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Chronic Noncommunicable Diseases Risk Factor Survey in Iraq

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Chronic Non-Communicable Diseases

Risk Factors Survey

In Iraq

2006

A STEP wise Approach

World Health Organization

Ministry of Planning and Development Cooperation, Central Organization for Statistics & Information

Ministry of Health, Directorate of Public Health and Primary Health Care

in collaboration with

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1. Introduction

1.1 Overview

Global Situation of Non-Communicable Diseases

The burden of chronic Non-communicable disease (NCDs) is rising rapidly and has now become a major challenge to global development. The World Health Organization (WHO) report 2002 stated that the mortality, morbidity and disability attributed to the major non-communicable diseases (NCDs) accounted for about 60% of global deaths and 47% of burden of disease. By 2020 these estimates are expected to rise to 73% and 60% respectively. Unfortunately, low and middle income countries are bearing the brunt of these diseases that will have significant social, economic, and health consequences (1). Chronic noncommunicable diseases include cardio vascular diseases, diabetes, chronic respiratory disease, and cancer. Most of these diseases are attributed to common preventable risk factors. The most modifiable risk factors are tobacco use, unhealthy diet, and physical inactivity. (1). In response to the rising challenge, a global strategy for the prevention and control of noncommunicable disease was developed in 1999 and endorsed by the World Health Assembly in May 2000 (WHA resolution 53.18). This strategy focuses on assessing the pattern and trends of risk factors of major non-communicable diseases, the national capacity for prevention and control, promoting the development of evidence-based strategy to reduce unhealthy behaviors and major risk factors, and implementing cost-effective and equitable interventions for the management of common non-communicable diseases(2).

Non-Communicable Disease in Iraq: a situational analysis

There has been a recent concern about chronic NCDs in Iraq. The country is undergoing an epidemiological transition with an increasing burden of chronic NCDs. These diseases constitute threats to health in terms of mortality and DALYs(3). Although there is inadequate information about accurate estimates, MOH statistics from hospital based data and routinely collected information show that such diseases represent most of the ten leading causes of mortality for the age groups of five years and over for the past years. They account more or less for 60% of total causes of death. Cardiovascular diseases represent the main causes of hospital admission and account for around 40% of all causes of death in the country(4). A local household survey undertaken in nine Iraqi governorates in 2000 showed that around 30% of the adult population above 40 years of age have hypertension and 15% have diabetes, The household survey reports (2004) showed that (9%) reported having chronic illnesses(5). In another household survey (2005), Self reported hypertension was (11.7%), and diabetes was (4.1%)(6). There are therefore, a large number of unrecorded or undiagnosed cases.

The main modifiable behavioural risk factors are smoking, unhealthy diet, and physical inactivity. The national smoking control committee report (2000) that the prevalence of smoking among is 40% among male and 5% among female above 16 years of age. The FAO report on BMI of adult population in three governorates showed that 47-67% had BMI of 25 and over (3).

1.2 Rationale

Iraq has witnessed an epidemiological transition with increasing prevalence of chronic noncommunicable diseases (NCDs) with their contributory risk factors. Being the leading




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causes of morbidity and mortality, the MOH is developing new projects to improve health and to reduce morbidity attributed to such diseases. Integrated prevention and control strategies are most effective-focusing on the common risk factors and cutting across specific diseases (7). So the basis of prevention is identification of the magnitude of the common risk factors for their prevention and control. Currently, data on NCDs and their risk factors is either very scanty or not collated. A timely and ongoing information is needed on the magnitude and trends of these diseases and their risk factors. Therefore, there is a need to establish a national baseline data in order to be utilized for developing a national NCD prevention and control program. This survey is considered the first national survey for NCDs risk factors in Iraq.

1.3 Goal and objectives

Goal

Provision of epidemiological information on chronic non-communicable diseases and the prevalence of their risk factors in the community which will be used to plan and implement a national NCD prevention and control programme.

Objectives

- To estimate the prevalence of risk factors and to identify target risk groups. - To utilize the information for developing a national strategy for NCD prevention and

control. - To establish an NCD surveillance system - To measure trends of prevalence of NCD risk factor over time . - To assess the impact of the NCD prevention and control programmes.

1.4 Survey administration

A national committee is established (annex1) consisting of: - The Deputy Minister / MoH - The Director General of Public Health and the Primary Health Care - The Director of the Primary Health Care Department - The Director of the Non-Communicable Diseases Section - The Chairman of the Scientific Council for Community Medicine and Family - Medicine/ICMS. - The Head of the COSIT/ Ministry of Planning - Representative of the International Health Department / MoH - Representative of the Iraq Cancer Board. - Consultants in the field of Internal Medicine / Cardiologists and Diabetologists from

the Ministry of Health and the Ministry of Higher Education and Scientific Research. - Statistician - Secretary

The trained NCD unit managers in the governorates were assigned to be the local surveillance focal points in their governorates.

1.5 Official approvals and support




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- Official approval is obtained from his Excellency the Minister of Health to implement the survey and support providing its requirements.

- The Ministries of internal affairs and of civil society were informed to obtain their support and participation during the survey implementation.

- The local data collection teams were provided with documents in Arabic and English to declare their mission to any inquiring body.

- Announcements consistently urged the local authorities to involve the civil society members in community preparedness and acceptance of the local teams work.

1.6 Ethical approvals

- Official approval is obtained at the MOH for adopting the prepared plan of action and the instrument used for data collection.

- A consent form is prepared for the participant to be informed.




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2. Materials and methods

2.1 Site of the survey: Iraq

The republic of Iraq is located in the south-west of Asia, to the north – east of the Arab homeland, bounded on the north by Turkey, on the East by Iran, on the west by Syria, Jordan and Saudi Arabia, on the south by Arab Gulf, Kuwait and Saudi Arabia. Iraq lies between latitudes 29.5’ and 37-22 between longitudes, 38-45’ East. The area of Iraq covers(435052) sq. km., the main topographic characteristics consist of the Alluvial Plain, forming a quarter of the land including the marsh and lake areas, the Desert Plateau in the west forming about half of the area, the Mountain Region in the north and north east, and the Terrain Region between lowlands in thesouth and high mountains in the north and north east. There are two main rivers, Tigris and Euphrates great river. Iraq lies within the moderate northern region, its climate is continental and subtropical. Similar to Mediterranean region, rainfall occurs almost in winter, autumn, and spring. Regarding administrative divisions, the country consists of eighteen Governorates each is made of a numbers of Qadhas which in turn is divided into Nahias(8). The main demographic and socio economic indicators are enlisted below (5,6,8).

Demographic indicators Value year Total population 28810441 2006 Population growth rate 2.99% 2006 average life expectancy at birth Males females

59.2 62.3

2001

Total fertility rate 5.7 2000 Crude birth rate/1000 39.4 1997 Crude death rate/1000 10.6 1997 Socio economic indicators Adult literacy ratio Both sexes 76.6% 1997 Males 85.1% Females 68.3 Per capita GDP USD 1526 2005 Proportion of population below I $(ppp) per day 5 (%) 11 2003 Proportion of population below minimum level of dietary energy consumption (%)

25 1997

Net attendance ratio in primary education (%) 83.1 2006 Ratios of girls to boys in primary education (%) 91 2006 Ratios of girls to boys in secondary education (%) 69 2006 Ratios of girls to boys in university education (%) 63.3 2004 Ratios of girls to boys in higher education (%) 54.0 2004




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2.2 Population frame: The population frame consists of the entire population of Iraq of (25 -65) years of both sexes living in the urban and rural areas. The survey frame is based on the 1997 census data except for the three governorates of Kurdistan Region, where the local statistics are used. Inclusion criteria: All permanent households of (25-65) years of age, who are residents in Iraq 2005/2006 at the time of implementation of the survey, Exclusion criteria: Temporary residents in Iraq and those living in institutionalized settings. 2.3 Study design: This is a national cross sectional survey conducted on a representative sample of the population of Iraq. The WHO stepwise approach is adopted, collecting data on risk factors that contribute to major non-communicable diseases(9). 2.3.1 Sampling design: The Sample was designed to provide estimates on a number of indicators on the situation of noncommunicable diseases risk factors in Iraq at the national level. A national based rather than a governorate based sample is selected. A multi stage cluster sampling was used with stratification to urban and rural areas. 2.3.2 Survey population: The target population for the NCD survey were all residents in Iraq during January 2006. The sample is based on residency rather than citizenship; thus it was probable for any household living within the borders of Iraq at the time of the survey to be included in the survey. For practical purposes, we have chosen not to include the 37 areas with predominantly nomadic population, as sampling and fieldwork in these areas was deemed very difficult within the short timeframe of the fieldwork. According to the census, the nomadic population consisted of only 2,266 households, or 0.09% of the population, hence it is not believed that this exclusion gave any systematic bias to the data. 2.3.3 Sample size: The calculated sample size is 5040 households. Erbil, one of the governorates in Kurdistan region, did not participate in the survey, so the remaining sample consisted of a total of 4483 households (annex 2 ). 2.3.4 Allocation: The sample has been allocated among governorates proportional to size. This means that the sample of the NCD survey is self-weighting for Iraq (annex 2 ). 2.3.5 Sample frame: For the 15 governorates, the sample frame was based on the 1997 census. In Sulaimaniya and Duhok governorates of Kurdistan region, the sample frame is developed based on information provided by the statistical office in the governorate. 2.3.6 Primary sampling units: Primary sampling units (PSUs) were majals and blocks, which were merged into units of between 70 and 100 households before selection.




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2.3.7 Stratification: the PSUs explicitly stratified by governorates, and urban and rural status within the governorate. The lists of PSUs were sorted according to these characteristics, and the PSUs drawn as a systematic linear sample within each strata. Re-listing a skatch map was created for each selected PSU that listed all households within the PSU. Ten households were then selected in each PSU, with linear systematic sampling. Respondents: The questionnaire calls for one respondent. The eligible household was randomly selected based on the number of the households (arranged in an array within the age group of 25-65 years) and the number of the family within the cluster(annex3).




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2.4 Survey preparation: 2.4.1 Action plan: Activities are presented in the following time table

Time Frame 2005/ months 2006/ months

Action Plan 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12

Establishment: Establish national committee planning & preparation Identify the scope Develop implementation plan Design and select sample frame Prepare materials Tailor& translate STEPS instrument Gain ethical approval

Set up STEPS office Workshop for central &local supervisors

Pilot test Schedule data collection Recruitment & training of local teams: Recruit interviewers

Train Teams Data collection Approach selected household Conduct survey Data management Data entry tool check-up data Enter data Clean data Data analysis preliminary analysis Final analysis Discussion of results Reporting &dissemination produce preliminary report ` Produce final report

Produce site report Hold national symposium




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2.4.2 The Scope identification: The core and expanded modules of Step 1 and Step 2 were included with the exception of the alcohol module as it can be under-reported. Besides, this issue can be covered by another functioning program. The available opportunity to conduct such a national work, and the importance to obtain the prevalence of diabetes mellitus, brought up the decision to include the core module of step 3. The expanded module of Step 3 were not included due to the time and resource constraints.

2.4.3 The Stepwise instrument: The stepwise instrument, the second version, is translated into Arabic and tailored by members from the MOH and the COSIT. The instrument was also piloted several times by the supervisors and the surveillance focal persons on accessible sample. Accordingly,

adjustments were made for the best acceptable form (annex4). The time needed to fill was measured, and thus the work accomplished per team could be decided. On the basis of such information, a preliminary estimate of the number of teams could be set. The instrument contained:

• Survey information: including the location and the time of the interview, the interview condition, in addition to information about the interviewer, and contact information of the participant.

• Step 1 Demographic information: including information about age, sex,

education, employment, and household income.

• Step 1 Behavioural information: including tobacco use, dietary habits regarding fruits and vegetables and oil or fat consumption, physical activity, and history of hypertension or diabetes.

• Step 2 Physical measurement: including information about the interviewer and

the instruments, in addition to recording anthropometric measurements (height, weight, waist circumference, and hip circumference), and the two or three blood pressure measurement readings.

• Step 3 Biochemical measurements: including information about the interviewer,

the participant preparation state, the instrument, in addition to recording the levels of fasting blood glucose and fasting total cholesterol.

Guidelines were prepared for utilization of the STEPS instrument, and included within the instruction form prepared for the data collection teams.




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2.4.4 Personnel (annex5)

Experts:

National experts in the specialties of Epidemiology and Statistics, in addition to Specialists in Medicine, provided consultation and continuous observation throughout the survey. WHO experts were also consulted at different stages of the work.

Supervisors:

- General supervision is carried out by the representatives of the directorate of public health and primary health care.

- A number of the MOH representatives were nominated as central supervisors for the field work. Central supervisor were also assigned for laboratory investigation and statistical analysis.

- Local supervision is carried out by the trained NCD surveillance focal person conjointly with the representative of the Health Directorate.

Working teams:

Data collection teams

The local team member was selected according to his prior experience in survey field work, and preferably be a resident in the same survey region so as to ensure acceptance among the interviewed families. A total of one hundred and seven (107) local data collection teams were decided for conducting the field survey. Each team consisted of:

o A physician as the head of the team responsible for the interview and checking the information before delivering to the local supervisor.

o A medical assistant/nurse for physical measurement. o A laboratory technician to draw the blood sample, prepare and deliver the

sample to the assigned lab in the governorate. o A member of the sampling staff for tracking the individuals.

The issue of including a female member within the team was taken into consideration.

Sampling staff

Responsible for sample selection, programming, and checking, in addition to the samplers in the governorates who were responsible for updating the sample before starting the survey, and participation in the field work.

Data management staff

- Data checking staff: for checking the STEPS instruments delivered from the governorates

- Data entry staff: for data entry, and data cleaning - Data analysis staff: for statistical analysis of the entered data

Laboratory analysis staff

Laboratory workers working at the biochemistry section in the governorate labs. The laboratories were selected by the Central Health Laboratory in Baghdad that is kept under central quality control.

STEP site operation staff

Responsible for communication and reporting and other required activities.

Finance staff

Responsible for the financial affairs of the survey.




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Report writing staff

Responsible for the preliminary and final report writing.

Administrative staff

Responsible for organizing training activities, preparing the materials, printing and sending official letters and announcements, filing the survey materials, and follow-up and communication with the health directorates.

2.4.5 Supplies and equipments

Necessary supplies and equipments were procured by the WHO and distributed to the health directorates to be used for the survey

- Stationary - Printing the STEPS instrument questionnaire form and other information papers. - Sphygmomanometers - Stethoscope - Laboratory requirements

The height scale and weight scale were provided by the Nutrition research institute in Baghdad and the related nutrition units in the governorates.

2.4.6 Training activities:

The first preparatory Stepwise NCD surveillance workshop was held in Amman for the NCD managers by the WHO office of Iraq, with the presence of an NCD surveillance expert in Geneva, and the Jordanian MOH senior officials. Then a central workshop was conducted In Iraq for the local NCD focal points to discuss the national action plan and the STEPS instrument. This was followed by local workshops held by the NCD focal persons in their health directorates for the assigned local data collection teams. Also, central training courses were conducted for the laboratory personnel and the data management staff (annex6). 2.4.7 Communication strategy and publicity

Public preparedness is of great importance prior to initiation of the round. For this reason, a collaboration is made with the health education department for raising public awareness and preparation as follows: - Local multi-sectoral symposia were carried out in the governorates prior to

surveillance for public preparedness. - TV graphic was broadcasted repeatedly through the day and continued through the

first days of the survey. - A notice was made in the subtitle news during the survey. - Announcement was also made through the local TVs and other mass media in the

governorates. - Interviews were made with Internal Medicine specialists at two different TV channels. - The consent for the individual approval was reformed to be more acceptable by

public and viewed on TV. - The NCD focal persons were asked to declare the end of the survey in their

governorates




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2.4.8 Materials prepared and distributed to the focal points(annex7):

- The STEPS instrument - Consent form containing STEPS operation site contact information for each

participant - Instruction forms for the central supervisors, local supervisors (NCD focal points),

data collection teams (including guidelines for utilizing the Steps instrument), laboratory personnel, show cards, in addition to the guidelines for utilization of the STEPS instrument

- Local action plan forms to be filled by the local supervisors (NCD focal points) - Daily report forms for the local supervisors (NCD focal points) - Central supervision report form to be filled by the central supervisor for each health

directorate 2.4.9 STEPS operation site: An operation site was set at the directorate of public health and primary health care. Personnel from the directorate office and NCD section with previous experience in communication and problem solving were nominated to run the operation site. Due to the difficulties faced in the services of telephone and email, in addition to the need of direct interference in the field work ,mobile phones constituted the main communication tool. The phone numbers of the directorate and the three depended lines (Iraqna, Asiacell, and Atheer) were distributed to the central supervisors, the NCD focal points, recorded in the consent form for the participants, and mentioned in the advertisement published on TV for the public.

Daily reports were requested to provide information regarding the rate of completed visits and laboratory investigations. In addition to the obstacles faced and initiatives made.(annex8).

2.5 Survey implementation

Field implementation of the survey

The date of onset was set on the 16th January, and continued through February, 2006. Apart from the northern governorates, all of the health directorates started collection of data on the same day. The sample updating process was carried out prior to implementation. The actual field work started early morning (at 6:00 am) especially at rural areas, and could extend beyond the official working hours till (6:00 pm). Work continued through holidays. Data collection extended around three weeks, according to the sample size in the governorate and the number of teams allocated. (Annex 9).

An informed consent was taken from the respondents before the interview. Few inquiries were made to the operation site by the visited families.

The first two steps were carried out during the first visit, whereas the step 3 was carried out during the second visit, as scheduled in agreement with the participant and with the laboratory. The selected household was visited three times before deciding to code it as a Non-response.

Data collection

Data was collected by direct interview with the individuals. The WHO Stepwise instrument for NCD risk factor surveillance was adopted which includes:

- Step I: Information by questionnaire: socioeconomic and demographic variables, tobacco, nutrition, physical activity

- Step II: Physical measurements: body weight, height, waist girth, hip girth, blood pressure

- Step III: Biochemical measurements: blood sugar, total cholesterol




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Physical measurements

Based on the consultants’ advice, the mercury type of sphygmomanometers was utilized; they agreed to consider the result of measurements to be valid. The required sphygmomanometers and stethoscopes were purchased by the WHO and distributed to the local data collection teams. The mean of two readings of the blood pressure is recorded unless if the difference between the readings is (≥10 mmHg) then a third reading is done.

The standardized uniform anthropometric measuring devices (UNISCALE weighing scales, SICA height measuring tapes, and measuring tapes for waist and hip circumference measurement) available at the Nutrition research institute in Baghdad and the related nutrition units in the governorates were utilized.

The teams were provided with checklists for correct physical measurement.

Laboratory investigations

It was preferred to carry out the biochemical investigations at the lab. Although the central health lab has the capacity to run large number of investigations, difficult accessibility to the lab from the governorates, urgency in transport of the samples to the lab, and the need to deal with the sample, necessitates implementing the investigations at local laboratories in the governorates. The laboratories were selected by the central lab and kept under central quality control. The required laboratory supplies and equipments were procured by the WHO. The responsible biochemists of the assigned labs attended a workshop at the central health lab for discussing details of implementation, and methods for evaluation of their work, they were also supplied with guideline forms for work. Also, a workplan was set by the central lab and was discussed with the selected local labs regarding sample collection, transport, and management.

Participants on the first visit were provided with a card with the name, serial number, the appointment time for the blood test, and instruction for preparation. According to the known instructions, participants had to be fasting for 10-14 hours. Those on hypoglycaemic medication were asked to postpone taking medication until after drawing the blood sample.

Blood samples were taken in the morning. Investigations were usually done for a number of participants in the cluster during the same day. Each data collection team included a laboratory personnel who was equipped with blood collection supplies. He was responsible for drawing blood sample, collection of the samples, management and delivering the samples to the lab. The blood sample had to be separated, and the serum had to be delivered to the lab in a suitable temperature.

In areas where the field work is in a distant place in relation to the selected lab, sample separation had to be done in the field. In some areas, the health directorate provided the teams with a centrifuge to separate the blood sample. When electric power went off, local generators where utilized for power source. Then the serum is transferred in a suitable temperature. Well enclosed ice bags were used to keep the blood sample till reaching the lab. In other areas, efforts were made to bring the participants to the nearest lab where blood sample is drawn and centrifuged

Investigations were carried out even during holidays, and the labs were kept open for a specified period during these days to receive the drawn samples. The enzymatic method (Glucose Oxidase for fasting blood glucose and Cholesterol Oxidase for total cholesterol) is used. Absorption is read utilizing (Visible Light Spectrophotometer) instrument.




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Data management

A national data entry tool was developed by the programmers of the Directorate of PH and PHC in collaboration with the COSIT. Taking into consideration the data entry staff experience, Visual Fox pro system was used.

In order to limit errors at entry, the range of values were set for several variables, based on the information obtained from the WHO experts and the national professionals. Accordingly, data checking and cleaning were done. According to the steps instrument requirements, the response options were created and skipping questions were provided..

A staff working at the directorate of public health were assigned to review and check up the STEPS instruments to be prepared for data entry. Detected errors were corrected by returning back to the central and local supervisors.

Data entry was carried out at the Directorate of PH and PHC. A staff of ten computer personnel were assigned to work for fourteen days. They were provided with guidelines and instructions, the supervisors were consulted when constraints were faced.

Data analysis was performed utilizing the statistical package for social sciences (SPSS) software version 10.5. The sociodemographic characteristics of the study population were assessed. The prevalence of risk factors and among study population and the subgroups were estimated. The relationship of some risk factors were assessed. Test of significance was used for assessment of any observed association.




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2.6Initiatives: 1. Response of people and cooperation in the advocacy campaign. 2. Performing interviews in unusual circumstances. 3. The teams were very keen to complete the interview in case of non-existence of

target person through: - Continuation of the work after the official commitment time. - Repetition of visit more than three times. - Visiting the workplace of the targeted person. - Starting work very early in the morning at rural areas for data collection to

4. Informing the respondent persons with the results of investigations and providing them with medical advice.

5. Some DOHs have given gifts for the participating families. 6. Benefiting from the interview opportunity with the families during the period of

survey for social mobilization and health education in the domain of encouraging healthy life styles.

7. Cooperation between mass media in preparation for the survey. 8. Participation of individuals from the community in accompanying the teams. 9. Response of members from civil society organizations, municipal council and squires

in accompanying work teams and citizens’ persuasion, in addition to cooperation of mosques, orators in advocacy and education through delivering orations.

10. Voluntary participation of health workers residing in hot areas to replace data collection teams in implementing field work.

