5.1-11.1 11.1-16.9 13.1-21.2 21.6-32.3 20.7-30.5 13.2-16.9

0.0-1.3 0.3-1.4 0.3-2.0 0.7-3.2 0.9-8.1 0.7-1.7

0.0-0.0 0.6-2.8 1.4-3.9 2.2-5.2 0.5-4.0 1.2-2.0

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Table 53. Blood sugar measurement and diagnosis Both sexes Age Group (years) % measured, not diagnosed 6.9 11.4 15.0 19.8 20.8 12.3 % diagnosed, but not within past 12 months 0.3 0.7 1.1 1.6 2.8 0.9 % diagnosed within past 12 months 0.5 1.5 2.8 3.4 1.6 1.7

% Never measured

95% CI

15-24 25-34 35-44 45-54 55-64 15-64

899 1525 1444 1046 524 5438

92.4 86.4 81.0 75.2 74.7 85.2

90.5-94.3 84.1-88.6 77.9-84.2 71.0-79.4 69.3-80.1 83.5-86.9

5.1-8.6 9.4-13.4 12.3-17.7 16.4-23.2 16.4-25.2 10.8-13.7

0.0-0.6 0.4-1.1 0.6-1.7 0.5-2.6 0.9-4.8 0.6-1.2

0.0-1.1 0.8-2.2 1.8-3.9 2.2-4.6 0.5-2.7 1.3-2.1

Table 54. Currently taking insulin prescribed for diabetes among those previously diagnosed Age Group (years) 15-24 25-34 35-44 45-54 55-64 15-64 Men n 2 12 17 18 6 55 % taking insulin 0.0 9.4 14.0 23.4 20.8 14.0 95% CI 0.0-0.0 0.0-24.2 0.0-31.9 0.0-49.5 0.0-56.1 1.3-26.7 n 3 27 30 40 15 115 Women % taking insulin 0.0 0.8 7.2 9.9 9.3 6.3 95% CI 0.0-0.0 0.0-2.4 0.0-15.3 0.1-19.6 0.0-28.5 1.9-10.8 n 5 39 47 58 21 170 Both Sexes 95% CI 0.0-0.0 0.0-10.4 2.4-29.7 0.0-29.2 3.4-16.3 0.0-21.9

0.0 4.5 10.8 16.0 11.7 9.9

Table 55. Currently taking oral drugs prescribed for diabetes among those previously diagnosed Age Group (years) 15-24 25-34 35-44 45-54 55-64 15-64 Men n 2 12 17 18 6 55 % taking meds 0.0 14.4 5.0 34.5 51.0 16.3 95% CI 0.0-0.0 0.0-42.0 0.0-15.4 4.4-64.6 9.1-93.0 4.7-27.9 n 3 27 30 40 15 115 Women % taking meds 0.0 1.7 21.1 34.4 9.3 17.1 95% CI 0.0-0.0 0.0-5.2 0.0-42.6 18.1-50.7 0.0-28.5 8.7-25.4 n 5 39 47 58 21 170 Both Sexes % taking meds 0.0 7.2 12.7 34.4 18.1 16.7 95% CI 0.0-0.0 0.0-19.5 0.0-25.4 19.3-49.6 0.0-38.3 10.0-23.5

Table 56. Advised by doctor or health worker to reduce salt intake among those previously diagnosed Age Group (years) 15-24 25-34 35-44 45-54 55-64 15-64 Men n 23 75 110 138 104 450 % 44.7 33.2 34.7 47.4 51.9 42.2 95% CI 25.0-64.5 18.9-47.4 22.0-47.4 35.9-58.8 39.5-64.4 34.6-49.8 n 38 146 256 314 174 928 Women % 20.4 37.7 44.8 54.1 54.8 45.5 95% CI 7.0-33.8 29.5-45.9 36.3-53.3 44.5-63.8 43.6-66.0 39.3-51.7 n 61 221 366 452 278 1378 Both Sexes % 32.0 35.6 40.7 51.3 53.5 44.1 95% CI 17.1-46.9 26.8-44.4 31.7-49.7 43.1-59.4 44.5-62.5 38.2-49.9

117

Annex I

% taking insulin

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Table 57. Advised by doctor or health worker to lose weight among those previously diagnosed Age Group (years) 15-24 25-34 35-44 45-54 55-64 15-64 Men n 15-24 25-34 35-44 45-54 55-64 TOTAL % 23 75 110 138 104 450 95% CI 5.7 15.2 33.0 30.1 40.6 26.9 n 38 146 256 314 174 928 Women % 8.4 23.8 34.2 37.7 30.5 30.1 95% CI 0.0-18.9 14.8-32.7 27.7-40.7 27.7-47.7 21.3-39.6 24.2-36.1 n 61 221 366 452 278 1378 Both Sexes % 7.1 19.8 33.7 34.5 35.0 28.7 95% CI 0.0-15.6 12.1-27.6 27.2-40.3 25.7-43.2 26.7-43.3 22.5-34.9

Table 58. Advised by doctor or health worker to stop smoking among those previously diagnosed Age Group (years) 15-24 25-34 Men n 15-24 25-34 35-44 45-54 55-64 TOTAL % 23 75 110 138 104 450 95% CI 17.8 27.5 27.4 29.6 38.1 28.7 n 38 146 256 314 174 928 Women % 1.4 9.9 7.5 12.0 9.9 9.0 95% CI 0.0-4.2 3.1-16.7 3.5-11.5 6.1-17.9 3.7-16.1 5.3-12.7 n 61 221 366 452 278 1378 Both Sexes % 9.2 18.1 15.6 19.5 22.5 17.6 95% CI 1.0-17.4 10.0-26.1 10.7-20.6 13.1-26.0 15.9-29.1 13.5-21.8

Annex I

35-44 45-54 55-64 15-64

118

Table 59. Advised by doctor or health worker to start or do more exercise among those previously diagnosed Age Group (years) 15-24 25-34 35-44 45-54 55-64 15-64 Men n 15-24 25-34 35-44 45-54 55-64 TOTAL % 23 75 110 138 104 450 95% CI 55.2 38.9 48.9 43.3 52.6 46.9 n 38 146 256 314 174 928 Women % 17.6 29.8 52.1 48.8 42.5 42.2 95% CI 3.4-31.8 21.8-37.8 41.5-62.8 39.9-57.7 32.1-52.9 35.6-48.8 n 61 221 366 452 278 1378 Both Sexes % 35.5 34.0 50.8 46.4 47.0 44.2 95% CI 15.6-55.5 24.3-43.7 42.5-59.1 37.8-55.0 38.0-56.1 37.8-50.7

INJURY AND VIOLENCE Table 60. Percentage of respondents who were seriously injured other than road traffic crashes Age Group (years) 15-24 25-34 35-44 45-54 55-64 15-64 Men n 45 57 41 35 10 188 % Fall 49.5 50.0 65.6 56.6 84.7 54.3 95% CI 30.9-68.1 31.5-68.4 45.9-85.2 33.2-80.0 62.5-100.0 42.4-66.2 % Burn 3.8 0.9 8.5 0.0 0.0 3.2 95% CI 0.0-11.2 0.0-2.2 0.0-24.7 0.0-0.0 0.0-0.0 0.0-7.1 % Cut 12.0 13.0 0.0 11.6 0.0 9.9 95% CI 0.0-25.1 0.0-26.3 0.0-0.0 0.0-24.1 0.0-0.0 1.6-18.3 % Animal Bites 0.0 1.6 0.0 0.0 0.0 0.4 95% CI 0.0-0.0 0.0-4.8 0.0-0.0 0.0-0.0 0.0-0.0 0.0-1.2 % Frostbite 2.1 0.0 0.0 5.1 0.0 1.6 95% CI 0.0-6.3 0.0-0.0 0.0-0.0 0.0-14.0 0.0-0.0 0.0-3.8 % Hit by Obj 23.4 17.4 6.8 21.7 5.9 18.4 95% CI 6.9-39.9 5.7-29.0 0.0-13.8 10.2-33.3 0.0-18.0 10.5-26.4 % Other 9.1 17.2 19.1 4.9 9.4 12.2 95% CI 1.1-17.2 6.7-27.7 2.9-35.3 0.0-12.1 0.0-28.2 6.6-17.8

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Table 61. Percentage of respondents who were seriously injured other than road traffic crashes Age Group (years) Women % Fall 60.8 52.4 53.0 67.7 79.1 60.4 % Burn 5.4 2.5 5.7 0.0 0.0 3.7 % Cut 9.3 10.3 0.0 0.0 0.0 5.1 % Animal Bites 0.0 9.8 0.9 3.2 14.4 3.6 % Frostbite 0.0 0.0 0.0 0.0 0.0 0.0 % Hit by Obj 8.7 21.9 20.7 17.2 5.9 14.5 % Other 15.8 3.1 19.7 12.0 0.6 12.7

95% CI

15-24 25-34 35-44 45-54 55-64 15-64

28 36 49 33 24 170

45.7-75.9 31.9-72.9 34.1-71.9 45.4-89.9 62.3-95.8 52.7-68.2

0.0-16.1 0.0-7.5 0.0-13.4 0.0-0.0 0.0-0.0 0.0-8.0

0.0-21.2 0.0-23.7 0.0-0.0 0.0-0.0 0.0-0.0 0.1-10.1

0.0-0.0 0.0-28.2 0.0-2.8 0.0-9.7 0.0-30.4 0.3-6.9

0.0-0.0 0.0-0.0 0.0-0.0 0.0-0.0 0.0-0.0 0.0-0.0

0.0-20.5 7.8-36.0 4.8-36.6 1.7-32.6 0.0-14.2 8.6-20.5

2.7-28.9 0.0-9.2 1.6-37.8 0.0-28.5 0.0-1.9 5.7-19.7

Table 62. Percentage of respondents who were seriously injured other than road traffic crashes Both Sexes Age Group (years)

