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.

A comparison of self-reported to cotinine-detected smoking status among adults in Georgia.

BACKGROUND: Self-reported measures of tobacco use may have limited validity, particularly among some populations. This study aims to validate self-reported smoking measures among Georgian adults participating in the 2016 STEPS survey using cotinine biomarker measurements, and to explore potential differences according to sociodemographic characteristics. Additionally, this paper examines how the estimated prevalence of smoking in the population varies according to measurement type. METHODS: Using the WHO standardized STEPS methodology, adults self-reported their smoking status. In a later stage of the survey, a subset of participants provided a urine sample, which was tested for cotinine. Using each participant's objective cotinine measurement and their self-reported smoking status, we calculated the sensitivity, specificity and positive predictive value of self-reported smoking. Next, we calculated the estimated prevalence of smokers according to the type of measurement. RESULTS: Results indicated high sensitivity (83.37%, 95% CI: 76.79-88.37%) among males and relatively low sensitivity (38.60% CI: 29.23-48.90%) among females. According to self-report, the prevalence of smokers was 26.44% (23.61-29.48%), while according to cotinine detection, the prevalence of smokers was 32.27% (29.16-35.55%). Among all subgroups, the self-reported prevalence of smoking was significantly lower than the cotinine-detected prevalence. CONCLUSIONS: To the best of our knowledge, this is the first time that the validity of the STEPS self-reported tobacco indicator has been tested. Self-reported measures of smoking status may lead to an under-estimation of smoking prevalence among Georgian adults, especially women. These findings suggest that integration of biochemical measures of smoking into tobacco use studies may be an important investment.

Отчет о ходе выполнения Программы и плана мероприятий по профилактике и контролю неинфекционных заболеваний в Кыргызской Республике, 2013–2020 гг.

В 2013 году Кыргызстан принял программу и план реализации программы по профилактике и контролюнеинфекционных заболеваний (НИЗ) на 2013–2020 гг. Страна обратилась к Региональному бюро ВОЗ за помощью впроведении среднесрочной оценки реализации программы с целью мониторинга прогресса в достижении целей,выявления проблем и возможностей для улучшения реализации программы и внедрения инноваций на второмэтапе. Проведение оценки программы и плана реализации программы по НИЗ руководствовалось всеобъемлющиммеханизмом, основанным на логической матрице цепочки результатов. Ключевые рекомендации, разработанныеи согласованные с Министерством здравоохранения, касались следующих направлений: активизации усилий вотношении контроля факторов риска НИЗ; наращивания потенциала в области мониторинга и оценки; повышенияэффективности распределения ресурсов; укрепления координации и подотчетности в целях наращиванияпотенциала

Progress report on the implementation of Kyrgyzstan’s programme and action plan on prevention and control of noncommunicable diseases, 2013–2020

Kyrgyzstan adopted a NCD programme and an action plan on noncommunicable diseases (NCDs) for 2013–2020 in 2013. The country requested support from the WHO Regional Office for Europe in conducting a mid-term review on its implementation to monitor progress towards the targets and to identify challenges and opportunities for improvement and innovation in the second part of the term. A comprehensive framework guided the review of the programme and action plan on NCDs based on the logical result-chain matrix. Key recommendations have been identified and discussed with the Ministry of Health in the following areas: accelerating efforts to control the NCD risk factors; increasing capacity in monitoring and evaluation; improving allocative efficiency; and strengthening coordination and accountability to ensure increased capacity.

Revising the WHO verbal autopsy instrument to facilitate routine cause-of-death monitoring.

OBJECTIVE: Verbal autopsy (VA) is a systematic approach for determining causes of death (CoD) in populations without routine medical certification. It has mainly been used in research contexts and involved relatively lengthy interviews. Our objective here is to describe the process used to shorten, simplify, and standardise the VA process to make it feasible for application on a larger scale such as in routine civil registration and vital statistics (CRVS) systems. METHODS: A literature review of existing VA instruments was undertaken. The World Health Organization (WHO) then facilitated an international consultation process to review experiences with existing VA instruments, including those from WHO, the Demographic Evaluation of Populations and their Health in Developing Countries (INDEPTH) Network, InterVA, and the Population Health Metrics Research Consortium (PHMRC). In an expert meeting, consideration was given to formulating a workable VA CoD list [with mapping to the International Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) CoD] and to the viability and utility of existing VA interview questions, with a view to undertaking systematic simplification. FINDINGS: A revised VA CoD list was compiled enabling mapping of all ICD-10 CoD onto 62 VA cause categories, chosen on the grounds of public health significance as well as potential for ascertainment from VA. A set of 221 indicators for inclusion in the revised VA instrument was developed on the basis of accumulated experience, with appropriate skip patterns for various population sub-groups. The duration of a VA interview was reduced by about 40% with this new approach. CONCLUSIONS: The revised VA instrument resulting from this consultation process is presented here as a means of making it available for widespread use and evaluation. It is envisaged that this will be used in conjunction with automated models for assigning CoD from VA data, rather than involving physicians.

Program for validation of aggregated hospital discharge data.

Hospitals are major providers of health services and analysis of hospital activity data is of great interest for both policy makers and public health researchers. The WHO Regional Office for Europe disseminates the hospital discharge data from European countries through the European Hospital Morbidity Database, available on http://data.euro.who.int/hmdb. In order to ensure that reliable high quality data on hospital activities can be published in a timely manner, a program for validation of hospital discharge data has been developed using the R language for statistical computing. This program has been in use since the October 2012 version of the European Hospital Morbidity Database and its use has contributed to improved quality and comparability of data on hospital activities across Europe.

Methods for measuring health inequalities (part I)

Source: Originally published with the title gb sMétodos de medición de las desigualdades de salud gc s, in Pan American Journal of Public Health 12(6), 2002

Overview of social inequalities in health in the Region of the Americas, using various methodological approaches

Over the past decade, according to several important indicators, health conditions have improved in the Region of the Americas. However, inequalities persist among the countries of the Region. This article has two primary objectives: 1) to provide some unbiased evidence on health inequalities among countries of the Region of the Americas and 2) to illustrate the application of some of the more frequently used methods for measuring inequalities, including effect measurements, population attributable risk, the slope index of inequality, the relative index of inequality, and the concentration index. Analyses have shown that there are great health disparities in the Region of the Americas. For example, residents of the poorest countries of the region live nearly 10 years less, on average, than do residents of the richest countries. If the other countries of the Americas had the same incidence of tuberculosis as does the subregion of North America (Bermuda, Canada, and the United States of America), there would be 76 percent fewer cases of this disease in the region. In the Americas, nearly 35 percent of deaths of infants under 1 year old are concentrated in the 20 percent of live births that occur in the group with the lowest income. As for maternal mortality in the Americas, fewer than 2 percent of maternal deaths occur in association with the 20 percent of live births in the group with the highest income. The analyses of health inequalities based on the use of various methods highlight the existence of important disparities among subregions and countries of the Americas that are not readily seen when using only the more-traditional methods for analyzing mortality and morbidity. There is also a need to incorporate the concepts of distribution and socioeconomic dimensions of health when interpreting a given situation. Using this approach will allow decisionmakers to target areas and populations that are in less-favorable conditions. A considerable body of aggregate data at the regional and country levels from routine information systems is already available-especially on morbidity, mortality, and other health-related factors-that can be used on a regular basis to analyze health inequalities. These kinds of analyses may be regarded as a first step toward the identification of health inequalities (AU)