11. Cooperation of statistics department in governorates in preparing emergency plan in the presence of crisis

12. In order to ensure obtaining the blood sample in an appropriate laboratory conditions, surveyors droved the respondents living in remote areas to the nearest health facility for blood testing.




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3.7 Constraints: 1. Occurrence of sudden security disturbances as manifested explicitly. 2. Electricity cut-off which demanded coordination of time for aspiration of blood in

order to make centrifugation. 3. Traffic jam, road block, bad weather, and unstable security circumstances, all

contributed to difficulties in transportation. 4. Raised kerosene price prior to survey conduction, affected vehicles rental. 5. Residence of some target persons in remote areas made it difficult to reach and to

carry out investigations. 6. Non-existence of target persons due to their professional commitment, made the

teams to perform the visit at work place or to repeat the visit after working hours. 7. Presence of locked houses due to internal displacement of the target persons. 8. Cut-off electricity and difficulty in communication through email and even land phone

which led to the dependence on mobile phones as a main mean for communications with DOHS, supervisors and directors of units.

9. Although the “EPI data” program was preferred to be used, there was an agreement that the experience of the data entry staff should be considered. Being well acquainted with, the visual fox pro was utilized.




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3 Results 3.1 Response rate: The planned sample for the study (excluding Erbil ) was 4780 households. The results showed a high response rate . Out of the planned sample, a total of 4503 (94.2% ) participated in the study. As for the other steps, the response rate was (93.8%) for step 2, and (87.8%) for step 3 (table 3.1.1). The distribution of the sample by governorate was found to be statistically and demographically representative of the actual structure of Iraq, ranging from 23.2% in Baghdad to 2.2 % in Duhok (annex 10)

Table (3.1.1) Response proportions of the sample for STEP 1, STEP 2,and STEP 3, Iraq 2006

Response proportion N= 4780

% n

STEPS

94.2 4503 STEP 1 93.8 4483 STEP 2 87.8 4196 STEP 3

3.2.Socio demographic characteristics

3.2.1.Age and gender

This section highlights the basic characteristics of the (25-65) years old Iraqi people who participated in the study.

Table (3.2.1.1) presents the distribution of the study sample by gender. It shows that the proportion of female was higher than male (56.8% Vs 43.2% respectively).

table (3.2.1.1.) Distribution of the study population by gender, Iraq 2006

Number %

Female 2557 56.8

Male 1946 43.2

Total 4503 100




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Fig (3.1.1) Distribution of the Respondents by Gender, Iraq 2006

Male 43.2%

Male 56.8%

Nearly one third (31%) of the study sample belonged to the age group of(25-34 years), a similar proportion (31.7%) belonged to the age group of (35-44 years). (table 3.2.2.2). The age and gender distribution were almost comparable to the national estimated census (8).

Table (3.2.1.2) Distribution of the respondents to STEP 1 by age groups and gender, Iraq 2006

Both sexes Male Female

% n % N % n

Age groups

31.0 1398 13.4 603 17.7 795 25-34

31.7 1428 14.3 644 17.4 784 35-44

21.3 960 8.5 381 12.9 579 45-54

15.9 717 16.3 318 15.6 399 55-65

100 4503 43.2 1946 56.8 2557 Total

3.2.2 Education

Most of the participants had low literacy level with a mean years of education of 9. There was an evident gender variation in the years of education in favour of male (table 3.2.2.1). Illiteracy rate was 27.8% . There was an evident gender gap in illiteracy, being higher among female (37.6%) than male (14.9%) by more than two folds (table 3.2.2.2) which was consistent with the national figures (8)

The highest level of education didn’t exceed the primary school in two thirds of the respondents among male and female (Fig3.2.2.1).

Literacy level is generally higher among male than female. Moreover, graduates (including institute diploma and university degree), constituted 12.9% of the study population, nearly as three folds higher among male as compared to female (20.1%, 8.4% respectively) (table 3.2.2.2). Respondents in the age groups of 45 years or older reported lower educational level than the younger age groups. This finding was clear in both sexes (annex11)




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Table( 3.2.2.1) Distribution of the respondents according to the mean number of years of education by age groups and gender , Iraq 2006

Table (3.2.2.2) Distribution of the respondents According to the Highest Level of Education by gender, Iraq 2006

Mean years of education

Age groups

Female N=2557

Male N=1946

Total N=4503 t test P value

25-34 8 10 8 -9.728 0.00

35-44 8 10 9 -12.458 0.00

45-54 7 10 9 -13.440 0.00

55-65 7 9 8 -9.935 0.00

25-65 8 10 9 -22.127 0.00

Female N=2557

Male N=1946

Both sexes N= 4503 Level of Education

N % No % No %

No response 6 0.2 0 0 6 0.1

Illiterate 962 37.6 289 14.9 1251 27.8

Read and write 448 17.5 266 13.7 714 15.9 Completed Primary Schooling 608 23.8 541 27.8 1149 25.5

Completed Intermediate Schooling 182 7.1 243 12.5 425 9.4

Completed Secondary Schooling 134 5.2 210 10.8 344 7.6

Institute Diploma 131 5.1 191 9.8 322 7.2

University Degree 80 3.1 178 9.1 258 5.7

Post Graduate-degree 5 0.2 24 1.2 322 0.6 Others 0 0 4 0.2 29 0.1




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0

5

10

15

20

25

30

35

40

Res

pond

ants

%

Illeterate

Read/write

Primary sch.

Intermediate

Secondary

Institute Diploma

University

Post graduate

Fig (3.2.3.1) Highest level of education of the respondants,by gender,Iraq 2006

Female Male Both sexex

3.2.3 Employment

Governmental employee constituted (15.6%) of the studied population with three folds being higher among male as compared to female (24.5% Vs 8.9 respectively). Apart from that, the employment rate was evidently higher among male as compared to female. So that the rest were either employed in private sector (3.4%), or performing other types of work (49.5%) (table 3.2.3.1).

Results showed that more than half of the sample were non-active (59.3%). This was mainly attributed to the high proportion of the unemployed or the retired among male, and the high proportion of the housewives among female (table 3.2.3.2) .

Unemployment is measured according to the ILCS definition(5), that considers a person unemployed if he has not worked for one hour or more during the week preceding the interview. Regarding unemployment status among male, it was estimated that ( 8.9 %) were unemployed but seeking work, whereas ( 3.1%) were not. The majority of unemployed belonged to the age groups of (25-34) and (35-44) years. On the other hand, (10%) of the male were retired.

The majority of female (83.5%) were housewives. The Iraq living condition survey (ILCS) in 2004 showed that the housewives constitute 70%. However, no further information was available regarding the proportion of those who were previously employed and quit work(5).

A household survey on food security and vulnerability in Iraq showed that 26% of the heads of households are not working, and 59% of the household members are unemployed of whom 47.3% were seeking work. Only 14% of women were employed( 6 )




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table (3.2.3.1) Distribution of the respondents according to Employment Status, Iraq 2006

Table (3.2.3.2) Distribution of the respondents according to the employment status, by age groups and

gender, Iraq 2006 Both sexes (N=4503) Male (1946) Female (N=2557)

Non

-ac

tive

*

Self

em

ploy

ed

Non

-gov

’t

empl

oyee

Gov

’t

empl

oyee

Non

-ac

tive

*

Self

em

ploy

ed

Non

-gov

’t

empl

oyee

Gov

’t

empl

oyee

Non

-ac

tive

*

Self

em

ploy

ed

Non

-gov

’t

empl

oyee

Gov

’t

Empl

oyee

% % % % % % % % % % % **%

Age Groups

56.2 27.1 2.5 14.1 15.6 59.4 4.5 20.6 86.9 2.6 1.0 9.2 25-34 54.1 26.2 1.5 18.1 15.5 56.4 3.1 27.6 85.7 3.6 0.3 10.2 35-44 61.6 15.9 1.8 16.9 46.2 46.2 3.4 28.9 87.9 2.4 0.7 8.9 45-54 67.1 13.8 1.1 12.1 26.1 26.1 2.2 20.1 89.5 4.0 0.3 5.8 55-65 59.3 23.1 1.8 15.6 22.6 49.5 3.4 24.5 87.2 3.1 0.6 8.9 25-65

* non-active includes persons who are non-paid, students, housewives, retired, and

unemployed.

Female Male Both sexes Employment Status N % n % n *%

Government Employee 228 8.9 476 24.5 704 15.6

Non-Government Employee 15 0.6 67 3.4 82 1.8

Self-Employed 22 0.9 275 14.1 297 6.6

Daily payment seeker 19 0.7 437 22.5 456 10.1

Farmer 28 1.1 178 9.1 206 4.6

Student 9 0.4 10 0.5 19 0.4

House Wife 2135 83.5 0 0 2135 47.4

Retired 38 1.5 196 10.1 234 5.2

Unemployed (seeking work) 17 0.7 174 8.9 191 4.2

Unemployed (not seeking work) 30 1.2 60 3.1 90 1.9

Others 10 0.4 73 3.8 83 1.8

Refused to Answer 6 0.2 0 0 6 0.1

Total 2557 100 1946 100 4503 100




21

0

10

20

30

40

50

60

70

80

90

resp

onde

nts

%

Government Employee Non-Government Employee Self-Employed non-active

Fig (3.2.4.2) Employment Status of the Rspondents by Gender, Iraq 2006

female male both sexes

3.2.4.Household income

Subjective measurement for the economic status was also followed to indicate the Data on household income based on subjective estimates, showed a mean yearly income of around 3,000,000 ID for almost all of the age groups. (Table 3.2.4.1) This may not allow accurate measurement of general economic status in regard to poverty mapping, but it may reflect the general status of the study population.

Perception of people towards their situation. The households were asked which statement best described their status. Nearly two thirds described their economic status as being below the middle class, while only (1.1%) reported belonging to the high class. (Table 3.2.4.2)

Table (3.2.4.1) Mean annual household income by age groups of respondents Iraq 2006

Mean annual income in ID

Age groups

3325822 25-34 3287856 35-44 3291921 45-54 3396371 55-65 3295724 25-65

Table (3.2.4.2)Distribution of the respondents according to their subjective description of their economic status, by age groups, Iraq 2006

Total High acceptable moderate Low Very low

No response

Age

groups % % % % % % %

100 0.9 5.3 34.7 36.3 21.8 1.0 25-34 100 1.3 6.1 32.2 37.1 22.1 1.1 35-44 100 0.7 5.2 33.5 36.9 22.1 1.4 45-54 100 1.4 5.7 30.9 34.7 25.1 2.1 55-65 100 1.1 5.6 33.1 36.4 22.5 1.3 25-65




22

3.3.Behavioural risk factors

3.3.1Tobacco use

Current smokers

In order to assess the prevalence of smoking habits in Iraq, respondents were asked about their current status of smoking. Results showed that the prevalence of smoking was (21.9%). (Table 3.3.1.1)

Table (3.3..1.1) Distribution of the respondents according to Smoking status Iraq 2006

Smoking status

Number of persons %

Current Smokers 985 21.9

Non Smokers 3518 78.1

Total 4503 100

The proportion of smoking among male was six folds higher than female (41.5 Vs 6.9 respectively). Regarding age specific smoking rate, it is noticed that smoking is more prevalent among old aged female of ≥55 years (11.4%). On the other hand, smoking rate decreased with increasing age among male. (Table 3.3.1.2). Although some of the strategies for tobacco control have already been put in place, the increased accessibility to tobacco products, publicity, may have contributed to the increased rate of smoking among the young groups especially male.

Table (3.3.1.2) Distribution of current smokers by age groups and gender (%), Iraq 2006

Female Male Both sexes Age

Group

N Smoker % N Smoker % N Smoker %

t Test

P value

25 – 34 795 15 1.9 603 242 40.1 1398 257 24.9 18.1 0.00

35 -44 784 46 5.9 644 287 44.6 1428 333 34.2 17.672 0.00 45 -54 579 50 8.6 381 165 43.3 960 215 22.5 12.394 0.00 55-65 399 66 11.4 318 114 35.8 717 180 18.4 5.811 0.00 Total 2557 177 6.9 1946 808 41.5 4503 985 21.9 27.693 0.00




23

Current daily smoking

Daily smoking habit was assessed among current smokers, by asking them whether they smoked on daily basis or not. The results showed that almost all of the current smokers were daily smokers (98.6%). This was evident among male and female (98.9% and 97.2% respectively). (Tables 3.3.1.3 & 3.3.1.4)

table (3.3.1.3) Percentage of daily smokers among current smokers, by age groups and gender, Iraq 2006

Female (N=177) Male (N=808) Both sexes (N=985)

Current daily

smokers

Non-daily smokers

Current daily

smokers

Non-daily smokers

Current daily

smokers

Non-daily smokers Age

groups % % % % % % 25 – 34 86.7 12.3 98.8 1.2 98.1 1.9 35 – 44 97.8 2.2 98.9 1.0 98.8 1.2 45 – 54 10.0 0.0 98.8 1.2 99.1 0.9 55-65 100.0 0.0 99.1 0.9 98.3 1.7 Total 97.2 2.8 98.9 1.1 98.6 1.4

Table (3.3.1.4) Distribution of the respondents (current smokers and non-smokers) according to smoking status (daily, non-daily) by age groups and gender, Iraq 2006*

Female (N=2557) Male (N=1946) Total (N=4503)

Current smoker % Current smoker Current smoker Age

groups Daily Non-

daily Total*

Non smoker

% Daily Non-daily Total*

Non smoker

% Daily Non-daily Total*

Non smoker

%

25-34 0.5 0.0 0.6 30.4 12.3 0.2 12.4 18.6 5.6 0.1 5.7 25.3 35-44 1.8 0.0 1.8 28.8 14.6 0.2 14.7 18.3 7.3 0.1 7.4 24.3 45-54 2.0 0 2.0 20.7 8.4 0.1 8.5 11.1 4.7 0.0 4.8 16.5 55-65 2.5 0.0 2.6 12.9 5.8 0.1 5.9 10.4 3.9 0.0 3.9 11.9 Total 6.8 0.1 6.9 92.9 41.1 0.4 41.5 58.4 21.6 0.2 21.9 78.0

* Non response is not included.




24

Initiation of smoking habit

The mean age for initiation of smoking was (20±8 years). Male reported initiation of smoking at a younger age (19±7 years) than female (26 ±10 years). Those who did not recall their age at initiation were asked, "if they remembered how long ago they started smoking". Results showed that the mean years of smoking was 17 years. Female reported longer duration than male (22yrs Vs 15yrs) . (Table 3.3.1.5)

Table (3.3.1.5) Mean age of initiation of smoking among current

daily smokers, by age groups and gender, Iraq 2006

Mean age of initiation of smoking Age

groups

Female N=177

Male N=808

Both sexes

N=985

mean mean Mean

25-34 20 17 17 35-44 24 19 19 45-54 29 21 23 55-65 25 21 22 25-65 26 19 20

t test -22.191 p value 0.00

Table ( 3.3.1.6) Mean duration of smoking (in years) among current daily

smokers, by age groups and gender, Iraq 2006

mean duration of smoking (Years)

Age groups

Female N=177

Male N=808

Both sexes N=985

Mean mean Mean

25-34 15 10 10 35-44 14 13 13 45-54 22 19 20 55-65 28 26 26 25-65 22 15 17




25

Type of tobacco products smoked

The majority used manufactured cigarettes (87.5). Other types were water pipes (2.0%), and hand rolled cigarettes (1.0%). (Table 3.3.1.7)

Table (3.3.1.7) Number and percentage of current smokers for each type of smoking ,Iraq 2006

Current smokers N=985

% n

Type

87.5 862 Manufactured cigarette 1.0 10 Hand rolled cigarettes 2.0 20 Water pipes 6.5 65 Others

As expected, male showed a higher rate for manufactured cigarette smoking than female (38.9% vs 6.4% respectively) with the predominance of smoking among younger age groups. (Table 3.3.1.8)

Table (3.3.1.8) Distribution of manufactured cigarette smokers by age groups and gender Iraq 2006

Female (N=2557)

Male (N=1946)

Both sexes (N=4503)

t Test

P value

Age groups Number % Number % Number % 25 – 34 11 0.8 219 15.7 230 16.5 -14.107 0.00 35 – 44 41 2.9 274 19.2 315 22.1 -15.016 0.00 45 – 54 48 5.0 159 11.1 207 14.5 -11.264 0.00 55-65 64 8.9 106 14.8 170 23.7 -6.330 0.00 25-65 164 3.6 758 38.9 922 20.5 -23.629 0.00

Intensity of tobacco use

To assess the intensity of cigarette smoking, respondents were asked about the average daily number of cigarettes smoked. Results showed that nearly two thirds of the current smokers (64.4%) smoked 20 cigarettes or more per day that could be categorized as heavy smokers with a mean number of 23 cigarettes/day (Table 3.3.1.9). Heavy smoking was evident mainly among male (Fig 3.3.1). The rest tobacco products showed low frequency of smoking (Table 3.3.1.10).




26

(table 3.3.1.9) distribution of current smokers according to the number of cigarette per day, Iraq 2006

Current smokers

Female N=177

Male N=808

Both sexes N=985

Number of Cigarettes/

day n %* n % n %

t Test

P value

<10 39 22.0 53 6.6 92 9.5 -3.831 0.00

10 – 19 30 16.9 109 14.1 139 14.3 0.615 0.541

≥20 82 46.3 543 67.2 625 64.4 -4.47 0.00

Don’t Know 13 7.3 47 5.8 60 6.1

No response 13 7.3 56 6.9 69 7.0

0

10

20

30

40

50

60

70

resp

onde

nts

%

female male both sexes

Fig (3.3.1) proportion of the respondents according to the daily number of cigarette smoking, by gender, Iraq 2006

<10 10- 19 >=20




27

(table3.3. 1.10) Mean amount of tobacco used by current smokers according to the type, by age groups, and gender, Iraq 2006

Female Male Total Age

groups

Manuf actured

Water Pipes

Hand rolled Other Manuf

actured Water Pipes

Hand Rolled other Manuf

actured Water pipes

Hand rolled other

25-34 16 0 0 3 20 1 0 3 20 1 0 3 35-44 15 0 0 3 25 2 0 3 24 2 0 3 45-54 15 0 0 0 26 0 2 5 24 0 1 4 55-65 18 0 3 3 26 1 0 8 23 1 1 6 25-65 16 0 1 2 24 1 0 4 23 1 1 4

Ex smokers

Non smokers were asked" if they ever smoked daily in the past". Results showed (6.9%) of them were ex-smokers, with male counting as twice as female (10.8% vs 3.9% respectively). Both, male and female, reported a similar age for quitting and duration of cessation of smoking. The high rate of smoking among young male seems to be accompanied by the increasing cessation rate among older age groups. (Table 3.3.1.11, 3.3.12, 3.3.13)




28

(table 3.3.1.11) Distribution of ex-smokers by age groups and gender, Iraq 2006

Ex smokers % Age groups

Female N=2557

Male N=1946

Both N=4503

% % %

25-34 0.6 3.9 2.1 35-44 61.9 8.9 5.0 45-54 6.0 14.2 9.3 55-65 11.8 23.9 17.2 25-65 3.9 10.8 6.9

Table ( 3.3.1.12 ) Distribution of the ex- smokers according to the mean age since cessation of smoking ,by age groups and gender, Iraq 2006

Table ( 3.3.1.13) Distribution of the ex-smokers according to the mean time since cessation ,by age groups, Iraq 2006

Mean age since cessation (years) female Male both

Age groups

mean Mean mean t test P value

25-34 27 23 24 0.997 0.520 35-44 30 31 31 0.626 0.542 45-54 38 35 36 0.885 0.538 55-65 40 47 45 -1.672 0.101 25-65 37 36 36 0.301 0.764

Mean time since cessation (years) female male Both

Age groups mean mean Mean

T test

P value

25-34 4 6 6 -0.380 0.725 35-44 8 7 7 -0.748 0.463 45-54 11 14 13 -1.428 0.567 55-65 14 14 14 0.115 0.909 25-65 11 11 11 0.456 0.949




29

Smokeless tobacco use

Results showed that the proportion of smokeless tobacco use is scanty. Only 1.6% male and 0.3% female reported current smoking. (Table 3.3.1.14)

Table (3.3.1.14) Percentage of current users of smokeless tobacco , by age groups and gender, Iraq 2006

Percentage of Current use %

Proportion of daily users % Ex-daily users % Age

groups

Female N=2557

Male N=1946

Both N=4503 female Male Both Female male both

25-34 0 0.8 0.3 0 0 0 0 0.7 0.3 35-44 o.4 2.0 1.1 0 0.1 0.0 0.3 0.2 0.2 45-54 0.2 3.1 1.4 0 0 0 0.2 0.8 0.4 55-65 0.8 0.6 0.7 0 0 0 0.6 0.6 0.6 25-65 0.3 1.6 0.9 0 0.1 0.0 0.2 0.5 0.3

3.3.2.Nutrition

Fruits and vegetables consumption

Respondents were asked about the number of days per week they consumed fruits or vegetables and the number of serving each day. Results showed that the majority reported low frequency of fruit or vegetable consumption of <5 servings per day (91.4%). (Table 3.3.2.1) Most of participants seemed to have single serving for fruits or vegetables with no gender related differences. (Table 3.3.2.2)

A previous assessment on Dietary profiles revealed that the main food items consumed by Iraqi households constituted of bread, rice, and fat. by the time that consumption of fruits or vegetables is less than 5 days a week ( 6 ).

Table (3.3.2.1) Distribution of the respondents according to the categories of servings for fruit and /or vegetables consumed per day, Iraq 2006

Five or more servings of fruit and/or vegetables per day

Less than five servings of fruit and/ or vegetable per day

No daily servings of fruit or vegetable

Both sexes

N=4503

Male N=1946

Female N=2557

Both sexes

N=4503

Male N=1946

Female N=2557

Both sexes

N=4503

Male N=1946

Female N=2557

% % % % % % % % %

age groups (years)

6.9 7.2 6.7 91.4 91.2 95.3 1.6 1.5 1.7 25-34 6.6 6.2 6.9 92.2 92.1 92.2 1.3 0.7 0.9 35-44 7.3 7.9 6.9 91.9 91.3 92.4 0.7 0.8 6.9 45-54 8.9 7.8 8.3 88.8 96.5 88.7 2.2 0.1 3.0 55-65 7.3 7.5 7.0 91.4 91.2 91.5 1.4 1.4 1.4 25-65




30

Table (3.3.2.2) Mean number of servings of fruit, vegetable, and combined fruit and vegetable servings per day, by age groups and gender, Iraq 2006*

Daily number of servings of fruit and

vegetables

Daily number of servings of vegetables

Daily number of servings of fruit

Both sexes N=45

03

Male N=19

46

Female N=2557

Both sexes N=45

03

Male N=19

46

Female N=2557

Both sexes N=45

03

Male N=19

46

Female N=2557

mean mean mean mean Mean Mean mean mean Mean

age groups (years)

2.4 2.4 2.4 1.6 1.5 1.6 0.7 0.8 0.7 25-34 2.3 2.2 2.2 1.5 1.5 1.5 0.7 0.7 0.7 35-44 2.4 2.4 2.4 1.6 1.6 1.6 0.7 0.7 0.7 45-54 2.4 2.5 2.3 1.6 1.6 1.5 0.6 0.7 0.6 55-65 2.4 2.4 2.3 1.6 1.6 1.6 0.7 0.7 0.7 25-65

t 0.653 t 0.014 t 0.316 p 0.514 p 0.989 p 0.752

Oil and Fat consumption

It is shown that the most of the respondents households used vegetable gee (74.8%), this may be due its availability being accessible to the whole population through monthly food ration. Only (12.1%) used vegetable oil. Small percentage of the respondents (1.2%) used animal oil. (Table 3.3.2.3).

