The WHO Stepwise Approach to Surveillance (Steps) of Non-Communicable Disease Risk Factors

Abstract

The third chapter in this comprehensive survey of 'Global Behavioral Risk Factor Surveillance' examines WHO's stepwise approach. Eight sections open with an introduction setting international context and effects of non-communicable diseases (NCD). The burden is fast increasing in developing countries with primary prevention the most cost-effective route to containment. Details of the emerging epidemic of chronic disease form section two. Demographic changes and increasing population risk factor levels account for the epidemic through economic and social changes. The third section explores surveillance definitions, the WHO role, a discussion on risk factor or disease surveillance, choice of factors and core measures. The WHO stepwise approach is explained in section four (STEPS), the main principle being the need for small amounts of good quality data in preference to considerable poor quality data or none at all. The recommended surveillance measures in STEPS are classified according to complexities in securing the data, such as questionnaires only, fieldwork or laboratory measures needing expertise from elsewhere. There is further detail on the core set of questionnaires and the information they should cover. Section four discusses a framework for NCD risk factor surveillance, additional NCD risk factors to be included according to local needs and the choice of summary measures. The challenges of moving from surveys to an effective surveillance system are reviewed in section five. There are brief conclusions in section six and 15 references in section seven. The Appendix in section eight lists 12 key questions for planning NCD risk factor surveillance.