95% CI

15-24 25-34 35-44 45-54 55-64 15-64

73 93 90 68 34 358

53.3 50.6 59.9 60.9 81.3 56.5

40.3-66.3 34.6-66.6 43.4-76.3 41.1-80.7 67.7-94.8 47.5-65.5

4.4 1.3 7.2 0.0 0.0 3.4

0.0-10.4 0.0-2.9 0.0-15.9 0.0-0.0 0.0-0.0 0.6-6.1

11.2 12.3 0.0 7.2 0.0 8.2

2.5-19.8 2.3-22.3 0.0-0.0 0.0-15.4 0.0-0.0 2.7-13.6

0.0 3.7 0.4 1.2 8.7 1.5

0.0-0.0 0.0-8.8 0.0-1.3 0.0-3.7 0.0-19.5 0.3-2.8

1.4 0.0 0.0 3.1 0.0 1.0

0.0-4.2 0.0-0.0 0.0-0.0 0.0-8.9 0.0-0.0 0.0-2.4

18.5 18.6 13.1 20.0 5.9 17.0

6.4-30.6 9.4-27.7 4.9-21.3 11.5-28.5 0.0-13.0 11.2-22.9

11.3 13.6 19.4 7.6 4.1 12.4

3.8-18.9 5.3-21.8 8.2-30.5 0.4-14.9 0.0-11.4 7.9-16.9

Table 63. Location of accidental serious injuries among respondents seriously injured Men Age Group (years) % Home 25.3 19.9 30.6 17.1 17.0 23.3 % School/ workplace 20.6 18.3 15.3 26.7 30.0 20.4 % RoadStreetHighway 33.2 29.9 27.9 35.9 28.9 31.8 % SportsAthletic area 14.9 10.2 4.8 3.3 0.0 10.1

95% CI

% Farm

95% CI

% other

95% CI

15-24 25-34 35-44 45-54 55-64 15-64

45 57 41 35 10 188

14.1-36.5 7.9-31.9 12.6-48.6 3.6-30.6 0.0-47.9 16.5-30.2

5.8-35.5 9.1-27.6 3.2-27.4 6.2-47.2 0.0-61.2 12.3-28.5

17.6-48.8 16.0-43.9 13.2-42.6 13.5-58.3 0.0-60.9 23.5-40.0

0.8 0.8 2.9 3.4 0.0 1.4

0.0-2.3 0.0-2.3 0.0-7.1 0.0-10.4 0.0-0.0 0.0-2.8

1.4-28.4 0.0-21.8 0.0-11.6 0.0-10.0 0.0-0.0 3.4-16.7

5.2 20.8 18.5 13.5 24.1 13.1

0.0-11.8 8.3-33.4 5.2-31.8 0.0-27.7 0.0-56.8 6.2-19.9

Table 64. Location of accidental serious injuries among respondents seriously injured Women Age Group (years) % Home 18.4 36.6 25.9 33.7 25.6 25.9 % School/ workplace 32.5 11.4 21.1 8.1 7.7 20.6 % RoadStreetHighway 41.7 42.2 40.4 50.5 64.4 44.9 % Farm 0.0 0.0 1.9 3.3 0.0 0.9 95% CI 0.0-0.0 0.0-0.0 0.0-4.7 0.0-9.9 0.0-0.0 0.0-2.1 % SportsAthletic area 2.1 0.0 5.5 1.0 0.0 2.2 % other 5.3 9.8 5.1 3.6 2.4 5.4

95% CI

15-24 25-34 35-44 45-54 55-64 15-64

29 37 49 33 24 172

1.9-34.8 17.2-56.1 12.1-39.7 11.4-56.0 5.5-45.6 17.3-34.6

7.7-57.3 0.0-23.2 5.9-36.3 0.4-15.7 0.0-17.1 8.3-32.9

20.7-62.7 21.3-63.2 17.7-63.1 27.7-73.2 40.4-88.3 32.4-57.4

0.0-6.4 0.0-0.0 0.0-13.4 0.0-2.8 0.0-0.0 0.0-4.7

0.0-15.8 0.7-18.8 0.0-12.6 0.0-8.8 0.0-7.2 0.8-10.0

119

Annex I

% Fall

% Burn

% Cut

% Animal Bites

% Frostbite

% Hit by Obj

% Other

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Table 65. Location of accidental serious injuries among respondents seriously injured Both Sexes Age Group (years) % RoadStreetHighway

% Home

95% CI

% School/ workplace

95% CI

% Farm

95% CI

% SportsAthletic area 10.6 7.6 5.1 2.4 0.0 7.2

95% CI

% other

95% CI

15-24 25-34 35-44 45-54 55-64 15-64

74 94 90 68 34 360

23.0 24.2 28.5 23.5 22.2 24.3

13.2-32.7 13.3-35.2 18.5-38.5 11.4-35.6 6.1-38.3 18.6-30.0

24.6 16.5 17.9 19.5 16.5 20.4

11.7-37.6 9.2-23.9 6.6-29.3 7.4-31.5 2.4-30.6 13.7-27.2

36.1 33.1 33.6 41.6 50.4 36.5

26.0-46.1 20.3-46.0 21.8-45.3 27.2-55.9 27.1-73.7 30.8-42.2

0.5 0.6 2.5 3.4 0.0 1.2

0.0-1.5 0.0-1.7 0.0-5.1 0.0-10.1 0.0-0.0 0.0-2.5

1.3-20.0 0.0-16.3 0.0-10.2 0.0-6.6 0.0-0.0 2.6-11.9

5.2 18.0 12.5 9.7 10.9 10.3

0.0-10.6 7.7-28.2 3.6-21.3 0.7-18.6 0.0-24.5 5.7-14.9

Table 66. Cause of crash among those respondents involved road trattic crash, by age group Age Group (years) 15-24 25-34 35-44 45-54 55-64 15-64 Men % Drunk driving % Fatigue/ disease % Speeding % Pedestrian violation of rule % External factor % Other

Annex I

95% CI

20 49 39 14 5 127

3.6 13.5 7.1 9.5 0.0 8.6

0.0-10.9 0.0-27.3 0.0-15.8 0.0-23.9 0.0-0.0 2.4-14.9

0.0 7.3 0.0 8.9 0.0 3.5

0.0-0.0 0.0-16.2 0.0-0.0 0.0-22.5 0.0-0.0 0.0-7.1

24.7 18.7 33.0 35.4 23.1 25.2

3.3-46.2 5.7-31.6 17.6-48.4 0.0-71.2 0.0-63.2 16.5-34.0

0.0 0.3 6.0 0.0 0.0 1.6

0.0-0.0 0.0-0.8 0.0-14.0 0.0-0.0 0.0-0.0 0.0-3.5

13.4 7.8 4.1 0.0 31.4 8.3

0.0-28.4 0.7-14.8 0.0-9.5 0.0-0.0 0.0-81.1 3.3-13.3

58.3 52.5 49.7 46.1 45.5 52.7

31.8-84.8 31.7-73.3 32.2-67.3 14.0-78.2 0.0-92.5 40.5-64.8

120

Table 67. Cause of crash among those respondents involved road trattic crash, by age group Age Group (years) 15-24 25-34 35-44 45-54 55-64 15-64 Women n 15 20 15 11 3 64 % Drunk driving

95% CI 0.0-41.2 0.0-20.2 0.0-0.0 0.0-0.0 0.0-0.0 0.0-21.1

% Fatigue/ disease

95% CI 0.0-22.4 0.0-21.3 0.0-30.3 0.0-0.0 0.0-0.0 0.0-15.7

% Speeding

95% CI 0.0-17.3 6.6-53.9 0.0-31.6 0.0-44.8 0.0-100.0 5.7-24.9

% Pedestrian violation of rule

95% CI 0.0-0.0 0.0-3.1 0.0-0.0 0.0-0.0 0.0-0.0 0.0-0.8

% External factor

95% CI 0.0-24.9 0.0-13.9 0.0-21.5 0.0-39.9 0.0-0.0 1.2-17.1

% Other

95% CI 24.0-89.8 24.8-70.5 44.3-93.2 30.1-95.3 0.0-100.0 41.0-74.1

18.8 7.9 0.0 0.0 0.0 10.2

7.5 8.6 10.5 0.0 0.0 7.5

5.7 30.3 13.7 19.0 39.3 15.3

0.0 1.0 0.0 0.0 0.0 0.3

11.1 4.6 7.1 18.3 0.0 9.2

56.9 47.7 68.7 62.7 60.7 57.5

Table 68. Cause of crash among those respondents involved road trattic crash, by age group Both Sexes Age Group (years) % Drunk driving % Fatigue/ disease % Speeding % Pedestrian violation of rule % External factor % Other

95% CI

15-24 25-34 35-44 45-54 55-64 15-64

35 69 54 25 8 191

9.2 12.4 5.5 6.7 0.0 9.1

0.0-19.1 1.3-23.6 0.0-12.2 0.0-16.7 0.0-0.0 3.8-14.3

2.8 7.5 2.3 6.3 0.0 4.6

0.0-8.4 0.0-15.2 0.0-7.0 0.0-15.5 0.0-0.0 1.1-8.0

17.7 20.8 28.7 30.7 26.2 22.7

3.7-31.6 9.1-32.6 16.4-41.0 2.6-58.7 0.0-61.3 15.7-29.7

0.0 0.4 4.7 0.0 0.0 1.2

0.0-0.0 0.0-1.0 0.0-10.9 0.0-0.0 0.0-0.0 0.0-2.7

12.6 7.2 4.8 5.3 25.3 8.5

1.9-23.3 1.3-13.0 0.0-9.9 0.0-11.9 0.0-67.7 4.6-12.5

57.8 51.6 53.9 51.0 48.5 53.9

37.1-78.5 33.3-69.9 39.5-68.4 24.1-77.8 5.0-91.9 44.5-63.4

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Table 69. Percentage of respondents seriously injured from violent incidents Men Age Group (years) % Seriously injured from violent incidents 5.7 3.2 4.8 3.2 2.9 4.4 Women % Seriously injured from violent incidents 1.9 3.0 4.0 1.6 1.3 2.5 Both Sexes % Seriously injured from violent incidents 3.8 3.1 4.4 2.4 2.1 3.5

95% CI

15-24 25-34 35-44 45-54 55-64 15-64

401 602 566 420 223 2212

2.7-8.7 1.6-4.7 2.5-7.0 1.1-5.3 0.3-5.5 2.9-5.9

494 920 874 622 299 3209

0.5-3.2 1.1-4.8 1.9-6.1 0.4-2.9 0.0-2.9 1.8-3.2

895 1522 1440 1042 522 5421

2.1-5.6 2.0-4.2 3.1-5.7 1.2-3.7 0.4-3.7 2.6-4.3

Table 70. Percentage of those receiving violent injuries caused by different persons Men Age Group n % Intimate partner 0.0 5.3 3.8 0.0 0.0 1.8 % Child, sibling, or other relative 2.7 4.0 3.6 0.0 26.1 3.9 % Friend or acquaintance 62.1 57.9 29.7 41.4 0.0 49.9 %Official or legal authorities 0.0 2.9 15.2 0.0 0.0 3.8