Table (3.3.2.3) Number and percentage of households according to the type of oil or fat usually used in cooking , Iraq 2006

%

Number of households

Type of Oil

12.1 545 Vegetable oil

74.8 3363 Gee

1.6 68 Animal fat

0.9 42 Mixed

10.2 459 None used

0.2 8 Others

0.1 4 Don’t know




31

3.3.3.Physical activity

Physical activity was assessed by asking the respondents about the time spent doing different types of activities.

The intensity of physical activity is categorized into:

1 Vigorous-intensity activity: defined as the activity, which causes large increases in breathing or heart rate, and sweating for at least 10 minutes continuously.

2 Moderate-intensity activity: defined as the activity, which causes small increase in breathing or heart rate for at least 10 minutes continuously.

3 Low-intensity physical activity: the remaining respondents who were not included in the previous categories were considered belonging to this category.

The frequency of performing different types of physical activity in a typical week was inquired, and the time spent doing these activities during the day was also assessed. The domains where physical activity was assessed included: work, travel to and from places (transportation), and recreation.

Physical activity at work

The prevalence of vigorous physical activity at work was (9.4%) among the respondents. Male were found to perform vigorous activity more than female (11.4% Vs 7.9 % respectively). While the prevalence of moderate physical activity was (29.1%) that was higher among female as compared to male (34.8% Vs 21.6%) It is obvious that both types of activity decreased with increasing age (table 3.3.3.1)

Table (3.3.3.1) Percentage of participants classified into three categories of work related physical activity, by age groups and gender, Iraq 2006

Both sexes N=4503

Male N=1946

Female N=2557

Vigorous

activity

%

Moderate

activity

%

Low activit

y %

vigorous

activity %

Moderate

activity %

Low activit

y %

vigorous

activity %

Moderate

activity

%

Low activity %

age groups

10.6 33.5 55.9 14.4 25.2 60.4 7.7 39.8 52.6 25-34 11.3 32.0 56.7 13.5 17.6 65.1 9.4 40.7 49.9 35-44 8.1 26.8 65.1 9.2 22.8 67.9 7.4 29.4 63.2 45-54 5.0 17.9 76.9 3.8 13.5 82.7 6.0 21.6 72.4 55-65 9.4 29.1 61.5 11.4 21.6 67.1 7.9 34.8 57.3 Total

Physical activity during travel to and from places (transportation)

Although around two thirds of the respondents (64.5%) reported walking to and from different place for at least 10 min. Only (28.5%) practiced moderate physical activity on walking 30 minutes a day, five days or more in a typical week. Male practiced walking more than female (42.2% Vs 19.7% respectively).The proportion of respondents practicing walking activity decreased with increasing age. (Table 3.3.3.2)




32

Table (3.3.3.2) Percentage of participants practicing moderate activity at walking to and from places (transportation), by age groups and gender, Iraq 2006

Physical activity at recreation

The majority of respondents had low level of physical activity during recreation time (90.5% for male and 88.9% for female).

Results showed that moderate physical activities were more practiced by respondents as compared to vigorous activities (8.6% vs 1.8%), (Table 3.3.3.3)

Table (3.3.3.3) Percentage of participants classified into three categories of recreational physical activity, by age groups and gender, Iraq 2006

Both sexes N=4503

Male N=1946

Female N=2557

age groups

Vigorous activity

%

Moderateacti

vity

%

Low activit

y %

Vigorous**

activity %

Moderate

activity

%*

Low activity

%

Vigorous**

Activity %

Moderate

activity*

%

Low activity %

1.9 10.1 87.9 2.3 9.1 88.5 1.6 10.8 87.5 25-34 2.0 8.8 89.1 2.6 7.3 90.1 1.5 10.1 88.4 35-44 1.7 8.4 89.9 1.0 5.8 93.2 2.1 10.2 87.7 45-54 0.9 5.4 93.6 2.2 5.7 92.1 0 5.3 94.7 55-65 1.8 8.6 89.7 2.2 7.3 90.5 1.4 9.6 88.9 Total

Total daily physical activity

Based on the total daily physical activity, it was found that (10.5%) of the respondents practiced vigorous activity; nearly one third (32.8) practiced moderate intensity activity. The remaining population (56.7%) reported low activity (table 3.3.3.4).

Female Male Total Age groups N=2557

% N=1946

% N= 4503

% 25-34 16.9 41.1 27.3 35-44 20.8 39.3 29.1 45-54 22.9 43.0 30.9 55-65 18.3 36.8 26.5 25-65 19.7 40.2 28.5




33

Table (3.3.3.4) Percentage of participants classified into three categories of total physical activity, by age groups and gender, Iraq 2006

Both sexes N=4503

Male N=1946

Female N=2557

Vigorous

activity %

Moderate

activity %

Low activit

y %

Vigorous activity**

%

Moderate activity*

%

Low activit

y %

Vigorous

activity*

* %

Moderate activity*

%

Low activity %

age groups

12.0 37.9 50.1 16.1 29.4 54.6 8.9 44.4 46.7 25-34 12.5 35.6 51.9 15.1 25.6 59.3 10.3 43.9 45.8 35-44 9.1 30.2 60.7 9.7 25.7 64.7 8.6 33.2 58.2 45-54 5.7 20.7 73.5 5.3 16.9 77.7 6.0 23.8 70.2 55-65 10.5 32.8 56.7 12.7 25.4 61.8 8.9 38.5 52.7 25-65

Time spent for physical activity

Results showed that the respondents practiced physical activity for (4-5) hours throughout the day (Table 3.3.3.5)

Table (3.3.3.5) Median time of total physical activity per day (minutes), by age groups and gender, Iraq 2006

both sexes N=4503 Median

Male N=1946 median

Female N=2557 Median

Age groups

355.7 412.9 282.9 25-34 288.6 271.8 288.6 35-44 240.0 287.1 228.6 45-54 195.0 181.8 231.4 55-65 288.6 310.7 274.7 Total

The median time spent for physical activity was higher during work than other domains. (Table 3.3.3.6) (Fig 3.3.2 )

Most of Iraqis are not accustomed to practice outdoor physical exercise. Due to the recent unstable, insecure conditions, physical fitness activities are not sufficiently appreciated at work, or even during recreation time.

Table (3.3.3.6) Median time spent per day in minutes, at work, transport- and recreation-related physical activity, by age groups and gender, Iraq 2006

Both sexes (N=4503) Male (N=1946) Female (N=2557) recreatio

n Transport Work Recreatio

n Transport Work Recreation Transport Work

median Median Median Median Median Median Median Median Median

age groups (years)

77.1 30.0 218.6 80.0 30.0 257.1 70.0 20.0 175.7 25-34 69.6 25.7 197.1 68.6 30.0 205.7 75.0 21.4 162.9 35-44 94.3 25.7 171.4 72.9 30.0 205.7 102.9 21.4 154.3 45-54 77.1 25.7 102.9 77.4 30.0 90.0 64.3 21.4 124.0 55-65 77.1 25.7 188.6 72.9 30.0 205 77.1 21.4 162.9 25-65




34

0

50

100

150

200

250

Res

pond

ants

%

Female Male Both Sexes

Fig (3.3.2) Median time (minutes) Spent Per Day at Work, Transport, and Recreation Related Physical Activity, Iraq 2006

Work Transport Recreation

Median time for vigorous or moderate activities

Median time spent for performing moderate or vigorous activities at work decreased with increasing age. Male practiced these activities more than female. (Table 3.3.3.7)

Few respondents practiced recreation related physical activities (vigorous or moderate). Female seemed to practice moderate physical activities during recreation time more than male. (Table 3.3.3.8)

Table (3.3.3.7) Median time of work-related moderate and vigorous-intensity physical activity per day, by age groups and gender, Iraq 2006

P

value

t test Both sexes

(N=4503)

Male (N=1946) Female (N= 2557)

vigorous Moderate vigorous Moderate vigorous moderate

median Median median Median Median Median

Age

groups

(years)

240 180 300 240 180 180 25-34

240 180 300 225 180 180 35-44

240 180 300 240 180 180 45-54

120 150 210 120 120 180 55-65

240 180 300 225 180 180 25-65




35

Table (3.3.3.8) Median time of recreational moderate and vigorous-intensity physical activity per day, by

age groups and gender, Iraq 2006

Both sexes

(N=4503)

Male (N=1946) Female (N= 2557)

vigorous moderate vigorous Moderate vigorous moderate

median Median median Median median median

Age

groups

(years)

90 120 75 60 120 120 25-34

120 105 120 60 105 120 35-44

60 120 120 90 60 120 45-54

110 100 110 90 0 120 55-65

90 120 100 60 90 120 25-65

Sedentary time

The mean sedentary time for both genders was more than four hours (281 minutes)/day. The time increased with increasing age. (Table 3.3.3.9)

Table (3.3.3.9) Total time spent in sedentary activity per day, by age groups and gender, Iraq 2006

Both sexes

(N=4503)

Male (N=1946) Female (N=

2557)

Median mean median mean Median Mean

Age

groups

(years)

210 256 193 259 240 254 25-34

240 267 240 277 240 258 35-44

240 290 240 301 240 282 45-54

300 344 300 336 300 351 55-65

240 281 240 286 240 277 25-65




36

3.4.Awareness to hypertension and diabetes:

To identify public awareness about their health status, the prevalence of hypertension and diabetes were estimated based on self reporting. The respondents were asked whether they have been told by health professional that that they had hypertension or diabetes, and were also asked about their compliance to medical treatment and the advice they received at health settings for promotion of healthy life style.

Self-reported hypertension

Results showed that nearly two thirds (61.4%) of the respondents had their blood pressure measured during the preceding 12 months period. Female seemed to measure their blood pressure more than male (66.3% compared to 55.1% respectively). (Table 3.4.1) (fig 3.3.3 )

Table (3.4.1) Distribution of the respondents according to the most recent time for measurement of blood pressure (years), self- reported, by age groups and gender, Iraq 2006

Female (N=1946) Male (N=2557) Total (N=4503) Age groups <1 yr*

% 1-5 yr %

Never %

<1 yr*

% 1-5 yr %

Never %

<1 yr %

1-5 yr %

Never %

25-34 57.7 18.6 22.9 43.1 18.1 38.8 51.4 18.6 29.8 35-44 62.5 20.4 16.8 50.5 17.1 32.5 57.1 18.9 23.9 45-54 71.7 16.2 12.1 66.9 12.6 20.5 69.8 14.2 15.4 55-65 82.9 8.0 8.5 72.9 15.1 11.6 78.5 11.2 9.9 25-65 66.3 17.1 16.4 55.1 16.2 28.7 61.4 16.7 21.6

0

5

10

15

20

25

Not

ific

atio

n %

Self-reportedhyper tension,

Iraq 2006

Self-reporteddiabetes, Iraq

2006

Fig (3.3.3) Awareness to hypertension pressure and diabetes, Iraq 2006

Female Male Both sexes




37

Accordingly, (19.2%) were informed by their doctors or health personnel to have hypertension. Also, (13%) of the population were currently on antihypertensive treatment. There was an evident gender variation the rate of self-reported hypertension in favour of female (22.2% for female compared to 15.3% for male). The rate increased with increasing age in both sexes (tables 3.4.2 & 3.4.3)

Table (3.4.2) Distribution of the respondents According to raised blood pressure ,Based on Notification by a doctor or health worker, Self- Reported ,Iraq 2006

Notified Having

Hypertension

Not Notified

Don't know

Total Hypertension

n % n % n % N %

Female 568 22.2 1980 77.4 9 0.3 2557 100

Male

298 15.3 1647 84.6 1 0.0 1946 100

Both sexes

866 19.2 3627 80.5 10 0.2 4503 100

Table (3.4.3) Proportion of hypertension among respondents based on notification and medical treatment, self reported, by age groups and gender, Iraq 2006

Currently taking blood pressure drugs prescribed by doctor or health worker

Raised blood pressure diagnosed by doctor or health worker

Both N=4503

%

male N= 1946

%

Female N= 2557

%

Both N=4503

male N= 1946

%

Female N=2557

%

Age groups

3.1 3.3 2.9 7.2 5.9 8.2 25-34 8.3 7.5 9.1 14.6 10.6 17.9 35-44

18.3 15.5 20.2 26.5 20.7 30.2 45-54 34.7 31.1 37.6 42.3 36.2 47.1 55-65

13.0 11.6 14.1 19.2 15.3 22.2 Total

Two thirds of the hypertensive population received medical treatment (67.8%); on the other hand, the provision of advice for life style modification was seen in one third of the patients or less. (Tables .3.4.4, 3.4.5,) Males were advised more than female in the issues of smoking and exercise, whereas female were mainly advised to loose weight




38

Table (3.4.4) Number and percentage of the self-reported hypertensive respondents

according to each Type of management ,Self-Reported, Iraq 2006

%

No.

N=866

Type of management 67.8 587 Drugs Prescribed by Physicians 34.4 298 Advice or Treatment to lose weight 23.6 204 Advice or Treatment to stop smoking 29.7 257 Advice or Treatment to do more exercise 11.0 95 Seen a traditional healer 8.7 75 Herbal or traditional remedy for hypertension

table (3.4.5. ) Distribution of self-reported hypertensive respondents according to life style modification advice, by age groups and gender Iraq 2006.

Advised by doctor or health worker to lose weight

Advised by doctor or health worker to stop smoking

Advised by doctor or health worker to do more exercise

Age groups

Female N= 568 %

Male N= 568 %

Total N= 568 %

Female N= 568 %

Male N=298 %

Total N=866 %

Female N= 568 %

Male N=298 %

Total N=866 %

25-34 20.0 22.2 20.8 2.8 30.6 17.9 20.0 30.6 23.8 35-44 31.4 32.4 31.7 1.4 38.2 17.8 21.4 36.8 26.4 45-54 38.9 36.7 13.7 4.7 46.8 25.2 27.4 30.4 28.3 55-65 43.6 28.8 37.6 9.3 46.9 30.9 31.9 41.8 34.9 25-65 36.4 30.5 34.4 13.4 42.9 23.6 26.6 35.6 29.7

The rate for seeking traditional healer advice was (11%) with no obvious gender variation, accordingly (8.7%) were taking herbal or traditional remedies. (Table 3.3.4.6)

table (3.4.6 ) Percentage of self-reported hypertensive respondents seen and treated by traditional healers, and currently taking herbal or traditional remedy, by age groups and gender, Iraq 2006

Seen by traditional healer Currently taking herbal or traditional remedy for treatment

Blood groups

Female N= 568

%

Male N=298

%

Both N=866

%

Female N= 568

%

Male N=298

%

Both N=866

% 25-34 3.1 2.8 2.9 0.0 2.8 0.9 35-44 5.7 10.3 7.2 6.4 7.4 6.7 45-54 12.6 16.5 13.7 10.3 12.7 11.0 55-65 14.4 13.0 13.9 12.8 6.9 10.6 25-65 10.4 12.1 11.0 8.9 8.1 8.7




39

Self reported diabetes

Results showed that (20.8%) of the respondents measured their blood sugar within 12 months prior to the interview. Based on medical notification, (6.5%) of the sample reported having diabetes mellitus, the rate among male was higher than female (7.3% vs 5.9% respectively). (Table 3.4.7 & .3.4.8) (Fig 3.3.3).

Table (3.4.7) Distribution of the respondents According to blood sugar measurement Within the Past 12 months by gender, Iraq 2006

Blood tested

Not tested

Don't know

Total

Sex No. % No. % No. % No. %

Female 545 21.3 2002 78.3 10 0.4 2557 100 Male 393 20.2 1552 79.8 1 0.1 1946 100 Total 938 20.8 3554 78.9 11 0.2 4503 100

Table (3.4.8) Distribution of the respondents According to diabetes ,Based on Notification by a doctor or health worker, Self- Reported ,Iraq 2006

Notified Having

Diabetes

Not Notified

Don't know

Total

Sex No % No. % No. % No. %

Female 152 5.9 2395 93.7 10 0.4 2557 100

Male 142 7.3 1803 92.7 1 0.1 1946 100

Both sexes 294 6.5 4198 93.2 11 0.2 4503 100

More than two-thirds (69.7%) were on oral hypoglycaemic medication and (13.6%) received Insulin. Around one third were advised to reduce their body weight (38.1%), a similar proportion received advice for quitting smoking (31%), or for promotion of physical activity (32.3%). Generally, male received advice more than female. (Tables 3.3.4.9, 3.3.4.10, 3.3.4.11)

Table (3.4.9) Number and percentage of self-reported Diabetics by each type of management, Iraq 2006

%

Number

Type of Treatment

13.6 40 Insulin 69.7 205 Oral Drug 38.1 112 Advice or Treatment to lose weight 30.9 91 Advice or Treatment to stop smoking 32.3 95 Advice to start or do exercise 15.6 46 Herbal traditional remedy for diabetes




40

Table (3.4.10 ) Type of treatment of the self-reported diabetic respondents, by age groups and gender, Iraq 2006

Currently taking oral drugs prescribed by doctor or health worker

Currently taking insulin prescribed by doctor or health worker

Both N=294 %

male N=142

%

Female N=152

%

Both N=294 %

male N=142

%

Female N=152%

Age groups

41.0 33.3 44.4 33.3 33.3 33.3 25-34 65.1 70.4 56.6 13.9 14.8 12.5 35-44 69.4 68.9 69.8 10.2 6.7 12.7 45-54 75.0 75.0 75.0 14.1 8.8 14.1 55-65 67.7 70.4 69.7 13.6 14.7 14.5 25-65

Table (3.4.11) Percentage of the self-reported diabetic respondents who received advice for life style modification, by age groups and gender, Iraq 2006

Advised by doctor or health worker to do more exercise

Advised or treated by doctor or health worker to stop smoking

Advised by doctor or health to lose weight

Both N=294 %

male N=142

%

Female N=152

%

Both N=294

%

male N=142

%

Female N=152

%

Both N=294 %

male N=142

%

Female N=152

%

Age groups

33.3 50.0 22.2 6.7 16.7 0 6.7 0.0 11.1 25-34 25.6 25.9 25.0 39.5 48.1 25.0 41.9 48.1 31.3 35-44 35.2 42.2 30.2 27.8 46.7 14.3 42.6 48.9 38.1 45-54 32.0 29.7 32.8 33.6 39.1 28.1 36.7 29.7 43.8 >55 32.3 33.8 30.9 30.9 42.3 20.4 38.1 38.0 38.2 Total

The rate for seeking advice with traditional healers was (20.1%) with minimum gender variation. Accordingly, (15.6%) were taking herbal or traditional remedy for treatment of diabetes. (Table3.4.12)

Table (3.4.12) Percentage of the self-reported diabetic respondents seen by traditional healers and currently taking traditional or herbal remedy, by age groups and gender, Iraq 2006

Seen by traditional healer Currently taking herbal or traditional remedy for treatment

Age Groups

Female N= 152 %

Male N=142 %

Both N=294 %

Female N= 152 %

Male N=142 %

Both N=294 %

25-34 22.2 50.0 33.3 11.1 0 6.7 35-44 12.5 29.6 23.3 6.2 25.9 18.6 45-54 19.0 17.8 18.5 20.6 11.1 16.7 55-65 25.0 12.5 18.8 15.6 14.1 14.8 25-65 21.1 19.0 20.1 16.4 14.8 15.6




41

3.5.Physical Measurements

The vast majority (4483 persons) out of the eligible respondents agreed to participate in STEP II of the survey for blood pressure and anthropometric measurements (height, weight, waist circumference, hip circumference).

3.5.1.Blood pressure measurements

Mean blood pressure

The results showed that the mean systolic blood pressure for the total study sample was (130.3) mmHg,(with a minimum of 60.5mmHg and a maximum of 223.3 mmHg and a SD 19.6), being higher among male as compared to female (131.0 Vs 129.8 respectively). The mean diastolic blood pressure was (82.4) mmHg ( with a minimum of 40.0, a maximum of 170.0 mmHg, and SD 11.9) that seems to be higher among male than female (83.3 mmHg Vs 81.6 mmHg respectively) . As expected, both the mean systolic and diastolic blood pressure increased with age. The gender based differences was notably minimized in the age groups of (≥45 years)

table (3.5.1.1) Mean blood pressure of the respondents by age groups and gender, Iraq 2006

Systolic blood pressure (mmHg) Diastolic blood pressure (mmHg) Age Groups

Female mean

Male mean

Both sexes Mean

t test

P value

Female mean

Male Mean

Both sexes Mean

t test

P value

25-34 119.6 123.9 121.4 76.7 80.1 78.2 35-44 126.8 127.4 127.1 80.7 82.3 81.4 45-54 136.8 136.5 136.7 85.2 85.9 85.5 55-65 145.7 145.4 145.6 87.9 88.6 88.2 25-65 129.8 131.0 130.3 -2.124 0.034 81.6 83.3 82.4 -4.648 0.00

Prevalence of hypertension

The WHO classification for blood pressure measurement was adopted: Category SBP* DBP** Optimal <120 <80 Pre-hypertension 120- <140 80 - <90 Hypertension stage I 140 - <160 90 - <100 Hypertension stage II ≥ 160 ≥ 100 *SBP = Systolic blood pressure ** DBP = Diastolic blood pressure Systolic hypertension (SHT) rate (≥ 140 mmHg) The prevalence of systolic hypertension was (30.9% ) with minimum gender differences. The rate increased with increasing age in both sexes peaking at the age group of (55-65 years) (table 3.5.1.2 ).




42

Diastolic hypertension (DHT) rate (≥90 mm Hg): A rate of (31.0% ) of the respondents were having diastolic hypertension. However, there was an evident gender related difference in favour of male (33.7% Vs 28.0% respectively). similarly, the rate of diastolic hypertension increased with age. (table 3.5.1.2).

