- Email: [email protected]
Ecuador's National Health and Nutrition Survey: objectives, design, and methods
Accepted Manuscript Ecuador’s National Health and Nutrition Survey: Objectives, Design, and Methods Wilma B. Freire, Ph.D, Philippe Belmont, MS, Daniel F. López-Cevallos, Ph.D, William F. Waters, Ph.D PII:
S1047-2797(15)00378-6
DOI:
10.1016/j.annepidem.2015.08.009
Reference:
AEP 7862
To appear in:
Annals of Epidemiology
Received Date: 20 July 2015 Revised Date:
27 July 2015
Accepted Date: 17 August 2015
Please cite this article as: Freire WB, Belmont P, López-Cevallos DF, Waters WF, Ecuador’s National Health and Nutrition Survey: Objectives, Design, and Methods, Annals of Epidemiology (2015), doi: 10.1016/j.annepidem.2015.08.009. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT Rapid Report:
Ecuador’s National Health and Nutrition Survey:
(1)
M AN U
SC
Wilma B. Freire, Ph.D (1) Philippe Belmont MS (1) Daniel F. López-Cevallos, Ph.D (1) William F. Waters, Ph.D (1)
RI PT
Objectives, Design, and Methods
Institute for Research in Health and Nutrition
Corresponding Author: Wilma B. Freire, PhD
TE D
Universidad San Francisco de Quito, Ecuador
EP
Institute for Research in Health and Nutrition Universidad San Francisco de Quito
AC C
Via Interocéanica, Círculo de Cumbayá; Quito, Ecuador E-mail: [email protected]
1
ACCEPTED MANUSCRIPT Introduction The steady increase in rates of diabetes, hypertension and overweight/obesity in low– and middle–income countries has been well documented [1, 2], and Ecuador is no exception [3]. Conducted in 2012, the National Health and Nutrition Survey (hereafter, ENSANUT-ECU)
RI PT
collected information from a representative sample of 87,280 Ecuadorians from 0 to 59 years old in 19,968 households; a subsample of 21,249 individuals provided data on 24-hour
dietary recall and blood and urine samples. The results of the results of the survey are reported in Spanish at: http://www.ecuadorencifras.gob.ec/documentos/web-
SC
inec/Estadisticas_Sociales/ENSANUT/MSP_ENSANUT-ECU_06-10-2014.pdf
M AN U
For international researchers, it is important to note that in addition to allowing for comprehensive analyses of the health and nutrition situation in Ecuador, ENSANUT-ECU allows for comparisons with similar Latin American surveys [4-7] because it includes standardized measures of health components, notably those defined by the U.S. Demographic and Health Surveys [8] and those recommended by WHO for breast feeding [9,
Methods
TE D
10] and by Hallal et al. for physical activity [11].
EP
ENSANUT-ECU was based on a nationally-representative, multi-stage, stratified sample design. Strata were established on the basis of residence in rural or urban areas,
AC C
region, and province. In the first stage of sampling, 64 rural and urban census tracts were selected in each province with probabilities for inclusion that were proportional to the number of occupied households. In each selected census tract, 19 households were preselected, which in the next stage yielded 12 occupied households per census tract. In each selected household, one individual in each age group and one woman of fertile age were selected using simple random sampling. Data were collected using 12 questionnaires: (i) socioeconomic and demographic household data; (ii) maternal and reproductive health; (iii) breast-feeding and complementary 2
ACCEPTED MANUSCRIPT feeding; (iv) health of children 5 years of age and under; (v) risk factors in children from 5 to ˂10 years of age; (vi) risk factors among adolescents from 10 to ˂20 years of age; (vii) risk factors among of adults from 20 to ˂60 years; (viii) physical activity in urban residents from 18 to ˂60 years of age; (ix) sexual and reproductive health behavior in males from 12 to ˂49
RI PT
years; (x) anthropometry of all participants and blood pressure in individuals ≥10 years old; (xi) 24-hour recall of food consumption in a subsample; and (xii) biomarkers in a subsample of participants ≥ 6 months old.
SC
The sample design was based on the 2004 DHS survey, which was updated using the 2010 census. Domains rural and urban areas for each of the 24 provinces and the cities of
M AN U
Guayaquil and Quito. Following training of the field team, fieldwork was conducted in three phases: identification of households in each census tract; initial visits to households; and data collection, including collection of samples for measurement in predefined groups of protein C reactive, hemoglobin, mean corpuscular volume, insulin, serum ferritin, B-12, serum folate, RBC folate, serum zinc, serum retinol, total cholesterol, HDL cholesterol,
Discussion
TE D
triglycerides and glucose.
