GMF Indicator Definitions FinalNOV2014
Global Monitoring Framework:
Member States have agreed 25 indicators across three areas which focus on the key outcomes, risk factors and national systems response needed to prevent and control NCDs. (see figure 1).
Figure 1. Global Monitoring Framework
Framework
Element
Target Indicator
OUTCOMES
Premature mortality
1. A 25 relative reduction in the
1. Unconditional probability of dying between ages of 30 and 70
from
overall mortality from cardiovascular
from cardiovascular diseases, cancer, diabetes or chronic
noncommunicable
diseases, cancer, diabetes, or
respiratory diseases
disease
chronic respiratory diseases
Additional indicator
2. Cancer incidence, by type of cancer, per 100 000 population
BEHAVIOURAL RISK FACTORS
Harmful use of
2. At least 10 relative reduction in
3. Total (recorded and unrecorded) alcohol per capita (aged
alcohol the harmful use of alcohol, as
15+ years old) consumption within a calendar year in litres of
appropriate, within the national
pure alcohol, as appropriate, within the national context
context 4. Age-standardized prevalence of heavy episodic drinking among adolescents and adults, as appropriate, within the national context
5. Alcohol-related morbidity and mortality among adolescents and adults, as appropriate, within the national context
Physical inactivity
3. A 10 relative reduction in
6. Prevalence of insufficiently physically active adolescents,
prevalence of insufficient physical
defined as less than 60 minutes of moderate to vigorous activity intensity activity daily
7. Age-standardized prevalence of insufficiently physically active persons aged 18+ years (defined as less than 150 minutes of moderate-intensity activity per week, or equivalent)
Saltsodium intake
4. A 30 relative reduction in mean
8. Age-standardized mean population intake of salt (sodium population intake of saltsodium chloride) per day in grams in persons aged 18+ years
Tobacco use 5. A 30 relative reduction in
9. Prevalence of current tobacco use among adolescents
prevalence of current tobacco use
10. Age-standardized prevalence of current tobacco use among persons aged 18+ years
BIOLOGICAL RISK FACTORS
Raised blood
6. A 25 relative reduction in the
11. Age-standardized prevalence of raised blood pressure
pressure prevalence of raised blood pressure
among persons aged 18+ years (defined as systolic blood
or contain the prevalence of raised
pressure ≥140 mmHg andor diastolic blood pressure ≥90
blood pressure, according to national
mmHg) and mean systolic blood pressure
circumstances Diabetes and obesity 7. Halt the rise in diabetes obesity 12. Age-standardized prevalence of raised blood
glucosediabetes among persons aged 18+ years (defined as fasting plasma glucose concentration ≥ 7.0 mmoll (126 mgdl) or on medication for raised blood glucose)
13. Prevalence of overweight and obesity in adolescents (defined according to the WHO growth reference for school- aged children and adolescents, overweight – one standard deviation body mass index for age and sex, and obese – two standard deviations body mass index for age and sex)
14. Age-standardized prevalence of overweight and obesity in persons aged 18+ years (defined as body mass index ≥ 25 kgm² for overweight and body mass index ≥ 30 kgm² for obesity)
Additional indicators
15. Age-standardized mean proportion of total energy intake from saturated fatty acids in persons aged 18+ years
16. Age-standardized prevalence of persons (aged 18+ years) consuming less than five total servings (400 grams) of fruit and vegetables per day
17. Age-standardized prevalence of raised total cholesterol among persons aged 18+ years (defined as total cholesterol ≥5.0 mmoll or 190 mgdl); and mean total cholesterol concentration
NATIONAL SYSTEMS RESPONSE
Drug therapy to
8. At least 50 of eligible people
18. Proportion of eligible persons (defined as aged 40 years
prevent heart attacks
receive drug therapy and counselling
and older with a 10-year cardiovascular risk ≥30, including
and strokes
(including glycaemic control) to
those with existing cardiovascular disease) receiving drug prevent heart attacks and strokes therapy and counselling (including glycaemic control) to prevent heart attacks and strokes
Essential
9. An 80 availability of the
19. Availability and affordability of quality, safe and efficacious
noncommunicable
affordable basic technologies and
essential noncommunicable disease medicines, including
disease medicines
essential medicines, including
generics, and basic technologies in both public and private
and basic
generics required to treat major
facilities
technologies to treat
noncommunicable diseases in both
major
public and private facilities
noncommunicable diseases
Additional indicators
20. Access to palliative care assessed by morphine-equivalent
21. Adoption of national policies that limit saturated fatty acids and virtually eliminate partially hydrogenated vegetable oils in the food supply, as appropriate, within the national context and national programmes
22. Availability, as appropriate, if cost-effective and affordable, of vaccines against human papillomavirus, according to national programmes and policies
23. Policies to reduce the impact on children of marketing of foods and non-alcoholic beverages high in saturated fats, trans fatty acids, free sugars, or salt
24. Vaccination coverage against hepatitis B virus monitored by number of third doses of Hep-B vaccine (HepB3) administered to infants
25. Proportion of women between the ages of 30–49 screened for cervical cancer at least once, or more often, and for lower or higher age groups according to national programmes or policies
Global Targets for NCDs:
Nine areas have been selected from the 25 indicators in the Global Monitoring Framework to be targets (see figure 2): one mortality target (previously agreed at the WHA in May 2012); six risk factor targets (harmful use of alcohol, physical inactivity, dietary sodium intake, tobacco use, raised blood pressure, and diabetes and obesity), and two national systems targets (drug therapy to prevent heart attacks and strokes, and essential NCD medicines and technologies to treat major NCDs). The targets are both attainable and significant, and when achieved will represent major accomplishments in NCD and risk factors reductions. The global NCD targets are intended to focus global attention on NCDs and would represent a major contribution to NCD prevention and control. Targets have been set for 2025, with a baseline of 2010.