Table (3.5.1.2 ) Rates of systolic hypertension and diastolic hypertension among the respondents, by age groups and gender, Iraq 2006

Systolic blood pressure ≥ 140 mmHg

Diastolic blood pressure ≥ 90 mmHg Age groups

Female %

Male %

Both sexes %

Female %

Male %

Both sexes %

25-34 9.6 13.8 11.4 11.8 21.9 16.2 35-44 24.9 21.6 23.5 26.9 29.6 28.2 45-54 46.8 46.6 46.7 40.4 42.9 41.4 55-65 62.1 64.0 62.9 50.8 53.3 51.9 25-65 30.9 31.0 30.9 28.0 33.7 31.0 Stage II SHT (≥ 160 mmHg): Results showed that (10.3%) of the respondents had stage II systolic hypertension (≥ 160 mmHg) with an evident gender difference being higher among female (11.0% Vs 9.5%respectively). The rate increased with increasing age Table (3.5.1.3) .

Stage II DHT (≥100 mmHg): Results showed that 10.3 % of the study population had stage II diastolic hypertension (≥ 100mm Hg), with no evident gender differences (10.4 for female and 10.2 % for male), similarly, the rate increased with increasing age Table (3.5.1.3). Table (3.5.1.3) Rates of stage II systolic hypertension and diastolic hypertension among the respondents, by age groups and gender, Iraq 2006

Systolic blood pressure ≥160 mmHg

Diastolic blood pressure ≥100 mmHg

Age groups

Female %

Male %

Both sexes

%

Female %

Male %

Both sexes

% 25-34 1.0 0.8 3.9 2.5 3.5 2.9 35-44 6.4 5.5 5.9 8.2 7.7 7.9 45-54 17.7 13.4 15.9 16.6 14.7 15.9 55-65 30.1 29.3 29.7 21.5 22.7 22.0 25-65 10.9 9.5 10.3 10.4 10.2 10.3 Prevalence of hypertension (systolic and/or diastolic): Generally speaking, the prevalence of hypertension ( SBP ≥140 mmHg and/or DBP ≥90 mmHg) was 40.4%. It was higher among male as compared to female ( 43.1 Vs 38.3) (Table 3.5.1.4, Fig 3.5.1). The prevalence of stage II hypertension ( SBP ≥160 mmHg and/or DBP ≥100 mmHg) was 13.9% being higher among female than male (15.3 Vs 14.1 respectively).(table 3.5.1.5, Fig 3.5.2).




43

In both sexes, there is an evident increase in the prevalence of hypertension after the age group of (45 years).

Table (3.5.1.4 ) Rate of hypertension (SBP ≥ 140mmHg and/or ≥ 90mmHg ) among the respondents, by age groups and gender, Iraq 2006

Systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg

Age groups

Female N=2545

%

Male N=1938

%

Both sexes N=4483

% 25-34 15.3 26.7 20.2 35-44 33.6 35.6 34.5 45-54 55.1 57.6 56.1 55-65 68.7 72.2 70.3 25-65 38.3 43.1 40.4

35

36

37

38

39

40

41

42

43

44

part

icip

ants

%

Female Male Both sexes

Fig (3.5.1) Prevalence of hypertension SBP>=140 mm Hg and/or DBP>=90 mm Hg by gender, Iraq 2006

Table (3.5.1.5 ) Rate of hypertension (SBP ≥ 160mmHg and/or ≥ 100mmHg ) among the respondents, by age groups and gender, Iraq 2006

Systolic blood pressure ≥ 160 mmHg and/or diastolic blood pressure ≥ 100 mmHg

Age groups

Female N=2545

%

Male N=1938

%

Both sexes N=4483

% 25-34 3.3 3.6 3.3 35-44 10.7 9.9 10.4 45-54 23.7 20.0 22.3 55-65 36.4 35.3 35.9 25-65 15.3 14.1 14.8




44

13,4

13,6

13,8

14

14,2

14,4

14,6

14,8

15

15,2

15,4

Par

ticip

ant

%

Female male Both sexes

Fig (3.5.2) Prevalence of stage II hypertension (SBP >= 160 and/or DBP >=100) by gender, Iraq 2006

3.5.2.Anthropometric measurements

Height and weight

Results showed that the mean height in the study population was (163.3) cm (with a maximum of 198.3 cm and a minimum of 104.0 cm). Male were taller than female (170.4 cm, 157.8 cm respectively). (Table 3.5.2.1)

The mean body weight of the whole study sample was (74.9) Kg (with a maximum of 194.2Kg and a minimum of 33 Kg). Similarly, male recorded higher figures in body weight than female (78.8 Vs 71.8 Kg respectively). In both sexes the body weight peaked at the age groups of (45-54 years).

table (3.5.2.1) Mean height and weight of the respondents, by age groups and gender, Iraq 2006

Height (cm) Weight (Kg) Age groups

Female mean

Male mean

Both sexes mean

Female mean

Male Mean

Both sexes mean

25-34 158.4 170.9 163.8 68.7 77.2 72.6 35-44 158.3 171.4 164.2 71.6 79.9 75.5 45-54 157.6 169.6 162.4 74.9 80.6 77.2 55-65 156.2 168.2 161.6 73.4 77.7 75.3 25-65 157.8 170.4 163.3 71.8 78.8 74.9

Body mass index (BMI):

This is a measure of nutritional status whereby the body weight in Kilogram is divided to the square meters for height

BMI = Body weight (Kg) Height (M2)

The mean BMI of the whole sample was (28.1). Although female recorded lower measurements than male in regard to body weight, their mean BMI was found to be higher than male (28.9 Vs 27.1 respectively). This could be attributed to their short stature that made their weight have more evident effect (Table 3.5.2.2).




45

Table ( 3.5.2.2 ) Mean body mass index of the respondents, by age groups and gender, Iraq 2006*

Age groups Female Mean

Male Mean

Both sexes Mean

25-34 27.4 26.4 26.9 35-44 28.7 27.2 27.9 45-54 30.2 27.9 29.3 55-65 30.2 27.4 28.9 25-65 28.9 27.1 28.1

*pregnant women are excluded. According to the WHO definition, two thirds (66.9%) of the respondents were found to be overweight (BMI ≥ 25). The rate of overweight among female was higher than male (69.6 Vs 63.6).(table 3.5.2.3, Fig 3.5.3)

table ( table 3.5.2.3 ) Rate of overweight (BMI ≥ 25 ) among the respondents, by age groups and gender, Iraq 2006

Age groups Female %

Male %

Both sexes %

25-34 60.8 56.3 58.7 35-44 70.7 63.5 67.3 45-54 76.7 73.1 70.8 55-65 73.1 66.6 70.2 25-65 69.6 63.6 66.9

60

61

62

63

64

65

66

67

68

69

70

Female male both sexes

Fig (3.5.3) Prevalence of Overweight (>=25 Kg/M2), BY Gender, Iraq 2006

Female Male Both Sexes

The WHO cut-off points for BMI were adopted to categorize the respondents as listed below:

Category BMI% Overweight 25 – 29.9 Obese ≥ 30

It is shown that nearly one third of the respondents were obese . Obesity was proportionately higher than overweight among female (38.2% Vs 31.4%), whereas overweight supervened among male (37.4% Vs 26.2%) (table 3.5.2.4)

It is recently believed that obesity is not necessary an indicator of affluence. It is partly due to consumption of unhealthy diet in addition to lack of exercise(9).




46

Table (3.5.2.4)) Proportion the overweight (BMI ≥ 25 )and the obese(BMI ≥ 30 ) among the respondents by age groups and gender, Iraq 2006

Female Male Age groups Over

weight %

Obese %

Over weight

%

Obese %

25-34 33.2 27.6 33.2 23.0 35-44 34.1 36.6 37.8 25.7 45-54 27.4 49.3 41.2 31.9 55-65 28.4 44.7 40.1 26.5 25-65 31.4 38.2 37.4 26.2

Waist and hip circumference:

The WHO standards for measurements of hip circumference were adopted:

Optimal waist circumference Male 102 cm Female 88 cm

Results showed that the waist circumference measurements for female exceeded the standard measurements (91.9 cm), whereas the measurements for male were within the acceptable standard (93.34 cm) (table 3.5.2.5)

Table (3.5.2.5) Mean waist and hip circumference of the respondents by age groups and gender, Iraq 2006

Waist circumference

Hip circumference Age groups Female

Mean Male mean

Female mean

Male Mean

25-34 86.5 89.8 100.9 100.2 35-44 91.7 92.7 103.8 101.0 45-54 95.4 97.1 104.9 103.5 55-65 96.6 97.0 106.5 101.8 25-65 91.9 93.3 103.6 101.4

Waist to hip ratio

According to the WHO standards, the cut off points for waist/ hip ratio are: Male 1 Female 0.85

Results showed (table3.5.2.6) that the waist to hip ratio in both sexes were within the standard measurement (0.7 for female and 0.8 for male)

Table (3.5.2.6) waist/ hip ratio of the respondents by age groups and gender, Iraq 2006

Female Male Age groups

Waist/hip ratio

Waist/hip ratio>0.85

Waist/hip ratio

Waist/hip ratio>1

25-34 0.7 0 0.8 0 35-44 0.7 0 0.8 0 45-54 0.8 0 0.8 0 55-65 0.7 0 0.8 0 25-65 0.7 0 0.8 0




47

3.6 Biological measurements

3.6.1Fasting blood glucose

Mean fasting blood glucose

The mean fasting blood sugar for the sample was 5.3 mmol/L (with a maximum of 30.90mmol/L and a minimum of 1.92 mmol/L), with similar distribution for male and female (5.28 mmol/L, 5.33 mmol/L respectively).

Generally, the mean FBS increased with age in both sexes.(table 3.6.1.1)

Table (3.6.1.1) Mean fasting blood glucose of the respondents by age groups and gender, Iraq 2006

Rates of hyperglycaemia

The respondent is considered hyperglycemic when fasting blood glucose (≥ 7 mmol/L). Accordingly, results showed that the prevalence of hyperglycemia was (10.4%) (table 3.6.1.2). It increased with increasing age. The rate peaked among female by the age of (≥45 years), whereas male showed two peaks , one among adults (25-34 years), and the other at old age (≥55 years). the underlying different types of diabetes may explain this pattern of distribution.

Table (3.6.1.2) Percentage of the respondents with hyperglycemia ( ≥ 7mmol/L) by age groups and gender, Iraq 2006

Fig (3.6.1) Prevalence of hyperglycemia among respondents, Iraq 2006

10.4%

Mean fasting blood glucose (mmol/L) P value t

test Both sexes

male female Age groups

4.9 4.9 4.8 25 – 34 5.0 5.1 4.9 35 -44 5.7 5.5 5.8 45 -54 6.0 6.3 5.9 55-65 0.204 -1.269 5.3 5.3 5.2 25-65

Fasting blood glucose (≥7mmol/L) Both sexes 4196

Male N=1817

Female N=2379

Age groups

5.5 9.9 4.5 25 – 34 7.5 6.9 6.8 35 -44

14.7 7.9 15.0 45 -54 19.5 22.5 17.2 55-65 10.4 10.9 9.9 25-65




48

Respondents were further categorized according to their fasting blood glucose as follows based on the WHO classification:

Category FBS mmol/L Normal < 5.5 Impaired FBG 5.5-7 Hyperglycaemia ≥ 7 For the reason of assessment of the severity of hyperglycemia, a cut-off point of 11.1 mmol/L (200 mg/dl) was considered severe hyperglycemia.

Results showed that those with impaired fasting blood glucose constituted (15.7%) of the study sample. The age specific rate increased gradually with increasing age, ranging from (13.9%) among the age group of (25-34) years to (19.7%) among (55-65) years. Hyperglycemia, on the other hand, showed an evident increase after the age of ( 45 years ) in both sexes (3.6.1.7)

All of these reflect the lack of screening for detection of asymptomatic conditions at young age. So, they were detected and managed late by the time when symptoms started to show. Initiation of management may have contributed to the reduction in the rates among older age groups.

Conversely, in severe hyperglycemia (>11.1 mmol/L), it appeared to peak up earlier among female (45-54 years), as compared to male. However, the rate is higher among male which could be due to poor compliance with management among old male.

Table (3.6.1.7) Distribution of the respondents according to fasting blood glucose categories, by age groups and gender, Iraq 2006

Fasting blood glucose (mmol/L)

Hyperglycemia Normal (< 5.5)

Impaired glucose

( 5.5 - <7) (7-<11.1 ) (≥11.1)

Total Age groups

No % No % No % No % No %

25 - 34 599 81.8 100 13.7 26 3.6 7 1.0 732 100 35 -44 576 78.7 103 14.1 37 5.1 16 2.2 732 100 45 -54 372 68.6 83 15.3 53 9.8 34 6.3 542 100 55-65 231 61.9 78 20.9 40 10.7 24 6.4 373 100 Fe

mal

e

25-65 1778 74.7 364 15.3 156 6.6 81 3.4 2379 100 25 - 34 447 78.8 81 14.3 32 5.6 7 1.2 567 100 35 -44 452 76.1 95 16.0 35 5.9 12 2.0 594 100 45 -54 248 69.3 65 18.2 28 7.8 17 4.7 358 100 55-65 177 59.4 54 18.1 38 12.8 29 9.7 298 100 M

ale

25-65 1324 72.9 295 16.2 133 7.3 65 3.6 1817 100 25 - 34 1046 80.5 181 13.9 58 4.5 14 1.1 1299 100 35 -44 1028 77.5 198 14.9 72 5.4 28 2.1 1326 100 45 -54 620 68.9 148 16.4 81 9.0 53 5.7 594 100 55-65 408 60.8 132 19.7 78 11.6 57 7.9 671 100 B

oth

se

xes

25-65 3102 73.9 659 15.7 289 6.9 146 3.5 4196 100




49

3.6.2 Fasting serum Cholesterol

Mean fasting serum cholesterol

The mean fasting serum cholesterol was 5 mmol/L (with maximum of 25.6 mmol/L, a minimum of 1 mmol/L, and SD 1.6), with no significant differences (Table 3.6.2.1).

Table (3.6.2.1) Mean fasting serum cholesterol of the respondents by age groups and gender, Iraq 2006

Rates of hypercholesterolemia:

The prevalence of high serum cholesterol (≥5.2 mmol/L) was 37.5% being higher among male than female (38.9% Vs 36.5% respectively). In both sexes the rate increased with increasing age. (Table 3.6.2.2).

Table (.3.6.2.2) Percentage of the respondents with total cholesterol of ≥ 5.2mmol/L by age groups and gender, Iraq 2006

Fig (3.6.2) Prevalence of hypercholesterolemia among respondents, Iraq 2006

37.5%

Respondents were further categorized as follows:

Category Fasting serum cholesterol Normal < 5.2 Mild 5.2-6.5 Severe ≥ 6.5

Mean fasting serum cholesterol (mmol/L) Age P value t test Both sexes Male Female groups

4.8 4.8 4.8 25 - 34 4.9 5.0 4.8 35 -44 5.2 5.1 5.3 45 -54 5.3 5.3 5.5 55-65

-0.126 -1.529 5.0 5.1 4.9 25-65

Fasting serum cholesterol (≥5.2 mmol/L) Both sexes N= 4200

Male N=1819

Female N= 2381

28.9 31.7 26.9 25 – 34 35.7 37.8 33.9 35 -44 43.5 42.6 44.2 45 -54 49.7 50.3 49.2 55-65 37.5 38.9 36.5 25-65




50

One fourth of the respondents (25.2%) had impaired cholesterol readings; this was similarly distributed among male and female. The prevalence for high total cholesterol was (12.3%) with no gender differences. The rate increased with increasing age. (Table 3.6.2.3)

It is evident that the problem starts early in life (25-34 years). This may reflect the presence of other behavioural risk factors that contributed to its occurrence in addition to the lack of screening for blood cholesterol for their early management.

Table (3.6.2.3) Distribution of the respondents according to fasting serum cholesterol categories by age groups and gender, Iraq 2006

3.7 Prevalence of risk factors:

The prevalence of risk factors among the respondents are summarized , with the expected number of conditions among the target population (25-65 years) in the community (table 3.7.1). Respondents were further assessed for having combined risk. the rate of raised risk for having at least three risk factors is calculated. The commonest combination of risk factors were due to raised blood pressure, high serum cholesterol, and low consumption of fruits and vegetable (table 3.7.2)

Desirable level(< 5.2 mmol/L)

impaired level

( 5.2 - <6.5 mmol/L)

High level (≥6.5mmol/L) Total

Age groups No % No % No % No %

25 - 34 536 73.1 124 16.9 73 10.0 733 100

35 -44 484 66.0 181 24.7 68 9.3 733 100 45 -54 302 55.8 151 27.9 58 16.3 541 100 55-65 190 50.8 5.0 32.0 64 17.1 374 100 Fe

mal

e

25-65 1512 63.5 576 24.2 293 12.3 2381 100

25 - 34 388 68.3 122 21.5 58 10.2 568 100

35 -44 371 62.2 163 27.3 62 10.4 596 100 45 -54 205 57.4 104 29.1 48 13.4 357 100 55-65 148 49.7 93 31.2 57 19.1 298 100

Mal

e

25-65 1112 61.1 482 26.5 225 12.4 1819 100

25 - 34 924 71.0 246 18.9 131 10.1 1301 100

35 -44 855 64.3 344 25.9 130 9.8 1329 100 45 -54 507 56.5 255 28.4 136 15.1 898 100 55-65 338 50.3 213 31.7 121 18.0 672 100 B

oth

sex

es

25-65 2624 62.5 1058 25.2 518 12.3 4200 100




51

Table (3.7.1) Prevalence of Non Communicable Diseases Risk Factors with the expected number of the conditions in the community, Iraq, 2006

Female Male Both Expected number of

population/cases* Behavioural risk factors Smoking 6.9 41.5 21.9 2,162,707 Less than 5 servings of fruit/vegetable per day

91.5 91.2 91.4 9,026,091

Physical inactivity 52.7 61.8 56.7 5,599,336 Biological factors Overweight** 31.4 37.4 34.1 3,367,502 Obesity** 38.2 26.2 32.8 3,239,122 Hypertension*** 38.3 43.1 40.4 3,989,651 hyperglycemia**** 9.9 10.9 10.4 1,027,039 High cholesterol***** 36.5 38.9 37.5 3,703,265

* Population 25-65 years of age in Iraq is 9,875,373; 34.4%of the total population

** Based on Body Mass Index (BMI) overweight is between 25-29.9 Kg/m2, and obesity is ≥30 Kg/m2 (pregnant women are not included). *** Hypertension prevalence is defined as total of systolic hypertension (SHT≥140 mmHg) and/or diastolic hypertension (DHT≥90 mmHg) **** Based on fasting blood glucose (≥7mmol/L) ***** Based on fasting serum cholesterol (≥5.2 mmol/L)




52

Table (3.7.2) Percentage of the respondents with combined risk according to the combination of risk factors, by gender, Iraq 2006

Female Male Both sexes Combination of risk factors Number % Number % Number %

Raised Blood pressure+ high blood glucose+ high total cholesterol 42 1.6 38 1.9 80 1.78 Raised Blood pressure+ high blood glucose+ current smoking 5 0.2 26 1.3 31 0.69 Raised Blood pressure+ high blood glucose+ low physical activity 1 0.0 1 0.1 2 0.04 Raised Blood pressure+ high blood glucose+ less than 5 servings of fruits and vegetables

68 2.7 55 2.8 123 2.73

high blood glucose + high total cholesterol + current smoking 12 0.5 51 2.6 63 1.4 high blood glucose + high total cholesterol + low physical activity 2 0.1 4 0.2 6 0.13 high blood glucose + high total cholesterol + less than 5 servings of fruits and vegetables

109 4.6 104 5.3 213 4.73

high total cholesterol + current smoking + low physical activity 1 0.4 11 0.6 12 0.27 high total cholesterol + current smoking + less than 5 servings of fruits and vegetables

65 2.5 284 14.6 349 7.75

current smoking + low physical activity + less than 5 servings of fruits and vegetables

3 0.1 30 1.5 33 073

Raised Blood pressure + high total cholesterol + current smoking 18 0.7 70 3.6 88 1.95 Raised Blood pressure + high total cholesterol + low physical activity 1 0.0 8 4.1 9 0.20 Raised Blood pressure + high total cholesterol + less than 5 servings of fruits and vegetables

202 7.9 167 8.6 369 8.19

Raised Blood pressure + current smoking + low physical activity 1 0.4 4 0.2 5 0.11 Raised Blood pressure + current smoking + less than 5 servings of fruits and vegetables

45 1.8 136 6.9 181 4.02

Raised Blood pressure + low physical activity + less than 5 servings of fruits and vegetables

10 0.4 19 0.9 29 0.64

high blood glucose + current smoking + low physical activity 1 0.0 3 0.2 4 0.09 high blood glucose + current smoking + less than 5 servings of fruits and vegetables

21 0.8 83 4.3 104 2.31

high blood glucose + low physical activity less than 5 servings of fruits and vegetables

3 0.1 8 0.4 11 0.24

high total cholesterol + low physical activity + less than 5 servings of fruits and vegetables

14 0.5 26 1.3 40 0.89




53

4 Conclusions:

The current survey deals with the identification of common modifiable risk factors: tobacco use, unhealthy diet, and physical inactivity, in addition to measurement of blood pressure, anthropometric measures, and fasting blood glucose and total cholesterol levels. The following conclusions are reached: 1. Epidemiological pattern of the risk factors:

1.1 Tobacco use: The prevalence of smoking was (21.9%).The proportion of smoking among male was six folds higher than female. The possibility of underreporting among female cannot be excluded. The mean age for initiation of smoking was (20) years. Male reported initiation of smoking at a younger age than female. The vast majority used manufactured cigarettes, and nearly two thirds smoked 20 cigarettes or more per day

1.2 Fruits and vegetables servings: The mean number of servings of fruits and vegetables was (2.4/day).The majority had single serving of fruits or vegetables, with no gender related differences.

1.3 Fat and oil: Most of the households used vegetable gee, probably due to its accessibility in the monthly food ration at the time of the survey.

1.4 Physical activity: Nearly one third practiced moderate intensity physical activity (32.8%), whereas more than half reported low physical activity (56.7%). The median time spent for physical activity was higher during work than other domains. The majority of female and the elderly respondents did not practice moderately active walking.

1.5 Awareness to hypertension and diabetes: - The prevalence of self reported hypertension was 19.%, 13% were currently on antihypertensive treatment.

