Cardiovascular disease is a major cause of disability and premature death throughout the world, and contributes substantially to the escalating costs of health care. The underlying pathology is atherosclerosis, which develops over many years and is usually advanced by the time symptoms occur, genera
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lly in middle age. Acute coronary and cerebrovascular events frequently occur suddenly, and are often fatal before medical care can be given. Modification of risk factors has been shown to reduce mortality and morbidity in people with diagnosed or undiagnosed cardiovascular disease.
This publication provides guidance on reducing disability and premature deaths from coronary heart disease, cerebrovascular disease and peripheral vascular disease in people at high risk, who have not yet experienced a cardiovascular event. People with established cardiovascular disease are at very high risk of recurrent events and are not the subject of these guidelines. They have been addressed in previous WHO guidelines.
Several forms of therapy can prevent coronary, cerebral and peripheral vascular events. Decisions about whether to initiate specific preventive action, and with what degree of intensity, should be guided by estimation of the risk of any such vascular event. The risk prediction charts that accompany these guidelinesb allow treatment to be targeted accord-
ing to simple predictions of absolute cardiovascular risk.
Recommendations are made for management of major cardiovascular risk factors through changes in lifestyle and prophylactic drug therapies. The guidelines provide a framework for the development of national guidance on prevention of cardiovascular disease that takes into account the particular political, economic, social and medical circumstances.
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Effective risk communication requires the alignment of complex factors including trust between the communicator and the audience(s), audience involvement, and emotional responses to
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risk. Risk communication is especially challenging now as new media changes the landscape for both
communicators and their audiences. Viewed as a discussion of the most important findings for risk communicators and managers, this report delves into research-driven recommendations for effective risk communication practices.
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Report on Main Findings
The review encompasses three complementary components: 1) a review of published literature 2000-2015 on NCDs and their risk factors; 2) qualitative interviews with key a
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ctors engaged in NCD research in Myanmar; and 3) additional reviews of Myanmar ethical committee inquiries and postgraduate research on NCDs in Myanmar. This report outlines the key findings from the three components including a synthesis of the key outcomes from the literature review and qualitative interviews, and an assessment of the gaps in the evidence against a framework of evidence needs.
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Background: Cardiovascular disease (CVD), mainly heart attack and stroke, is the
leading cause of premature mortality in low and middle income countries (LMICs).
Identifying and managing individuals at high risk of CVD is an important strategy to
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prevent and control CVD, in addition to multisectoral population-based interventions to reduce CVD risk factors in the entire population.
Methods: We describe key public health considerations in identifying and managing individuals at high risk of CVD in LMICs.
Results: A main objective of any strategy to identify individuals at high CVD risk is to maximize the number of CVD events averted while minimizing the numbers of
individuals needing treatment. Scores estimating the total risk of CVD (e.g. ten-year risk of fatal and non-fatal CVD) are available for LMICs, and are based on the main CVD risk factors (history of CVD, age, sex, tobacco use, blood pressure, blood cholesterol and diabetes status). Opportunistic screening of CVD risk factors enables identification of persons with high CVD risk, but this strategy can be widely applied in low resource settings only if cost effective interventions are used (e.g. the WHO Package of Essential NCD interventions for primary health care in low resource settings package) and if treatment (generally for years) can be sustained, including continued availability ofaffordable medications and funding mechanisms that allow people to purchase medications without impoverishing them (e.g. universal access to health care). Thisalso emphasises the need to re-orient health systems in LMICs towards chronic diseases management.
Conclusion: The large burden of CVD in LMICs and the fact that persons with high
CVD can be identified and managed along cost-effective interventions mean that
health systems need to be structured in a way that encourages patient registration, opportunistic screening of CVD risk factors, efficient procedures for the management of chronic conditions (e.g. task sharing) and provision of affordable treatment for those with high CVD risk. The focus needs to be in primary care because that is where most of the population can access health care and because CVD programmes can be run effectively at this level.
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The Rwandan Ministry of Health recognizes the threat that Non-Communicable Diseases (NCDs) pose to health and development in Rwanda and in 2009 articulates strategies to respond to them in the Health Sector Strategic Plan 2012 - 2018 (HSSP3). Among other things, the plan calls for a national prevale
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nce survey on NCD risk factors. This report responds to that call and summarizes the findings of the first NCD risk factor survey in Rwanda conducted from November 2012 to March 2013.
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This revised trainer's guide contains a prototype training schedule for four days. Teaching and learning strategies are highly interactive, using participatory and experiential approach. Training outcomes include developing skills in assessment of clients for
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risk factors; conduct basic screening procedures and interpreting the results; holding health education sessions on risk factor modification; promoting healthy lifestyle; and mobilizing communities. The manual is divided into six modules.
