Dili: Dr. Jenia Jeronimo (27) and Dr. Sarvia N. dos Santos (28), both young and passionate doctors, embark on their journey to Fatuhada, a locality in Timor-Leste’s capital city Dili, with a shared mission every morning. As enumerators for the survey focused on Noncommunicable Diseases (NCDs) risk factors and health facility readiness, these young doctors diligently collect vital data, as well as blood and urine samples from community members.
They meticulously follow the STEPwise approach, a WHO-developed framework for monitoring NCD risk factors through questionnaires and physical and biochemical measurements. Their routine involves visiting five to six households each day, conducting interviews with a selected member of a family, and progressing through three comprehensive steps.
Step 1 involves collecting data on behaviours such as smoking habits, alcohol consumption, types of food consumed, the occupation of family members and income, among other factors. They also perform a quick iodine test on the salt used in the household to determine if it is iodised. Step 2 delves into checking blood pressure, height, weight, and waist size of the family members, while the Step 3 involves collecting urine and blood samples. The survey is fully digitized with the enumerators filling in data on the WHO STEPs application on a tablet.
“There are some instances of rejection, but we do our best to persuade people by educating them about the purpose of the survey,” said Dr. Jenia, adding that the survey is conducted only after obtaining thorough and informed consent.
This marks the second NCDs risk factors and health facility readiness survey in Timor-Leste. The first survey was conducted in 2014, and its findings have been instrumental in developing and fine-tuning interventions to prevent and control NCDs in the nation. However, there was an urgent need for updated data.
The Ministry of Health is optimistic that the second survey will provide robust and up-to-date insights into the NCDs and their risk factors. It will provide insights into essential behavioral risk factors, such as tobacco and alcohol use, physical inactivity, and unhealthy diets, as well as crucial biological risk factors, including overweight and obesity, high blood pressure, elevated blood glucose, and abnormal blood lipids.
“This second NCD Risk Factor Survey also offers the chance to consolidate data on vital nutrition and diet-related indicators and address our existing data gaps,” said Dr Arvind Mathur, WHO Representative to Timor-Leste. “We've enhanced the survey with urine iodine, urine sodium, and urine creatinine tests, a noteworthy step forward made possible with the support of the National Health Laboratory and our technical partner, Mahidol University in Thailand,” he added.
The survey began on October 13, 2023, and is expected to be completed in a little more than a month. Fourteen data collection teams have been formed to cover over 300 households across the country, mapped through GPS.
Each team consists of three people including a supervisor and two enumerators, recruited from the Universidade Nacional Timor Lorosa'e (UNTL), the national university of Timor-Leste. The supervisors and enumerators were trained by WHO experts in collaboration with UNTL and the Ministry of Health on the STEPwise approach and other aspects of data collection and reporting.
Timor-Leste’s demographic landscape is characterized by a youthful majority with approximately 72% of the population below the age of 35. An estimated 45% deaths in Timor-Leste are attributed to NCDs.
The country has made significant progress over the years in combating NCDs. This includes the implementation of pro-health taxes on items such as tobacco, alcohol, sugar, and sugar-sweetened beverages. WHO has been collaborating closely with the Ministry of Health to promote physical activity, encourage healthy eating practices, and facilitate early diagnosis and treatment for risk factors like diabetes and hypertension, among others.