Nearly one third received advice on promotion of healthy life style behaviour. - Self reported diabetes was 6.5%. more than one third received advice for promoting healthy life style

behaviour. - There is a tendency towards seeking traditional healers advice, (8.7%) of the hypertensive and (15.6%) of

the diabetic patients were taking herbal or traditional remedy for treatment. 1.6 High blood pressure: - Based on physical measurement, the mean systolic blood pressure was (130.3 mmHg) and the diastolic blood

pressure (82.4 mmHg). The means of both systolic and diastolic blood pressure were significantly higher among male as compared to female.

- The prevalence of hypertension ( SBP ≥140 mmHg and/or DBP ≥90 mmHg) was 40.4%. It was higher among male as compared to female.

1.7 Overweight and obesity: Overweight was estimated to be 66.9%. Obesity constituted one third of the population being higher among female (38.2%) as compared to male (26.2%).

1.8 Hyperglycemia: the mean fasting blood glucose was (5.3 mmol/L) with no gender variation. The prevalence of hyperglycemia was 10.4%. with an evident increase after the age of 45 years. The rate among male was higher than female with varying pattern of distribution. Impaired blood glucose was evident among (15.7%) of the population that was apparent among young adults and proportionately increasing with age.

1.9 Hypercholesterolemia: The mean serum cholesterol was (5.0 mmol/L) with no gender-related difference. The prevalence of high serum cholesterol (≥5.2 mmol/L) was 37.5% being higher among male than female. More than one fourth of the young adults (age group 25-34 years) suffered from hypercholesterolemia.

2 Poor consumption of fruits and vegetables, high consumption of fat, low intensity physical activity, all may result

in high cholesterol level and obesity in the population. These in turn, may have contributed to the high prevalence of hypertension and hyperglycemia.

3 The distribution of behaviour risk factors shows that smoking is more prevalent among male, with increasing risk among young age groups. Whereas lack of physical activity practices is evident among the female and the elderly. However, the total population share the problem of unhealthy dietary habits.

4 The prevalence of raised blood pressure, based on measurement, was as twice as the self-reported hypertension. Also self-reported diabetes constituted two third of the measurement based prevalent hyperglycemia. The differences between the self reported and the measurement based rates may be attributed to the lack of awareness or the presence of uncontrolled cases.

5 The increasing impact of behavioural risk factors over the life course might have contributed to the high prevalence of hypertension and hyperglycemia among the old age group (55-65 years).

6 There is raised risk among young adults. This might reflects the underlying risk behaviour that is already established during youth.




54

7 The prevalent behavioural risk factors reflect the underlying major social, economic and cultural driving forces like low education, unemployment, poor income, unhealthy envireonmental conditions, in addition to the stressful events.

8 The underlying determinants of the risk factors lie outside the health sector, these include: transport, education, agriculture, sports, and trade.




55

5 Recommendations:

1- Strengthening integration of chronic NCD care into PHC services: 1.1 Ascertaining the establishment of a health facility based screening system for early detection of asymptomatic

hypertension and diabetes conditions at PHC level. 1.2 Capacity building of the PHC health workers (PHC physicians, nurses, and laboratory technicians) in the

integrated Chronic NCD care. 1.3 Improvement of the facilities for chronic NCD detection and management at PHC services. 1.4 Integration of NCD prevention and control program into reproductive health services (MCH, school health,

adolescence care) and the elderly health care services. 2- Starting community based health education programs on the importance of the consultation and follow-up

processes for early detection of hypertension, diabetes, and their complications. 3- Building up a national strategy for enhancement of healthy life style practices in coordination with the related

ministries of Education, Higher Education and Scientific Research, Justice, Trade, Youth, Women care, Civil Society, in addition to the Religious bodies and the media. The following activities should be considered:

3.1 Starting a comprehensive project for banning tobacco use at schools, workplaces, transportation, and public places.

3.2 Strengthening action to promote healthy diet and physical activity at schools and universities. 3.3 Initiation of home based programs on healthy diet and indoor physical exercise targeting the female and the

elderly. 3.4 Enhancing utilization of the accessible sports and fitness recreational facilities 3.5 Raising public awareness through holding educational campaigns promoting healthy life style. 4- Establishment of a stepwise surveillance system: 4.1 Implementation of a survey on a sub-sample when the security situation is stabilized to neutralize the impact

of stress on the studied risk factors. 4.2 Repetition of the national survey within three to five years to measure the trend of risk factors over time and

to evaluate the NCD prevention and control program. 4.3 Modification of the national STEPS instrument on the next survey to include further expanded questions

regarding step 3, and the addition of optional questions to serve other NCDs like common cancers (breast, rectum), mental health, injuries. In addition to extension of the study framework to include younger age groups.

5 Collateral collaboration with international organizations and scientific centers like CDC to sponsor studies in the field. 6 Continuous collaboration with the neighbouring countries in the region in implementation of the NCD control

projects .




56

Annex 1

National committee

ةروطخلا لماوع دصرل ةيزكرملا ةنجللا يعازخلا ناسح رماع روتكدلا –١ ةنجللا سيئر/ةينفلا رومألل ةحصلا ريزو ليكو/

ةيبطلا تاصاصتخاللةيقارعلا ةئيهلا/ عمتجملا بطل يملعلا سلجملا سيئر / يزاين دواد دجما . د–٢ اريبخ/ ءاصحالل يزكرملا زاهجلاسيئر/قالعلا يدهم. د -٣ اريبخ/يئامنالا نواعتلاو طيطختلا ةرازو / .اريبخ/بطلا ةنيدم/ ةيومدلا ةيعوألا و بلقلا ضارما-ينطابلا بطلا يف صاصتخا بيبط/ يدومح مثيم . د–٤قازرلا دبع مزاح . د-٥ يركسلا-ينطابلا بطلا يف صاصتخا بيبط / يركسلل ينطولا زكرملا/ .وضع/ وضع/يركسلل ينطولا زكرملا/ يركسلا–ينطابلا بطلا يف صاصتخا بيبط / يوسوملا يدهم سابع. د– ٦

وضع/يدنكلا بط ةيلك / يكم ءايلع . د - ٧ وضع/ةيلوالا ةيحصلا ةياعرلا مسق/ يجرزخلا باهولا دبع ظفاحلا دبع . د-٨يلع ةفيلخ هللا اطع ىنم. د- ٩ وضع/ةيسفنلا و ةيلاقتنألا ريغ ضارمألا ةبعش ةريدم/

وضع/ناطرسلا سلجم/ ديجم يماس ءانس . د. د – ١٠فيطللا دبع ىذش ةسنالا – ١١ وضع/ةيلودلا ةحصلا مسق / باهو نسحم لصيف -١٢ ةنجللا ريتركس/ةيلوالا ةيحصلا ةياعرلا مسق /

:ءاربخلا ةيبطلا تاصاصتخالل ةيقارعلا ةئيهلا/ عمتجملا بطل يملعلا سلجملا سيئر / يزاين دوواد دجمأ. د.أ -١ءاصحالل يزكرملا زاهجلا سيئر/قالعلا يدهم. د -٢ يئامنالا نواعتلاو طيطختلا ةرازو /

.وضع/بطلا ةنيدم/ ةيومدلا ةيعوألا و بلقلا ضارما-ينطابلا بطلا يف صاصتخا بيبط / يدومح مثيم. د -٣

حادنزرسيم.د -٤ .ةيملاعلا ةحصلا ةمظنم ةريبخ/

:ريرقتلا دادعا ةنجل

اسيئر/ ةيلوألا ةيحصلا ةياعرلا و ةماعلا ةحصلا ةرئاد ماع ريدم/ دمحأ رفعج ناسحا. د -١ اريبخ/ةيبطلا تاصاصتخالل ةيقارعلا ةئيهلا/ عمتجملا بطل يملعلا سلجملا سيئر / يزاين دواد دجما . د -٢جلاسيئر/قالعلا يدهم. د -٣ اريبخ/يئامنالا نواعتلاو طيطختلا ةرازو /ءاصحالل يزكرملا زاه اوضع/ ةيرصنتسملا ةعماجلا/ بطلا ةيلك/ عمتجملا بط صاصتخا ذاتسا/ غابدلا معنملا دبع. د -٤ةيلوألا ةيحصلا ةياعرلا و ةماعلا ةحصلا ةرئاداوضع/يرادألا نواعملا/ ليوحربج دمحم. د -٥ / وضع /ةيلوالا ةيحصلا ةياعرلا مسق/ يجرزخ لا باهولا دبع ظفاحلا دبع. د -٦ وضع/ةيسفنلا و ةيلاقتنألا ريغ ضارمألا ةبعش ةريدم/ يلع ةفيلخ هللا اطع ىنم . د -٧

ينادیملاحسملا ىلع يزكرملا فارشألا :

ماعلا فرشملا/روفغلا دبع بيعش دمحم. د -١ .جمانربلاةريدم / يلع ةفيلخ هللااطع ىنم. د-٢




57

Annex 2

Sampling design Sampling design: The sampling frame consists of the entire population of Iraq. A nationally representative sample was prepared consisting of 5040 household residents proportionately distributed to the governorates The survey frame is based on the 1997 census data except for the three governorates of Kurdistan Region, where the local statistics are used. The sampling strategy is multi stage cluster sampling with stratification of urban and rural areas.

The following formula has been used to calculate the sample size:

n =

Where:

• n is the required sample size, as number of households. • Z is the 95 percent of confidence (Z=1.96). • r is the predicted prevalence for the indicator being estimated (here, r is the predicted prevalence of blood

pressure)(r=0.20). • d.f is the design effect (d.f = 1.7). • NRR is the expected non-response rate (NRR=0.15). • E is the error term (E=0.05). • E(r) is the relative sampling error (0.05(0.2)). • P is the proportion of the total population (≥ 25 years old) upon which the indicator, r, is based (P=0.37). • nh is the average household size (nh = 6.444).

n =

The Sample Design used is "Multi-Stage Stratified Cluster Sampling Technique" as follows;

1. Allocation of the sample size (5040 HHs) to Urban and Rural strata proportional to size (67% Urban and 33% Rural according to 1997 population Census Results).

2. Allocation of the Urban Sample (3377 HHs) to the governorates Urban areas proportional to size, and allocation of the Rural Sample (1663 HHs) to the governorates Rural areas proportional to size.

3. Allocation of Urban Sample and Rural Sample of each governorates to the Urban areas and Rural areas of the governorates. districts proportional to size.

4. In order to select clusters of 10HHs size, the sample size of each division has been divided by 10 to get the "Number of Clusters". This procedure required some adjustments to have integer number of clusters (i.e, to have sample size applicable to divide by 10).

5. The targeted numbers of clusters have been selected with linear systematic probability proportional to size from 1997 population census frame. For this reason each "Majal"* is considered as a cluster.

Z2 r (1-r) df (1+NRR) [E(r)]2 Pnµ

(1.96)2 x 0.2 x 0.8 x 1.7 x 1.15 [0.05 (0.2)]2 x 0.37 x 6.444




58

6. The list of households of each selected "Majal" has been updated in the field to project the changes happened between 1997 and 2005.

7. From the new list of households of each selected "Majal", 10 households were selected randomly. 8. One eligible person from each household was randomly selected

* The Majal is defined as a group of (15-25) neighbor households living in one street; or in part of street; or in more than one street.

NB:

- The sample size, calculated at 5040 HHs, allows to provide the estimates with 95% confidence value, and with a marginal error of 0.05 of the indicator.

- In order to have self-weighted indicators, the sample of (5040)HHs has been distributed to the governorates, “urban, and rural”, proportionate to the size of each area. So that there is no need to weight the data for the calculation of the indicators at the national level since they are self-weighted.




59

Distribution of the sample according to the governorates, Iraq 2006

Number of Families

Urban Rural Total

Governorate

N % N % N % Duhok 70 1.3 30 5.9 100 1.9

Naynawa 290 5.8 180 3.6 470 9.3

Sulaimania 230 4.6 90 1.8 320 6.3

Arbil 200 3.9 60 1.2 260 5.2

Kirkuk 110 2.2 50 0.9 160 3.2

Diyala 110 2.2 150 2.9 260 5.2

Al-Anbar 130 2.6 120 2.4 250 4.9

Baghdad 1060 21.0 150 2.9 1210 24.0

Babil 130 2.6 150 2.9 280 5.6

Kerbalaa 100 1.3 50 0.9 150 2.9

Wasit 90 1.8 90 1.8 180 3.6

Salahaddin 90 1.8 110 2.2 200 3.9

Al-Najaf 120 2.4 60 1.2 180 3.6

Diwanya 90 1.8 80 1.6 170 3.4

Al-Muthana 50 0.9 60 1.2 110 2.2

Thiqar 160 3.2 110 2.2 270 5.4

Misan 90 1.8 50 0.9 140 2.8

Basrah 260 5.2 70 1.4 330 6.5

Total 3380 67.1 1660 32.9 5040 100.0




60

Annex 3 اختیار األشخاص عشوائیا

ةنس٦٥- ٢٥(ةرسألا دارفا لودج (

مقرلا رسألا رمعلا ركذ ىثنأ راتخملا صخشلا

١ ١ ٢ ٢ ١ ٢ ٣ ١ ٢ ٤ ١ ٢ ٥ ١ ٢ ٦ ١ ٢ ٧ ١ ٢ ٨ ١ ٢ ٩ ١ ٢ ١٠ ١ ٢ ١١ ١ ٢ ١٢ ١ ٢

ةنس٦٥- ٢٥( ةرسألا يف صاخشألا عومجم لثمي ي ذلا مقرلا يف ةرسألا لسلست ) ١٢ ١١ ١٠ ٩ ٨ ٧ ٦ ٥ ٤ ٣ ٢ ١ لاجملا

٩ ٥ ١ ٢ ٣ ٣ ٤ ٤ ١ ١ ٢ ١ ١ ١٠ ٦ ٢ ٣ ٤ ٤ ٥ ٥ ٢ ٢ ١ ١ ٢ ١١ ٧ ٣ ٤ ٥ ٥ ٦ ١ ٣ ٣ ٢ ١ ٣ ١٢ ٨ ٤ ٥ ٦ ٦ ١ ٢ ٤ ١ ١ ١ ٤ ١ ٩ ٥ ٦ ٧ ٧ ٢ ٣ ١ ٢ ٢ ١ ٥ ٢ ١٠ ٦ ٧ ٨ ١ ٣ ٤ ٢ ٣ ١ ١ ٦ ٣ ١١ ٧ ٨ ١ ٢ ٤ ٥ ٣ ١ ٢ ١ ٧ ٤ ١ ٨ ٩ ٢ ٣ ٥ ١ ٤ ٢ ١ ١ ٨ ٥ ٢ ٩ ١ ٣ ٤ ٦ ٢ ١ ٣ ٢ ١ ٩

٦ ٣ ١٠ ٢ ٤ ٥ ١ ٣ ٢ ١ ١ ١ ١٠




61

Annex 4 Steps Instrument

استمارة المسح الخاص برصد عوامل الخطورة لألمراض غیر األنتقالیة ٢٠٠٦في العراق لسنة

: دائرة الصحة

:مركز الرعایة الصحیة األولیة: القطاع

:المشرف المركزي

:المشرف المحلي- -

:فریق جمع المعلومات

1- ٢- ٣- ٤-

:تسلسل رقم الزیارة و تاریخها

یوم شهرالزیارة األولى

الزیارة الثانیة یوم شهر

نتیجة الزیارة:

1 تمت 2 ارجأت 3 رفضت 4 مغلق

5غیرمتواجد

وزارة الصحة

دائرة الصحة العامة و الرعایة الصحیة األولیة

السیطرة على األمراض شعبة غیر األنتقالیة والنفسیة

وزارة التخطیط و التعاون األنمائي

الجهاز المركزي لألحصاء و تكنولوجیا المعلومات

منظمة الصحة العالمیة




62

رھش موي ةثلاثلا ةرايزلا

:

.في حال عدم تواجد الشخص بعد ثالث زیارات متتالیة، یعتبر غیر مشمول بالمسح: مالحظة




63

)ةيوهلا تيبثت: (ةيفيرعت تامولعم I1 ١ :ةظفاحملا زمر: ةظفاحم

I2 ةيحان: ءاضق : ٢

I3 ىنبملا مقر: قاقزلا: ةلحملا ةقطنملا: ١رضح : ةئيب

فير 2

٣

I4 يناديملا ثحابلا مسا:

٤

I5

السنة الشهر الیوم

: نايبتسألا لامكا خيرات

٥

ةرامتسألا مقرI6 ١معن

ةقفاوملا أرقإ ،ال اذإ 2ال

٦ ؟كرتشملل ايهفش تأرق ةقفاوملا ،ةلباقملا ءارجا ىلع ةقفاوملا

I7 ١ معن ةلباقملا ةياهن ،ال اذإ 2ال

٧ ةقفاوملا تمت

I8 لباقملا ةغل ٨ ) ةغللا لخدأ( I9 ةعاس ةقيقد

: :

ةعاس٢٤(ةلباقملا ءدب تقو (

ةلباقملا ءاهتناتقو

٩

I10 لاجملا مقر: ١٠

I11 لاجملا يف ةرسألا مقر: ١١

I12 ثوحبملا صخشلا مسإ: ١٢

I13 :نوفيلتلا مقر ١٣

" "




64

أ ىلإ٦أ لاؤس نم تانايبلا ةقرو نايبتسإلا يقاب نع ةلصفنم اهظفح بجو كلذل ةصاخ ةيصخش تامولعم ىلع يوتحت١٣ نم ءزجك بولطم راد لا وأ ةيرقلا زمر: ةظحالم. تاوطخلا يأ نايبتسإلا نم ةحفص لك ىلع ةرامتسألا مقر لاخدإ نم دكأتلا . ةلباقملا دنع رمعلا ديدحتل ماه ةلباقملا ءارجإ خيرات . تامولعملا ليلحت لالخ ةيسيئرلا ةادألا.ةيصخشلا تانايبلا ةقرو ةلازإ دعب تامولعملا سبتلت ال ىتح ،ةثلاثلا و ةيناثلا ،ىلوألا

:معلومات دیموغرافیة أساسیة

C1 ١ركذ

2ىثنأ ١٤ سنجلا

C2 مويلا ةنسلا / رهشلا/

١٥ ةدالولا خيرات

C3 تاونس ١٦ ؟كرمع مك C4 تاونس

، يف اهتيضق يتلا تاونسلا ددع،لمجملاب وه ام ؟)ةناضحلا ادع ام(ةساردلا

١٧

C6 ١يما 2بتكيو أرقي 3ةيئادتبالا ةداهش 4ةطسوتملا ةداهش

5 ةيدادعألا ةداهش 6) مولبد(دهعم ةداهش 7) سويرولاكب(ةيعماج ةداهش

8ايلع تاسارد 9ىرخأ

١٩ ؟هيلا تلصو يميلعت ىوتسم ىلعأ وه ام

C7 01يموكح فظوم صاخ عاطق يموكح ريغ فظوم 02

03ةحلصم بحاص 04ةيموي روجأب بساك 05حالف 06غرفتم بلاط

07ةغرفتم لزنم ةبر 08دعاقتم

09) لمعلل دعتسم(لمعلا نع لطاع 10) لمعلل دعتسمريغ(لمعلا نع لطاع

11ىرخأ

يساسألا كلمع اديج فصت ةيتألا تائفلا نم يأ ؟ةريخألا رشع ينثالا رهشألا لالخ

٢٠

فورعم اذا ١٧ىلا بھذا




65

C8 هيف امب ،ةنس )٦٥-٢٥(نيب ام صخش مك صاخشألا ددع ؟كراد يف شيعي ،كترضح

٢١

C9a

C9b

C9c

C9d

C9e

عوبسألا يف وا

رهشلا يف وأ

ةنسلا يف 7ملعا آل 8ضفرأ

ارهش رشع ينثألا لالخ ةرسألا لخد لدعم غلب مك ؟ةيضاملا

:ةظحالم

لخدلا عونل بسانملا لقحلا ألمي

٢٢

C10

١ادج فيعض 2فيعض 3طسوتم 4طسوتملا قوف 5لاع

لخدلل كريدقت ىلإ برقألا ةرسألا لخد ةئف ؟يونسلا

٢٣




66

ةیساسألا ةیكولسلا تانایبلا ىلوألا ةوطخلا

غبتلا كالهتسإ

طاشنلا و ةهكافلا و راضخلا لوانت ،نيخدتلا لثم عيضاوم نمضتت ةلئسإلا ه ذه. ةيحصلا تايكولسلا فلتخم لوح ةلئسألا ضعب حرطأ فوس نآلا . نيخدتلاب أدبنل. يندبلا

T1 معن ١ 2 ال

؟ايلاح نينخدملا نم تنأ له ٢٤

T2 ١معن 2ال

تاجتنملا هذه نم يأ نخدت له ،معن باوجلا ناك اذا ؟ةليجرألا وأ نويلغلا ،راجيسلا ،ةراجيسلا الثم ؟ ايموي

٢٥

T3 تاونسلا(رمعلا ( 77ركذتأ ال

٢٦ ؟ايموي نيخدتلا تأدب امدنع كرمع ناك مك

T4a T4b T4c

تضم تاونس وأ

تضم روهش وا

تضم عيباسأ

، نيخدتلاب تأدب امدنع كرمع ناك مك فرعت مل اذا ؟اهب تأدب يتلا ةينمزلا ةرتفلا ركذتت له

٢٧

T5a T5b T5c T5d T5e

ةعنصم ةراجيس

فل ةراجيس نويلغ ريغص راجيس/ راجيسةليكرأ

؟ عاونألا هذه نم يأل يمويلا كلامعتسا لدعم وه ام

:ةظحالمناك اذا 77زمر عون لكل لجس اذا 88و " ملعي ال"

" قبطني ال"ناك

٢٨

T6

معن ١ 2 ال

٢٩ ؟ايموي تنخد نأ قبس له ،يضاملا يف

T7

رمعلا 77ركذتأ ال

٣٠ نیخدتلا نع تعلقأ امدنع كرمع ناك مك

T8a T8b T8c

تضم تاونس

تضم روهش

تضم عيباسأ

تعلقأ امدنع كرمع ناك مك فرعت مل اذا ؟ةینمزلا ةرتفلا ركذتت لھ ،نیخدتلا نع

٣١

T9 ١معن 2ال

ناخد نودب غبتلا ايلاح لمعتست له

؟)هباش ام وا ةكلع ،قوشن (

٣٢

T10 ١ معن 2ال

٣٣ ؟ ايموي اهلوانتت له ،معن باوجلا ناك اذا

T11 ٣٤ عاونألا هذهل يمويلا كلامعتسا لدعم وه ام

T12 ١معن 2 ال

؟اهتلوانت نأ قبس له ،يضاملا يف

٣٥

ةيدغتلا

بھذا ،ال اذإ ٢٩س ىلإ

، فورعم اذإ ٢٨س ىلإ بھذإ

بھذا فورعم اذا ٣٢س ىلا

بھذا ال اذا ٣٥س ىلا

بھذا ال اذا ٣٥س ىلا

بھذا ،ال اذإ ٢٩س ىلإ

ىلإ بھذإ ٣٢ س

بھذا ال اذا ٣٢س ىلا




67

ةيلحملا ةهكافلا و راضخلا نع ةلثمأ نيبت ةيذغتلا نع تاقاطب. ةداع اهلوانتت يتلا ةهكافلا و راضخلا نع نوكتس ةيلاتلا ةلئسألا لثمت ةروص لك . يدل . يضاملا ماعلا عيباسأ نم يداع عوبسأ يف امك تالوكأملا هذه لامعتسإ لوح ةبوجألا دروأ. ةصح