15-24 24-34 35-44 45-54 55-64 15-64

27 25 28 12 5 97

0.0-0.0 0.0-13.8 0.0-11.3 0.0-0.0 0.0-0.0 0.0-4.0

7.5 0.0 0.0 0.0 0.0 3.5

0.0-16.3 0.0-0.0 0.0-0.0 0.0-0.0 0.0-0.0 0.0-7.9

0.0-7.6 0.0-10.1 0.0-11.1 0.0-0.0 0.0-71.1 0.6-7.2

43.9-80.3 34.9-80.8 10.6-48.7 7.8-75.0 0.0-0.0 38.0-61.7

27.7 30.0 47.7 51.1 73.9 36.5

10.3-45.1 8.7-51.2 25.9-69.5 17.1-85.2 28.9-100.0 24.6-48.4

0.0-0.0 0.0-8.7 2.8-27.7 0.0-0.0 0.0-0.0 0.0-7.5

0.0 0.0 0.0 7.4 0.0 0.7

0.0-0.0 0.0-0.0

0.0-22.6 0.0-0.0 0.0-2.1

Table 71. Percentage of those receiving violent injuries caused by different persons Women Age Group n % Child, sibling, or other relative 8.3 23.8 20.6 17.6 0.0 17.1

% Intimate partner

95% CI

% Parent

95% CI

% Friend or acquaintance

95% CI

% Stranger

95% CI

%Official or legal authorities

95% CI

% Other

95% CI

15-24 25-34 35-44 45-54 55-64 15-64

10 18 26 9 2 65

30.9 39.0 34.1 0.0 0.0 30.4

0.0-67.3 15.3-62.6 19.2-48.9 0.0-0.0 0.0-0.0 13.9-46.8

0.0 0.0 0.0 0.0 0.0 0.0

0.0-0.0 0.0-0.0 0.0-0.0 0.0-0.0 0.0-0.0 0.0-0.0

0.0-25.4 7.3-40.3 4.1-37.0 0.0-38.8 0.0-0.0 8.4-25.8

38.4 9.2 5.7 73.2 77.7 24.2

0.6-76.2 0.0-21.9 0.0-13.3 47.1-99.2 27.7-100.0 7.9-40.4

22.4 28.1 39.7 0.0 0.0 26.9

0.0-56.2 10.8-45.3 21.9-57.6 0.0-0.0 0.0-0.0 13.6-40.2

0.0 0.0 0.0 9.3 0.0 0.9

0.0-0.0 0.0-0.0 0.0-0.0 0.0-28.5 0.0-0.0 0.0-2.7

0.0 0.0 0.0 0.0 22.3 0.6

0.0-0.0 0.0-0.0 0.0-0.0 0.0-0.0 0.0-72.3 0.0-1.8

Table 72. Percentage of those receiving violent injuries caused by different persons Both Sexes Age Group n % Intimate partner 7.6 20.4 17.5 0.0 0.0 11.8 % Child, sibling, or other relative 4.1 12.8 11.3 6.2 19.4 8.5 % Friend or acquaintance 56.3 36.1 18.8 52.6 19.9 40.9 %Official or legal authorities 0.0 1.6 8.3 3.3 0.0 2.8

95% CI

% Parent

95% CI

% Stranger

95% CI

% Other

95% CI

15-24 25-34 35-44 45-54 55-64 15-64

37 43 54 21 7 162

0.0-18.8 6.9-33.9 8.1-26.9 0.0-0.0 0.0-0.0 4.3-19.3

5.6 0.0 0.0 0.0 0.0 2.3

0.012.4 0.0-0.0 0.0-0.0 0.0-0.0 0.0-0.0 0.0-5.2

0.0-9.2 2.3-23.3 2.7-19.9 0.0-14.8 0.0-54.4 4.9-12.1

41.5-71.0 15.9-56.3 6.2-31.4 29.8-75.4 0.0-55.4 30.5-51.3

26.4 29.1 44.1 33.1 55.0 33.1

11.6-41.2 16.6-41.6 29.5-58.6 9.0-57.2 13.0-96.9 24.3-42.0

0.0-0.0 0.0-4.8 0.6-16.0 0.0-10.0 0.0-0.0 0.3-5.2

0.0 0.0 0.0 4.8 5.7 0.7

0.0-0.0 0.0-0.0 0.0-0.0 0.0-14.6 0.0-17.6 0.0-1.7

121

0.0-0.0

Annex I

95% CI

% Parent

95% CI

% Stranger

95% CI

% Other

95% CI

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

SURVEY RESULT, BY STRATUM

ANNEX II

123

Annex I

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

TOBACCO USE Table 1. Smoking status Men Stratum n Urban Rural Total 996 1221 2217 % Daily 43.3 42.7 43.0 Current smoker 95% CI 39.3-47.2 38.2-47.2 39.9-46.0 % Non-daily 5.7 4.5 5.0 95% CI 3.8-7.5 3.4-5.6 4.0-6.1 % Does not smoke 51.1 52.8 52.0 95% CI 46.3-55.8 47.9-57.7 48.5-55.4

Table 2. Smoking status Stratum n % Daily 5.9 4.5 5.2 95% CI 4.3-7.5 2.0-7.1 3.8-6.7 Women Current smoker % Non-daily 2.3 0.9 1.6 95% CI 0.9-3.6 0.4-1.5 0.9-2.4 % Does not smoke 91.8 94.6 93.1 95% CI 89.8-93.9 91.9-97.2 91.5-94.8

Annex II

Urban Rural Total

1550 1671 3221

124

Table 3. Smoking status Stratum n Urban Rural Total 2546 2892 5438 % Daily 23.7 25.0 24.3 95% CI 21.7-25.7 23.1-26.8 22.9-25.7 Both Sexes Current smoker % Non-daily 3.9 2.8 3.4 95% CI 2.7-5.1 2.2-3.4 2.7-4.0 % Does not smoke 72.4 72.2 72.3 95% CI 69.7-75.2 70.2-74.3 70.6-74.0

Table 4. Mean age started smoking Men Stratum Urban Rural TOTAL n 470 568 1038 Mean age 18.9 18.5 18.7 95% CI 18.1-19.8 17.9-19.1 18.2-19.2 n 107 87 194 Women Mean age 22.6 24.1 23.2 95% CI 20.5-24.7 20.6-27.5 21.3-25.1 n 577 655 1232 Both Sexes Mean age 19.4 19.0 19.2 95% CI 18.8-20.1 18.3-19.6 18.7-19.6

Table 5. Mean duration of smoking Men Stratum Urban Rural TOTAL n 470 568 1038 Mean duration 14.9 17.1 16.1 95% CI 13.4-16.5 16.0-18.2 15.1-17.1 n 107 87 194 Women Mean duration 12.2 14.3 13.1 95% CI 9.9-14.6 11.0-17.7 11.0-15.2 n 577 655 1232 Both Sexes Mean duration 14.6 16.9 15.8 95% CI 13.3-15.9 15.7-18.0 14.9-16.7

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

ALCOHOL USE Table 6. Alcohol consumption status Men Stratum % Current drinker (past 30 days) 49.3 50.2 49.8 % Drank in past 12 months, not current 21.7 18.8 20.1 % Past 12 months abstainer 5.0 6.9 6.1 % Lifetime abstainer 24.0 24.1 24.0

95% CI

Urban Rural TOTAL

996 1221 2217

42.7-55.9 42.8-57.6 44.8-54.8

15.3-28.0 13.2-24.4 15.9-24.4

2.9-7.1 4.5-9.3 4.4-7.7

17.1-30.9 17.6-30.6 19.3-28.8

Table 7. Alcohol consumption status Women Stratum % Current drinker (past 30 days) 27.6 26.7 27.2 % Drank in past 12 months, not current 21.9 16.9 19.5 % Past 12 months abstainer 6.6 11.1 8.8 % Lifetime abstainer 43.9 45.3 44.5

Urban Rural TOTAL

1550 1671 3221

23.2-32.0 19.6-33.9 23.1-31.3

16.7-27.1 12.0-21.8 15.9-23.1

4.7-8.6 7.2-15.0 6.5-11.0

34.4-53.3 36.7-53.9 38.1-51.0

Table 8. Alcohol consumption status Both Sexes Stratum % Current drinker (past 30 days) 37.9 39.3 38.6 % Drank in past 12 months, not current 21.8 17.9 19.8 % Past 12 months abstainer 5.9 8.9 7.4 % Lifetime abstainer 34.4 33.9 34.2

95% CI

Urban Rural TOTAL

2546 2892 5438

33.7-42.2 32.5-46.0 34.6-42.6

16.4-27.1 12.9-22.9 16.1-23.5

4.2-7.6 6.2-11.6 5.7-9.1

26.5-42.3 26.5-41.4 28.7-39.6

Table 9. Mean number of times with five/four or more drinks during a single occasion in the past 30 days among current drinkers Men Stratum n 531 645 1176 Mean number of times 1.8 2.2 2.1 95% CI 1.6-2.1 1.7-2.8 1.7-2.4 n 424.0 469.0 893.0 Women Mean number of times 1.0 1.0 1.0 95% CI 0.7-1.2 0.8-1.2 0.8-1.1

Urban Rural TOTAL

125

Annex II

95% CI

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

CONSUMPTION OF FRUITS AND VEGETABLES Table 10. Number of servings of fruit and/or vegetables on average per day Men Stratum n 996 1221 2217 % no fruit and/or vegetables 15.1 54.5 36.3 95% CI 11.1-19.0 41.7-67.3 26.5-46.1 % 1-2 servings 60.5 33.4 45.9 95% CI 51.5-69.5 25.4-41.4 38.1-53.7 % 3-4 servings 14.4 8.4 11.2 95% CI 9.4-19.4 3.0-13.9 7.4-15.0 % ≥5 servings 10.1 3.7 6.6 95% CI 3.8-16.3 0.2-7.2 3.1-10.2

