Integrated NCD prevention in the population, through guided changes in these risk factors, is the most cost effective way for NCD control. Risk factors should be targeted on individual, family, community, regional and national level. To address these factors a stepwise approach has been developed by WHO.

The WHO STEPwise approach to Risk Factor Surveillance (STEPS) is a simple, standardized method for collecting, analyzing and disseminating data for NCD risk factors in WHO member countries. STEPS was developed as a part of a global surveillance strategy in response to the growing need for country-level surveillance of NCDs. By using the same standardized questions and protocols, all countries can use STEPS information not only for monitoring within-country trends, but also for making between-country comparisons. The approach encourages the collection of small amounts of useful data on a regular and continuing basis.

STEPS is a sequential process, starting with the gathering of information on key risk factors by the use of questionnaires - Step 1; Step 2 moves on to the take of simple physical measurements, and Step 3 recommends the collection of blood samples for biochemical assessment. The goal of STEPS is to ensure that the implementation programme is strategic, coordinated, cost-effective, builds capacity and is sustainable. Data on surveillance of NCDs and their risk factors can be used to:

• Provide prevalence of NCDs and their risk factors
• Track trends over time
• Develop targeted programmes, policy and legislation
• Evaluate programme and policy progress/success
• Demonstrate progress in meeting global/national health objectives
  

Country Situation:

NCDs are important cause of disease burden, morbidity and mortality. At least 25% of the deaths in primary and secondary government health facilities are caused by these diseases. Presently, Bangladesh does not have a community-based public health program for NCDs. Only hospital-based information, although poor, is available. The major constraints being faced are lack of advocacy, lack of logistic and other facilities for initiation of surveillance on NCDs, as well as difficulties in the generating resources for newer initiatives. Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) has initiated surveillance of diabetes. Recently, the Cancer Institute has taken the initiative for cancer registry. National Institute of Cardiovascular Diseases and National Heart Foundation Hospital are working for treatment of heart diseases and running post-graduate courses for doctors. National Center for Control of Rheumatic Fever and Heart Diseases (NCCRFHD) has started registration of Rheumatic Heart Disease (RHD) cases both at Dhaka and outlying rural health complexes. Zia Heart Foundation (Dinajpur) has started services for people of north-western districts. Recently it has also initiated surveillance of RHD. All these institutes are financially and technically supported by WHO. NCD risk factor data: 

The NCCRFHD has already reported risk factor data using cross-sectional data in a rural population. All or some of the following risk factors are being addressed in the population of Dhaka by NIPSOM and BIRDEM with WHO.s support. The area of the studies are being expanded to other divisions. 

• Tobacco use: chewing and smoking 
• Excess alcohol consumption 
• Body mass index as a measure for obesity 
• High blood cholesterol 
• Diabetes mellitus
• High blood pressure 
• Physical inactivity 
• Diet (low consumption of fruit and vegetables)

The distribution of these risk factors are may be obtained from the following websites:

http://www.who.int/ncd_surveillance/resources/infobase/en/

ftp://ftp.who.int/data/NMH/NCD-Surveillance/SuRF_1/

http://www.who.int/hpr/

WHO supports:

Currently WHO provides supports to several government and non-governmental organizations in the field of non-communicable diseases. 

1. Community-based surveillance of major NCDs and their risk factors.

2. Hospital-based surveillance of NCDs. Establishment and operationaliation of the National Disease Surveillance Centre (NDSC) for integrated

3. Capacity building of NCD-related institutes for surveillance, prevention and management of NCDs.

4. Public awareness on prevention of NCDs.

National Professional Guidelines: 

1. Guidelines for management of acute coronary syndrome

2. Guidelines for diagnosis, prophylaxis and follow-up of streptococcal pharyngitis and rheumatic fever patients

3. Guidelines for care of type 2 diabetes mellitus in Bangladesh

4. A plan for cancer control in Bangladesh

SAARC guidelines:

Sonia Nishtar (Editor), Preventing Coronary Heart Disease in South Asia: SAARC Cardiac Society Guidelines and Recommendations, SAARC Cardiac Society and Heartfile, Islamabad, Pakistan, 2002, ISBN: 969-8651-00-4

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