Figure 2. Global voluntary targets for NCDs
A 25 relative reduction in risk of premature mortality from cardiovascular diseases, cancer, diabetes, or chronic respiratory diseases
At least 10 relative reduction in the harmful use of alcohol
A 10 relative reduction in prevalence of insufficient physical activity
A 30 relative reduction in mean population intake of saltsodium
A 30 relative reduction in prevalence of current tobacco use
A 25 relative reduction in the prevalence of raised blood pressure or contain the prevalence of raised blood pressure, according to national circumstances
Halt the rise in diabetes and obesity
At least 50 of eligible people receive drug therapy and counselling (including glycaemic control) to prevent heart attacks and strokes
An 80 availability of the affordable basic technologies and essential medicines, including generics, required to treat major noncommunicable diseases in both public and private facilities
Setting National Targets:
Member States are strongly encouraged to consider the development of national targets based on their own national situations, which build on the nine global voluntary targets. Setting targets is a way to draw attention to NCDs and help mobilize resources to address NCD priorities. National targets may need to be adapted from the global targets if a country has already achieved a target or if the global target is too low given the progress already achieved within the country.
As a starting point, Member States interested in setting national NCD targets are encouraged to consider the following: •
Are the targets and indicators included in the GMF all suitable in the national context?
•
Are there additional targets and indicators needed for the country?
•
Are the systems in place to track these 25 global indicators and report on nine global targets? And systems which track any new proposed ones?
•
What is the current level of exposuremortalityservice provision?
•
Are the reductions or coverage proposed for global targets appropriate in the national context or should they be more ambitious?
Reporting on the Global NCD Indicators:
WHO is mandated to prepare regular updates on the progress towards achieving the nine global NCD targets and the status globally in relation to the 25 indicators included in the Global Monitoring Framework. To enable these reports to
be as comprehensive as possible, Member States are strongly encouraged to submit data to WHO on a regular basis to enable analysis of the global status of NCD targets and indicators. For ease of data submission, WHO has prepared a template for reporting against the NCD indicators. This template is available upon request from WHO by contacting: ncdmonitoringwho.int .
Where multiple indicators exist for one target (i.e. for alcohol), Member States should endeavor to report against as many indicators as possible. However they should also choose to report against the one most appropriate for their national circumstances.
It is important to note that WHO will continue to produce figures for each country that are comparable across all Member States. While these comparable figures will be based on the data submitted by Member States, they will also take into consideration differences across countries in data availability, data type, population structure and other data characteristics that reduce comparability across countries. Thus, the figures produced by WHO may differ from those reported by each individual Member State.
Name abbreviated
Premature NCD Mortality
Indicator name
Unconditional probability of dying between ages 30 and 70 years from cardiovascular diseases, cancer, diabetes, or chronic respiratory diseases
Definition
Probability of dying between the exact ages 30 and 70 years from cardiovascular diseases, cancer, diabetes, or chronic respiratory diseases. Deaths from these four causes will be based on the following ICD codes: I00-I99, C00-C97, E10-E14, and J30-J98.
Method of
Age-specific death rates for the combined four cause categories (typically in terms of 5-
estimationcalculation
year age groups 30-34,…, 65-69). A life table method allows calculation of the risk of death between exact ages 30 and 70 from any of these causes, in the absence of other causes of death. The ICD codes to be included in the calculation are: cardiovascular disease: I00-I99, Cancer: C00-C97, Diabetes: E10-E14, Chronic respiratory: J30-J98. To calculate age-specific mortality rate for each five-year age group and country, for each 5-year age range between 30 and 70:
Then translate the 5-year death rate to the probability of death in each 5-year age range:
The probability of death from age 30 to age 70, independent of other causes of death can
be calculated as:
Preferred data sources
Vital registration systems which record deaths with sufficient completeness to allow estimation of all-cause death rates.
Other possible data sources Sample registration systems; verbal autopsy.
NCD Framework
Outcome
Disaggregation
Sex, other relevant socio-demographic stratifiers where available
Expected frequency of data Annual
collection Limitations
Potential limitations include: - incomplete or unusable death registration data
Data type
Probability
Related links
http:www.who.intghomortality_burden_diseaseen http:www.who.inthealthinfostatisticsLT_method.pdf
Name abbreviated
Cancer incidence
Indicator name
Cancer incidence, by type of cancer
Definition
Number of new cancers of a specific sitetype occurring in the population per year, usually expressed as the number of new cancers per 100,000 population.
Method of
× 100,000
estimationcalculation
At-ri ℎ
Numerator
Number of new cancer cases diagnosed in a specific year. This may include multiple primary cancers occurring in one patient. The primary site reported is the site of origin and not the metastatic site. In general, the incidence rate would not include recurrences.
Denominator
At-risk population for the given category of cancer. The population used depends on the rate to be calculated. For cancer sites that occur in only one sex, the sex-specific population (e.g., females for cervical cancer) is used.
