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Scandinavian Journal of Public Health
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Combining risk factors and demographic surveillance: Potentials of WHO STEPS and INDEPTH methodologies for assessing epidemiological transition

Nawi Ng

Department of Public Health, Faculty of Medicine, Gadjah Mada University, Jogjakarta, Indonesia, nawi_ng{at}yahoo.com

Hoang Van Minh

Faculty of Public Health, Hanoi Medical University, Hanoi, Vietnam

Fikru Tesfaye

Department of Community Health, Faculty of Medicine, Addis Ababa University, Addis Ababa, Ethiopia

Ruth Bonita

Evidence for Information and Policy (EIP), World Health Organization, Geneva

Peter Byass

UmeÅ International School of Public Health, Epidemiology and Public Health Sciences, Department of Public Health and Clinical Medicine, UmeÅ University, UmeÅ, Sweden

Hans Stenlund

UmeÅ International School of Public Health, Epidemiology and Public Health Sciences, Department of Public Health and Clinical Medicine, UmeÅ University, UmeÅ, Sweden

Lars Weinehall

UmeÅ International School of Public Health, Epidemiology and Public Health Sciences, Department of Public Health and Clinical Medicine, UmeÅ University, UmeÅ, Sweden

Stig Wall

UmeÅ International School of Public Health, Epidemiology and Public Health Sciences, Department of Public Health and Clinical Medicine, UmeÅ University, UmeÅ, Sweden

Aims: Demographic surveillance systems (DSSs) create platforms to monitor population dynamics. This paper discusses the potential of combining the WHO STEPwise approach to Surveillance (STEPS) within ongoing DSSs, to assess changes in non-communicable disease (NCD) risk factors. Methods: Three DSSs in Ethiopia, Vietnam, and Indonesia have collected NCD risk factors using WHO STEPS, focusing on self-reported lifestyle risk factors (Step 1) and measurement of blood pressure and anthropometric parameters (Step 2). Results: DSSs provide sampling frames for NCD risk factor surveillance, which reveals the distribution of risk factors and their dynamics at the population level. The WHO STEPS approach with its add-on modules is feasible and adaptable in DSS settings. Available mortality data in the DSSs enable mortality assessment by cause of death using verbal autopsy, which is relevant in estimating the impact of NCDs. DSSs as well as risk factor surveillance data may potentially be a lever for hypothesis-driven research to address specific a priori hypotheses or research questions. Conclusion: Combining DSSs with the WHO STEPS approach can potentially address basic epidemiological questions on NCDs, which can be used as a powerful advocacy tool in public health decision-making for NCD prevention.

Key Words: Demographic surveillance systems • hypothesis-driven research • non-communicable diseases • risk factor surveillance • WHO STEPS

Scandinavian Journal of Public Health, Vol. 34, No. 2, 199-208 (2006)
DOI: 10.1080/14034940500204506
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