Urban Rural TOTAL

Table 11. Number of servings of fruit and/or vegetables on average per day Women Stratum n 1549 1670 3219 % no fruit and/or vegetables 14.2 47.6 30.2 95% CI 10.5-18.0 35.2-60.0 22.3-38.2 % 1-2 servings 56.0 37.7 47.2 95% CI 47.1-64.8 29.6-45.7 40.6-53.8 % 3-4 servings 17.2 9.8 13.7 95% CI 12.0-22.5 4.4-15.3 9.7-17.7 % ≥5 servings 12.6 4.9 8.9 95% CI 6.8-18.3 0.4-9.4 5.1-12.7

Annex II

Urban Rural TOTAL

126

Table 12. Less than five servings of fruit and/or vegetables on average per day Men Stratum n 996 1221 2217 % < five servings per day 89.9 96.3 93.4 95% CI 83.7-96.2 92.8-99.8 89.8-96.9 n 1549 1670 3219 Women % < five servings per day 87.4 95.1 91.1 95% CI 81.7-93.2 90.6-99.6 87.3-94.9 n 2545 2891 5436 Both Sexes % < five servings per day 88.6 95.8 92.3 95% CI 82.8-94.5 91.8-99.7 88.6-95.9

Urban Rural TOTAL

Table 13. Mean consumption of salt per day Men Stratum n Mean number of servings 6.4 8.1 7.3 95% CI n Women Mean number of servings 6.6 8.0 7.3 Both Sexes Mean number of servings 6.5 8.1 7.3

95% CI

Urban Rural TOTAL

815 1066 1881

5.9-6.8 7.5-8.7 6.8-7.8

1466 1606 3072

6.2-7.1 7.4-8.7 6.9-7.7

2281 2672 4953

6.1-6.9 7.5-8.6 6.9-7.7

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

PHYSICAL ACTIVITY Table 14. Level of total physical activity Men Stratum Urban Rural TOTAL n 982 1157 2139 % Low 12.0 3.3 7.4 95% CI 7.3-16.7 1.4-5.2 4.5-10.3 % Moderate 12.9 7.5 10.0 95% CI 9.0-16.8 3.9-11.1 7.3-12.8 % High 75.1 89.2 82.5 95% CI 67.1-83.2 84.3-94.1 77.4-87.7

Table 15. Level of total physical activity Women Stratum Urban Rural TOTAL n 1528 1620 3148 % Low 10.8 4.2 7.7 95% CI 7.1-14.6 1.6-6.7 5.1-10.2 % Moderate 17.4 8.9 13.4 95% CI 12.0-22.9 3.6-14.2 9.3-17.5 % High 71.7 87.0 78.9 95% CI

79.6-94.3 72.6-85.3

Table 16. Level of total physical activity Both Sexes Stratum Urban Rural TOTAL n 2510 2777 5287 % Low 11.4 3.7 7.5 95% CI 7.5-15.2 1.7-5.8 5.0-10.1 % Moderate 15.3 8.2 11.7 95% CI 11.2-19.3 4.1-12.3 8.6-14.8 % High 73.3 88.1 80.8 95% CI 65.8-80.9 82.5-93.8 75.4-86.1

Table 17. No vigorous physical activity Men Stratum n 982 1157 2139 % no vigorous activity 46.9 39.2 42.9 95% CI 39.0-54.9 31.6-46.9 37.3-48.4 n 1528.0 1620.0 3148.0 Women % no vigorous activity 61.5 46.1 54.2 95% CI 56.5-66.4 35.8-56.3 48.2-60.1 n 2510 2777 5287 Both Sexes % no vigorous activity 54.5 42.4 48.5 95% CI 48.5-60.6 34.1-50.8 43.1-53.8

Urban Rural TOTAL

PHYSICAL MEASUREMENT Table 18. BMI classifications Men Stratum n 991 1206 2197 % Underweight <18.5 5.2 4.0 4.6 95% CI 2.7-7.8 2.2-5.8 3.0-6.1 % Normal weight 18.5-24.9 55.7 60.8 58.4 95% CI 49.4-61.9 56.2-65.4 54.5-62.4 % BMI 25.0-29.9 28.1 24.1 26.0 95% CI 24.6-31.7 20.3-27.8 23.2-28.7 % Obese ≥30.0 11.0 11.1 11.1 95% CI 7.0-15.0 8.6-13.7 8.8-13.4

Urban Rural TOTAL

127

Annex II

63.1-80.4

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Table 19. BMI classifications Women Stratum n 1508 1609 3117 % Underweight <18.5 5.1 3.7 4.4 95% CI 2.6-7.6 2.3-5.0 2.9-5.9 % Normal weight 18.5-24.9 51.9 53.9 52.9 95% CI 48.5-55.4 50.0-57.9 50.3-55.5 % BMI 25.0-29.9 28.3 29.0 28.6 95% CI 24.8-31.9 25.8-32.1 26.3-31.0 % Obese ≥30.0 14.6 13.4 14.1 95% CI 12.1-17.1 10.5-16.4 12.1-16.0

Urban Rural TOTAL

Table 20. BMI classifications Both Sexes Stratum n 2499 2815 5314 % Underweight <18.5 5.2 3.9 4.5 95% CI 3.1-7.3 2.5-5.3 3.2-5.8 % Normal weight 18.5-24.9 53.7 57.7 55.7 95% CI 50.1-57.3 54.3-61.0 53.1-58.3 % BMI 25.0-29.9 28.2 26.3 27.3 95% CI 25.9-30.6 23.3-29.3 25.3-29.2 % Obese ≥30.0 12.9 12.2 12.5 95% CI 10.0-15.7 10.2-14.2 10.8-14.2

Urban

Annex II

Rural TOTAL

Table 21. BMI≥25

128

Men Stratum Urban Rural TOTAL n 991 1206 2197 % BMI≥25 39.1 35.2 37.0 95% CI 33.0-45.2 30.2-40.1 33.0-41.0 n 1508 1609 3117

Women % BMI≥25 43.0 42.4 42.7 95% CI 39.4-46.5 38.2-46.6 40.0-45.4 n 2499 2815 5314

Both Sexes % BMI≥25 41.1 38.5 39.8 95% CI 37.5-44.7 34.7-42.3 37.1-42.5

Table 22. Waist circumference (cm)

Stratum Urban Rural TOTAL

Men n 992 1216 2208 Mean 83.5 83.0 83.2 95% CI 81.8-85.2 81.7-84.3 82.2-84.3 n 1511 1613 3124

Women Mean 81.7 83.5 82.6 95% CI 80.6-82.9 82.2-84.9 81.7-83.5

RAISED BLOOD PRESSURE Table 23. SBP ≥140 and/or DBP ≥ 90 mmHg, excluding those on medication for raised blood pressure Stratum Urban Rural TOTAL Men n 886 1105 1991 % 23.9 25.5 24.8 95% CI 19.8-28.0 20.6-30.3 21.5-28.0 n 1317 1378 2695 Women % 10.2 14.2 12.1 95% CI 7.7-12.7 12.1-16.4 10.3-13.9 n 2203 2483 4686 Both Sexes % 16.8 20.4 18.6 95% CI 14.1-19.6 17.0-23.8 16.4-20.9

Table 24. SBP ≥140 and/or DBP ≥ 90 mmHg or currently on medication for raised blood pressure Stratum Urban Men n 990 % 30.7 95% CI 26.0-35.3 n 1540 Women % 20.4 95% CI 17.1-23.7 n 2530 Both Sexes % 25.3 95% CI 21.8-28.8

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Rural TOTAL

1219 2209

32.0 31.4

27.6-36.5 28.2-34.6

1665 3205

26.2 23.2

22.5-29.9 20.6-25.8

2884 5414

29.3 27.3

26.1-32.6 24.9-29.8

Table 25. SBP ≥160 and/or DBP ≥ 100 mmHg, excluding those on medication for raised blood pressure Stratum Urban Rural TOTAL Men n 886 1105 1991 % 7.2 5.1 6.1 95% CI 4.7-9.8 3.5-6.7 4.6-7.6 n 1317 1378 2695 Women % 3.0 2.6 2.8 95% CI 2.0-4.0 1.5-3.7 2.1-3.6 n 2203 2483 4686 Both Sexes % 5.1 4.0 4.5 95% CI 3.4-6.7 2.9-5.0 3.5-5.5

Table 26. SBP ≥160 and/or DBP ≥ 100 mmHg or currently on medication for raised blood pressure Stratum Urban Rural TOTAL Men n 990 1219 2209 % 15.4 13.5 14.4 95% CI 11.8-19.1 10.4-16.5 12.0-16.8 n 1540 1665 3205 Women % 14.1 16.2 15.1 95% CI 11.6-16.5 12.9-19.4 13.1-17.1 n 2530 2884 5414 Both Sexes % 14.7 14.7 14.7 95% CI 12.0-17.4 12.2-17.3 12.9-16.6

Table 27. Respondents with treated and/or controlled raised blood pressure Men Stratum n % Not on medication and SBP≥140 and/orDBP≥90 71.2 72.5 71.9 95% CI % On medication and SBP<140 and DBP<90 4.4 10.0 7.5 95% CI % On medication and SBP≥140 and/orDBP≥90 24.4 17.5 20.6 95% CI

Urban Rural TOTAL

371 439 810

64.4-77.9 64.7-80.2 66.6-77.1

1.6-7.2 4.8-15.3 4.2-10.8

18.9-29.9 12.0-23.0 16.4-24.8

Table 28. Respondents with treated and/or controlled raised blood pressure Women Stratum n % Not on medication and SBP≥140 and/orDBP≥90 44.4 47.3 46.0 95% CI % On medication and SBP<140 and DBP<90 23.6 19.4 21.4 95% CI % On medication and SBP≥140 and/orDBP≥90 31.9 33.3 32.7 95% CI

Urban Rural TOTAL

418 513 931

37.6-51.3 39.7-54.8 40.8-51.1

18.6-28.6 14.3-24.6 17.6-25.1

26.4-37.4 26.6-40.0 28.2-37.1

Table 29. Respondents with treated and/or controlled raised blood pressure Both Sexes Stratum n % Not on medication and SBP≥140 and/orDBP≥90 60.0 62.1 61.1 95% CI % On medication and SBP<140 and DBP<90 12.5 13.9 13.3 95% CI % On medication and SBP≥140 and/orDBP≥90 27.6 24.0 25.6 95% CI