Preferred data sources
Population-based cancer registries, which collect and classify information on all new cases of cancer in a defined population
Other possible data sources NCD Framework
Outcome
Disaggregation
Age, Sex, other relevant socio-demographic stratifiers where available
Expected frequency of data Annual
collection Limitations
Potential limitations include: - incomplete records - inadequate coverage of registries
Data type
Rate
Related links
http:globocan.iarc.fr http:www.iacr.com.frcanreg5.htm
Name abbreviated
Harmful use of alcohol: Adult Per Capita Consumption
Indicator name
Total (recorded and unrecorded) alcohol per capita (APC) (15+ years old) consumption within a calendar year in litres of pure alcohol
Definition
Consumption of pure alcohol (ethanol) in litres per person aged 15+ during one calendar year.
Method of
Sum of recorded and unrecorded alcohol consumed in a population during a calendar year, in litres.
Denominator
Midyear resident population aged 15+ for the same calendar year.
Preferred data sources
Administrative reporting systems for recorded APC and survey data for unrecorded APC. The priority of data sources for recorded alcohol per capita consumption should be given to government statistics on sales of alcoholic beverages during a calendar year or data on production, export and import of alcohol in different beverage categories. For countries, where the governmental sales or production data is not available, the preferred data source would be country specific and publicly available data from the private sector, including alcohol producers or country specific data from the Food and Agriculture Organization of the United Nations statistical database (FAOSTAT), which may also include the estimates of unrecorded alcohol consumption. For main categories of alcohol beverages “Beer” includes malt beers, “Wine” includes wine made from grapes, “Spirits” include all distilled beverages, and “Other” includes one or several other alcoholic beverages, such as fermented beverages made from sorghum, maize, millet, rice, or cider, fruit wine, fortified wine, etc. Data sources for unrecorded alcohol consumption include survey data, FAOSTAT data, other data sources such as customs or police data, and expert opinions.
Other possible data sources Data sets of FAO and UN Statistical office
NCD Framework
Risk factor exposure
Disaggregation
Age, Sex, other relevant socio-demographic stratifiers where available
Expected frequency of data Annual
collection Limitations
Potential limitations include: - incomplete administrative records - bias through self-report, including under-reporting of alcohol consumption - misunderstanding -interpretation of questions and or size of a standard drink - limited validity of survey instruments
Data type
Volume
Related links
http:apps.who.intghodataview.main?showonly=GISAH
Name abbreviated
Harmful use of alcohol: heavy episodic drinking
Indicator name
Age-standardized prevalence of heavy episodic drinking
Definition
Heavy episodic drinking among adults is defined as those who report drinking 6 (60 grams) or more standard drinks in a single drinking occasion
Method of
ℎ ℎ
estimationcalculation
x 100
Numerator
Number of persons reporting consuming 60 grams or more of pure alcohol on at least one
occasion monthly
Denominator
All respondents of the survey
Preferred data sources Population-based (preferably nationally representative) survey
Other possible data sources
NCD Framework
Risk factor exposure
Disaggregation
Age, Sex, other relevant socio-demographic stratifiers where available
Expected frequency of At least every 5 years
data collection Limitations
Potential limitations include: - bias through self-report, including under-reporting of alcohol consumption - misunderstanding -interpretation of questions and or size of a standard drink - limited validity of survey instruments
Data type
Prevalence
Related links
http:apps.who.intghodataview.main?showonly=GISAH
Name abbreviated
Harmful use of alcohol: alcohol-related morbidity and mortality
Indicator name
Alcohol-related morbidity and mortality among adolescents and adults (monitored by alcohol use disorders).
Definition
Adults (15+ years) who suffer from disorders attributable to the consumption of alcohol (according to ICD-10: F10.1 Harmful use of alcohol; F10.2 Alcohol dependence) during a given calendar year.
Method of
Number of adults (15+ years) with a diagnosis of F10. or F10.2 during a calendar year. Using the algorithms specified in the validated instruments, presence or absence of harmful use of alcohol or alcohol dependence can be determined. AUD will be scored if either disease category is present.
Denominator
All respondents of the survey aged 15+ years.
Preferred data sources
Population-based (preferably nationally representative) survey using validated instruments
Other possible data sources Additional health services reporting systems may provide complementary or confirmatory
information regarding to the frequency and severity of alcohol use Disorders.
NCD Framework
Risk factor exposure
Disaggregation
Age, Sex, other relevant socio-demographic stratifiers where available
Expected frequency of data At least every 5 years
collection Limitations
Potential limitations include:
-bias through self-report, including under-reporting - misunderstanding -interpretation of questions - limited validity of survey instruments
Data type
Prevalence
Related links
http:apps.who.intghodataview.main?showonly=GISAH
Name abbreviated
Physical inactivity in adolescents
Indicator name
Prevalence of insufficiently physically active adolescents
Definition
Percentage of adolescents participating in less than 60 minutes of moderate to vigorous intensity physical activity daily.
Adolescents are defined as 10 – 19 year olds or according to country definition.