EP
ENSANUT-ECU allows for analysis of different population subgroups because data bases can be joined in different combinations by using sampling weights to report confidence
AC C
intervals for point estimates. The majority of indicators and definitions included in the survey follow WHO standards [12]. The overlap of age groups allows for cross-sectional analysis. Although ENSANUT-ECU was implemented to support Ecuadorian public health
policy, it was also designed to allow for comparison with other national-level surveys based on DHS indicators, definitions, and methodologies. Examples in Latin America include Mexico [4], Chile [5], Brazil [5], and Colombia [7]. Since the U.S. Hispanic Community Health Study/Study of Latinos includes a South American subsample [13], comparisons of immigrants and non-immigrants are also possible. International comparisons can also be 3
ACCEPTED MANUSCRIPT made in several key areas: (i) breastfeeding and complementary feeding, because ENSANUT-ECU incorporates WHO indicators and recommendations, (ii) physical activity in adults, because it uses the IPAQ questionnaire, and (iii) youth risk behavior, because CDC indicators were adopted. Researchers can access the ENSANUT-ECU data base and the
RI PT
syntax at the following address: http://www.ecuadorencifras.gob.ec/category/ensanut/.
References
Popkin BM, Adair LS, Ng SW: Global nutrition transition and the pandemic of obesity in developing countries. Nutrition reviews 2012, 70(1):3-21.
[2]
Abegunde DO, Mathers CD, Adam T, Ortegon M, Strong K: The burden and costs of chronic diseases in low-income and middle-income countries. The Lancet 2007, 370(9603):1929-1938.
[3]
Freire WB, Silva-Jaramillo KM, Ramirez-Luzuriaga MJ, Belmont P, Waters WF: The double burden of undernutrition and excess body weight in Ecuador. American Journal of Clinical Nutrition 100 (suppl.): 1636S-1643S.
[4]
Romero-Martínez M, Shamah-Levy T, Franco-Núñez A, Villalpando S, Cuevas-Nasu L, Gutiérrez JP, Rivera-Dommarco JÁ: Encuesta Nacional de Salud y Nutrición 2012: diseño y cobertura. Salud Pública de México 2013, 55:S332-S340.
[5]
MINSAL: Encuesta Nacional de Salud ENS Chile 2009-2010. Santiago de Chile: Ministerio de Salud Pública, Pontificia Universidad Católica de Chile, Universidad Alberto Hurtado; 2011.
[6]
IBGE-Fiocruz: Pesquisa Nacional de Saúde 2013: Percepção do estado de saúde, estilos de vida e doenças crônicas. Rio de Janeiro Instituto Brasileiro de Geografia e Estatística (IBGE), Fundação Oswaldo Cruz (Fiocruz), Ministério da Saúde; 2014.
[7]
Profamila: Encuesta Nacional de Demografía y Salud del 2010 (ENDS 2010). Bogotá - Colombia: Profamilia, Ministerio de la Protección Social, USAID; 2011.
[9]
M AN U
TE D
EP
AC C
[8]
SC
[1]
Short Fabic M, Choo YJ, Bird S: A systematic review of Demographic and Health Surveys: data availability and utilization for research. Bulletin of the World Health Organization 2012;90:604-606. World Health Organization: Indicators for assessing infant and young children practices part 1: definitions. Geneva: World Health Organization; 2009.
[10]
World Health Organization: Indicators for assessing infant and young children practices part 2: measuremente. Geneva: World Health Organization; 2010.
[11]
Hallal PC, Gomez LF, Parra DC, Lobelo F., Mosquera J, Florindo A, Sarmento OL: Lessons leard after 10 years of IPAQ use in Brazil and Colombia. Journal of Physical Activity and Health 2010, 7 (Suppl. 2):S259-264.
4
ACCEPTED MANUSCRIPT World Health Organization: Global reference list of core health indicators. Geneva: World Health Organization; 2015.
[13]
Sorlie PD, Avilés-Santa LM, Wassertheil-Smoller S, Kaplan RC, Daviglus ML, Giachello AL, Schneiderman N, Raij L, Talavera G, Allison M: Design and implementation of the Hispanic Community Health Study/Study of Latinos. Annals of Epidemiology 2010, 20(8):629-641.
