Suboptimal Intake of Fruits and Vegetables in Nine Selected Countries of the World Health Organization European Region.

The objective of this study was to characterize fruit and vegetable consumption in 9 selected countries of the World Health Organization (WHO) European Region. We analyzed data on fruit and vegetable intake and participant sociodemographic characteristics for 30,455 adults in 9 Eastern European and Central Asian countries via standardized STEPS survey methodology. Fruit and vegetable consumption across all countries was suboptimal, with a high percentage of populations not meeting the WHO-recommended intake of at least 5 servings (400 g) per day. Strengthened implementation of evidence-based policies to increase intake of fruit and vegetables is needed to reduce the burden of and disparities in NCDs.

Exploring educational inequalities in hypertension control, salt knowledge and awareness, and patient advice: insights from the WHO STEPS surveys of adults from nine Eastern European and Central Asian countries.

OBJECTIVE: To inform strategies aimed at improving blood pressure (BP) control and reducing salt intake, we assessed educational inequalities in high blood pressure (HBP) awareness, treatment and control; physician's advice on salt reduction; and salt knowledge, perceptions and consumption behaviours in Eastern Europe and Central Asia. DESIGN: Data were collected in cross-sectional, population-based nationally representative surveys, using a multi-stage clustered sampling design. Five HBP awareness, treatment and control categories were created from measured BP and hypertension medication use. Education and other variables were self-reported. Weighted multinomial mixed-effects regression models, adjusted for confounders, were used to assess differences across education categories. SETTINGS: Nine Eastern European and Central Asian countries (Armenia, Azerbaijan, Belarus, Georgia, Kyrgyzstan, Republic of Moldova, Tajikistan, Turkey and Uzbekistan). PARTICIPANTS: Nationally representative samples of 30 455 adults aged 25-65 years. RESULTS: HBP awareness, treatment and control varied substantially by education. The coverage of physician's advice on salt was less frequent among participants with lower education, and those with untreated HBP or unaware of their HBP. The education gradient was evident in salt knowledge and perceptions of salt intake but not in salt consumption behaviours. Improved salt knowledge and perceptions were more prevalent among participants who received physician's advice on salt reduction. CONCLUSIONS: There is a strong education gradient in HBP awareness, treatment and control as well as salt knowledge and perceived intake. Enhancements in public and patient knowledge and awareness of HBP and its risk factors targeting socio-economically disadvantaged groups are urgently needed to alleviate the growing HBP burden in low- and middle-income countries.

Снижение потребления соли и уменьшение связанных с ним неблагоприятных последствий для здоровья населения в Республике Молдова. Аналитический обзор EVIPNet для формирования политики, Номер 9

Во всем мире высокий уровень потребления соли является одним из ведущих алиментарно-зависимых факторов риска смерти и сокращения лет жизни с поправкой на нетрудоспособность, а также одним из ведущих факторов риска гипертонии, сердечно-сосудистых заболеваний, инсульта, рака желудка и заболеваний почек. Задачи сокращения потребления соли и улучшения пищевых привычек требуют внедрения комплексной политики, направленной на различные сектора продовольственной инфраструктуры, и активного сотрудничества различных заинтересованных сторон. Настоящий АОФП был разработан Министерством здравоохранения совместно с Государственным университетом медицины и фармации имени Николая Тестемицану и страновым офисом ВОЗ в Республике Молдова, при поддержке технических экспертов Европейского регионального бюро ВОЗ. Обзор публикуется в рамках деятельности Европейской сети ВОЗ по вопросам использования научных данных при формировании политики с целью предоставления лицам, формирующим политику, научно обоснованных вариантов дальнейших действий для решения проблемы сокращения потребления соли в Республике Молдова. Рабочей группой при Министерстве здравоохранения были выявлены, отобраны, оценены и обобщены наилучшие имеющиеся фактические данные по данной проблеме, разработаны варианты ее решения и сформулированы соображения по реализации каждого варианта. В обзоре представлены семь вариантов политики, сгруппированных по двум элементам: Элемент 1. Структурные вмешательства на уровне населения: (1.1) Изменение состава продуктов питания; (1.2) Этикетирование продуктов питания; (1.3) Политика закупок продуктов питания в конкретных учреждениях и условиях; (1.4) Ограничение маркетинга для детей; (1.5) Вмешательства в области ценообразования; и Элемент 2. Мероприятия по изменению поведения на уровне населения: (2.1) Медико-санитарное просвещение; и (2.2) Информационные кампании.