D1 مايالا ددع

٤٤ ؟ةهكافلا لوانتت يداعلا عوبسألا يف اموي مك

D2 صصحلا ددع

ةصح مك ٤٥ ؟يداعلا مويلا يف لوانتت هكاوف

D3 ٤٦ ؟راضخلا لوانتت يداعلا عوبسألا يف اموي مك مايالا ددع

D4 ٤٧ ؟يداعلا مويلا يف لوانتت راضخ ةصح مك صصحلا ددع

D5 ١0 تيز 02 يتابن نمس

03 يناويح نمس 04 ددحم ريغ

05 انمس وا اتويز لمعتست ال ٠٦ركذت ىرخا

77 فرعا ال

ابلاغ لمعتست نوهدلاو تويزلا نم عون يأ؟تيبلا يف ةيئاذغلا ماعطلا ةبجو ريصحتل

طقف ةدحاو رتخإ تاقاطبلا لامعتس إ

٤٨

يندبلا طاشنلا

يف هيضمت يذلا تقولاب الوأ ركف . ايضاير نكت مل ول ىتح ةلئسألا هذه ىلع ةباجإلا وجرأ.يندبلا طاشنلا نم ةفلتخم عاونأ ةسراممب هيضمت يذلا تقولا نع كلأسأ فوس نآلودهجلا بلطتت يتلا لامعالا ةلاح يف ةيلاتلا ةلئسالا ئلع ةباجالا ةلاح يف ) ةجاحلا تعد اذإ ىرخأ ةلثمأ لخدأ. (ديص وأ داصح ،ةيلزنم لامعأ ،ةرجإ نودب وأ ةرجإب ناكأ. لمعلا

بلقلا عارساو سفنتلايف ةفيفط ةدايز ببست يتلاو طسوتملا دهجلا بلطتت يتلا لامعالاةلاح يفو بلقلا يف عارسا وا سفنتلا يف ةدايز ببست يتلا لامعالا يه قاشلا P1 ١معن

2ال

ةريبك ةدايز ببسي اقاش اطاشن بجوتي لمعلا طمن لهلثم بلقلا تابرض عارساو سفنتلا يف ) ، ليقثلا لمحلا ؟لقألا ىلع قئاقد ةرشعةدمل ) ءانب ةشرو ،رفحلا

٤٩

P2 قاشلا طاشنلا كيلع بجوتي عوبسألا مايأ نم مك عوبسألاب مايألا ددع ؟كلمع نم ءزجك

٥٠

P3 : : ةقيقد ةعاس

اذه زاجنال قرغتست مويلا يف تقولا نم مك ؟قاشلا طاشنلا

٥١

P4 ١معن 2ال

ببست يتلا طغضلا ةطسوتم ةطشنأ كلمع لمشي له يشملا (لثم ب لقلا تاضبنو سفنتلا يف ةفيفط ةدايزقئاقد رشع ةدمل ) نزولا ةفيفخ ءايشأ لمح عيرسلا

؟لقألا ىلع

٥٢

P5 نم ءزجك طسوتم طاشن لدب كيلع بجوتي عوبسألا مايأ نم مك عوبسألاب مايألا ددع ؟ كلمع

٥٣

P6 (a-b)

: : ةقيقد ةعاس

يف طسوتملا طاشنلا اذه زاجنال قرغتست تقولا نم مك؟ يمويلا كلمع

٥٤

.ةالصلل ،قوستلل ،كلمع ىلأ الثم ةيدايتعإ نكامأ ىلإ و نم كلقنت ةقيرط نع كلأسأ نأ دوأ ،نآلا اهتركذ يتلا ةطشنألا )رمألا مزل اذإ لثمألا ضعب لخدأ (

"رفص"اذا ىلإ بھذا

٤٨ س

"صفر"اذا ` ٤٦اذهب الى س

بھذا ال اذا ٥٢س ىلا

بھذا ال اذا ٥٥س ىلا




68

P7 ١معن 2ال

ةنیعم نكامأ ىلاو نم ةجارد بكرت وأ مادقألا ىلع ریست لھ ةدمل

؟لقألا ىلع ةلصاوتم قئاقد رشع

٥٥

P8 عوبسألاب مايألا ددع

وأ ةجاردلا لمعتست يداعلا عوبسألا يف اموي مك

نم ریست؟ةنیعم نكامأ ىلإ و

٥٦

P9 (a-b)

: : ةعاس ةقيقد

وأ ةجاردلاب لقنتللقرغتستعومجملا يف تقولا نم مك يداعلا مویلا يف مادقألا ىلع اریس

٥٧

. تالقنتلاب وأ لمعلاب ةقلعتملا ةيندبلا ةطشنألا نع ثدحتت ال. مامجتسإلا وأ ةضايرلا الثم مامجتسألا و غارفلا تقو لالخ اهب موقت يتلا تاطاشنلا نع لأست ةيلاتلا ةلئسألا ).رمألا مزل اذإ ةلثمألا ضعب لخدأ(

P10 ١معن 2ال

لمحلا (لثم اقاش اطاشن غارفلا تقو نمضتي لھ ، ءانب ةشرورفحلا ،لیقثلا ؟لقألا ىلع قئاقد ةرشع ةدمل)

٥٨

P11 عوبسألاب مايألا ددع

يداعلا عوبسألا يف اموي مكمعن باوجلاناك اذا قاش طاشنب موقت ، ؟كغارف تقو نم ءزجك

٥٩

P12 (a-b) : : :

ةقيقد ةعاس

٦٠ ؟ طاشنلا اذه زاجنال قرغتست يداعلا مويلا يف ةعاس مك

P13 ١معن 2ال

، طغضلا ةطسوتم ةطشنأ كغارف تقو لمشي لھ لثم

ءایشأ لمح وأ ةجارد بوكر ، عيرسلا يشملا( ؟لقألا ىلع قئاقد رشع ةدمل ) نزولا ةفیفخ

٦١

P14 موقت عوبسألا يف اموي مك ،معن باوجلا ناك اذإ عوبسألاب مايألا ددع؟غارفلا تقو نم ءزجك ةلدتعم ةطشنأب

٦٢

P15 :

ةعاس ةقيق د

؟يداع موي يف طاشنلا اذهب مايقلل قرغتست تقولا نم مك

٦٣

تقولا لمشل ءاقدصالا عم نكامالا ضعب ىلاو نم باهدلاو تيبلا يف وا لمعلا دنع ءاقلتسإلا و ا سولجلا عضوب قلعتت ةيلاتلا ةلئسألايضقملا إ مونلا تاقوا لمشتال نكل نويزفلتلا ةدهاشموا قرولا بعل , ةءارقلا , راطقلا, صابلا , ةرايسلاب رفسلا , يسولجلا (

P16 (a-b)

:

ةعاس ةقيقد

هتيضمأ تقولا نم مك ،ةريخألا عبسلا مايألا لالخ .يداعلا مويلا يف ايقلتسم وأ اسلاج

٦٤

مدلا طغضعافترإ قباوس

H1 1.1

1

تاونس ٥-١نم 2 3ة ريخألا سمخلا تاونسلا لبق

4اقباس متي مل

؟يحص كالم وا بيبط لبق نم كمد طغض سايق متىتم

٦٥

H2 ١ معن كربخأ له،ةريخألا رشع ينثألا رهشألا لالخ ٦٦

بھذ اال اذا ، س ىلا ٥٨

بهذإ ،ال اذإ

س ىلإ ٦٤

بھذ ، ال اذا س ىلا

٦١




69

؟عفترم مد طغض كيدل نأ يحصلا كالملا وأ بيبطلا 2 ال؟عفترملا مدلا طغض ةجلعمل وأ ةياقولل يحصلا كالملا وأ بيبطلا لبق نم تاجالعلا وأ حئاصنلا هذه نم يأ ميدقت متي له ٦٧

H3a ١ معن 2ال

؟نيريخألا نيعوبسألا لالخ اهتذخأ ةيودأ

H3b ١معن 2ال

ةصاخ ةيئاذغ ةيمح

H3c ١معن 2ال

نزولا فيفختل جالع وأ ةحيصن

H3d ١معن 2ال

نيخدتلا نع عالقإلل جالع وأ ةحيصن

H3e ١معن 2ال

يندبلا طاشنلا ةدايزل وا ءدبلل ةحيصن

H4 ١معن 2 ال

له ،ةريخألا رشع ينثألا رهشألا لالخيديلقتلا بطلا يف اجلاعم تلباق بط/

؟مدلا طغض عافترإ ةجلاعمل باشعأ

٦٨

H5 ١معن 2ال

نم وأ باشعألا تاجالع نم يأ ايلاح عباتت له

؟مدلا طغض عافترإل ةيديلقتلا تاجالعلا ٦٩

يركسلا ءاد قباوس

H6 ١معن 2ال

يف ركسلا ةبسن سايقب تمق له؟ةريخألا رشع ينثألا رهشألا لالخ مدلا

٧٠

H7 ١معن 2ال

يحصلا كالملا وأ بيبطلا كربخأ له ؟يركسلاب باصم كنأ

٧١

؟يركسلا ةجلعمل وأ ةياقولل يحصلا كالملا وأ بيبطلا لبق نم تاجالعلا وأ حئاصنلا هذه نم يأ ميدقت متي له ٧٢ H8a ١معن

2ال نيلوسنإ

H8b ١ معن 2ال

نيعوبسألا لالخ ةصاخ مفلا قيرط نع ةيودأنيريخألا

H8c ١معن 2ال

ةصاخ ةيئاذغ ةيمح

H8d ١معن 2ال

نزولا فيفختل جالع وأ ةحيصن

H8e ١معن 2ال

نع عالقإلل جالع وأ ةحيصننيخدتلا

H8f ١معن 2ال

يندبلا طاشنلا ةدايز وأ ءدبلل ةحيصن




70

H9 ١معن 2 ال

تعجار له ،ةريخألا رشع ينثألاا رهشألاا لالخ ةجلاعمل باشعألا بط / يديلقتلا بطلا يف اجلاعم ؟يركسلا

H10 ١معن 2ال

باشعألا تاجالع نم يأ ايلاح عباتت لهيركسلل ةيديلقتلا تاجالع نم وأ ؟




71

ةيندبلا سيياقملا: ةيناثلا ةوطخلا

نزولا و لوطلا M1

يربتخملا/ يبطلا نواعملا مسا٧٣

M2a ٧٤ نزولا و لوطلا زاهج زمر لوطلا زاهج

M2b نزولا زاهج

M3 .

مس

٧٥ لوطلا سایق

M4 . .

غك ٧٦ نزولا سایق

M5 ١معن 2ال

٧٧ ؟لماح يه له تاجوزتملا ءاسنلل

رصخلا M6 ٧٨ يربتخملا/يبطلا نواعملا مسا

M٧٩ رصخلل زاهج زمر ٧ M٨

. .

مس ٨٠ رصخلا سايق

مدلا طغض M٨١ يربتخملا/يبطلا نواعملا مسا ٩

Mطغضلا صحف زاهج زمر ١٠

٨٢

M1ريغص ١١ 2طسو ريبك 3

٨٣ سايقلل لمعتسملا دنزلا سايقم

M١٢a M12b

قبئز ملم قبئز ملم

يضابقنالا مدلا طغض ١ةءارق يطاسبنألا مدلا طغض

٨٤

M١3a M13b

قبئز ملم قبئز ملم

يضابقنالا مدلا طغض ٢ةءار قيطاسبنألا مدلا طغض

٨٥

M1٤a M1٤b

قبئز ملم قبئز مم

يضابقنالا مدلا طغض ٣ةءارق يطاسبنألا مدلا طغض

٨٦

M15 معن وأ بیبطلا هفصو ةيودألاب اجالع لوانتت لھ ٨٧

بھذا معن اذا كرتا ٨١س ىلا

٨٨س

٢ و ١اذا بھذا قباطتم

٨٧س ىلا




72

ال كالملا ؟يحصلا

M16 .

مس ٨٨ كرولا سايق

ضبنلا لدعم ٨٩ M17a ةقيقد/ةضبن

١ةءارق

M17b ةقيقد/ةضبن

٢ةءارق

M17c ةقيقد/ةضبن

٣ةءارق



ةيويحلا سيياقملا :ةثلاثلا ةو

مدلا يف ركسلا B1 ١معن

2ال ١٢لا لالخءاملا ريغ ائيش تبرش وأ تلكأ له

؟ةيضاملا ةعاس B2 يربتخملا مسا B3 زاهجلا زمر

B4a B4b

ةعاس ةقيقد :

:

مدلا ةنيع بحس تقو

صحفلا ءارجا تقو

B5a ل/ لوم م B5b

.

.

١ةضفخنم 2ةعفترم 3اهسايق نكمي ال

مدلا يف ركسلا ةبسن

مدلا يف تاینھدل 1.1.1.1 ا B6 يربتخملا مسا B7 زاهجلا زمر

B8a ل/لوم م B8b

.

١ةضفخنم 2ةعفترم 3اهسايق نكمي ال

لوريتسيلوكلا يلامجا

ةرامتسألا مقر



74

شخاص عشوائیااختیار األ ) سنة٦٥-٢٥(جدول افراد األسرة

الرقم األسر العمر ذكر أنثى الشخص المختار ١ ١ ٢ ٢ ١ ٢ ٣ ١ ٢ ٤ ١ ٢ ٥ ١ ٢ ٦ ١ ٢ ٧ ١ ٢ ٨ ١ ٢ ٩ ١ ٢ ١٠ ١ ٢ ١١ ١ ٢ ١٢ ١ ٢

تسلسل األسرة ) سنة٦٥- ٢٥( موع األشخاص في األسرة الرقم الذي یمثل مج ١٢ ١١ ١٠ ٩ ٨ ٧ ٦ ٥ ٤ ٣ ٢ ١ في المجال

٩ ٥ ١ ٢ ٣ ٣ ٤ ٤ ١ ١ ٢ ١ ١ ١٠ ٦ ٢ ٣ ٤ ٤ ٥ ٥ ٢ ٢ ١ ١ ٢ ١١ ٧ ٣ ٤ ٥ ٥ ٦ ١ ٣ ٣ ٢ ١ ٣ ١٢ ٨ ٤ ٥ ٦ ٦ ١ ٢ ٤ ١ ١ ١ ٤ ١ ٩ ٥ ٦ ٧ ٧ ٢ ٣ ١ ٢ ٢ ١ ٥ ٢ ١٠ ٦ ٧ ٨ ١ ٣ ٤ ٢ ٣ ١ ١ ٦ ٣ ١١ ٧ ٨ ١ ٢ ٤ ٥ ٣ ١ ٢ ١ ٧ ٤ ١ ٨ ٩ ٢ ٣ ٥ ١ ٤ ٢ ١ ١ ٨ ٥ ٢ ٩ ١ ٣ ٤ ٦ ٢ ١ ٣ ٢ ١ ٩

٦ ٣ ١٠ ٢ ٤ ٥ ١ ٣ ٢ ١ ١ ١ ١٠



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Annex 5

ميحرلا نمحرلا هللا مسب

يناديملا حسملا ىلع نويزكرملا نوفرشملا يجرزخلا باهولا دبع ظفاحلا دبع . د -١ ليوح ربج دمحم . د -٢

يوسوملا يدهم سابع . د -٣

قا زرلا دبع مزاح. د -٤

دمحم مظاك نيجل . د -٥

لضاف محازم مايه . د -٦

ديجم يماس ءانس . د -٧

ليلخ ةحجار . د -٨

يواتسخ راون ناندع . د -٩

ينوسحلا ناملس دمحم . د - ١٠

نيسحلا دبع يلع . د - ١١

فلخم هللا اطع . د - ١٢

مساج يكم ةريمس . د - ١٣

ناديز رمسا دامع . د - ١٤

روفغلا دبع داهج دولخ . د - ١٥

زيزعلا دبع ةماسا . د - ١٦

يداهلا دبع ناسح - ١٧

قداص ءايض ءادغر . د - ١٨

رداقلا دبع ناميا . د - ١٩

سابع دمحم زتعم - ٢٠

ةيئاصحالا ليلاحتلا ىلع نويزكرملا نوفرشملا

ةيرصنتسملا ةعماجلا - بطلا ةيلك/ دمحم سنوي معنملا دبع روتكدلا -١ يئامنالا نواعتلاو طيطختلا ةرازو/ ميركلا دبع نيساي دمحا -٢

ةيربتخملا ليلاحتلا ىلع نويزكرملا نوفرشمل اريشب دحاولا دبع يناه ينالديصلا - ١ ةينفلا رومالا ةرئاد /تاربتخملا مسق سيئر/ يلع دحاولا دبع حالص ينالديصلا – ٢ يزكرملا ةحصلا ربتخم / ةينفلا رومالا ةرئاد / تاربتخملا مسق/دوبع نيسح مظاك . د- ٣



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تايلمعلا ةفرغساوه ةخيش نسحم – ١ ةيلوالا ةيحصلا ةياعرلاو ةماعلا ةحصلا ةرئاد / اضر دمحم دمحم نسح – ٢ ةيلوالا ةيحصلا ةياعرلاو ةماعلا ةحصلا ةرئاد/ لماه دبع ماستبا – ٣ ةيلوالا ةيحصلا ةياعرلاو ةماعلا ةحصلا ةرئاد/ لالط مظاكلا دبع ديجم – ٤ ةيلوالا ةيحصلاةياعرلاو ةماعلا ةحصلا ةرئاد/

فرصلا ىلع ةباقرلا ةنجليدهم نيسحت ماركا-١ ةيلوالا ةيحصلا ةياعرلاو ةماعلا ةحصلا ةرئاد/ ديمح ءانه– ٢ ةيلودلا ةحصلا مسق/ انح مزاح رحس–٣ قيقدتلا مسق/ليكولا بتكم /

نويرادالا ةيلوالا ةيحصلا ةياعرلاو ةماعلا ةحصلا ةرئاد / ىسوم ميحر نيرسن -١لا -٢ ةينفلا رومالا ةرئاد / دومحم زيزع دجما ينالديص

فراع يرون ناميا -٣ ةيلوالا ةيحصلا ةياعرلاو ةماعلا ةحصلا ةرئاد/

ريمالا دبع مالحا -٤ ةيلوالا ةيحصلا ةياعرلاو ةماعلا ةحصلا ةرئاد/

سابع ديرغت -٥ ةيلوالا ةيحصلا ةياعرلاو ةماعلا ةحصلا ةرئاد/

ريمالا دبع يلع -٦ ةيلوالا ةيحصلا ةياعرلاو ةماعلا ةحصلا ةرئاد/

باهولا دبع بارس -٧ ةيلوالا ةيحصلا ةياعرلاو ةماعلا ةحصلا ةرئاد/

ناولع رباج بلاغ -٨ ةيلوالا ةيحصلا ةياعرلاو ةماعلا ةحصلا ةرئاد/

دارم هاش مظاك داوج -٩ ةيلوالا ةيحصلا ةياعرلاو ةماعلا ةحصلا ةرئاد/

ةداسلا دبع دمحم - ١٠ ةيلوالا ةيحصلا ةياعرلاو ةماعلا ةحصلا ةرئاد/

ةيلودلا ةحصلا مسق/ فيطللا دبع ىذش - ١١

ةيلودلا ةحصلا مسق / لعزم ةيرخف - ١٢

ةيلوالا ةيحصلا ةياعرلاو ةماعلا ةحصلا ةرئاد/ ةحصلا زيزعت مسق كلام دمحا راصتنا . د -١ ناحرس قراط دايز . د -٢

نونذ قفوم عفار -٣ تارامتسالا قيقدت حم رابج ماستبا- ١ ةيلوالا ةيحصلا ةياعرلا مسق/ ةماعلا ةحصلا ةرئاد / دوم

لالش دعس - ٢ .يتايحلاو يحصلا ءاصحالا مسق/ دراوملا ةيمنتو طيطختلا ةرئاد/

دمحم دولخ - ٣ .يتايحلاو يحصلا ءاصحالا مسق/ دراوملا ةيمنتو طيطختلا ةرئاد/

باهو نسحم لصيف - ٤ ةيلوالا ةيحصلا ةياعرلامسق / ةماعلا ةحصلا ةرئاد /



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ةيئاصحالا تانايبلا لاخدا سنوي رابجلا دبع ءانس - ١ .ةبساحلا ةبعش / ةماعلا ةحصلا ةرئاد /

ليمج ليلخ- ٢ .ةبساحلا ةبعش / ةماعلا ةحصلا ةرئاد /

ميهاربا نابعش ايند - ٣ .ةبساحلا ةبعش / ةماعلا ةحصلا ةرئاد /

ليهس- ٤ .ةبساحلا ةبعش / ةماعلا ةحصلا ةرئاد / ىفطصم اضر ة

رضخ عفان ىنبل- ٥ .ةبساحلا ةبعش / ةماعلا ةحصلا ةرئاد /

ناولع لضاف ءاديب- ٦ .ةبساحلا ةبعش / ةماعلا ةحصلا ةرئاد /

ديشر ريمالا دبع نسح - ٧ .ةبساحلا ةبعش / ةماعلا ةحصلا ةرئاد /

سا ءافو-٨ .ةبساحلا ةبعش / ةماعلا ةحصلا ةرئاد / مساج دو

يلع نيسح سارف - ٩ .ةبساحلا ةبعش / ةماعلا ةحصلا ةرئاد /

دلاخ يدهم ءارسا- ١٠ .ةبساحلا ةبعش / ةماعلا ةحصلا ةرئاد /

خركلا/ دادغب ةحص ةرئاد

يماللا عطاك دوبع. د– ١ يدامح مظاك نتاف. د– ٢ حاتف يرون دايا. د– ٣ ةمعن دفار. د– ٤ زيزع ىنثم. د – ٥ حلاص دمحم. د– ٧ ديمح دوبع ةدلاخ. د– ٨ ديمح دمحم مسار. د– ٩