Urban Rural TOTAL

789 952 1741

55.0-64.9 54.6-69.6 56.4-65.8

9.2-15.7 10.1-17.8 10.7-15.8

23.5-31.6 18.5-29.5 22.1-29.2

129

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Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

BIOCHEMICAL INDICATORS Table 30. Mean total cholesterol (mmol/L) Stratum Urban Rural TOTAL Men n 292 314 606 Mean 4.3 4.6 4.5 95% CI 4.0-4.7 4.3-5.0 4.2-4.7 n 456 476 932 Women Mean 4.1 4.4 4.2 95% CI 3.8-4.3 4.1-4.7 4.0-4.4 n 748 790 1538 Both Sexes Mean 4.2 4.5 4.4 95% CI 3.9-4.5 4.2-4.8 4.1-4.6

Table 31. Mean total cholesterol (mg/dl) Stratum Urban Rural Men n 292 314 606 Mean 167.9 178.2 173.3 95% CI 153.9-181.8 164.4-192.0 163.5-183.2 n 456 476 932 Women Mean 157.6 169.9 163.8 95% CI 147.8-167.5 157.7-182.1 155.7-171.9 n 748 790 1538 Both Sexes Mean 162.6 174.1 168.6 95% CI 151.8-173.4 162.0-186.3 160.3-176.9

Annex II

TOTAL

Table 32. Total cholesterol ≥ 5.0 mmol/L or ≥ 190 mg/dl or currently on medication for raised cholesterol Stratum Urban Rural TOTAL Men n 292 314 606 % 26.1 28.6 27.4 95% CI 16.2-36.0 20.2-37.0 21.0-33.9 n 456 476 932 Women % 19.7 25.2 22.5 95% CI 13.1-26.3 16.1-34.3 16.8-28.2 n 748 790 1538 Both Sexes % 22.8 26.9 25.0 95% CI 15.8-29.8 18.6-35.2 19.4-30.5

130

Table 33. Total cholesterol ≥ 6.2 mmol/L or ≥ 240 mg/dl or currently on medication for raised cholesterol Stratum Urban Rural TOTAL Men n 292 314 606 % 8.1 12.0 10.2 95% CI 1.6-14.6 6.5-17.5 5.9-14.4 n 456 476 932 Women % 4.3 9.3 6.8 95% CI 2.7-5.9 3.0-15.7 3.4-10.3 n 748 790 1538 Both Sexes % 6.2 10.7 8.5 95% CI 2.7-9.6 5.7-15.7 5.3-11.7

Table 34. Mean fasting triglycerides (mmol/L) Stratum Urban Rural TOTAL Men n 286 296 582 Mean 1.7 1.4 1.5 95% CI 1.4-2.0 1.2-1.5 1.4-1.7 n 447 452 899 Women Mean 1.2 1.1 1.1 95% CI 1.1-1.3 1.0-1.2 1.1-1.2 n 733 748 1481 Both Sexes Mean 1.4 1.2 1.3 95% CI 1.3-1.6 1.1-1.4 1.2-1.4

Table 35. Mean fasting triglycerides (mg/dl) Stratum Urban Rural TOTAL Men n 286 296 582 Mean 149.4 121.4 134.8 95% CI 124.9-173.8 106.1-136.7 119.8-149.8 n 447 452 899 Women Mean 105.1 95.5 100.3 95% CI 94.0-116.2 86.4-104.5 93.0-107.7 n 733 748 1481 Both Sexes Mean 126.4 108.7 117.4 95% CI 111.2-141.7 96.9-120.4 107.3-127.5

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Table 36. Percentage of respondents with fasting triglycerides ≥ 1.7 mmol/L or ≥ 150 mg/dl Stratum Urban Rural TOTAL Men n 286 296 582 % 32.6 26.6 29.5 95% CI 24.8-40.5 18.3-34.9 23.7-35.3 n 447 452 899 Women % 18.1 12.6 15.4 95% CI 12.9-23.4 7.8-17.3 11.8-19.0 n 733 748 1481 Both Sexes % 25.1 19.7 22.4 95% CI 20.1-30.1 13.9-25.6 18.4-26.3

Table 37. Percentage of respondents with fasting triglycerides ≥ 2.0 mmol/L or ≥ 180 mg/dl Stratum Urban Rural TOTAL Men n 286 296 582 % 26.9 20.5 23.6 95% CI 18.3-35.5 12.2-28.8 17.5-29.7 n 447 452 899 Women % 11.3 7.4 9.4 95% CI 7.7-14.9 4.2-10.6 6.9-11.9 n 733 748 1481 Both Sexes % 18.8 14.1 16.4 95% CI 13.9-23.8 9.0-19.2 12.8-20.1

Table 38. Mean LDL cholesterol (mmol/L) Stratum Urban Rural TOTAL Men n 304 336 640 Mean 3.6 3.3 3.4 95% CI 3.4-3.8 3.1-3.5 3.3-3.6 n 464 502 966 Women Mean 3.5 3.2 3.3 95% CI 3.3-3.7 3.0-3.3 3.2-3.5 n 768 838 1606 Both Sexes Mean 3.5 3.2 3.4 95% CI 3.4-3.7 3.2-3.5 3.1-3.4

Table 39. Mean fasting triglycerides (mg/dl) Stratum Urban Rural TOTAL Men n 304 336 640 Mean 137.7 125.8 131.5 95% CI 130.1-145.3 119.0-132.7 126.1-136.8 n 464 502 966 Women Mean 133.8 121.4 127.3 95% CI 127.0-140.6 115.0-127.7 122.4-132.2 n 768 838 1606 Both Sexes Mean 135.7 123.6 129.3 95% CI 128.7-142.7 117.6-129.5 124.5-134.2

Table 40. Percentage of respondents with LDL cholesterol =>4.15 Stratum Urban Rural TOTAL Men n 304 336 640 % 26.4 16.7 21.3 95% CI 18.2-34.7 10.8-22.6 16.1-26.4 n 464 502 966 Women % 21.9 13.2 17.4 95% CI 15.6-28.2 8.8-17.6 13.5-21.3 n 768 838 1606 Both Sexes % 24.1 14.9 19.3 95% CI 17.2-31.0 10.4-19.4 15.1-23.5

131

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Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

INJURY AND VIOLENCE Table 41. Percentage of drivers or passengers not always using a seat belt Men Stratum n % Not always using seat belt 69.6 88.3 78.6 95% CI n Women % Not always using seat belt 85.7 93.5 88.9 Both Sexes % Not always using seat belt 78.0 90.6 83.6

95% CI

Urban Rural TOTAL

877 878 1755

64.7-74.6 84.8-91.7 74.7-82.5

1276 1089 2365

81.4-90.1 90.9-96.1 86.2-91.6

2153 1967 4120

73.6-82.3 87.8-93.3 80.7-86.5

Table 42. Cause of crash among those respondents involved in road traffic crash in the past 12 months Men % didn’t use pedestrian route 1.7 1.5 1.6

Annex II

Stratum n

% Alcoholic drink

95% CI

% fatigue / illness

95% CI

% excess speed

95% CI

% external factor

95% CI

% Other

95% CI

Urban

53 74 127

9.3 8.1 8.6

0.018.9 0.016.2 2.514.8

4.2 3.0 3.5

0.0-9.2 0.0-8.0 0.0-7.1

24.9 25.6 25.2

14.8-34.9 12.2-38.9 16.6-33.9

0.0-4.3 0.0-4.3 0.0-3.5

6.6 9.7 8.3

0.0-14.5 3.5-16.0 3.3-13.3

53.4

35.7-71.0

132

Rural TOTAL

52.1

35.7-68.5

52.7

40.6-64.7

Table 43. Cause of crash among those respondents involved in road traffic crash in the past 12 months Women % didn’t use pedestrian route 0.6 #VALUE! 0.3

Stratum n

% Alcoholic drink

95% CI

% fatigue / illness

95% CI

% excess speed

95% CI

% external factor

95% CI

% Other

95% CI

Urban Rural TOTAL

29 35 64

1.8 17.1 10.2

0.0-4.7 0.0-34.5 0.0-21.2

13.7 2.5 7.5

0.0-30.0 0.0-7.8 0.0-15.8

21.4 10.3 15.3

6.4-36.4 0.0-21.6 5.7-24.9

0.0-1.8 #VALUE! 0.0-0.8

13.5 5.7 9.2

0.0-28.2 0.0-14.5 1.3-17.1

49.1 64.4 57.5

28.2-69.9 38.7-90.2 41.0-74.1

Table 44. Cause of crash among those respondents involved in road traffic crash in the past 12 months Both Sexes Stratum n % Alcoholic drink 7.4 10.4 9.1 % fatigue / illness 6.6 2.9 4.6 % excess speed 24.0 21.6 22.7 % didn’t use pedestrian route 1.4 1.1 1.2 95% CI 0.0-3.4 0.0-3.2 0.0-2.7 % external factor 8.4 8.7 8.5

95% CI

% Other

95% CI

Urban Rural TOTAL

82 109 191

0.3-14.5 3.1-17.8 3.9-14.3

0.8-12.5 0.0-6.8 1.1-8.0

16.2-31.8 10.8-32.4 15.7-29.6

1.7-15.0 4.1-13.2 4.6-12.5

52.2 55.3 53.9

37.9-66.6 42.9-67.8 44.5-63.3

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Table 45. Percentage of those receiving violent injuries caused by different persons Men Stratum n % Intimate partner 0.5 2.7 1.8 % Child, sibling, or other relative 1.8 5.4 3.9 % Friend or acquainttance 49.6 50.1 49.9 %Official or legal authorities 3.4 4.0 3.8

95% CI

% Parent

95% CI

% Stranger

95% CI

% Other

95% CI

Urban Rural TOTAL

47 50 97

0.0-1.5 0.0-6.5 0.0-4.0

0.0 6.2 3.5

0.0-0.0 0.0-13.1 0.0-8.0

0.0-5.1 0.3-10.5 0.5-7.2

29.8-69.4 36.1-64.2 38.2-61.6

44.7 30.3 36.5

24.3-65.1 16.3-44.3 24.5-48.5

0.0-8.9 0.0-9.0 0.1-7.5

0.0 1.2 0.7

0.0-0.0 0.0-3.8 0.0-2.1

Table 46. Percentage of those receiving violent injuries caused by different persons Women Stratum n % Intimate partner 21.6 40.1 30.3 % Child, sibling, or other relative 14.7 19.8 17.1 % Friend or acquaint-tance 21.1 27.7 24.2 % Stranger 41.5 10.6 26.9 %Official or legal authorities 0.0 1.8 0.9 95% CI 0.0-0.0 0.0-5.7 0.0-2.7 % Other 1.1 0.0 0.6 95% CI 0.0-3.4 0.0-0.0 0.0-1.8