Relationship between cardiovascular health status and attitudes towards responsibility for health.

Abstract.

Reducing salt consumption and its negative impacts in the Republic of Moldova: EVIPNet evidence brief for policy, number 9

High salt intake is one of the main dietary risk factors for death and disability-adjusted life years globally, and one of the main risk factors for hypertension, cardiovascular disease, stroke, stomach cancer and renal disease. Reducing salt consumption and improving dietary habits requires comprehensive policies targeting multiple sectors of the food system and active collaboration among of a variety of stakeholders. The Ministry of Health, along with “Nicolae Testemitanu” State University of Medicine and Pharmacy and the WHO Country Office in the Republic of Moldova developed this EBP, supported by technical experts from WHO Regional Office for Europe, to be published under the guidance of the WHO European Evidence-informed Policy Network, to make available evidence-informed options for policy-makers to tackle the problem of reducing salt consumption in the Republic of Moldova. A working group convened by the Ministry of Health identified, selected, appraised and synthesized best available evidence on the problem; formulated the options for tackling it; and weighed up considerations in implementing each option. The seven options grouped across two approaches are: Approach 1 Structural population-level interventions, including (1.1) Food product reformulation; (1.2) Food labelling; (1.3) Food procurement policy in specific settings; (1.4) Restrictions on marketing to children; (1.5) Pricing interventions; and Approach 2 Population-level behaviour change interventions, including (2.1) Health education; and (2.2) Information campaigns.

Cross-sectional study on the characteristics of unrecorded alcohol consumption in nine newly independent states between 2013 and 2017.

OBJECTIVES: As unrecorded alcohol use contributes to a substantial burden of disease, this study characterises this phenomenon in newly independent states (NIS) of the former Soviet Union with regard to the sources of unrecorded alcohol, and the proportion of unrecorded of total alcohol consumption. We also investigate associated sociodemographic characteristics and drinking patterns. DESIGN: Cross-sectional data on overall and unrecorded alcohol use in the past 7 days from WHO STEPwise Approach to NCD Risk Factor Surveillance (STEPS) surveys. Descriptive statistics were calculated at the country level, hierarchical logistic and linear regression models were used to investigate sociodemographic characteristics and drinking patterns associated with using unrecorded alcohol. SETTING: Nine NIS (Armenia, Azerbaijan, Belarus, Georgia, Kyrgyzstan, Republic of Moldova, Tajikistan, Turkmenistan and Uzbekistan) in the years 2013-2017. PARTICIPANTS: Nationally representative samples including a total of 36 259 participants. RESULTS: A total of 6251 participants (19.7%; 95% CI 7.9% to 31.5%) reported alcohol consumption in the past 7 days, 2185 of which (35.1%; 95% CI 8.2% to 62.0%) reported unrecorded alcohol consumption with pronounced differences between countries. The population-weighted average proportion of unrecorded consumption in nine NIS was 8.7% (95% CI 5.9% to 12.4%). The most common type of unrecorded alcohol was home-made spirits, followed by home-made beer and wine. Older (45-69 vs 25-44 years) and unemployed (vs employed) participants had higher odds of using unrecorded alcohol. More nuanced sociodemographic differences were observed for specific types of unrecorded alcohol. CONCLUSIONS: This contribution is the first to highlight both, prevalence and composition of unrecorded alcohol consumption in nine NIS. The observed proportions and sources of unrecorded alcohol are discussed in light of local challenges in policy implementation, especially in regard to the newly formed Eurasian Economic Union (EAEU), as some but not all NIS are in the EAEU.

Cervical cancer testing among women aged 30-49 years in the WHO European Region.

