The document discusses various screening tools for assessing risk of non-communicable diseases (NCDs) such as the WHO NCD Risk Assessment tool. It describes tools for screening major NCD risk factors like obesity, smoking, unhealthy diet, physical inactivity, and stress. The WHO STEPwise approach to NCD risk factor surveillance is also summarized. Recommended screening tests for diseases like diabetes, hypertension, breast cancer, lung cancer, and vision problems are outlined. Screening tools for substance abuse and addiction assessment are also mentioned.

1. Screening Tools –NCD Risk
Assessment (WHO);Addiction and
Vision Screening
Mohammad Aslam Shaiekh
MPH - 3rd Batch
School of Health and Allied Sciences (SHAS)
Pokhara University (P.U)

2. Introduction
 The emerging pandemic of non-communicable diseases
(NCDs) is creating major health challenges worldwide.
Of the 56 million global deaths in 2012, 38 million (68%)
were attributed to NCDs, with almost three quarters
(74%) of these deaths occurring in low and middle
income countries .TheWorld Health Organization
(WHO) estimates that deaths attributed to NCDs in
Nepal have risen from 51% in 2010 to 60% in 2014 .
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3. Risk Factors and Risk Factors
Assessment
 The basis of NCD prevention is the identification of the
major common risk factors and their prevention and
control.A risk factor refers to any attribute,
characteristic or exposure of an individual, which
increases the likelihood of developing NCD (WHO,
2001). Assessment of these risk factors and screening
for NCDs in individuals and communities are important
in preventing and controlling future diseases.
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4. Risk factor assessment
 Risk factors assessment basically involves history taking,
and taking of simple measurements, which become the
basis of classifying whether the person is at risk or not.
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6. Risk factor assessment
 Obesity or overweight : it can best be assessed using
the Body Mass Index (BMI). The BMI is a measure of
body fat based on height and weight. It is calculated by
dividing the person’s weight in kilograms (kg) by the
height in meters squared (m2). Central obesity is
defined as a waist-to-hip ratio (WHR) of 1.0 and over in
men, and 0.85 in women.
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7. Degree of risk based on BMI and
waist circumference
CLASSIFICATIO
N
Waist
circumference
BMI Waist-Hip Ratio
underweight ˂18.5
Healthy weight Males <90cm
Female <80cm
18.6-22.9 Male <1.0
Female <0.85
overweight >23.0
At risk Male >90cm
Female > 80cm
23.0-24.9 Male >1.0
Female>0.85
Obese 1 25.0 -29.9
Obese 2 >30.0
Source: DOH Manual of Operation on NCD Prevention and Control, 2009
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8.  Smoking – In assessing use of tobacco or
smoking, it is essential to determine: (1) the smoking
status (smoker or non- smoker); (2) the trend in client’s
smoking practice; and (3) exposure to second-hand
smoke.
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9.  Unhealthy diet –This normally require a comprehensive
assessment, which includes: (1) a detailed food recall, (2) an
extensive questionnaire on food frequency, and (3) estimation
of food nutrients using the Food Composition Table and Food
Exchange List.Ask about the amount and frequency of food
eaten particularly vegetables, fruits, fat, sodium or salt, and
sugars or simple carbohydrates.
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10. •Age-standardized prevalence of persons aged 18+ years
consuming less than five total servings(400 grams) of fruit
and vegetables per day’
•Percentage of population aged 18+ years who eat less
than five servings of fruit and/or vegetables on average per
day
•Unit of measure A serving of fruit and vegetables is
equivalent to 80 grams
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11.  Physical inactivity – In assessing physical inactivity, obtain
information on the following areas: a) occupation or type of
work of the individual clients, b) means of transportation, and
c) type of leisure activities, like sports and formal exercise.
 One MET is defined as 1 kcal/kg/hour and is roughly
equivalent to the energy cost of sitting quietly.A MET also is
defined as oxygen uptake in ml/kg/min with one MET equal
to the oxygen cost of sitting quietly, equivalent to 3.5
ml/kg/min.
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12. Light
<3.0 METs
Moderate
3.0–6.0 METs
Vigorous
>6.0 METS
•Walking—slowly
•Sitting—using
computer
•Standing—light
work (cooking,
washing dishes)
•Fishing—sitting
•Playing most
instruments
•Walking—very brisk (4 mph)
•Cleaning—heavy (washing
windows, vacuuming, mopping)
•Mowing lawn (walking power
mower)
•Bicycling—light effort (10–12
mph)
•Badminton—recreational
•Tennis—doubles
•Walking/hiking
•Jogging at 6 mph
•Shoveling
•Carrying heavy loads
•Bicycling fast (14–16 mph)
•Basketball game
•Soccer game
•Tennis—singles
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13.  Stress - Determine if the individual is suffering
from any form of stress.This may come in the
form of physical, emotional, psychological, mental
problem or issue.Try to establish the degree or
extent of stress or pressure the individual is
subjected to day to day. Find out the specific
factors causing the individual to be stressed or
under pressure.
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14. Guidelines and Approaches to Risk
Factor Assessment
 TheWorld Health Organization developed a tool to help assess
risk factor profiles- the STEPwise approach to Surveillance (STEPS),
which collects risk factor data as follows:
 Step 1: Collecting questionnaire-based information about diet and
physical activity, tobacco use and alcohol consumption;
 Step 2: Using standardized physical measurements to collect data
on blood pressure, height and weight;
 Step 3: Expanding physical measurements with the collection of
blood samples for measurement of lipids and glucose status.
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15. Importance of the Chart
 Guideline for WHO/ISH risk assessment chart for CVD
was developed in 2007.
 Using the chart, a health worker in PHC can select
people at high-risk and, if necessary, refer them for
appropriate treatment to the next level of care.