95% CI

Urban Rural TOTAL

30 35 65

10.1-33.1 10.5-69.6 13.9-46.8

1.0-28.4 9.6-30.0 8.5-25.7

0.1-42.1 3.5-51.9 8.2-40.2

22.5-60.6 0.0-21.9 12.7-41.1

Table 47. Percentage of those receiving violent injuries caused by different persons Both Sexes % Intimate partner 8.9 14.3 % Parent 0.0 4.3 95% CI 0.0-0.0 0.0-9.2 % Child, sibling, or other relative 6.9 9.9 % Friend or acquaint-tance 38.2 43.2 % Stranger 43.4 24.2 %Official or legal authorities 2.1 3.4 % Other 0.4 0.8 95% CI 0.0-1.3 0.0-2.6 Stratum n

95% CI

Urban Rural

77 85

2.7-15.1 1.5-27.2

1.4-12.5 5.1-14.7

21.7-54.7 30.5-55.8

29.4-57.4 13.5-34.9

0.0-5.3 0.0-6.9

Table 48. Percentage of respondents To whom you would apply in case of violence Men Stratum n Urban Rural TOTAL 928 1153 2081 % police 57.7 48.0 52.5 95% CI 52.8-62.6 40.5-55.5 47.6-57.3 % local authority 0.4 8.3 4.7 95% CI 0.0-0.8 2.4-14.3 1.3-8.1 % health worker 1.5 2.5 2.0 95% CI 0.0-3.4 1.5-3.5 1.0-3.0 % family members 28.1 30.2 29.3 95% CI 22.9-33.3 25.8-34.7 25.8-32.7 % friends 12.3 10.0 11.0 95% CI 8.9-15.7 6.9-13.1 8.7-13.4 % teacher #VALUE! 0.9 0.5 95% CI #VALUE! 0.2-1.7 0.1-0.9

Table 49. Percentage of respondents To whom you would apply in case of violence Women Stratum n % police 49.7 42.7 46.3 95% CI % local authority 1.4 7.7 4.4 95% CI % health worker 0.7 2.7 1.7 95% CI % family members 41.4 37.9 39.7 95% CI % friends 95% CI % teacher 0.1 1.3 0.6 % someone unfamiliar 0.0 #VALUE! 0.0

95% CI

Urban Rural TOTAL

1483 1630 3113

43.0-56.3 35.5-50.0 41.3-51.3

0.3-2.5 4.2-11.3 2.5-6.4

0.3-1.1 1.6-3.7 1.1-2.3

36.3-46.4 32.1-43.8 35.8-43.6

6.8 7.7 7.2

4.8-8.8 5.8-9.6 5.8-8.6

0.0-0.2 0.1-2.5 0.0-1.2

0.0-0.0 #VALUE! 0.0-0.0

Table 50. Percentage of respondents To whom you would apply in case of violence Both Sexes Stratum n % police 53.4 45.5 49.4 95% CI % local authority 0.9 8.0 4.6 95% CI % health worker 1.1 2.6 1.8 95% CI % family members 35.1 33.9 34.5 95% CI % friends 9.4 8.9 9.1 % teacher 0.0 1.1 0.6 % someone unfamiliar 0.0 0.0 0.0

95% CI

Urban Rural TOTAL

2411 2783 5194

48.0-58.8 38.9-52.1 45.0-53.8

0.2-1.7 3.4-12.7 2.0-7.1

0.2-2.0 1.8-3.3 1.2-2.5

30.5-39.7 29.3-38.4 31.2-37.7

7.4-11.4 7.0-10.9 7.7-10.5

0.0-0.1 0.2-2.0 0.1-1.0

0.0-0.0 0.0-0.0 0.0-0.0

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SURVEY INSTRUMENT

ANNEX III

135

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Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

WHO STEPS INSTRUMENT FOR CHRONIC DISEASE RISK FACTOR SURVEILLANCE MONGOLIA

Survey Information Location and Date 1 2 3 4 Cluster/Centre/Village ID Cluster/Centre/Village name Interviewer ID Date of completion of the instrument Response

Code └─┴─┴─┘ └─┴─┴─┘ I1 I2 I3 I4

└─┴─┘ dd

└─┴─┘ └─┴─┴─┴─┘ mm year

Annex III

Participant Id Number └─┴─┴─┘└─┴─┴─┘└─┴─┴─┘ Consent, Interview Language and Name Response Yes No Mongolian 6 Interview Language Time of interview (24 hour clock) Family Surname First Name Contact phone number where possible Khazakh Other 7 8 9 10 1 2 If NO, END 1 2 3 I7 I8 I9 I10 I6 Code I5

136

Consent has been read and obtained

└─┴─┘: └─┴─┘ hrs mins

Additional Information that may be helpful

Record and file identification information (I5 to I10) separately from the completed questionnaire.

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Step 1 Demographic Information CORE: Demographic Information Question 11 Sex (Record Male / Female as observed) What is your date of birth? Don’t Know 77 77 7777 How old are you? In total, how many years have you spent at school or in full-time study (excluding pre-school)? Male Female Response 1 2 Code C1

12 13 14

└─┴─┘ └─┴─┘ └─┴─┴─┴─┘ If known, Go to C4 dd mm year Years Years └─┴─┘ └─┴─┘

C2 C3 C4

EXPANDED: Demographic Information No formal schooling Less than primary school Primary school completed Secondary school completed High school completed College completed University completed Post graduate degree Refused Khalkh Khazakh Other Refused Never married Currently married Separated Divorced Widowed Cohabitating Refused Government employee Non-government employee Self-employed Non-paid Student Homemaker Retired Unemployed (able to work) Unemployed (unable to work) Refused Number of people Don’t know 77 Refused 88 Number of people Don’t know 77 Refused 88 1 2 3 4 5 6 7 8 88 1 2 3 88 1 2 3 4 5 6 88 1 2 3 4 5 6 7 8 9 88 └─┴─┘

What is your ethnic background?

What is your marital status?

Which of the following best describes your main work status over the past 12 months?

(USE SHOWCARD)

How many people, including yourself, live in your household? How many people older than 18 years, including yourself, live in your household?

└─┴─┘

137

What is the highest level of education you have completed?

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Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

EXPANDED: Demographic Information, Continued Question Per week Taking the past year, can you tell OR per month me what the average earnings of 21 the household have been? OR per year (RECORD ONLY ONE, NOT ALL 3) Refused £ 113,056 113,057-282,640 If you don’t know the amount, can 282,641 - 410,140 you give an estimate of the annual 410,141 - 452,640 household income if I read some 22 options to you? Is it: 452,641-495,140 ≥ 495,141 (READ OPTIONS) Don’t Know Refused

Response └─┴─┴─┴─┴─┴─┴─┘ Go to T1 └─┴─┴─┴─┴─┴─┴─┘ Go to T1 └─┴─┴─┴─┴─┴─┴─┘ Go to T1 88 1 2 3 4 5 6 77 88

Code C10a C10b C10c C10d

C11

Step 1 Behavioural Measurements Annex III CORE: Tobacco Use Now I am going to ask you some questions about various health behaviours. This includes things like smoking, drinking alcohol, eating fruits and vegetables and physical activity. Let’s start with tobacco. Question Do you currently smoke any tobacco products, such as cigarettes, cigars or pipes? (USE SHOWCARD) Do you currently smoke tobacco products daily? How old were you when you first started smoking daily? Do you remember how long ago it was? (RECORD ONLY 1, NOT ALL 3) Don’t know 77 Response Yes No Yes No Age (years) Don’t know 77 In Years OR in Months OR in Weeks Manufactured cigarettes Hand-rolled cigarettes Pipes full of tobacco Cigars, cheroots, cigarillos Other Other (please specify): Code 1 2 If No, go to T6 1 2 If No, go to T6 └─┴─┘ If Known, go to T5a └─┴─┘ If Known, go to T5a └─┴─┘ If Known, go to T5a └─┴─┘ └─┴─┘ └─┴─┘ └─┴─┘ └─┴─┘ If Other, go to T5other, └─┴─┘ else go to T9 └─┴─┴─┴─┴─┴─┘ Go to T9

138

24 25

T2 T3 T4a T4b T4c T5a T5b T5c T5d T5e T5other

On average, how many of the following do you smoke each day? (RECORD FOR EACH TYPE, USE SHOWCARD) Don’t Know 77

EXPANDED: Tobacco Use Question 28 In the past, did you ever smoke daily? Do you currently use any smokeless tobacco such as [snuff, chewing tobacco, betel]? (USE SHOWCARD) Do you currently use smokeless tobacco products daily? Response Yes No Yes No Yes No 1 2 If No, go to T9 1 2 If No, go to T12 1 2 If No, go to T12 T9 Code T6

T10

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

On average, how many times a day do you use ….

Snuff, by mouth Snuff, by nose Chewing tobacco Betel, quid Other Other (specify) Yes No Number of days Don’t know 77 Number of days

└─┴─┘ └─┴─┘ └─┴─┘ └─┴─┘ If Other, go to T11other, └─┴─┘ else go to T13 └─┴─┴─┴─┴─┴─┴─┘ Go to T13 1 2

T11a T11b T11c T11d T11e T11other

(RECORD FOR EACH TYPE, USE SHOWCARD)

Don’t Know 77 In the past, did you ever use smokeless tobacco such as [snuff, chewing tobacco, or betel] daily? During the past 7 days, on how many days did someone in your home smoke when you were present? During the past 7 days, on how many days did someone smoke in closed areas in your workplace (in the building, in a work area or a specific office) when you were present? During the past 7 days, on how many days did someone smoke in an enclosed public area (inside a store, bus, etc.) when you were present?