BACKGROUND: Screening programs play an important role in a comprehensive strategy to prevent cervical cancer, a leading cause of death among women of reproductive age. Unfortunately, there is a dearth of information about rates of cervical cancer testing, particularly in Eastern Europe and Central Asia where levels of cervical cancer are among the highest in the WHO European Region. The purpose of this article is to report on the lifetime prevalence of cervical cancer testing among females aged 30-49 years from across the WHO European region, and to describe high-level geographic and socioeconomic differences. METHODS: We used data from the European Health Information Survey and the WHO STEPwise approach to Surveillance survey to calculate the proportions of women who were tested for cervical cancer. RESULTS: The percentage of tested women ranged from 11.7% in Azerbaijan to 98.4% in Finland, with the lowest percentages observed in Azerbaijan, Tajikistan and Uzbekistan. Testing was lower in Eastern Europe (compared to Western Europe), among low-income countries and among women with lower levels of education. CONCLUSION: Effective cervical cancer screening programs are one part of a larger strategy, which must also include national scale-up of human papilloma virus vaccination, screening and treatment.

Physical inactivity in nine European and Central Asian countries: an analysis of national population-based survey results.

BACKGROUND: Physical inactivity is a major risk factor for non-communicable diseases. However, recent and systematically obtained national-level data to guide policy responses are often lacking, especially in countries in Eastern Europe and Central Asia. This article describes physical inactivity patterns among adults in Armenia, Azerbaijan, Belarus, Georgia, Kyrgyzstan, Republic of Moldova, Tajikistan, Turkey and Uzbekistan. METHODS: Data were collected using the Global Physical Activity Questionnaire drawing nationally representative samples of adults in each country. The national prevalence of physical inactivity was calculated as well as the proportional contribution to total physical activity (PA) during work, transport and leisure-time. An adjusted logistic regression model was applied to analyze the association of age, gender, education, household status and income with physical inactivity. RESULTS: National prevalence of physical inactivity ranged from 10.1% to 43.6%. The highest proportion of PA was registered during work or in the household in most countries, whereas the lowest was during leisure-time in all countries. Physical inactivity was more likely with older age in eight countries, with female gender in three countries, and with living alone in three countries. There was no clear pattern of association with education and income. CONCLUSION: Prevalence of physical inactivity is heterogeneous across the region. PA during leisure-time contributes minimally to total PA in all countries. Policies and programs that increase opportunities for active travel and leisure-time PA, especially for older adults, women and people living alone will be an essential part of strategies to increase overall population PA.

Sodium, Potassium and Iodine Intake, in A National Adult Population Sample of the Republic of Moldova.

In the Republic of Moldova, more than half of all deaths due to noncommunicable diseases (NCDs) are caused by cardiovascular disease (CVD). Excess salt (sodium) and inadequate potassium intakes are associated with high CVD. Moreover, salt iodisation is the preferred policy to prevent iodine deficiency and associated disorders. However, there is no survey that has directly measured sodium, potassium and iodine consumption in adults in the Republic of Moldova. A national random sample of adults attended a screening including demographic, anthropometric and physical measurements. Sodium, potassium and iodine intakes were assessed by 24 h urinary sodium (UNa), potassium (UK) and iodine (UI) excretions. Knowledge, attidues and behaviours were collected by questionnaire. Eight-hundred and fifty-eight participants (326 men and 532 women, 18-69 years) were included in the analysis (response rate 66%). Mean age was 48.5 years (SD 13.8). Mean UNa was 172.7 (79.3) mmoL/day, equivalent to 10.8 g of salt/day and potassium excretion 72.7 (31.5) mmoL/day, equivalent to 3.26 g/day. Only 11.3% met the World Health Organization (WHO) recommended salt targets of 5 g/day and 39% met potassium targets (>90 mmoL/day). Whilst 81.7% declared limiting their consumption of processed food and over 70% not adding salt at the table, only 8.8% looked at sodium content of food, 31% still added salt when cooking and less than 1% took other measures to control salt consumption. Measures of awareness were significantly more common in urban compared to rural areas. Mean urinary iodine was 225 (SD: 152; median 196) mcg/24 h, with no difference between sexes. According to WHO criteria, 41.0% had adequate iodine intake. Iodine content of salt table was 21.0 (SD: 18.6) mg/kg, lower in rural than urban areas (16.7, SD = 18.6 vs. 28.1, SD = 16.5 mg/kg, p < 0.001). In most cases participants were not using iodised salt as their main source of salt, more so in rural areas. In the Republic of Moldova, salt consumption is unequivocally high, potassium consumption is lower than recommended, both in men and in women, whilst iodine intake is still inadequate in one in three people, although severe iodine deficiency is rare. Salt consumed is often not iodised.