Method of
Number of respondents for whom the number of days per week with <60 minutes of moderate to vigorous intensity activity is <7 days
Denominator
All adolescent respondents of the survey
Preferred data sources
School-based or population-based (preferably nationally representative) survey
Other possible data sources NCD Framework
Risk factor exposure
Disaggregation
Age, Sex, other relevant socio-demographic stratifiers where available
Expected frequency of
At least every 5 years
data collection Limitations
Potential limitations include: - bias through self-report, including over-reporting of activity - misunderstanding -interpretation of questions and or intensity of physical activity - limited validity of survey instruments
Data type
Prevalence
Related links
http:who.intchpgshsen http:www.who.intdietphysicalactivitypublications9789241599979enindex.html
Name abbreviated Physical inactivity in adults
Indicator name
Age-standardized prevalence of insufficiently physically active persons aged 18+ years
Definition
Percentage of adults aged 18+ years not meeting any of the following criteria: – 150 minutes of moderate-intensity physical activity per week – 75 minutes of vigorous-intensity physical activity per week – an equivalent combination of moderate- and vigorous-intensity physical activity
accumulating at least 600 MET-minutes per week
Minutes of physical activity can be accumulated over the course of a week but must be of
a duration of at least 10 minutes.
MET refers to metabolic equivalent. It is the ratio of a person's working metabolic rate relative to the resting metabolic rate. One MET is defined as the energy cost of sitting quietly, and is equivalent to a caloric consumption of 1 kcalkghour. Physical activities are frequently classified by their intensity, using the MET as a reference.
Method of
Number of respondents where all 3 of the following criteria are true: (1) Weekly minutes of vigorous activity < 75 mins. (2) Weekly minutes of moderate activity < 150 mins. (3) Weekly MET-minutes < 600.
Weekly minutes is calculated by multiplying the number of days on which vigorousmoderate is done by the number of minutes of vigorousmoderate activity per day. Weekly MET-minutes is calculated by multiplying the weekly minutes of vigorous activity by 8 and the number of weekly minutes of moderate activity by 4 and then adding these two results together.
Denominator
All respondents of the survey aged 18+ years.
Preferred data sources
Population-based (preferably nationally representative) survey
Other possible data sources NCD Framework
Risk factor exposure
Disaggregation
Age, Sex, other relevant socio-demographic stratifiers where available
Expected frequency of data At least every 5 years
collection Limitations
Potential limitations include: - bias through self-report, including over-reporting of activity - misunderstanding -interpretation of questions and or intensity of physical activity - limited validity of survey instruments
Data type
Prevalence
Related links
http:www.who.intchpstepsGPAQen http:www.who.intchpstepsenindex.html http:www.who.intdietphysicalactivitypublications9789241599979enindex.html
Name abbreviated
Salt intake
Indicator name
Age-standardized mean population intake of salt (sodium chloride) per day in grams in persons aged 18+ years
Definition
Mean population intake of salt in grams
Method of
estimationcalculation Numerator
Sum of sodium excretion in urine samples from all respondents aged 18+years. The gold- standard for estimating salt intake is through 24-hour urine collection, however other methods such as spot urines and food frequency surveys may be more feasible to administer at the population level.
Denominator
All respondents of the survey aged 18+ years.
Preferred data sources
Population-based (preferably nationally representative) survey
Other possible data sources NCD Framework
Risk factor exposure
Disaggregation
Age, Sex, other relevant socio-demographic stratifiers where available
Expected frequency of data At least every 5 years
collection Limitations
Potential limitations include: - measurement error
Data type
Mean
Related links
http:www.who.intchpstepsenindex.html http:whqlibdoc.who.intpublications20119789241501699_eng.pdf
Name abbreviated Name abbreviated
Tobacco use in adolescents
Indicator name
Prevalence of current tobacco use among adolescents
Definition
Percentage of adolescents who currently use any tobacco product (smoked or smokeless). “Smoked tobacco products” includes the consumption of cigarettes, bidis, cigars, cheroots, pipes, shisha (water pipes), fine-cut smoking articles (roll-your-own), krekets, and any other form of smoked tobacco.
"Smokeless tobacco" includes moist snuff, plug, creamy snuff, dissolvables, dry snuff, gul, loose leaf, red tooth powder, snus, chimo, gutkha, khaini, gudakhu, zarda, quiwam, dohra, tuibur, nasway, naasnaswar, shammah, betel quid, toombak, pan (betel quid), iq’mik, mishri, tapkeer, tombol and any other tobacco product that is sniffed, held in the mouth, or chewed.
Adolescents are defined as 10 – 19 year olds or according to country definition.
Method of
Number of current adolescent tobacco users. “Current users” includes both daily and non-daily users of smoked or smokeless tobacco.
Denominator
All adolescent respondents of the survey.
Preferred data sources
School-based or population-based (preferably nationally representative) survey
Other possible data sources NCD Framework
Risk factor exposure
Disaggregation
Age, Sex, other relevant socio-demographic stratifiers where available
Expected frequency of data At least every 5 years
collection Limitations
Potential limitations include: - bias through self-report, including under-reporting of tobacco use - misunderstanding -interpretation of questions - limited validity of survey instruments
Data type
Prevalence
Related links
http:www.who.inttobaccosurveillancegytsen http:who.intchpgshsen
Name abbreviated Name abbreviated
Tobacco use in adults Tobacco use in adults
Definition Indicator name
Age-standardized prevalence of current tobacco use among persons aged 18+ years
Indicator name
Age-standardized prevalence of current tobacco use among persons aged 18+ years
Definition
“Smoked tobacco products” includes the consumption of cigarettes, bidis, cigars, cheroots, pipes, shisha (water pipes), fine-cut smoking articles (roll-your-own), krekets, and any other form of smoked tobacco.