T12

└─┴─┘

T13

└─┴─┘

T14

Number of days Don’t know 77

CORE: Alcohol Consumption The next questions ask about the consumption of alcohol. Question Have you ever consumed an alcoholic drink such as beer, wine, spirits, fermented cider or [add other local examples]? (USE SHOWCARD OR SHOW EXAMPLES) Response Yes No Yes 37 Have you consumed an alcoholic drink within the past 12 months? No Daily During the past 12 months, how frequently have you had at least one alcoholic drink? 38 (READ RESPONSES, USE SHOWCARD) 5-6 days per week 1-4 days per week 1-3 days per month Less than once a month Yes 39 Have you consumed an alcoholic drink within the past 30 days? No Number Don’t know 77 1 2 If No, go to D1 1 2 If No, go to D1 1 2 3 4 5 1 2 If No, go to D1 └─┴─┘ A3 A2 A1b A1a Code

During the past 30 days, on how many occasions did you have at least one alcoholic drink? During the past 30 days, when you drank alcohol, on average, how many standard alcoholic drinks did you have during one drinking occasion? (USE SHOWCARD)

Number Don’t know 77

└─┴─┘

139

└─┴─┘

Annex III

Don’t know or don’t work in a closed area 77

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

During the past 30 days, what was the largest number of standard alcoholic drinks you had on a single occasion, counting all types of alcoholic drinks together? During the past 30 days, how many times did you have for men: five or more for women: four or more standard alcoholic drinks in a single drinking occasion?

Largest number Don’t Know 77

└─┴─┘

Number of times Don’t Know 77

└─┴─┘

EXPANDED: Alcohol Consumption Usually with meals 44 During the past 30 days, when you consumed an alcoholic drink, how often was it with meals? Please do not count snacks. Sometimes with meals Rarely with meals Never with meals 1 2 3 4 A8

Annex III

CORE: Diet The next questions ask about the fruits and vegetables that you usually eat. I have a nutrition card here that shows you some examples of local fruits and vegetables. Each picture represents the size of a serving. As you answer these questions please think of a typical week in the last year. Question 45 In a typical week, on how many days do you eat fruit? (USE SHOWCARD) How many servings of fruit do you eat on one of those days? (USE SHOWCARD) In a typical week, on how many days do you eat vegetables? (USE SHOWCARD) How many servings of vegetables do you eat on one of those days? (USE SHOWCARD) Response Number of days Don’t Know 77 Number of servings Don’t Know 77 Number of days Don’t Know 77 Number of servings Don’t know 77 └─┴─┘ If Zero days, go to D3 Code D1

140

└─┴─┘

└─┴─┘ If Zero days, go to D5

└─┴─┘

EXPANDED: Diet Olive oil Corn oil Sunflower oil What type of oil or fat is most often used for meal preparation in your household? 49 (USE SHOWCARD) (SELECT ONLY ONE) Animal fat Dairy oil Margarine Other None in particular None used Don’t know Other 1 2 3 4 5 6 7 If Other, go to D5 other 8 9 77 └─┴─┴─┴─┴─┴─┴─┘ D5other D5

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Beef Mutton Camel or goat Chicken or duck 50 What type of meat is most often used for meal preparation in your household? Horse Marmot Fish Pork Other Don’t know Other On average, how many meals per week do you eat that were not prepared at a home? By meal, I mean breakfast, lunch and dinner. On average, how long does it take your household to consume 500 g of salt? Number Don’t know 77

1 2 3 4 5 6 7 8 9 If Other, go to X4other 77 └─┴─┴─┴─┴─┴─┴─┘ X4other X3

└─┴─┘

Number of days Don’t know 77

└─┴─┘

Next I am going to ask you about the time you spend doing different types of physical activity in a typical week. Please answer these questions even if you do not consider yourself to be a physically active person. Think first about the time you spend doing work. Think of work as the things that you have to do such as paid or unpaid work, study/training, household chores, harvesting food/crops, fishing or hunting for food, seeking employment. [Insert other examples if needed]. In answering the following questions ‘vigorous-intensity activities’ are activities that require hard physical effort and cause large increases in breathing or heart rate, ‘moderateintensity activities’ are activities that require moderate physical effort and cause small increases in breathing or heart rate. Question Work Does your work involve vigorous-intensity activity that causes large increases in breathing or heart rate like [carrying or lifting heavy loads, digging or construction work] for at least 10 minutes continuously? [INSERT EXAMPLES] (USE SHOWCARD) In a typical week, on how many days do you do vigorous-intensity activities as part of your work? How much time do you spend doing vigorousintensity activities at work on a typical day? Does your work involve moderate-intensity activity, that causes small increases in breathing or heart rate such as brisk walking [or carrying light loads] for at least 10 minutes continuously? [INSERT EXAMPLES] (USE SHOWCARD) In a typical week, on how many days do you do moderate-intensity activities as part of your work? Yes 1 P1 No 2 If No, go to P 4 Response Code

Number of days

└─┘ └─┴─┘: └─┴─┘ hrs mins 1

P2 P3 (a-b)

Hours : minutes

Yes

P4 No 2 If No, go to P 7

Number of days

└─┘

141

CORE: Physical Activity

Annex III

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

How much time do you spend doing moderateintensity activities at work on a typical day?

Hours : minutes

└─┴─┘: └─┴─┘ hrs mins

P6 (a-b)

Travel to and from places The next questions exclude the physical activities at work that you have already mentioned. Now I would like to ask you about the usual way you travel to and from places. For example to work, for shopping, to market, to place of worship. [Insert other examples if needed] Do you walk or use a bicycle (pedal cycle) for at least 10 minutes continuously to get to and from places? In a typical week, on how many days do you walk or bicycle for at least 10 minutes continuously to get to and from places? How much time do you spend walking or bicycling for travel on a typical day? Yes No 1 P7 2 If No, go to P 10 └─┘

Number of days

Annex III

Hours : minutes

└─┴─┘: └─┴─┘ hrs mins

P9 (a-b)

CORE: Physical Activity, Continued Question Response Code Recreational activities The next questions exclude the work and transport activities that you have already mentioned. Now I would like to ask you about sports, fitness and recreational activities (leisure), [Insert relevant terms]. Do you do any vigorous-intensity sports, fitness or recreational (leisure) activities that cause large increases in breathing or heart rate like [running or footballcarry water by bucket from river or well, pull water by gutter, carry stone &coal, heavy work related to dwelling ] for at least 10 minutes continuously? [INSERT EXAMPLES] (USE SHOWCARD) In a typical week, on how many days do you do vigorous-intensity sports, fitness or recreational (leisure) activities? How much time do you spend doing vigorousintensity sports, fitness or recreational activities on a typical day? Do you do any moderate-intensity sports, fitness or recreational (leisure) activities that cause a small increase in breathing or heart rate such as brisk walking, [cycling, swimming, volleyball, dancing, jogging, carry heavy things of traditional dwelling, berrying or nutting] for at least 10 minutes continuously? [INSERT EXAMPLES] (USE SHOWCARD) In a typical week, on how many days do you do moderate-intensity sports, fitness or recreational (leisure) activities? How much time do you spend doing moderateintensity sports, fitness or recreational (leisure) activities on a typical day? Yes 1 P10 No 2 If No, go to P 13

142

Number of days

└─┘

P11

Hours : minutes

└─┴─┘: └─┴─┘ hrs mins

P12 (a-b)

Yes

1 P13

2 If No, go to P16

Number of days

└─┘

P14

Hours : minutes

└─┴─┘: └─┴─┘ hrs mins

P15 (a-b)

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

EXPANDED: Physical Activity Sedentary behaviour The following question is about sitting or reclining at work, at home, getting to and from places, or with friends including time spent sitting at a desk, sitting with friends, traveling in car, bus, train, reading, playing cards or watching television, but do not include time spent sleeping. [INSERT EXAMPLES] (USE SHOWCARD) 68 How much time do you usually spend sitting or reclining on a typical day? Hours : minutes └─┴─┘: └─┴─┘ hrs mins P16 (a-b)

CORE: History of Raised Blood Pressure Question 69 70 71 Have you ever had your blood pressure measured by a doctor or other health worker? Have you ever been told by a doctor or other health worker that you have raised blood pressure or hypertension? Have you been told in the past 12 months? Response Yes No Yes No Yes No 1 2 If No, go to H6 1 2 If No, go to H6 1 2 Code H1 H2a H2b

EXPANDED: History of Raised Blood Pressure Are you currently receiving any of the following treatments/advice for high blood pressure prescribed by a doctor or other health worker? Yes Drugs (medication) that you have taken in the past two weeks No Yes Advice to reduce salt intake No 72 Advice or treatment to lose weight No Yes Advice or treatment to stop smoking No Yes Advice to start or do more exercise No Yes 73 Have you ever seen a traditional healer for raised blood pressure or hypertension? No 74 Are you currently taking any herbal or traditional remedy for your raised blood pressure? Yes No 2 1 2 H5 2 1 H4 2 1 H3e 2 1 H3d Yes 2 1 H3c 2 1 H3b 1 H3a

CORE: History of Diabetes Question 75 Have you ever had your blood sugar measured by a doctor or other health worker? Have you ever been told by a doctor or other health worker that you have raised blood sugar or diabetes? Response Yes No Yes No 1 H6 2 If No, go to M1 1 H7a 2 If No, go to M1 Code

143

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Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Yes 77 Have you been told in the past 12 months? No EXPANDED: History of Diabetes

1 H7b 2

Are you currently receiving any of the following treatments/advice for diabetes prescribed by a doctor or other health worker? Yes Insulin No Yes Drugs (medication) that you have taken in the past two weeks No Yes 78 Special prescribed diet No Yes Advice or treatment to lose weight No Yes Advice or treatment to stop smoking No Yes Advice to start or do more exercise No Yes 79 Have you ever seen a traditional healer for diabetes or raised blood sugar? No Yes 80 Are you currently taking any herbal or traditional remedy for your diabetes? No 2 2 1 H10 2 1 H9 2 1 H8f 2 1 H8e 2 1 H8d 2 1 H8c 2 1 H8b 1 H8a

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Annex III

Breast and Cervical Cancer Question 81 Do you have a family history of cancer in a first-degree blood relative? (e.g. mother, father, sister, brother, son, daughter) Have you ever had a cervical cancer examination? Response Yes No Yes No 1 year or less Between 1 and 2 years 83 Have you ever had VIA test? (visual inspection of uterine cervix with acidic acid) More than 2 years Never Don’t know Breast and Cervical Cancer, continued Question Response 1 year or less Between 1 and 2 years 84 Have you ever had a Pap smear test? More than 2 years Never Don’t know 1 2 3 4 77 X6b Code 1 2 1 2 If No, go to X11 1 2 3 4 77 X6a X5 Code

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Have you ever had a breast cancer examination by a health care provider?