Prevalence of Severe Obesity among Primary School Children in 21 European Countries.

BACKGROUND: The World Health Organization (WHO) European Childhood Obesity Surveillance Initiative (COSI) was established more than 10 years ago to estimate prevalence and monitor changes in overweight and obesity in children aged 6-9 years. Since then, there have been five rounds of data collection in more than 40 countries involving more than half a million children. To date, no comparative studies with data on severe childhood obesity from European countries have been published. OBJECTIVES: The aim of this work was to present the prevalence of severe obesity in school-aged children from 21 countries participating in COSI. METHOD: The data are from cross-sectional studies in 21 European WHO member states that took part in the first three COSI rounds of data collection (2007/2008, 2009/2010, 2012/2013). School-aged children were measured using standardized instruments and methodology. Children were classified as severely obese using the definitions provided by WHO and the International Obesity Task Force (IOTF). Analyses overtime, by child's age and mother's educational level, were performed in a select group of countries. RESULTS: A total of 636,933 children were included in the analysis (323,648 boys and 313,285 girls). The prevalence of severe obesity varied greatly among countries, with higher values in Southern Europe. According to the WHO definition, severe obesity ranged from 1.0% in Swedish and Moldovan children (95% CI 0.7-1.3 and 0.7-1.5, respectively) to 5.5% (95% CI 4.9-6.1) in Maltese children. The prevalence was generally higher among boys compared to girls. The IOTF cut-offs lead to lower estimates, but confirm the differences among countries, and were more similar for both boys and girls. In many countries 1 in 4 obese children were severely obese. Applying the estimates of prevalence based on the WHO definition to the whole population of children aged 6-9 years in each country, around 398,000 children would be expected to be severely obese in the 21 European countries. The trend between 2007 and 2013 and the analysis by child's age did not show a clear pattern. Severe obesity was more common among children whose mother's educational level was lower. CONCLUSIONS: Severe obesity is a serious public health issue which affects a large number of children in Europe. Because of the impact on educational, health, social care, and economic systems, obesity needs to be addressed via a range of approaches from early prevention of overweight and obesity to treatment of those who need it.

Analysis of public health operations, services and activities in the Republic of Moldova

The public health system in the Republic of Moldova has undergone various reforms since 1992. The inherited sanitary–epidemiological services were transformed into a broader public health service. Reorganization of the public health system will continue in the coming years, both at national and regional levels, in order to strengthen the institutional framework, building a system that can address and respond to both communicable and noncommunicable diseases. To evaluate the current public health services and to make recommendations for strengthening their capacities, an overall assessment was carried out during 2011–2012, using the WHO European Region self-assessment tool. This report presents the results of the assessment, a joint effort of the WHO Regional Office for Europe, the WHO Country Office in the Republic of Moldova, the Ministry of Health, the National Centre of Public Health, and representatives of Centres of Public Health and health institutions within the country. It addresses the major challenges in the health sector, including demographics, the low level of public health service financing, and the significant burden of noncommunicable diseases and social and health inequalities. It also argues in favour of promoting public health governance and a “Health in All Policies” approach through multi- and intersectoral collaboration, including the coordination of public health activities within the health sector and beyond it. The main conclusions and recommendations will serve as a base for the development of the National Public Health Strategy 2013–2020, a policy document for effective interventions to reduce health inequalities and improve population health.