AC C
EP
TE D
M AN U
SC
RI PT
[12]
5
S1047-2797(15)00378-6
DOI:
10.1016/j.annepidem.2015.08.009
Reference:
AEP 7862
To appear in:
Annals of Epidemiology
Received Date: 20 July 2015 Revised Date:
27 July 2015
Accepted Date: 17 August 2015
Please cite this article as: Freire WB, Belmont P, López-Cevallos DF, Waters WF, Ecuador’s National Health and Nutrition Survey: Objectives, Design, and Methods, Annals of Epidemiology (2015), doi: 10.1016/j.annepidem.2015.08.009. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT Rapid Report:
Ecuador’s National Health and Nutrition Survey:
(1)
M AN U
SC
Wilma B. Freire, Ph.D (1) Philippe Belmont MS (1) Daniel F. López-Cevallos, Ph.D (1) William F. Waters, Ph.D (1)
RI PT
Objectives, Design, and Methods
Institute for Research in Health and Nutrition
Corresponding Author: Wilma B. Freire, PhD
TE D
Universidad San Francisco de Quito, Ecuador
EP
Institute for Research in Health and Nutrition Universidad San Francisco de Quito
AC C
Via Interocéanica, Círculo de Cumbayá; Quito, Ecuador E-mail: [email protected]
1
ACCEPTED MANUSCRIPT Introduction The steady increase in rates of diabetes, hypertension and overweight/obesity in low– and middle–income countries has been well documented [1, 2], and Ecuador is no exception [3]. Conducted in 2012, the National Health and Nutrition Survey (hereafter, ENSANUT-ECU)
RI PT
collected information from a representative sample of 87,280 Ecuadorians from 0 to 59 years old in 19,968 households; a subsample of 21,249 individuals provided data on 24-hour
dietary recall and blood and urine samples. The results of the results of the survey are reported in Spanish at: http://www.ecuadorencifras.gob.ec/documentos/web-
SC
inec/Estadisticas_Sociales/ENSANUT/MSP_ENSANUT-ECU_06-10-2014.pdf
M AN U
For international researchers, it is important to note that in addition to allowing for comprehensive analyses of the health and nutrition situation in Ecuador, ENSANUT-ECU allows for comparisons with similar Latin American surveys [4-7] because it includes standardized measures of health components, notably those defined by the U.S. Demographic and Health Surveys [8] and those recommended by WHO for breast feeding [9,
Methods
TE D
10] and by Hallal et al. for physical activity [11].
EP
ENSANUT-ECU was based on a nationally-representative, multi-stage, stratified sample design. Strata were established on the basis of residence in rural or urban areas,
AC C
region, and province. In the first stage of sampling, 64 rural and urban census tracts were selected in each province with probabilities for inclusion that were proportional to the number of occupied households. In each selected census tract, 19 households were preselected, which in the next stage yielded 12 occupied households per census tract. In each selected household, one individual in each age group and one woman of fertile age were selected using simple random sampling. Data were collected using 12 questionnaires: (i) socioeconomic and demographic household data; (ii) maternal and reproductive health; (iii) breast-feeding and complementary 2
ACCEPTED MANUSCRIPT feeding; (iv) health of children 5 years of age and under; (v) risk factors in children from 5 to ˂10 years of age; (vi) risk factors among adolescents from 10 to ˂20 years of age; (vii) risk factors among of adults from 20 to ˂60 years; (viii) physical activity in urban residents from 18 to ˂60 years of age; (ix) sexual and reproductive health behavior in males from 12 to ˂49
RI PT
years; (x) anthropometry of all participants and blood pressure in individuals ≥10 years old; (xi) 24-hour recall of food consumption in a subsample; and (xii) biomarkers in a subsample of participants ≥ 6 months old.
SC
The sample design was based on the 2004 DHS survey, which was updated using the 2010 census. Domains rural and urban areas for each of the 24 provinces and the cities of
M AN U
Guayaquil and Quito. Following training of the field team, fieldwork was conducted in three phases: identification of households in each census tract; initial visits to households; and data collection, including collection of samples for measurement in predefined groups of protein C reactive, hemoglobin, mean corpuscular volume, insulin, serum ferritin, B-12, serum folate, RBC folate, serum zinc, serum retinol, total cholesterol, HDL cholesterol,
Discussion
TE D
triglycerides and glucose.