"Smokeless tobacco" includes moist snuff, plug, creamy snuff, dissolvables, dry snuff, gul, loose leaf, red tooth powder, snus, chimo, gutkha, khaini, gudakhu, zarda, quiwam, dohra, tuibur, nasway, naasnaswar, shammah, betel quid, toombak, pan (betel quid), iq’mik, mishri, tapkeer, tombol and any other tobacco product that is sniffed, held in the mouth, or chewed.
Method of
Number of current tobacco users aged 18+ years. “Current users” includes both daily and non-daily users or smoked or smokeless tobacco.
Denominator
All respondents of the survey aged 18+ years.
Preferred data sources
Population-based (preferably nationally representative) survey
Other possible data sources
NCD Framework
Risk factor exposure
Disaggregation
Age, Sex, other relevant socio-demographic stratifiers where available
Expected frequency of
At least every 5 years
data collection Limitations
Potential limitations include: - bias through self-report, including under-reporting of tobacco use - misunderstanding -interpretation of questions - limited validity of survey instruments - representativeness of the sample
Data type
Prevalence
Related links
http:www.who.inttobaccosurveillancesurveygatsen http:www.who.intchpstepsenindex.html
Name abbreviated
Raised blood pressure
Indicator name
Age-standardized prevalence of raised blood pressure among persons aged 18+ years
Definition
Systolic blood pressure ≥140 andor diastolic blood pressure ≥90 among persons aged 18+ years.
Method of
Number of respondents with systolic blood pressure ≥140mmHg or diastolic blood pressure ≥90mmHg. Ideally three blood pressure measurements should be taken and the average systolic and diastolic readings of the second and third measures should be used in this calculation.
Denominator
All respondents of the survey aged 18+ years.
Preferred data sources
Population-based (preferably nationally representative) survey in which blood pressure was measured, not self-reported.
Other possible data sources
NCD Framework
Risk factor exposure
Disaggregation
Age, Sex, other relevant socio-demographic stratifiers where available
Expected frequency of
At least every 5 years
data collection Limitations
Potential limitations include: - measurement error - representativeness of the sample
Data type
Prevalence
Related links
http:www.who.intchpstepsen
Name abbreviated
Mean blood pressure
Indicator name
Age-standardized mean systolic blood pressure in persons aged 18+ years
Definition
Mean systolic blood pressure in persons aged 18+ years
Method of
estimationcalculation Numerator
Sum of systolic blood pressure from all participants aged 18+ years. Ideally three blood pressure measurements should be taken and the average systolic reading of the second and third measures should be used in this calculation.
Denominator
All respondents of the survey aged 18+ years.
Preferred data sources
Population-based (preferably nationally representative) survey in which blood pressure was measured, not self-reported.
Other possible data sources NCD Framework
Risk factor exposure
Disaggregation
Age, Sex, other relevant socio-demographic stratifiers where available
Expected frequency of data At least every 5 years
collection Limitations
Potential limitations include: - measurement error - representativeness of the sample
Data type
Mean
Related links
http:www.who.intchpstepsen
Name abbreviated
Raised blood glucosediabetes
Indicator name
Age-standardized prevalence of raised blood glucosediabetes among persons aged 18+ years or on medication for raised blood glucose
Definition
Fasting plasma glucose value ≥7.0 mmolL (126 mgdl) or on medication for raised blood glucose among adults aged 18+ years.
Method of
18 + ℎ
estimationcalculation
≥ 7.0 ( 126 mgdl ) or
Number of respondents aged 18+ years with fasting plasma glucose value ≥7.0 mmolL (126 mgdl) or on medication for raised blood glucose. Fasting blood glucose must be measured, not self-reported, and measurements must be taken after the person has fasted for at least eight hours.
Denominator
All respondents of the survey aged 18+ years.
Preferred data sources
Population-based (preferably nationally representative) survey. There are two main blood chemistry screening methods- dry and wet chemistry. Dry chemistry uses capillary blood taken from a finger and used in a rapid diagnostic test. Wet chemistry uses a venous blood sample with a laboratory based test. Either method is acceptable.
Other possible data sources NCD Framework
Risk factor exposure
Disaggregation
Age, Sex, other relevant socio-demographic stratifiers where available
Expected frequency of data At least every 5 years
collection Limitations
Potential limitations include: - measurement error - lack of fasting status - limited validity of measurement instruments - representativeness of the sample
Data type
Prevalence
Related links
http:www.who.intchpstepsen
Name abbreviated
Overweight and obesity in adolescents
Indicator name
Prevalence of overweight and obesity in adolescents
Definition
According to the WHO growth reference for school-aged children and adolescents, overweight – one standard deviation body mass index for age and sex, and obese – two standard deviations body mass index for age and sex.
Adolescents are defined as 10 – 19 year olds or according to country definition.
Method of estimationcalculation
Number of adolescent respondents who are overweight. Number of adolescent respondents who are obese. Body mass index (BMI) is calculated by dividing weight in kilograms by height in meters squared. Overweight is ≥ 1SD BMI for age and sex (equivalent to BMI 25kgm² at 19 years). Obese is ≥ 2SD BMI for age and sex (equivalent to BMI 30kgm² at 19 years).