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Chen et al. BMC Public Health 2014, 14:776 http://www.biomedcentral.com/1471-2458/14/776
Noncommunicable diseases (NCDs) are the principal cause of morbidity, disability and premature mortality in Azerbaijan. The most effective way to reduce the NCD burden is to prevent NCD development, by addressing thebehavioural risk
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factors underlying NCDs at the population and individual levels: smoking, alcohol use, excessive salt intake, low physical activity, overweight and obesity, and unhealthy diets. In Azerbaijan, a national survey of the prevalence of major NCD risk factors, aligned with the WHO-endorsed STEPwise approach to surveillance (STEPS) methodology, was conducted in 2017.
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Lack of satisfactory progress in mainstreaming disaster risk reduction within development is attributed to various factors. One of the important factor that is often not much appreciated is the inad
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equate comprehension of mainstreaming and the absence of clear, cogent and practical guidelines, tools and techniques for mainstreaming DRR within development. This Guidebook helps to tackle this challenge by providing strategic and practical guidelines on how to mainstream disaster risk reduction into their policies plans and programmes across key sectors. It discusses strategic approaches towards risk resilient development in the Asia-Pacific region and demonstrates how to operationalize them using examples from various countries in the region. These guidelines can be adopted by countries according to their specific contexts, resources and capacities.
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The World Health Organization (WHO) Global Status Report on Noncommunicable Diseases 2010 projects that noncommunicable diseases (NCDs) will be responsible for over 44 million deaths during the next decade, representing an increase of about 15% since 2010. Most of these deaths will occur in the WHO
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regions of Africa, South-East Asia and the Eastern Mediterranean. In the African Region alone, NCDs will cause around 3.9 million deaths by 2020.
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Data on asthma aetiology in Africa are scarce. We investigated the risk factors for asthma among schoolchildren (5–17 years) in urban Uganda. We conducted a case-control study, among 555 cases and
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1115 controls. Asthma was diagnosed by study clinicians. The main risk factors for asthma were tertiary education for fathers (adjusted OR (95% CI); 2.32 (1.71–3.16)) and mothers (1.85 (1.38–2.48)); area of residence at birth, with children born in a small town or in the city having an increased asthma risk compared to schoolchildren born in rural areas (2.16 (1.60–2.92)) and (2.79 (1.79–4.35)), respectively; father’s and mother’s history of asthma; children’s own allergic conditions; atopy; and cooking on gas/electricity. In conclusion, asthma was associated with a strong rural-town-city risk gradient, higher parental socio-economic status and urbanicity. This work provides the basis for future studies to identify specific environmental/lifestyle factors responsible for increasing asthma risk among children in urban areas in LMICs.
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A WHO Guideline for Emergency Risk Communication (ERC) policy and practice.
Recent public health emergencies, such as the Ebola virus disease outbreak in West Africa (2014–2015), the emergence of the Zika virus syndrome in 2015–2016 and multi-
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country yellow fever outbreaks in Africa in 2016, have highlighted major challenges and gaps in how risk is communicated during epidemics and other health emergencies. The challenges include the rapid transformation in communications technology, including the near-universal penetration of mobile telephones, the widespread use and increasingly powerful influence of digital media which has had an impact on ‘traditional’ media (newspapers, radio and television), and major changes in how people access and trust health information. Important gaps include considerations of context – the social, economic, political and cultural factors influencing people’s perception of risk and their risk-reduction behaviours.
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Non-communicable diseases (NCDs) are of increasing concern for society and national governments, as well as globally due to their high mortality rate. The main risk factors of NCDs can be classified
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into the categories of self-management, genetic factors, environmental factors, factors of medical conditions, and socio-demographic factors.
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This summary covers the preventive approach to breast cancer control and includes prophylactic medications, prophylactic surgery and lifestyle modifications for breast cancer prevention. Health professional training and individual risk assessments a
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nd counseling are also discussed.
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The Ministry of Health conducted STEPS surveys on adult risk factors surveillance in Myanmar in 2003, 2009 and 2014. Amongst these three surveys, the 2014 one is the most comprehensive, providing an
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analysis of all States and Regions within Myanmar through not only questionnaires and physical measurements – STEPs 1 and 2 of the survey – but also with data obtained through biochemical measurements (STEP 3).
The STEPS survey was initiated by the Ministry of Health in December 2014 with the technical support of WHO Headquarters, regional and country offices.
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DHS Working Papers No. 85
Lancet Glob Health 2018 Published Online September 12, 2018 http://dx.doi.org/10.1016/S2214-109X(18)30407-8