نيدلا ءافص دمحا. د– ١٠رينم مثيه . د– ١١فلخ لصيف اشر . د – ١٢

دومحم دمحم دجام . د– ١٣ روكشم رماع . د– ١٤ تجاس ةرهزلا دبع ربتخم . م– ١٥ رابج قازرلا دبع يبط . م– ١٦ رابجلا دبع راتسلا دبع يئاصحالا – ١٧ ةدوج حيبص ربتخم . م– ١٨

طبيرخ نوع دبع يبط . م– ١٩ يكم رظنم يئاصحالا – ٢٠

ولح دمحم ربتخم . م– ٢١ نسر ةمطاف يئافو . م– ٢٢

ءايض يلع يئاصحالا – ٢٣ رصان ريشب ربتخم .م – ٢٤

ناضور ةحيلف يئاقو . م– ٢٥ رداقلا دبع ةمالس يئاصحال ا - ٢٦ نسح يحبص ىذش ربتخم . م-٢٧ يلع اضر بلاغ يئاقو . م– ٢٨

لضاف سابع يئاصحالا – ٢٩ دومح رساي ليلخ ربتخم . م– ٣٠ ديجملا دبع قورش يئاقو . م-٣١

راتسلا دبع دامع يئاصحالا -٣٢ سابع دلاخ ربتخم . م ٣٣

ىفطصم حابص يبط . م– ٣٤ ريمالا دبع نانح يئاصحالا– ٣٥

مظاك داوج . م-٣٦ ناولع لما يئاقو . م– ٣٧

سابع دمحم رحس يئاصحالا – ٣٨ نيسح يلع ربتخم . م– ٣٩نسح داؤف يئاقو . م– ٤٠

دمحم اضر هلالا دبع يئاصحالا – ٤١ مشاه ميرك ربتخم . م-٤٢فلخ نيسح يلع يبط . م– ٤٣رهزم دمح يربص يئاصحالا – ٤٤ ناضور دبع لما ربتخم . م– ٤٥ مظاك نيسح يلع يبط . م– ٤٦هللا دبع دمحا يئاصحالا– ٤٧



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دادغب ةحصةرئاد ةفاصرلا/

رقاب يداه نسح. د-١ دومحم يحم ءارسا. د-٢فيطللا دبع ءاقل د-٣ ميلس دنه. د– ٤

حالف ءافيه– ٥

نابضغ دعر– ٦

ديحو نانس. د– ٧ اضر لداع . د– ٨ ريضخ ليلخ . د-٩ نوعمش رصان. د– ١٠ ديشر لامج . د-١١ دوبع ةاجن . د– ١٢باهولادبع نيون. د– ١٣ سنوي دمحم قثاو . د– ١٤ سرطب نانح. د– ١٥ متاح رامع . د– ١٦نيسح ةراس رصب ةصحاف -١٧ ريغص رامع ربتخم . م– ١٨ديمح يرصم يئاصحالا -١٩ هللا دبع بنيز ربتخم . م– ٢٠ دجما هط يئاقو . م– ٢١

يداهلا دبع نانح يئاصحالا – ٢٢

رماع ر ون ربتخم. م– ٢٣ نيسح ءاميش رصب ةصحاف – ٢٤

رباص حمالم يئاصحالا ٢٥ حيبص ةيده يبط . م– ٢٦ حيفس يلع ربتخم م ٣٧

زيزع قراط يئاصحالا – ٢٨

حلاص دبع دمحم ربتخم . م– ٢٩

رباج ةنيز رصب ةصحاف– ٣٠ رباج دمحا يئاصحالا – ٣١ نيسح ىلعم مساج ربتخم . م– ٣٢ نسحم ماستبا يئاقو . م– ٣٣ ميعن حافك يئاصحالا – ٣٤ نيسح ةمساب رصب ةصحاف – ٣٥ ديمح يلع ربتخم. م– ٣٦ رضخ دمحم يئاصحالا -٣٧

ةعمج ماهس رصب ةصحاف – ٣٨ يرون قراط ربتخم . م– ٣٩

ةوانش رديح يئاصحالا – ٤٠ ميرك دامع يئاقو . م– ٤٢

قراط دايز يئاصحالا – ٤٣ رماث ةعمج ربتخم . م– ٤٤

لساب ةسينا رصب ةصحاف – ٤٥

دمحم ةنيثب يئاصحالا – ٤٦ بتخم م– ٤٧ بيدا دمحم ر

سابع ةليهس ةيحص ةثحاب - ٤٨ دمحم نينسح يئاصحالا – ٤٩

مظاك داوج رصب صحاف – ٥٠ فلخ رماع ربتخم . م– ٥١ دمحا ةدهان يئاصحالا - ٥٢ دبع ىرشب ربتخم . م– ٥٣

دشنم نيسح يبط . م– ٥٤ لضاف نودلخ يئاصحالا – ٥٥

ةرصبلا ةحص ةرئاد

ضاير٠د – ١ نيسح ريمالا دبع

ىسوم نارمع ةميلس ٠ د٠ د-٢ دمحا مساق ءايض ٠ د-٣ قوزرم ريضخ مايه ٠ د-٤ سابع دومحم لما ٠ د-٥ لعزم ةرهزلا دبع لامج ٠ د-٦ هللا دبع دواد نيسحلا دبع ٠ د-٧

ناولع نسح يئاصحالا -١٧ سابع يربص ةمسق ةيجولويابلا – ١٨ خم٠ م– ١٩ دجام ردنب قداص ربت ظفاحلا دبع دمحا يئاصحالا – ٢٠ اضرلا دبع نيرسن يبط ينقت -٢١ ديجم ديمح مساق ربتخم ٠ م-٢٢ حلاف يلع نيسح يئاصحالا – ٢٣



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بيبح رهاظ ءانه ٠ د-٨ مساق نيسح داعس ٠ د– ٩ نيسحلا دبع لوتب ةيوايميكلا -١٠

داهج مساق ميكح ربتخم ٠م -١١ نسر يبيعل ةحيبص يئاقو ٠ م– ١٢ دمحم مساج تئاو ربتخم م -١٣ دواد رصان ىفطصم يئاصحالا – ١٤ دوبع رابجلا دبع ىده ةيحص ةثحاب – ١٥ قوزرم نيسحلا دبع ءالع ربتخم ٠ م– ١٦

قلاخلا دبع ءايمل يلديص ٠ م– ٢٤ بكث هوافن بوقعي ربتخم ٠ م– ٢٥ يمور يراج هللا دبع يئاصحالا – ٢٦ حم دعو رهام ضرمم-٢٧ نازوك دم ربج مظاك نيسح ربتخم ٠ م– ٢٨ شويرم نيسح اضرلا دبع يئاصحالا– ٢٩ يدهم ةمعن داؤف يئاقو ٠ م– ٣٠ ناويص ءاهب ربتخم ٠ م-٣١ يزوش نيسح لصيف يئاصحالا -٣٢

ناسيم ةحص ةرئاد

يبيرعلا دمحم عايش لماز ٠ د -١ مشاه رابج سارف ٠ د-٢ نسح يضام دومح ٠ د-٣ داوج ميرك لاون ٠ د-٤ يبيعلا يضار دمحم ٠ د-٥ رمع يزاغ فسوي يوايميكلا -٦ ناهرب ءاروح يبط ٠ م-٧ ديبع نيسح يلع = - ٨

دعس نيسح مظاك = - 9

فلخ دمح لامك ربتخم م – ١٠ يطاعزا رديح = -١١ ناملس نامرف ةميكح = -١٢ ف داوج يئاصحالا-١٣ لضا

يلع مشاه = - 14

بيبح فسوي = - ١٥

ىنثملا ةحص ةرئاد

ركس نسحلا دبع حلاف ٠ د-١ ةدوع ربص رماع ٠ د-٢ فوطكم رضخلا دبع ٠ د-٣ زيزع لضاف ٠ د-٤ ةعمج داوج يلع يئاقو ٠ م– ٥ رهاط مظاكلا دبع يلع يبط ٠ م-٦

مظاك رهاط ربتخم ٠ م -٧ بياس لعز مكاح = -٨ يدهملا دبع لئاو يئاصحالا -٩

زودنه ةيطع ريمالا دبع = - ١٠ بعتم ةقيزر ةيجولويرتكبلا– ١١

راق يذ ةحص ةرئاد

يحامرلا ردب يداه ٠ د– ١

بحاصلا دبع ميحرلا دبع ةحيدم ٠ د-٢ ليلجلا دبع بنيز ٠د-٣

فيرش ميرك ٠ د-٤ دغر٠ د-٥ نيسح رصان رابجلا دبع ءارسا ٠ د– ٦ هللا دبع دمحم نيسحلا دبع٠ د-٧ يعيبرلا ةدوع تارف ٠ د -٨

كهر حلاص حاجن = - ١٧ ميرك لاما = - ١٨ مشاه هط بلاغ = - ١٩ نسحم رهاط حابص = - ٢٠ مظاك ةزمح = -٢١ ىسيع لاله ناملس يئاصحالا -٢٢ ديجم ريمالا دبع يداه = - ٢٣ ناحرف د محا دلاخ = - ٢٤



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ميظعلا دبع رهزا يبط ٠ م-٩ ضوع راونا = - ١٠ يلع دبع ةنيز = -١١ يخص مظاك ميركلا دبع رهام ضرمم = -١٢ فيهر نسح سارف يئاقو ٠ م- ١٤ ي يسفن ثحاب-١٥ نونح لداع ىيح ريضخ ناوطع يفاص ربتخم ٠ م– ١٦

ريمالا دبع يداه ناوزغ = - ٢٥ اضرلا دبع لداع = - ٢٦ نيساي هط = - ٢٧ ليجث دانع نسحم يوايميكلا - ٢٨ يويلخ دمحم دمحا ربتخم ٠ م– ٢٩

ةيناويدلا ةحص ةرئاد

مساج ركاش نمحر ٠ د-١ سابع دمحم ءايلع ٠ د-٢ يزوف يلع ٠ د-٣ ديشر ريمالا دبع ٠ د-٤ ليلج ضاير ٠ د-٥ ردبم ميرك ديمح ٠ د-٦ فسوي مايه ةيوايميكلا -٧ دمحم سابع لضاف ربتخم ٠ م-٨ متاح ةرهزلا دبع = -٩ يدينه ريمالا دبع = - ١٠ دايج يجان يلع = -١١

يلع دمحم رفظم يبط ٠ م– ١٢

ميهاربا سابع ديهش = - ١٣ ديبع ميحر دمحم = - ١٤ يرودق ىرشب يئاقو ٠ م- ١٥ دشرم دبع دمحم يئاصحالا – ١٦ لعزم تصيف يزاغ = - ١٧ مشاه دمحم ميحر = - ١٨ ربج ملاس دمحا = -١٩

فجنلا ةحص ةرئاد

نيسح دمحم ىسوم ٠ د- رون دبع يلع ٠ د– ٢ ديعس ديمح ناسحا -٣ سح مساج٠ د– ٤ زيوع ني نسح ةمطاف ٠ د-٥ يداه سابع نيسح ٠ د-٦ مازح ناديعس ةينغ -٧ ةزريم ةزمح رحس -٨ ناولع نيسح -٩ يهاد نيسح ساي– ١٠

ديعس ديجم لاون -١١ رساي نامعن – ١٢ يداه نسح نامز -١٣ دمحم نسح نيسحلا دبع – ١٤ ىسوم ديشر يلع – ١٥ دايز رطم رثوك – ١٦ ظفاح – ١٧ نارمع دمحم روشاع ناحرف يدهم – ١٨ ةداسلا دبع ةدئام ةيوايميكلا– ١٩

طساو ةحص ةرئاد

يرصبلا فسوي ماهلا ٠ د -١ دوبع دبع تمكح ٠ د -٢ نسح دمحم نيسح ٠ د-٣ مظاك ديجم ديمح ٠ د-٤ دبع نارمع يجان ٠ د-٥

وضر ناولع = - ديبع يداه رضامت = - ١١ نسحملا دبع ىليل = - ١٢ لفاغ فيطل لداع يئاصحالا – ١٤ ديمح دومحم = - ١٥



81

ينانلا ديعس ديلو ٠ د -٦ رلا دبع قلاخلا دبع يئاقو٠ م– ٧ قاز لاعلا دبع لماك = -٨ ةدوج ميرك ةزمح ربتخم ٠ م-٩

اضرلا دبع رابج مظاك = - ١٦ دبع ليجع مزاح = - ١٧ يديرك يلع مزاح يبط٠م = - ١٨

ىونين ةحص ةرئاد

١ ديجم قيفوت رهام ٠-٢ دومحم هط نيدلا ءالع يبط ٠ م– ٩

دومحم نودمح ىهتنم ٠ د بيجن هللا دبع رماع ٠ د-٤ فيطلا دبع دعر ٠ د-٥ ساج دومحم زافم٠ د-٦ ديوع ليعامسا هللا دبع٠ د– ٧ يلع دمحم فيرش دمحم٠ د-٨ دواد ديعس يماس ٠ د-٩ رزال زيزع ماسب ٠ د– ١٠ انيزرام عيدو دعس ٠ د-١١ كلطم نسح ةمالس ٠ د– ١٢ لضاف هللا دبع ءاميش ةيوايميكلا ٠ م– ١٣ ىيحي مناغ ةنيز = - ١٤ نيسحت ءارسا = - ١٥ نودمح سنوي دمحا ربتخم ٠ م-١٦ رابجلا دبع سارف = - ١٧ ملاس ىدن = - ١٨ نيدلا يحم ةواك = - ١٩ مساق تارف ةعفان = - ٢٠ نيسح ربكا يلع = -٢١ ناديز ليعامسا دلاخ = -٢٢ مانهب هللا دعس ليسا = - ٢٣

روصنم مانهب رونا = ٢٤ هللا دبع ةدوع يرون = - ٢٥

دمح لالج ةداغ يئاصحالا - ٢٦

نسح لامج ردان = - ٢٧ رداق رباص ةنافس = -٢٨ ديمح ديجم ىذش = - ٢٩ سيجرج يتم ىسيع = - ٣٠ سايل ا قداص دمحم = -٣١ ميهاربا ىفطصم ليلخ = - ٣٢ ناملس دمحم ديمح = -٣٣ انح يتب ءاور = - ٣٤ ىسوم اباش جرف = - ٢٥ دمح فلخ هللا دبع يلديص٠ م- ٢٦

ىيحي هللا راج ةمساب- ٣٧ رداق دمحا حابصضرمم – ٢٨

ا دم رضخ ضرمم– ٤٠ دمحا هللا لدجم دمحم دمحا يبط ٠ م–٤١

سابع يقت يلع يبط ٠ م– ٤٢ يشوم حيسملا دبع يئاقو ٠ م– ٤٣

عوشيا سايلا ىنم ةضرمم- ٤٤ ناميلس داوع ماحد يبط ٠ م- ٤٥

كوكرك ةحص ةرئاد

بالج نسح رابج ٠ د-١ ديجملا دبع نيدلازع مالحا ٠ د-٢ دلا ءاهب لوكورب٠ د-٣ سيجرج ني يلع قراط يانوص ٠ د-٤ حلاص دحاولا دبع رسا ٠ د-٥ ىفطصم بلاغ ةريزو ةيوايميكلا -٦ سابع ليلخ نيدباعلا نيز يبط ٠ م-٧

نيدلا يحم دمحم يلع ربتخم م – ٩ قيفوت دمحا ناسيا يبط ٠ م– ١٠ دمحم ميهاربا ليلخ يئاصحالا -١١ نيمس رضخ فسوي ربتخم ٠ م -١٢ دمحم سابع ةيلع يحص ينقت -١٣ دمحم بيبش دمحم ءاصحا ٠ م– ١٤ ميهاربا سابع رساي ةيضرم تاليلحت– ١٥



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ناحرس ناطحق نانح ةبساحملا – ٨

ءالبرك ةحص ةرئاد

نيسح يحم لداع ٠ د-١ يضار مظاك ةربج ٠ د-٢ ناولع نوسح راهزا ٠ د-٣ مجاح لضاف قاوشا ٠ د-٤ ميهاربا دعس ميسو ٠ د-٥ يدابع نسح مظاك يبط ٠م -٦ ناتفع ديمح ناسحا = -٧ قازرلا دبع نسوس = -٨

بيبش ديجم دمحم ربتخم م -٩ غاتلش ليجث رباص = - ١٠ دمحم مساج دمحا = ١١ ميرك نيسحلا دبع ءاهب يئاصحالا - ١٢ ةزمح رباج راتس = - ١٣ نسح اضر نسح = -١٤ دومح ميهاربا دمحا يوايميكلا- ١٥

ىلايد ةحص ةرئاد

يوادهملا داوج يلع ٠ د-١ نسح ديشر ةلاخ ٠ د-٢ يدهم داعس ةيوايميكلا -٣ نيسح يلع قازرلا دبع يوايميكلا – ٤ راصنلا ميهاربا ىرشب ٠ د-٥ دمح ديمح رديح ٠ د-٦ لضاف ليبن ٠ د-٧ شيورد رفص نيس ح٠ د– ٨ قيفش نودعس ماسو ٠ د– ٩ باهولا دبع ءارهز ٠ ص– ١٠ دمحا نيدلا ءافص قارب يبط ٠ م-١١ حابص نيمساي = -١٢ دمحم مسلب = - ١٣

لبجم مساج = - ١٤

ناديغ ميحر يلع = -١٥ ةزمح ةدرو = - ١٦ دورطم يمزج ربتخم ٠ م- ١٧ نانو دعس = -١٨ داوج لماك = - ١٩ نابضغ دفار = - ٢٠ تكوش رابج = - ٢١ سيمخ رداق = - ٢٢ ناديز ميهاربا ليلخ يئاصحالا – ٢٣ هللا دبع رواي دمحم = -٢٤ دمحا دبع يلع = - ٢٥ قازرلا دبع طسابلا دبع = - ٢٦ دمحم مشاه يدهملا دبع = - ٢٧ ريضخ يلع ةمطاف = - ٢٨

لباب ةحص ةرئاد

اضرلا دبع دومحم ٠ د-١ ةدوج دمحم ىنثم ٠ د-٢ نيسح يلع دجام ٠ د-٣ ةرهزلا دبع يلع ٠ د-٤ داوج رفعج ٠ د-٥ ةمعن متاح ىمل ٠ د-٦ صكم مساق٠ د-٧ يضار د يدوعس نيسح سابع ٠ د-٨ نيسحلا دبع رصان دمحا يوايميكلا -٩

ناملس لوس رلا دبع لاهتبا = - ١٥ ديعس شوتنح دامع ربتخم ٠ م-١٦ لويرد يلع = -١٧ رصان ميرك دعر = - ١٨ جيزول دمحم = - ١٩

روبنز ديبع مظاك = - ٢٠ مشاه دواد يفصو = - ٢١ يداهلا دبع دنهم يئاصحالا -٢٢

ميهاربا ناندع = - ٢٣



83

ميرك قازر ةمطاف = - ١٠ ىسيع ءافو يبط ٠ م– ١١ دومحم لما = -١٢ راكداي نيدلا ردص = -١٣ نسح دبع بنيز = -١٤

نسح دمحم دنهم = - ٢٤ رهاط ناطحق = - ٢٥ نسح نيسح دمحم = - ٢٦ روكشم يزمر = - ٢٧

نيسح مظاكلا دبع ةايح نيظحالم سيئر- ٢٨

رابنالا ةحص ةرئاد

كارع ديا٠ د-١ فلخم لالش فلخ ريضخ ٠ د-٢ هللادبع دماح ءامسا ٠ د-٣ مظاك يلع لامج ٠ د-٤ نسح دمحم مساب ٠ د-٥ نيدلا ءاهب عفار ابص ٠ د-٦ يلع دومحم بيهص ٠ د-٧ قازرلا دبع يلع ٠ د-٨ يديرك دمحا دومحم يبط ٠ م-٩ نيسح داوع دمحا = -١٠ دحاولا دبع ىفطصم = - ١١ يتبس يحتف مالس = -١٢ دمحا زيزع ةعمج = - ١٣

حاتفلا دبع نابعش رماع = - ١٤ نيدلا رخف نامرهق ربتخم ٠ م– ١٥ دواد فيان يروما = -١٦ دمحا باهش سابع = -١٧ دمحم يرهق فسوي = - ١٨ يوالع نيسح ديمح = - ١٩ هللا رصن د ومحم ركاش = - ٢٠ نيسح يلع رازن يئاصحا -٢١ حلاص يدهم نيساي = -٢٢ دومحم نيدلا يلو رهاط = -٢٣ كلملا دبع يرخف يلع = - ٢٤ فيصن دمحا هللا دبع = -٢٥ دمحم قداص دلاخ = - ٢٦

كوهد ةحص ةرئاد

نسح ىفطصم لافه ٠ د-١ اح ىمل٠ د-٢ مز دوسا دمحم ناوريس ٠ د-٣ دمحم ميهاربا هللا دبع ٠ د-٤ دمحا دمحم نسحملا دبع يبط ٠ م-٥ وفيطسا ردنكسا روصنم = -٦ ليلخ حالص لامج ربتخم ٠ م- ٧ دمحم هللا دبع ةريمس = -٨

نيدلا حالص ةحص ةرئاد

يقت نيدباعلا نيز نسح ٠ د-١ دهم سابع٠ د-٢ سابع ي دمحم فلخ ناديز ٠ د-٣ ميركلا دبع يكرت ريثا ٠ د-٤ يلع فلخ يلع ٠ د-٥ ناملس نسح ناميا ٠ د-٦

عازه نايده نسوسربتخم . م - 11

رو صنم ركاش دادقم = - ١٢

بوجحم ديمح ربتخم. م- ١٣ فراع دمحم = - ١٤ داجنا دمحم يئاصحالا - ١٥



84

شولع ةليصا يبط ٠ م-٧ ديع ىفطصم رسيا = -٨ رباج مالحا ةضرمم -٩ نسح يلع سابع يبط ٠ م– ١٠

رهام دومحم = - ١٦ دمحم يدعس = - ١٧

حورم يداه يلع = - ١٨ حالص ناشلك = - ١٩

ةيناميلسلا ةحص ةرئاد

دمحا نسح نيدلا مجن د -١ رابج راتسلا دبع ٠ د-٢ ميلس دمحم مساق ٠ د-٣ لوسر دمحم داشلد ٠ د-٤ دومحم لالج نازوس ٠ د-٥ نيدلا يحم ناروك ٠ د-٦ ىسوم رفس ناوريس ٠ د-٧ ميهاربا يلع ٠ د-٨ يلع ةمح دومحم بويا ٠ د-٩ دمحم حلاص ميرم مدقا يوايميك ١٠ ميرك رداق ةميسن ربتخم ٠ م-١١ قيفوت ناوريس = -١٢ نمحرلا دبع قيفوت نامثع = -١٣ دمحم زيزع فيرش = -١٤ ديبع دمحا لامك ربتخم م – ١٥ رداق دمحم ناليش = -١٦

حلاص نمحر وسان = - حاتف دمحا راوبير = -١٨ دمحم ديمح نيرسن يئاصحالا - ١٩ ةخيش دمح هللا دبع = - ٢٠ دمحم نامثع ةورس = -٢١ دمحا ركب ديموا = -٢٢ هللا دبع دومحم ايديم = - ٢٣ زيزع ربص لامك يئاقو ٠ م- ٢٤ نمحرلا دبع دمحم نامتشين يبط ٠ م- ٢٥ ىفطصم ديعس ةمح رمع يئاقو ٠ م- ٢٦ دمحم نسح لضاف = -٢٧ دمحا ردخ دم حا يبط٠ م-٢٨ دمحا هللا دبع يلع = -٢٩ رباص رهاط ريلد = - ٣٠ نيما همح فوؤر قراط يئاصحالا -٣١ زيزع هللا دبع لالج = - ٣٢



85

Annex 6 Training activities

- The Stepwise NCD surveillance workshop was held in August/2005 in Amman with

the presence of an NCD surveillance expert in Geneva, and the Jordanian MOH senior officials who shared their national experience in conducting the NCD risk factor surveillance. Participants consisted of the NCD managers in the MOH and the governorates that would be responsible for conducting the survey in Iraq. The candidates have passed an orientation course in Iraq before joining the workshop in Amman.