Yes No 1 year or less Between 1 and 2 years

1 2 If No, go to X8 1 2 3 4 77 1 2 3 4 77 1 3 4 77 2

Have you ever had a physical exam of the breasts?

More than 2 years Never Don’t know 1 year or less Between 1 and 2 years

X7a

Have you ever had a mammogram?

More than 2 years Never Don’t know 1 year or less Between 1 and 2 years

X7b

How often do you perform breast self-exams?

More than 2 years Never Don’t know

Violence and Injury CORE: Injury The next questions ask about different experiences and behaviours that are related to road traffic injuries. Question Response All of the time Sometimes 89 In the past 30 days, how often did you use a seat belt when you were the driver or passenger of a motor vehicle? Never Have not been in a vehicle in past 30 days No seat belt in the car I usually am in Don’t Know Refused All of the time Sometimes Never In the past 30 days, how often did you wear a helmet when you drove or rode as a passenger on a motorcycle or motor-scooter? Have not been on a motorcycle or motor-scooter in past 30 days Do not have a helmet Don’t Know Refused 1 2 3 1 2 3 4 5 77 88 V1 Code

5 77 88

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Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Yes (as driver) Yes (as passenger) 91 In the past 12 months, have you been involved in a road traffic crash as a driver, passenger, pedestrian, or cyclist? Yes (as pedestrian) Yes (as a cyclist) No Don’t know Refused Alcoholic drink Recreational medicine Fatigue / Illness Excess speed Pedestrian passed through wrong route / Failed to go by pedestrian route External factor (e.g. poor signage, poor road quality, poor lighting) Other (specify) Don’t Know Refused Other (please specify) 1 - 2 hours 93 On average, how many hours do you drive a motor vehicle per day? 3 - 6 hours 6 - 12 hours 12 hours or more Don’t know

1 2 3 4 5 If No, go to X7 77 If don’t know, go to X7 88 If Refused, go to X7 1 2 3 4 5 X9 6 7 77 88 └─┴─┴─┴─┴─┴─┴─┘ 1 2 3 4 77 X10 X9other V3

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Please indicate which of the following was the main reason for this road traffic crash?

The next questions ask about the most serious accidental injury you have had in the past 12 months. Yes 94 In the past 12 months, were you injured accidentally, other than the road traffic crashes which required medical attention? No Don’t know Refused Fall Burn Poisoning Cut Near-drowning Animal bite 95 Please indicate which of the following was the cause of this injury. Frostbite Hit by object / object fell on me Other (specify) Don’t know Refused Other (please specify) 1 2 If No, go to V10 77 If don’t know, go to V10 88 If Refused, go to V10 1 2 3 4 5 6 7 8 9 77 88 └─┴─┴─┴─┴─┴─┴─┘ V6other V6 V5

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

CORE: Injury, Continued Question Response Home School Workplace / Construction Site Road / Street / Highway / Tunnel (Transheine) 96 Where were you when you had this injury? Farm Sports / athletic area Public show / event River Other (specify) Don’t know Refused Other (please specify) EXPANDED: Unintentional Injury The next questions ask about behaviours related to your safety and whether or not you drink alcohol while driving or being a passenger. In the past 30 days, how many times have you ridden in a motorized vehicle where the driver has had 2 or more alcoholic drinks? (USE SHOWCARDS) Number of times Don’t Know Refused └─┴─┘ 77 88 V10 1 2 3 4 5 6 7 8 9 77 88 └─┴─┴─┴─┴─┴─┴─┘ V7other V7 Code

CORE: Violence The following questions are about different experiences and behaviours that are related to violence. Question Response Never Rarely (1- 2 times) In the past 12 months, how many times were you in a violent incident in which you were injured and required medical attention? Sometimes (3 – 5 times) Often (6 or more times) Don’t know Refused 1 If never, go to V14 2 3 4 77 If don’t know, go to V14 88 If Refused, go to V14 V11 Code

The next questions ask about the most serious violent incidence you have had in the past 12 months. Being shot with a firearm Please indicate which of the following caused your most serious injury in the last 12 months. (USE SHOWCARDS) A weapon (other than a firearm) was used by the person who injured me Being injured without any weapon (slapped, pushed…) Don’t know Refused 1 2 V12 3 77 88

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Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Intimate partner Parent Child, sibling, or other relative Friend or acquaintance Please indicate the relationship between yourself and the person(s) who caused your injury. Unrelated caregiver Stranger Official or legal authorities Other (specify) Refused

1 2 3 4 5 6 7 8 88 V13

100

Other (please specify)

└─┴─┴─┴─┴─┴─┴─┘

V13other

Annex III

Never Looking back on your childhood (before age 18 years), did a parent or adult in the household ever push, grab, shove, slap, hit, burn, or throw something at you? Very rarely Once a month Once a week Almost daily Don’t know Refused EXPANDED: Violence The next questions ask about behaviours related to your safety. Question In the past 12 months, have you been frightened for the safety of yourself or your family because of the anger or threats of another person(s)? Response Yes No Refused Intimate partner Parent Child, sibling, or other relative Friend or acquaintance 103 Please specify of whom you were most often frightened. Unrelated caregiver Stranger Official or legal authority Other (specify) Refused Other (please specify) 1

1 2 3 4 5 77 88 V14

101

148

Code 2 If no, go to X8 88 If refused, go to X8 1 2 3 4 5 6 7 8 88 └─┴─┴─┴─┴─┴─┴─┘ V18other V18

102

V17

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

Police Public administration staff Doctor or other health worker Family Friends Teacher Strangers Don’t know Refused

1 2 3 4 5 6 7 77 88 X11

104

Who would you directly contact if you were frightened for the safety of yourself or your family?

Step 2 Physical Measurements CORE: Height and Weight Question 105 106 107 108 Interviewer ID Device IDs for height and weight Height Weight If too large for scale 666.6 For women: Are you pregnant? Height Weight in Centimetres (cm) in Kilograms (kg) Yes No Response └─┴─┴─┘ └─┴─┘ └─┴─┘ └─┴─┴─┘. └─┘ └─┴─┴─┘.└─┘ 1 If Yes, go to M 8 2 └─┴─┘ in Centimetres (cm) └─┴─┴─┘.└─┘ └─┴─┴─┘ └─┴─┘ Small 114 Cuff size used Medium Large Systolic ( mmHg) 115 Reading 1 Diastolic (mmHg) Systolic ( mmHg) 116 Reading 2 Diastolic (mmHg) Systolic ( mmHg) 117 Reading 3 Diastolic (mmHg) During the past two weeks, have you been treated for raised blood pressure with drugs (medication) prescribed by a doctor or other health worker? Yes No └─┴─┴─┘ 1 M14 2 M13b └─┴─┴─┘ └─┴─┴─┘ M12b M13a └─┴─┴─┘ └─┴─┴─┘ M11b M12a 1 2 3 └─┴─┴─┘ M11a M10 Code M1 M2a M3 M4 M2b

109

CORE: Waist 110 111 112 113 Device ID for waist Waist circumference Interviewer ID Device ID for blood pressure M6 M7 M8 M9

CORE: Blood Pressure

118

149

Annex III

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

EXPANDED: Hip Circumference and Heart Rate Heart Rate Reading 1 119 Reading 2 Reading 3 120 Body Fat Beats per minute Beats per minute Beats per minute └─┴─┴─┘ └─┴─┴─┘ └─┴─┴─┘ M16a M16b M16c X13

Physical Fitness Test 121 Has participant agreed to participate in fitness test? yes -1 Measure Test Push up no - 2, If no go to STEP2 END Result Number of attempts in 1 minute Number of attempts within 15 seconds Number └─┴─┴ Duration Duration of breathing └─┴─┴ seconds └─┴─┴ seconds X17 └─┴─┴ X14 Code X15

Annex III

122

Power

123

Speed

Running in place

└─┴─┴

X16

150

124

Flexibility Balance Tolerability

Upward from sitting position (record only the highest number from two attempts) Standing on one leg Deep breath in and out

125 126

X18 X19

Step 3 Biochemical Measurements CORE: Blood Glucose Question 127 128 129 130 131 During the past 12 hours have you had anything to eat or drink, other than water? Technician ID Device ID Time of day blood specimen taken (24 hour clock) Fasting blood glucose Choose accordingly: mmol/l or mg/dl Today, have you taken insulin or other drugs (medication) that have been prescribed by a doctor or other health worker for raised blood glucose? Hours : minutes mmol/l mg/dl Yes No Response Yes No 1 2 └─┴─┴─┘ └─┴─┘ └─┴─┘: └─┴─┘ hrs mins └─┴─┘. └─┴─┘ └─┴─┴─┘.└─┘ 1 2 B6 Code B1 B2 B3 B4 B5

132

CORE: Blood Lipids, Cholesterol 133 134 Device ID Total cholesterol Choose accordingly: mmol/l or mg/dl During the past two weeks, have you been treated for raised cholesterol with drugs (medication) prescribed by a doctor or other health worker? mmol/l mg/dl Yes No └─┴─┘ └─┴─┘. └─┴─┘ └─┴─┴─┘.└─┘ 1 2 B7 B8

135

Mongolian Steps Survey On The Prevalence Of Noncommunicable Disease And Injury Risk Factors-2009

EXPANDED: Triglycerides and HDL Cholesterol 136 Device ID Triglycerides Choose accordingly: mmol/l or mg/dl └─┴─┘ mmol/l mg/dl mmol/l mg/dl mmol/l mg/dl └─┴─┘. └─┴─┘ B10 └─┴─┴─┘.└─┘ └─┘. └─┴─┘ B11 └─┴─┴─┘.└─┘ └─┘. └─┴─┘ X20 └─┴─┴─┘.└─┘

137

138

HDL Cholesterol Choose accordingly: mmol/l or mg/dl

139

LDL Cholesterol Choose accordingly: mmol/l or mg/dl

151

Annex III

Informations clés

Organisation Organisation mondiale de la santé (OMS)

Type de document Publications

Date d'adoption 31 décembre 2010

Source Organisation mondiale de la santé