2015-12-31-世界卫生组织-2016_STEPS_Country_report_Sudan_148页_4mb

Sudan STEPwise Survey for Non-Communicable Diseases Risk Factors 2016 Report Summary

Core Content

The Sudan STEPwise Survey for Non-Communicable Diseases (NCD) Risk Factors 2016 was the first nationally representative survey to collect comprehensive data on NCD risk factors and oral health among Sudanese adults aged 18–69 years. Conducted between February and December 2016, the survey was a joint effort by the Federal Ministry of Health (FMOH), the World Health Organization (WHO), and the Central Bureau of Statistics (CBS). It covered 11 states across six geographical regions, employing a four-stage stratified cluster sampling design to collect data from 302 clusters, resulting in a total sample of 8,154 households and individuals.

The survey was structured into three steps:

• STEP 1: Behavioral Risk Factors
• STEP 2: Anthropometric and Physical Measurements
• STEP 3: Biochemical Measurements

All data were weighted by gender and age, and the response rate was high (95% for STEP 1/2 and 88% for STEP 3). The primary goal was to establish baseline indicators for NCD risk factors to support policy and planning in Sudan.

Main Objectives

1. To determine the prevalence of four major behavioral risk factors for NCD: tobacco use, physical inactivity, unhealthy diet, and harmful use of alcohol.
2. To assess the prevalence and determinants of major biological risk factors for NCD: overweight and obesity, raised blood pressure, raised blood glucose, abnormal cholesterol levels, and salt intake.
3. To evaluate the burden of oral diseases.
4. To explore the link between different risk factors and health determinants such as socio-demographic status, gender, and age.

Key Findings

Behavioral Risk Factors (STEP 1)

• Tobacco Use:

  • 27.9% of Sudanese men used tobacco in any form (smoking or snuff dipping).
  • Overall smoking prevalence was 9.6%, with men (17.1%) significantly more likely to smoke than women (0.7%).
  • Khartoum had the highest smoking prevalence (22.3%), while Darfur had the lowest (12.2%).
  • The mean age of initiation into tobacco smoking was 19.5 years.
  • Smokeless tobacco use (snuff dipping) was very common, with an overall prevalence of 7.9%.
  • 71.8% of current smokers considered quitting after noticing health warnings on cigarette packages.
  • Only 34% of smokers received advice from doctors or health workers to quit.

• Alcohol Consumption:

  • The overall prevalence of current alcohol drinkers was low (3.6% for men).
  • Binge drinking (excessive drinking) was high (3.2%), putting the entire population of drinkers at risk.

• Dietary Pattern:

  • 94.7% of the population did not meet the WHO recommendation of consuming at least five portions of fruits and vegetables daily.
  • On average, fruits were consumed 1.9 days per week and vegetables 4.0 days per week.
  • The Darfur, Khartoum, Northern, and Central regions had higher fruit consumption than the national average.

• Salt Consumption:

  • 87% of participants believed that excessive salt intake could cause serious health issues.
  • 91.8% recognized the importance of reducing salt consumption.
  • 32.4% added salt or salty sauce to their food before eating.
  • Measured sodium in urine was 8.2 grams in Khartoum State.

• Sugar and Oil Consumption:

  • Sugar and oil consumption data were not fully provided in the summary, but the survey included metrics on daily sugar intake and types of oil/fat used for cooking.

• Physical Activity (PA):

  • 49% of participants did not meet WHO physical activity recommendations.
  • Work-related PA was the most common type, followed by transport and recreation-related activities.
  • Sedentary time was high, with 63% of participants spending more than 150 minutes per day in sedentary activities.

Biological Risk Factors (STEP 2 and 3)

Anthropometric and Physical Measurements (STEP 2)

• Overweight and Obesity:

  • The prevalence of overweight (BMI ≥ 25) and obesity was significant across all age groups and regions.
  • BMI data varied by region and urban/rural settings, with higher prevalence in urban areas.

• Raised Blood Pressure (RBP):

  • Prevalence of RBP (SBP ≥140 and/or DBP ≥90 mmHg) was notable, with some regions showing higher rates.
  • 34% of participants with RBP were on medication, and 22.1% had a history of visiting traditional healers.
  • The mean SBP and DBP were recorded, and the prevalence of Grade II RBP was reported.

• Raised Blood Glucose (RBG):

  • 48.7% of participants had RBG or were on medication.
  • Impaired Fasting Glucose (IFG) was also prevalent, with regional variations noted.

• Total Cholesterol:

  • The prevalence of high total cholesterol (≥5.0 mmol/L or ≥190 mg/dl) was significant.
  • 32.4% of participants had high cholesterol or were on medication.

Oral Health

• Teeth and Gum Status:
  • 46.2% of participants had poor or very poor teeth.
  • 34.7% had poor or very poor gums.
  • 31.1% used removable dentures.
  • 41.2% reported difficulty in chewing, and 35.4% experienced oral pain or discomfort in the past 12 months.
  • Many participants avoided smiling or experienced embarrassment due to dental issues.
  • Only 36.7% had visited a dentist in the past 12 months, and 53.6% had never received dental care.

Recommendations

The survey results will be used to update the NCDs action plan 2013–2020, with a focus on a multi-stakeholder approach to prevent and control NCDs. Key recommendations include:

• Strengthening tobacco control measures, including increasing awareness and access to cessation advice.
• Addressing binge drinking through targeted interventions.
• Promoting healthier dietary habits and reducing salt and sugar intake.
• Encouraging regular physical activity and reducing sedentary behavior.
• Improving access to dental care and promoting oral health awareness.
• Enhancing surveillance systems and integrating NCD prevention into broader policy frameworks.

Conclusion

The Sudan STEPwise Survey 2016 provides critical baseline data on NCD risk factors and oral health, enabling evidence-based policy-making and program development. It highlights the need for targeted interventions in key areas such as tobacco use, unhealthy diets, and physical inactivity. The survey also underscores the importance of improving access to health services, especially for dental care and chronic disease management, to address the growing burden of NCDs in Sudan.