EP
ENSANUT-ECU allows for analysis of different population subgroups because data bases can be joined in different combinations by using sampling weights to report confidence
AC C
intervals for point estimates. The majority of indicators and definitions included in the survey follow WHO standards [12]. The overlap of age groups allows for cross-sectional analysis. Although ENSANUT-ECU was implemented to support Ecuadorian public health
policy, it was also designed to allow for comparison with other national-level surveys based on DHS indicators, definitions, and methodologies. Examples in Latin America include Mexico [4], Chile [5], Brazil [5], and Colombia [7]. Since the U.S. Hispanic Community Health Study/Study of Latinos includes a South American subsample [13], comparisons of immigrants and non-immigrants are also possible. International comparisons can also be 3
ACCEPTED MANUSCRIPT made in several key areas: (i) breastfeeding and complementary feeding, because ENSANUT-ECU incorporates WHO indicators and recommendations, (ii) physical activity in adults, because it uses the IPAQ questionnaire, and (iii) youth risk behavior, because CDC indicators were adopted. Researchers can access the ENSANUT-ECU data base and the
RI PT
syntax at the following address: http://www.ecuadorencifras.gob.ec/category/ensanut/.
References
Popkin BM, Adair LS, Ng SW: Global nutrition transition and the pandemic of obesity in developing countries. Nutrition reviews 2012, 70(1):3-21.
[2]
Abegunde DO, Mathers CD, Adam T, Ortegon M, Strong K: The burden and costs of chronic diseases in low-income and middle-income countries. The Lancet 2007, 370(9603):1929-1938.
[3]
Freire WB, Silva-Jaramillo KM, Ramirez-Luzuriaga MJ, Belmont P, Waters WF: The double burden of undernutrition and excess body weight in Ecuador. American Journal of Clinical Nutrition 100 (suppl.): 1636S-1643S.
[4]
Romero-Martínez M, Shamah-Levy T, Franco-Núñez A, Villalpando S, Cuevas-Nasu L, Gutiérrez JP, Rivera-Dommarco JÁ: Encuesta Nacional de Salud y Nutrición 2012: diseño y cobertura. Salud Pública de México 2013, 55:S332-S340.
[5]
MINSAL: Encuesta Nacional de Salud ENS Chile 2009-2010. Santiago de Chile: Ministerio de Salud Pública, Pontificia Universidad Católica de Chile, Universidad Alberto Hurtado; 2011.
[6]
IBGE-Fiocruz: Pesquisa Nacional de Saúde 2013: Percepção do estado de saúde, estilos de vida e doenças crônicas. Rio de Janeiro Instituto Brasileiro de Geografia e Estatística (IBGE), Fundação Oswaldo Cruz (Fiocruz), Ministério da Saúde; 2014.
[7]
Profamila: Encuesta Nacional de Demografía y Salud del 2010 (ENDS 2010). Bogotá - Colombia: Profamilia, Ministerio de la Protección Social, USAID; 2011.
[9]
M AN U
TE D
EP
AC C
[8]
SC
[1]
Short Fabic M, Choo YJ, Bird S: A systematic review of Demographic and Health Surveys: data availability and utilization for research. Bulletin of the World Health Organization 2012;90:604-606. World Health Organization: Indicators for assessing infant and young children practices part 1: definitions. Geneva: World Health Organization; 2009.
[10]
World Health Organization: Indicators for assessing infant and young children practices part 2: measuremente. Geneva: World Health Organization; 2010.
[11]
Hallal PC, Gomez LF, Parra DC, Lobelo F., Mosquera J, Florindo A, Sarmento OL: Lessons leard after 10 years of IPAQ use in Brazil and Colombia. Journal of Physical Activity and Health 2010, 7 (Suppl. 2):S259-264.
4
ACCEPTED MANUSCRIPT World Health Organization: Global reference list of core health indicators. Geneva: World Health Organization; 2015.
[13]
Sorlie PD, Avilés-Santa LM, Wassertheil-Smoller S, Kaplan RC, Daviglus ML, Giachello AL, Schneiderman N, Raij L, Talavera G, Allison M: Design and implementation of the Hispanic Community Health Study/Study of Latinos. Annals of Epidemiology 2010, 20(8):629-641.
AC C
EP
TE D
M AN U
SC
RI PT
[12]
5