Rinchen Zangmo | Tsirang
A survey health ministry conducted this year revealed a steady decline in the consumption of tobacco, alcohol and salt intake.
The survey was conducted to assess the prevalence of the behavioural as well as physiological risk factors using the World Health Organisation’s (WHO) step-wise approach to non-communicable disease (NCD) surveillance.
The survey referred to as STEP 2019 survey was presented at the biennial health conference held in Tsirang last month.
Deputy chief programme officer with the NCD division, Pemba Yangchen, said that WHO recommended every country to conduct STEP survey to assess the prevalence of risk factors, health coverage, implementation of key policies and programmes. “STEP is actually a process with three steps, the first step being the interviewing process or the behavioural as well as the metabolic risk factors.”
The other two are physical measurements and biochemical measurements.
STEP was conducted after five years in the country to track the prevalence of risk factors and health coverage. It is the second STEP survey after the first one in 2014.
A cross-sectional national survey was conducted between April and July this year. A multi-Stage sampling design was used to collect data that was representative of the age group between 15 and 19 years of age.
A total of 5,575 participants were recruited with 99 percent response rate.
Pemba Yangchen said that despite the restriction against smoking, the study found that about 22.9 percent of the population used tobacco at the national level. “This trend was higher among the male with 32.9 percent while the female was at 11.8 percent.”
However, there was a steady decline in the trend in comparison to the 2014 STEP survey.
At the national level, about 33.1 percent of the population consumed alcohol. The trend again was seen higher in male with 40.1 percent consuming alcohol and female at 25.1 percent.
Pemba Yangchen said that although alcohol was deeply rooted in Bhutanese culture, a decline in the trend was observed over the past five years.
She said that the 2014 STEP survey did not include beetle nut survey. “At the national level, 56.8 percent of the population were found consuming beetle and areca nut, with higher consumption in male at 57.6 percent this year.”
Female was at 55.9 percent, she said. “Region-wise, people in western consumed more than the central or eastern. However, when it came to alcohol, the eastern region topped the list.”
Using the standards of WHO, the survey found that 86.4 percent of the population weren’t consuming the recommended amount of fruits and vegetables, she said. “WHO recommends a minimum of five servings of fruits and vegetables. I believe it is because of the availability and affordability of fruits and vegetables.”
Six percent of the population did not meet the WHO recommended physical activity. For assessing the physical inactivity, the intensity and duration undertaken by the work, transport or recreational activity were considered.
A physical activity of less than 150 minutes of moderate-intensity physical activity is recommended by WHO which can involve walking, swimming and bicycling.
For physical measurements, height and weight are measured to calculate the nutritional status of the body mass index. Blood pressure was also measured for the survey.
Using the WHO cutoff standards at the national level, 33.5 percent of the population was overweight. Of these, 11.5 percent were obese and 3.1 percent of the population was underweight.
Pemba Yangchen said that it was seen higher among female. “While the trend remained almost the same for overweight and underweight categories when it came to obesity, the trend doubled over a period of five years. The affected lot were women.”
At the national level, the survey indicated that 28 percent of the population had raised blood pressure. It was observed higher in male with 31.6 percent and female at 24 percent. However, a steady decline observed from 2014.
About 1.9 percent population had raised blood sugar with the raised blood sugar being higher in female at 2.1 percent. About 1.8 percent of raised blood sugar observed in male. The overall trend was also in decline.
Although the overall trend was observed to be declining, female had higher raised cholesterol at 12 percent. At the national level, about 10.6 percent of the population had bad cholesterol.
The deputy chief programme officer said that excessive salt is believed to cause hypertension. “Hypertension is a major cause of premature death. WHO recommends 5gms of salt per day, however, at the national level, the mean salt intake was 8.3, which is higher.”
The trend was seen higher in male at 9.1 percent and female at 7.4 percent. The mean salt intake was a decline in the trend.
To address all these issues, she said that the health ministry was planning to reinforce a people-centred approach, which is currently being implemented in Tsirang and Wangdue.