 This chart will improve the effectiveness of
cardiovascular risk management, even in settings
which do not have sophisticated technology.
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16. Steps to estimate the 10-years
cardiovascular risk as follows.
Step 1: Select the appropriate chart depending on the presence or
absence of diabetes
Step 2: Select male or female tables
Step 3: Select smoker or non smoker boxes
Step 4: Select age group box (if age is 50-59 years select 50, if 60-
69 years select 60 etc)
Step 5: Within this box find the nearest cell where the individuals
systolic blood pressure (mm Hg) and total blood cholesterol
level (mmol/l). The color of this cell determines the 10-year
cardiovascular risk.
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17. People with Blood Cholesterol examination
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18. People with Blood Cholesterol
examination
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19. People without Blood Cholesterol
examination
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20. People without Blood Cholesterol
examination
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21. When are the charts useful for
stratifying risk?
 useful for stratifying risk for people with BP<160/100
mm Hg or blood cholesterol < 8 mmol/l or
uncomplicated diabetes.
•Person Y needs intensive lifestyle interventions and drug treatment to prevent a heart attack
or stroke.
•Person X needs lifestyle interventions and may need drug treatment if risk persists at follow
up.
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22. Screening
 Screening is a service component towards promoting
healthy lifestyle and preventive interventions. Risk factor
assessment is an important component of screening
procedures. Individuals identified with high- risk factors
need to be further screened for the possible presence
of a disease.
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23.  Screening focuses on the principle that before a disease
develops, there is an asymptomatic period.
 During this time, risk factors predisposing a person to the
pathologic condition sort of builds up to produce certain
manifestations.
 The screening procedures, often in the form of simple tests-
when applied during this stage can help identify the individual’s
chances of becoming ill.
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24. Recommended ScreeningTests and
Classifications by Disease
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25. Disease Screening
tools
recommended
Classification Remarks
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26. Screening of breast cancer
 Breast self examination method : Breast self-
examination (BSE) is a screening method used in an
attempt to detect early breast cancer.The method
involves the woman herself looking at and feeling each
breast for possible lumps, distortions or swelling.
 BSE includes five step:
Step 1: Begin by looking at your breasts in the mirror
with your shoulders straight and your arms on your
hips.
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27.  Here's we should look for:
 Breasts that are their usual size, shape, and color
 Breasts that are evenly shaped without visible distortion
or swelling
 Step 2: Now, raise your arms and look for the same
changes.
 Step 3: While you're at the mirror, look for any signs of
fluid coming out of one or both nipples (this could be a
watery, milky, or yellow fluid or blood).
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28.  Step 4: Next, feel your breasts while lying down, using
your right hand to feel your left breast and then your
left hand to feel your right breast. Use a firm, smooth
touch with the first few finger pads of your hand,
keeping the fingers flat and together. Use a circular
motion, about the size of a quarter.
 Step 5: Finally, feel your breasts while you are standing
or sitting.
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30. Disease Screening
tools
recommende
d
Classification
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32. Percentage of
predicted FEV1
value
Result
80% or greater normal
70%–79% mildly abnormal
60%–69% moderately abnormal
50%–59% moderate to severely abnormal
35%–49% severely abnormal
Less than 35% very severely abnormal
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33. Vision
 The appropriateness of vision tests is determined by
their technological aspects and content and the training
required to administer them.
 Screening helps to detect people with impaired vision
who may require referral for treatment, and to identify
those with potentially normal or low vision but who
have been regarded as blind .
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34. TheVisual AcuityTest Card.The upper panel shows the
optotypes which appear on the outside of the card when
it is folded in half.The near vision test types and the instructions,
which appear on the inside faces, are shown on the lower panel .
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36. Addiction
 Treatment for a drug or alcohol problem usually begins
with an addiction assessment.The purpose of the
assessment is to determine whether an addiction is
present, the extent of the addiction.
 Assessments often include questionnaires, physical
exams, and self-assessment.
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37. Substance abuse assessment tools
 The alcohol use disorder identification test (AUDIT)
 Brief Michigan alcoholism screening test (BMAST)
 CAGE (cut ,annoyed ,guilty, eye opener) questionnaire
 Michigam alcoholism screening test (MAST)
 Clinical institute withdrawl assessment (CIWA)
 Short michigam alcoholism screening test (SMAST)
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38.  Article : Usefulness of Alcohol-screening Instruments in
Detecting Problem Drinking among Elderly Male
Drinkers
 Author :Young Ryou,Jonq Sunq kim and Jin Gyu Jung
 Journal : Korean journal of family medicine
 Published online 2012 May 24
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39. Validity of ScreeningTools for at-
Risk Drinking
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40.  Regarding the AUROC of the three screening tools
used for identifying at-risk drinking in elderly male
drinkers aged ≥ 65 years, the AUDIT produced the
greatest AUROC (0.903), followed by the SMAST-G
(0.742) and CAGE (0.726).The AUROC was significantly
greater for the AUDIT than for the SMAST-G (P <
0.001) and the CAGE (P < 0.001).There was no
statistically significant difference in AUROC between the
CAGE and the SMAST-G
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41. Refrences
 World Health Report 2008. Primary health care – now
more than ever. Geneva,World Health Organization,
2008
 Strong K,Wald N, Miller A,Alwan A (2005). Current
concepts in screening for noncommunicable disease.
World Health Organization Consultation Group
Report on Methodology of Noncommunicable Disease
Screening. Journal of Medical Screening, 1 March 2005;
12: 12 - 19.
 National Institute on Drug Abuse. (2015). Chart of
evidence-based screening tools for adults and adolescents.
 Foster A, Johnson G. Blindness in the developing world.
British journal of ophthalmology, 1993, 77: 398-399
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