Denominator
All adolescent respondents of the survey.
Preferred data sources
School-based or population-based (preferably nationally representative) survey in which height and weight were measured.
Other possible data sources NCD Framework
Risk factor exposure
Disaggregation
Age, Sex, other relevant socio-demographic stratifiers where available
Expected frequency of data At least every 5 years
collection Limitations
Potential limitations include: - measurement error - representativeness of the sample
Data type
Prevalence
Related links
http:who.intchpgshsen
Name abbreviated
Overweight and obesity in adults
Indicator name
Age-standardized prevalence of overweight and obesity in persons aged 18+ years
Definition
Body mass index ≥25 kgm² for overweight and body mass index ≥ 30 kgm² for obesity in adults aged 18+ years.
Method of
Number of respondents aged 18+ years who are overweight. Number of respondents aged 18+ years who are obese. Body mass index (BMI) is calculated by dividing weight in kilograms by height in meters squared. Overweight is defined as having a BMI ≥25 kgm² and obesity is defined as having a BMI ≥ 30 kgm².
Denominator
All respondents of the survey aged 18+ years.
Preferred data sources
Population-based (preferably nationally representative) survey in which height and weight were measured.
Other possible data sources NCD Framework
Risk factor exposure
Disaggregation
Age, Sex, other relevant socio-demographic stratifiers where available
Expected frequency of data At least every 5 years
collection Limitations
Potential limitations include: - measurement error - representativeness of the sample
Data type
Prevalence
Related links
http:www.who.intchpstepsen
Name abbreviated
Saturated fat
Indicator name
Age-standardized mean proportion of total energy intake from saturated fatty acids in persons aged 18+ years
Definition
Mean proportion of total energy intake from saturated fatty acids in persons aged 18+ years
Method of
estimationcalculatio n
X100Numerator
Sum of proportion of SFA of total energy intake from all participants aged 18+years. For each participant, divide the saturated fatty acid intake by the total energy intake to get the proportion of total energy from SFA.
Denominator
All respondents of the survey aged 18+ years.
Preferred data
Population-based (preferably nationally representative) survey
sources Other possible data
FAO National Food Balance Sheets
sources NCD Framework
Risk factor exposure
Disaggregation
Age, Sex, other relevant socio-demographic stratifiers where available
Expected frequency of At least every 5 years
data collection Limitations
Potential limitations include: - bias through self-report, including under-reporting of consumption - misunderstanding -interpretation of questions - limited validity of survey instruments
Data type
Prevalence
Related links
Name abbreviated
Low fruit and vegetable consumption
Indicator name
Age-standardized prevalence of persons aged 18+ years consuming less than five total servings (400 grams) of fruit and vegetables per day
Definition
Percentage of population aged 18+ years who eat less than five servings of fruit andor vegetables on average per day
Unit of measure
A serving of fruit and vegetables is equivalent to 80 grams
Method of
Self-report
measurement Method of
18 + ℎ 5
estimationcalculation
t andor ve
Number of respondents aged 18+ years eating less than 5 servings of fruit andor vegetables per day. The average number of servings of fruit andor vegetables is calculated for each participant as follows:
1) Calculate the average number of vegetable servings per week: total number of vegetable servings per day multiplied by number of days per week vegetables are eaten divided by 7.
2) Calculate the average number of fruit servings per week: total number of fruit servings per day multiplied by number of days per week fruit are eaten divided by 7.
3) Sum the average number of vegetable and fruit servings per week. If this total is less than 5, then the participant is counted in the numerator of the equation as eating less than 5 servings of fruit andor vegetables per day.
A serving of fruit or vegetables is equivalent to 80 grams.
Denominator
All respondents of the survey aged 18+ years.
Preferred data sources Population-based (preferably nationally representative) survey
Other possible data sources
NCD Framework
Risk factor exposure
Disaggregation
Age, Sex, other relevant socio-demographic stratifiers where available
Expected frequency of At least every 5 years
data collection Limitations
Potential limitations include: - bias through self-report
Data type
Prevalence - misunderstanding -interpretation of questions and or portion size of a serving of fruit or vegetables
- limited validity of survey instruments
Related links
http:who.intchpstepsen
Name abbreviated
Raised total cholesterol
Indicator name
Age-standardized prevalence of raised total cholesterol among persons aged 18+ years
Definition
Total cholesterol ≥5.0 mmolL (190 mgdl).
Method of
18 + ℎ ℎ
estimationcalculation
≥ 5.0 ( 190 mgdl )
Number of respondents aged 18+ years with total cholesterol value ≥ 5.0 mmolL (190 mgdl).
Denominator
All respondents of the survey aged 18+ years.
Preferred data sources
Population-based (preferably nationally representative) survey in which cholesterol was measured, not self-reported. There are two main blood chemistry screening methods- dry and wet chemistry. Dry chemistry uses capillary blood taken from a finger and used in
a rapid diagnostic test. Wet chemistry uses a venous blood sample with a laboratory based test. Either method is acceptable.
Other possible data sources NCD Framework
Risk factor exposure
Disaggregation
Age, Sex, other relevant socio-demographic stratifiers where available
Expected frequency of data At least every 5 years
collection Limitations
Potential limitations include: - measurement error due to insufficient blood sample - limited validity of measurement instruments
representativeness of the sample
Data type
Prevalence
Related links
http:www.who.intchpstepsen
Name abbreviated
Mean total cholesterol
Indicator name
Age-standardized mean total cholesterol among persons aged 18+ years
Definition
Mean total cholesterol.
Method of
Sum of total cholesterol (in mmolL or mgdl) from all participants aged 18+ years.
Denominator
All respondents of the survey aged 18+ years.
Preferred data sources
Population-based (preferably nationally representative) survey in which cholesterol was measured, not self-reported. There are two main blood chemistry screening methods- dry and wet chemistry. Dry chemistry uses capillary blood taken from a finger and used in
a rapid diagnostic test. Wet chemistry uses a venous blood sample with a laboratory based test. Either method is acceptable.
Other possible data sources NCD Framework
Risk factor exposure
Disaggregation
Age, Sex, other relevant socio-demographic stratifiers where available
Expected frequency of data At least every 5 years
collection Limitations
Potential limitations include: - measurement error due to insufficient blood sample - limited validity of measurement instruments -
representativeness of the sample
Data type
Mean
Related links
http:www.who.intchpstepsen
Name abbreviated
Drug therapy and counseling to prevent heart attacks and stroke
Indicator name
Proportion of eligible persons receiving drug therapy and counseling (including glycaemic control) to prevent heart attacks and strokes
Definition
Percentage of eligible persons (defined as aged 40 years and older with a 10-year cardiovascular disease (CVD) risk ≥30, including those with existing CVD) receiving drug therapy and counseling (including glycaemic control) to prevent heart attacks and strokes.
A 10-year CVD risk of ≥30 is defined according to Age, Sex, other relevant socio- demographic stratifiers where available, blood pressure, smoking status (current smokers OR those who quit smoking less than 1 year before the assessment), total cholesterol, and diabetes (previously diagnosed OR a fasting plasma glucose concentration >7.0 mmoll (126 mgdl).
Drug therapy is defined as taking medication for raised blood glucosediabetes, raised total cholesterol, or raised blood pressure, or taking aspirin or statins to prevent or treat heart disease.
Counseling is defined as receiving advice from a doctor or other health worker to quit using tobacco or not start, reduce salt in diet, eat at least five servings of fruit andor vegetables per day, reduce fat in diet, start or do more physical activity, maintain a healthy body weight or lose weight.
Method of estimationcalculation
Number of eligible survey participants who are receiving drug therapy and counseling. See Denominator for definition of eligible people. Receiving drug therapy and counseling is calculated by self-report from respondents reporting they are taking medication for raised blood glucosediabetes, raised total cholesterol, or raised blood pressure, or taking aspirin or statins to prevent or treat heart disease; and receiving advice from a doctor or other health worker to quit using tobacco or not start, reduce salt in diet, eat at least five servings of fruit andor vegetables per day, reduce fat in diet, start or do more physical activity, maintain a healthy body weight or lose weight.
Denominator
Total number of eligible survey participants. Eligible people are those people aged 40 and older who either currently self-report that they have existing CVD or who have a 10 year cardiovascular risk of 30 per cent or higher calculated by using the WHOISH Risk prediction charts for 14 WHO epidemiological sub-regions which provide the approximate estimates of cardiovascular disease (CVD) risk in people who do not have established coronary heart disease, stroke or other atherosclerotic disease, based on responses to the following: Age, gender, smoking status, SBP, TC and absence or presence of diabetes.
Preferred data sources
Population-based (preferably nationally representative) survey
Other possible data sources NCD Framework
Risk factor exposure
Disaggregation
Age, Sex, other relevant socio-demographic stratifiers where available
Expected frequency of data At least every 5 years
collection
Limitations
Potential limitations include: - bias through self-report - misunderstanding -interpretation of questions - limited validity of survey instruments - measurement error due to insufficient blood sample - limited validity of measurement instruments
Data type
Prevalence
Related links
http:www.who.intchpstepsen http:www.who.intcardiovascular_diseasespublicationsChart_predictionsen
Name abbreviated
Essential medicines and technologies for NCD
Indicator name
Availability and affordability of quality, safe and efficacious essential noncommunicable disease medicines, including generics, and basic technologies in both public and private facilities
Definition
Percentage of public and private primary health care facilities who have all of the following available: Medicines - at least aspirin, a statin, an angiotensin converting enzyme inhibitor, thiazide diuretic, a long acting calcium channel blocker, a beta-blocker, metformin, insulin, a bronchodilator and a steroid inhalant. Technologies - at least a blood pressure measurement device, a weighing scale, blood sugar and blood cholesterol measurement devices with strips and urine strips for albumin assay.
Method of
Number of facilities that have available during assessment the minimum list of essential medicines and basic technologies. The minimum list is: Medicines - at least aspirin, a statin, an angiotensin converting enzyme inhibitor, thiazide diuretic, a long acting calcium channel blocker, a beta-blocker, metformin, insulin, a bronchodilator and a steroid inhalant. Technologies - at least a blood pressure measurement device, a weighing scale, height measuring equipment, blood sugar and blood cholesterol measurement devices with strips and urine strips for albumin assay.
Denominator
Number of surveyed facilities.
Preferred data sources
Nationally-representative health facility assessment
Other possible data sources NCD Framework
National systems response
Disaggregation
Public, Private
Expected frequency of data At least every 5 years
collection Limitations Data type
Prevalence
Related links
http:www.who.inthealthinfosystemssara_introductionen
Name abbreviated
Palliative care
Indicator name
Access to palliative care assessed by morphine-equivalent consumption of strong opioid analgesics (excluding methadone) per death from cancer
Definition
Consumption of morphine-equivalent strong opioid analgesics (excluding methadone) per death from cancer. Morphine- equivalent is a method of standardizing and combining volumes of opioids with differing potencies and is used as a measure of opioid consumption, which is used as the indicator for access to pain and palliation.
Method of
n-le ℎ -e
Population-level consumption of morphine-equivalent strong opioid analgesics for a given time period. Levels of consumption of opioid medicines in kilograms or grams (for Fentanyl) are calculated by the INCB on the basis of statistics on manufacture and trade provided by Governments. Consumed quantities include those distributed by wholesalers or manufacturers to retailers (mainly pharmacies and hospitals) plus quantities imported directly by retailers. In countries where the retailers obtain their supply from abroad, quantities declared as imported are considered to be destined for consumption. Therefore the average reported consumption for the previous three-year period in many cases provides a more accurate estimate of actual consumption since volumes procured in one year may be consumed in the following year.
Morphine-equivalent volumes are calculated as: (1morphine)+(83.3fentanyl)+(5hydromorphone)+(1.33oxycodone)+ (0.25pethidine)
Denominator
Number of cancers deaths occurring in the population over the same time period.
Preferred data sources
Consumption of opioids from International Narcotics Control Board annual reports for narcotics consumption. Cancer deaths from vital registration systems which record deaths with sufficient completeness to allow estimation of all-cause death rates.
Other possible data sources Opioid consumption data from national competent authorities
NCD Framework
National systems response
Disaggregation
None
Expected frequency of data Annual
collection Limitations
Potential limitations include: - incomplete administrative records - incomplete or unusable death registration data
Data type
Ratio
Related links
http:www.incb.orgdocumentsPublicationsAnnualReportsAR2010Supplement- AR10_availability_English.pdf
Name abbreviated
Elimination of trans-fats
Indicator name
Adoption of national policies that limit saturated fatty acids and virtually eliminate partially hydrogenated vegetable oils in the food supply, as appropriate, within the national context and national programmes
Definition
Adoption of a policy to limit saturated fatty acids and virtually eliminate partially hydrogenated vegetable oils in the food supply.
Method of
Country can respond "yes" to the question “Is your country implementing any national
estimationcalculation
policies that limit saturated fatty acids and virtually eliminate industrially produced trans- fats (i.e. partially hydrogenated vegetable oils) in the food supply?”
Preferred data sources
WHO NCD Country Capacity Survey
Other possible data sources NCD Framework
National systems response
Disaggregation
None
Expected frequency of data Every 2 years
collection Limitations
Potential limitations include: - bias through self-report - misunderstanding -interpretation of questions - limited validity of survey instruments
Data type
Prevalence
Related links
http:www.who.intchpncd_capacityen
Name abbreviated Name abbreviated
Vaccination for Human Papillomavirus (HPV)
Indicator name Indicator name
Availability, as appropriate, if cost-effective and affordable, of vaccines against human papillomavirus, according to national programmes and policies
Definition
Availability of HPV vaccines as part of a national immunization schedule
Method of
Country can indicate that they have added HPV vaccine to their national immunization
estimationcalculation
programme, as reflected in their responses to the WHO-UNICEF Joint Reporting Form.
Preferred data sources
WHO-UNICEF Joint Reporting Form (JRF)
Other possible data sources NCD Framework
National systems response
Disaggregation
None
Expected frequency of data Annual
collection Limitations
Potential limitations include: - bias through self-report - misunderstanding -interpretation of questions
Data type
Percentage
Related links
http:www.who.intnuvihpvdecision_implementationenindex.html http:www.who.intimmunization_monitoringroutinejoint_reportingenindex.html
Name abbreviated
Marketing to children
Indicator name
Policies to reduce the impact on children of marketing of foods and non-alcoholic beverages high in saturated fats, trans-fatty acids, free sugars, or salt
Definition
Existence of a policy to reduce the impact on children of marketing of foods and non- alcoholic beverages high in saturated fats, trans-fatty acids, free sugars, or salt
Method of
Country can respond "yes" to the question “Is your country implementing any policies to
estimationcalculation
reduce the impact on children of marketing of foods and non-alcoholic beverages high in saturated fats, trans-fatty acids, free sugars, or salt?”
Preferred data sources
WHO NCD Country Capacity Survey
Other possible data sources NCD Framework
National systems response
Disaggregation
None
Expected frequency of data Every 2 years
collection Limitations
Potential limitations include: - bias through self-report - misunderstanding -interpretation of questions - limited validity of survey instruments
Data type
Prevalence
Related links
http:www.who.intchpncd_capacityen http:www.who.intdietphysicalactivitypublicationsrecsmarketingen
Name abbreviated
Vaccination for Hepatitis B
Indicator name
Vaccination coverage against hepatitis B virus monitored by number of third doses of Hep-B vaccine (HepB3) administered to infants
Definition
Percentage of one-year-olds who have received three doses of hepatitis B vaccine in a given year.
Unit of measure
Doses of Hep-B vaccine (HepB3) administered to infants
Method of measurement