- In order to increase the response rate in attending a central meeting, the MOH in collaboration with the WHO, and the cooperation of the Health Directorate of Sulaimaniya, organized a training workshop for the NCD focal persons in Iraq in addition to the staff of MOH and the Health Directorate of Sulaimaniya.

- This is followed by local workshops held by the NCD focal persons in their health

directorates for the assigned local data collection teams. - A training course was conducted by the Central Health Lab in Baghdad for the

biochemists in the assigned biochemistry lab in the health directorates - A training course was held for the statistical analysis staff at the MOH. - A central pre-surveillance symposium was held for the NCD focal points of the Health

directorates for discussion of the final instruction. - The focal points carried out local pre-surveillance symposia with their data collection

teams to convey the instructions obtained from the central symposium. - The focal points were informed to intensify the training activities of the local data

collection teams on physical measurements till the actual field work starts.



Annex 7- a

ةنمزملا ضارمألاةسارد يف نيكراشملا ةقفاوم جذومنقارعلا يف اهتاببسمو ٢٠٠٦

اختي المواطنة / اخي المواطن

عافترا لثم ةنمزملا ضارمألا دعت يف تايفولاو ةضارم لل ةيسيئرلا بابسألا نم يركسلاو نييارشلاو بلقلا ضارمأومدلا طغض .قارعلا

.اهليجست متي مل يتلا تالاحلا ىلا ةفاضا ،ايونس ضارمألا هذهب نيباصملل ةلجسملا تالاحلا دادعا ديازتت .بيبطلا ةعجارم يعدتست ضارعا دوجو نودب ضرملاب اباصم ءرملا نوكي دقف اهصيخشت متي مل يتلا تالاحلا نم ديدعلا كانه امك

.اهل ةببسملا لماوعلاوةنمزملا ضارمألا لوح ةسارد ذيفنتب ةيملاعلا ةحصلا ةمظنم عم نواعتلاب ةحصلا ةراز و موقت ةيرمعلا ةئفلا نمضعمتجملا نم ادرف) ٥٠٠٠( رايتخا متي ةنس25-65 ( قارعلا يف تاظفاحملا فلتخميفروكذلا وثانألا نم) . ل كرايتخا/كرايتخا مت دق .ةساردلا هذهب نيلومشملا دارفألا نمض نم .اقباس ةروكذملا اهتيمهأل ارظن ةساردلا هذه ذيفنت ضرغل انعم كنواعت وجرن

:ةساردلا هذه نم كل ةرشابملا ةدئافلا ما نزولا يف ةدايز كيدل ناك ام اذاو مدلا طغض ةفرعم- لاب باصم كنأ تاسايقلا جئاتنب كغالبا متيس ثيحةنادب ، . لدعم - تاصوحفلا جئاتنب كغالبا متيس ثيح مدلا يف لورتسلوكلاو يركسلا متيس - .كلةروشملا ميدقت انعمةكراشملا ىلع كتقفاوم لاح يف : طغض سايق متيسامك ، ةينامسجلا ةطشنالا ، نيخدتلا ، ةيذغتلا لثم ضارمالا هذهب ةقلعتملا ةلئسألا ضعب ىلع بيجت نا وجرن - اناجم ن زولاو لوطلا ، مدلا وجرن امك - اهصحف متيل قيرفلا هددحي يذلا دعوملا بسحمد ةنيع ءاطعا ركسلا ىوتسم ةفرعمل هذه نوكت و . لورتسلوكلاو

.ةساردلل ازيزعت يناجملكشب تامدخلا

نكل و.ضفرلا وا ةساردلا هذه يف كارتشالاب ةلماكلا ةيرحلا كل ا هذه يف كتمهاسم عفر يف ةدئافلاب دوعتس ةساردل .قارعلا يف ضارمألا هذهل ةيئاقولا ططخلا عضوو ةيحصلا تامدخلا ىوتسم

:راسفتسالا نم ديزمل

لاصتالا كنكمي :ةيلاتلا فتاوهلا ىلع ةيلوألا ةيحصلا ةياعرلا و ةماعلا ةحصلا ةرئاد/ ةحصلا ةرازوب

٤١٦٧٠٧١

٠٧٧٠٢٥٤٢٩٢٨ ٠٧٩٠١٩٢٥٥٠٥

..................هعيقوت .......... ................................ ثحابلا

Annex 7-b



87

:تعلیمات المشرف المركزي

:ةحصلا ةرئاد ةرايز

مدير عام دائرة الصحة و مدير قسم الرعاية الصحية األولية لمناقشة األلتقاء ب -١ .األستعدادات للمسح

األلتقاء بمدير وحدة األمراض غير األنتقالية واألطالع على خطة العمل الطرفية -٢ :التفصيلية وكما يلي

االوامراألدارية للمشرفين المحليين وتشكيل فرق المسح الميداني -٣ ة التحضيرية ما قبل المسح األمر األداري للورش -٤التأكد من وجود وسائل األتصال بين المشرف المحلي على الرصد و غرفة العمليات -٥

في وزارة الصحة التأكد من من توفير السيارات للمسح -٦ :مستلزمات المسح التأكد من قوائم استالم -٧

استمارات األستبيان و التعليمات - أ اجهزة فحص الطول و الوزن - ب الدم و السماعةاجهزة فحص ضغط - ت القرطاسية و المستلزمات األخرى - ث

:التحرك الجماهيري األلتقاء بمدير وحدة التربية الصحية لمناقشة سبل -٨ .الحملة األعالمية المحلية و استخدام وسائل األعالم المختلفة في المحافظة - أ

. مفاتحة قطاع المجتمع المدني للتعاون و المساهمة في المسح - ب . القطاعات بالتعاونتنفيذ ندوة متعددة - تمفاتحة الجهات األمنية لألعالم عن قيام المسح لغرض توفير الظروف األمنة - ث

للفرق الميدانية :حسملا جذامنل ةيربتخملا تاليلحتلا ءارجأل دمتعملا ربتخملا ةرايز

التأكد من تدريب المختبري المسؤول مخصصة ألغراض المسحلتأكد من استالم المواد المختبرية و المستلزمات الا 1- األطالع على الخطة الطرفية بالتنسيق مع فرق المسح الميداني لغرض استالم 2-

.النماذج، اجراء التحليل المختبري، تسجيل النتائجن و تسليم النتائج الى الفرق وجود سجل ألستالم النماذج من فرق المسح الميدانية و تسجيل النتائج 3- تفاظ بالنماذج المتبقية بعد اجراء فحوصات المسح في التأكيد على األح 4-

ظروف مختبرية مالئمة لغرض ارسالها الى مختبر الصحة المركزي في بغداد .فيما بعد



88

:يناديملا لمعلا تاريضحت ىلع عالطألا

وجود قائمة بالمناطق و اسماء األسر- ١ ) Mapping(الخرائط و )Microplanning(التفصيلية اكتمال الخطة - ٢

.توفر السيارات المخصصة للمسح 3 - :مستلزمات المسح موزعة على الفرق 4 - استمارات األستبيان و التعليمات -ا

اجهزة فحص الطول و الوزن-ب اجهزة فحص ضغط الدم و السماعة - ج القرطاسية و المستلزمات األخرى - د

.بالمسح واألمر األداري بأسماء أعضاء الفريق و الباجوجود األوامر األدارية 5 - وجود احد اعضاء المجلس البلدي و الكوادر الساندة األخرى 6 -

:يناديملا حسملا قرف لمع ىلع عالطألا

مكان تواجد الفريق ضمن الخطة-١ مشاهدة المقابلة-٢ مشاهدة الفحوصات البدنية-٣ تعديل األخطاء-٤ تأكد من اكتمال األستمارة ال-٥ التأكد من سحب نماذج الدم و جمعها و ايصالها الى المختبر و استرجاع النتائج-٦ ارسال األستمارات حسب جدول زمني محدد-٧ .ةقباسلا مايألل حسملا جئاتنريراقت ىلع عالطألا

تايلمعلا ةفرغب لاصتألا وا ايعقوم تابوعصلل لولحلا داجيا



89

Annex 7-c

:تعلیمات المشرف المحلي مسؤول الرصد

يناديملا حسملا قرف ليكشتو نييلحملا نيفرشملل ةيرادألارماوالا رادصا ١

تنفيذ الورشة التحضيرية ما قبل المسح- ٢ اقامة ندوة تحضيرية ماقبل المسح مع اعضاء الفرق ٣

توفير السيارات للمسح- ٤ :مستلزمات المسح استالم ٥

تبيان و التعليماتاستمارات األس - اجهزة فحص الطول و الوزن - اجهزة فحص ضغط الدم و السماعة - القرطاسية و المستلزمات األخرى -

:التحرك الجماهيري التنسيق مع وحدة التربية الصحية ألعداد سبل ٦ .ةالحملة األعالمية المحلية و استخدام وسائل األعالم المختلفة في المحافظ - مفاتحة قطاع المجتمع المدني للتعاون و لمساهمة احد اعضاء المجلس البلدي في -

. المسح مع الفرق .تنفيذ ندوة متعددة القطاعات -

مفاتحة الجهات األمنية المحلية لألعالم عن قيام المسح ولغرض توفير الظروف األمنة ألجراء ٧ .المسح

: المعتمد ألجراء التحليالت المختبرية لنماذج المسح لمتابعةالتنسيق مع المختبر8 تدريب المختبري المسؤول متابعة متابعة استالم المواد المختبرية و المستلزمات المخصصة ألغراض المسح

التنسيق بين فرق المسح الميداني و المختبر ألعداد الخطة الطرفية لغرض استالم .ء التحليل المختبري، تسجيل النتائج، و تسليم النتائج الى الفرقنماذج الدم، اجرا

التأكد من وجود سجل ألستالم النماذج من فرق المسح الميدانية و تسجيل النتائج -د التأكيد على األحتفاظ بالنماذج المتبقية بعد اجراء فحوصات المسح في ظروف -ه

. المركزي في بغداد فيما بعدمختبرية مالئمة لغرض ارسالها الى مختبر الصحة : تحضيرات العمل الميداني-٩

اعداد قائمة بالمناطق و اسماء األسر-أ ) Mapping( و الخرائط )Microplanning(التفصيلية اعداد الخطة -ب

بتوزيع الفرق على المناطق المختارة، تحديد مناطق العمل لكل فريق حسب االيام .

.المخصصة للمسح على المشرف المحلي و الفرق توزيع السيارات -ج



90

: توزيع مستلزمات المسح على الفرق- د

استمارات األستبيان و التعليمات - اجهزة فحص الطول و الوزن- اجهزة فحص ضغط الدم و السماعة- القرطاسية و المستلزمات األخرى-

لباج و تزويد كل فريق باألمر األداري بأسماء أعضاء الفريق و ا- ه.نسخة باألمر األداري للمسح

:حسملا ءانثا قرفلا لمع ىلع يناديملا فارشألا -١٠

كيفية البدء بالمقابلة، اختيار الفرد المشمول، حصول موافقة األشتراك- أ طريقة ملىء األستمارة- ب طريقة اجراء الفحوصات البدنية- ج األخطاء تعديل - د التأكد من سحب نماذج الدم و جمعها و ايصالها الى المختبر و استرجاع - ه

النتائج استالم مجاميع األستمارات من الفرق - و األجتماع بالفرق بعد رجوعها و مناقشة سير العمل-ز تدقيق األستمارات -ح سال األستمارات المكتملة الى مركز الوزارة في بغداد دوريا على شكل ار-ط

.التأشير عليه طرد مع

ايموي تايلمعلا ةفرغ ىلا اهلاسرا و ةيمويلا جئاتنلاب ريرقت دادعا-١١



91

Annex 7-d

المسح الخاص برصد عوامل الخطورة لألمراض غیر األنتقالیة ٢٠٠٥ة في العراق لسن

دلیل تعلیمات فریق المسح المیداني

الغ رض م ن ه ذا ال دلیل ه و تزوی د فری ق الم سح المی داني بتعلیم ات ع ن كیفی ة اج راء المقابل ة و كما ی ساعد ف ي توض یح بع ض األس ئلة الت ي ق د یستف سر عنه ا ال شخص . استخدام استمارة المسح

و ع دم الت صرف ف ي التف سیر لتك ون المشمول بالمسح، حیث ینبغ ي للباح ث الرج وع ال ى ال دلیل .األجابة موحدة

:اجراء الزیارة

.یتم األستدالل على موقع األسرة المشمولة بالمسح حسب قائمة األسر المعدة مسبقاعند عدم تواجد األسرة ینبغي األستفسار من الجیران م ن ك ون الوح دة ال سكنیة ت سكنها أس رة، او

تسكنها اسرة یمكن الرجوع عندما تكون مأهول ة او ف ي نهای ة اذا كانت. كون الدار خالي او مغلق .الیوم

.تثبت نتیجة الزیارة في غالف األستمارة كما یثبت موعدالزیارة الثانیةیقوم رئیس الفریق بمقابلة رب األسرة و تعریف الفریق و سبب الزیارة مع شرح فحوى المسح و

ب راز هوی ة التعری ف أو األم ر األداري عن د س بب اج راء مقابل ة اح د اف راد األس رة، و یمك ن ا األستفسار

-٢٥(یستخدم الجدول في نهایة الكراس ألختیار أحد األفراد األس رة م ن ال ذین تت راوح اعم ارهم .سنة بشكل عشوائي) ٦٥

یثبت اسم الشخص المشمول و رقم األستمارة في صفحة المعلومات التعریفیةو یثب ت موع د . ابل ة و یثب ت ذل ك ف ي نتیج ة الزی ارةعن د ع دم وج ود ال شخص یمك ن ارج اء المق

. الزیارة األخرى .عند عدم تواجد الشخص ثالث مرات، یعتبرغیر مشمول بالمسح

عن د وج ود ال شخص، یق رأ ن ص الموافق ة الم شاركة ف ي الم سح عل ى ال شخص و توق ع م ن قب ل .الباحث

. الزیارة في غالف األستبیاناذا لم تتم الموافقة تنتهي المقابلة و یثبت الرفض في نتیجة اذا تمت الموافقة تستكمل المعلومات التعریفیة س اعة، ف ان ابت دأت ال ساعة الثانی ة بع د الظه ر ٢٤یحت سب وق ت ب دء و انته اء المقابل ة بطریق ة

.14:00تسجل

:معلومات عامة : تستخدم بعض الرموز لألجوبة التالیة-

٧٧٧ ٧٧ ٧ ال أعلم ٨٨٨ ٨٨ ٨ أرفض

عدم ترك السؤال ب دون ج واب اال اذا كان ت هن اك تعلیم ات لل ذهاب ال ى س ؤال اخ رو یعن ي ان -

یهمل السؤال األضافي حینها كتابة رقم األستمارة في أعلى كل ورقة



92

كتابة األرقام باللغة األنكلیزیة بشكل واضح و منفصل .محاولة األلتزام بتوقیتات المقابلة

:علومات توضیحیةم یسجل تاریخ الوالدة، : ١٥س

اذا لم یتذكر یمكن تقدیر العم ر م ن . اذا كان الجواب غیر معروف یسجل العمر بالسنوات ١٦س خالل السؤال عن العمر عند الزواج أو عند والدة احد األطفال أوبالمقارنة مع تاریخ أحد األحداث

.ئلة عمره معروف و ال یترك حقل العمر فارغاالمهمة، أومقارنته بعمر شخص أخر في العا ال تحتسب سنوات الرسوب ، مثال شخص اكمل المرحلة الثانی ة م ن : عدد سنوات الدراسة ١٧س

. سنوات٨الدراسة المتوسطة، و كان قد رسب سنتین من األول، یكتب عدد سنوات الدراسةم ثال عن دما یك ون ف ي المرحل ة . یعني أعلى شهادة اكمله ا ال شخص : أعلى مستوى تعلیمي ١٨س

.الثانیة من الدراسة المتوسطة تعتبر الشهادة األبتدائیة أعلى مستوى تعلیمي حصل علیه . الموظف الحكومي الذي یتلقى راتبا من الوظیفة٢٠س

.الموظف غیر الحكومي الذي یعمل في القطاع الخاص .الخ.... محل , صاحب المصلحة مثال صاحب مكتب

:األسرة و الدخل٢٣ - ٢١ساالسرة فرد واحد او مجموعة افراد یسكنون معا ویشتركون في ضرورات المعیشة ولهم میزانی ة

٣٠خ الل ش هر الدراس ة ( مشتركة وقد تربط بینهم صلة قربى او ال وللمفهوم فت رة اس ناد زمن ي ) یوما على االقل مع االسرة یعتبر فردا من افراد االسرة ١٥یوم مضى

:رةدخل األساذا كان فرد واحد هو معیل االسرة فیملئ الحقل المناسب لن وع دخل ه ام ا اذا ك ان هن اك اكث ر م ن

.فرد حاصل على دخل فیدخل مقدار دخله كما هو یحصل علیه في واقع الحالمجموع مایحصل علیه فرد او اف راد االس رة م ن م دخوالت نقدی ة او عینی ة م ن م صادر ال دخول

ال دخول م ن االن شطة االقت صادیة ال دخل من ة / االج ور ال دخول التحویلی ة / الروات ب ( المختلفة )الخ..... التسول, التصدق , االرباح , الملكیة المؤجرة

, ١٠٠لنفت رض ان هن اك ثالث ة اف راد ف ي االس رة اح دهم یعم ل میك انیكي بمرت ب اس بوعي ق دره وان , دین ار ١٠٠٫٠٠٠ وهن اك ابن ه م ثال موظ ف حك ومي برات ب ش هري ق دره , دین ار ١٠٠

دینار لذلك یدخل دخل كل واحد حسب نوعیة ٣٠٠،٠٠٠زوجته لدیها عئد ایجار دار سكن قدره الدخل االسبوعي الشهري السنوي

: البیانات السلوكیة األساسیة٦٤ - ٢٤ سالمقصود به اس تثناء الفت رات الت ي ت صادف مناس بات ق د ت ؤثر عل ى ال سلوكیات : األسبوع العادي

.یومیةال .تستخدم التعلیمات الخاصة بالتغذیة و النشاط البدني

بع د األنته اء م ن اج راء المقابل ة و الفحوص ات البدنی ة، ی زود ال شخص بك ارت یح دد فی ه موع د

. الفحص المختبري مع التعلیمات الخاصة بالتحضیرألجراء الفحص

.ینبغي تدقیق األستمارة قبل الخروج من المنزل

ستمارات المكتملة خالل الیوم في كیس واحد تؤشرعلیه اسم ال دائرة، رم ز الفری ق، تجمع كافة األ التاریخ، ارقام األستمارات و تسلم الى المشرف على الفرق مسؤول الرصد



93

Annex 7-e ةينامسجلا تاسايقلا ءارجا ةيفيك لوح ةماع تاميلعت

نزولا سايق ىلا ةبسنلاب نزولا سايق ةيلمع ءارجا متي عون ينورتكلا نازيم مادختسا ةطساوب نيغلابلا صاخشالا Uniscsle

دنعو :ةيلاتلا تءارجالا عبتت سايقلاب مايقلا ددع نازيم ذخا متي – ١ لمع ةحصو ةقد نم دكاتلل مقرلا تيبثتو هنزو سايق ةيلمعب قيرفلا ءاضعا دحا مايق متيو ٢/

عم رخالاب نازيملا لادبتسا متي يقيقح فالتخا دوجو لاح يفو تاءارق ٥-٤لك ل دعمب كلذ دعب قيقدتلا ءارجا متيو نينازيملا .هالعا تاميلعتلا سفن عابتا

ةيفاك ةرانا وا ةءاضا وذ ناكم يفو ةيوتسم ةبلص ضرا ىلع نازيملا عضو -٢ سمشلا ةعشال هضيرعت مدع ةظحالم عم ( .هباشام وا داجسلا ىلع هعضو وا ةدوربلا ديدش ناكم يف ةعضو مدع ىلا ةفاضا ) ةرشابملا

ةمالع هراهظاو ليغشتلا دعب هسفنل نازيملا قيقدت نم ءاهتنالا نيحل راظتنالا عم هيلا دوعصلا لبق زاهجلا ليغشت – ٣ 0.0ريفصتلا

ايقلا ةيلمعب مايقلا ءانثا اهل ةجاحال يتلاو ةليقثلا سبالملا ةفاك علخب هنزو سايق دارملا صخشلا سايق- ٤ ىلا ةفاضا س .نيمدقلا يفاح نازيملا ىلا دوعصلا نم دكاتلا

مدعل ءارولا ىلا اليلقهسبالم بحسب هغيلبت عم سايقلا ةيلمع ءارجا ءانثا ةكرح ياب هنزو سايق دارملا صخشلا مايق مدع -٥ .ةجيتنلا ضرع ةشاشو ةيئوضلا ةيلخلا بجح

ك ضرعلا ةشاش ىلع رهاظلا مقرلا ةءارق متي-٦ .67.4الثم ةيرشعلا ةبترملا لامها مدع عم ( صيقنت وا بيرقت وه ام

لوطلا سايق لوطلا سايق طيرش ةطساوب نيغلابلا صاخشالا ىلا ةبسنلاب لوطلا سايق ةيلمع ءارجا متي )هتيف(

لوطلا سايق ةيلمعب مايقلا دنع ةيلاتلا تاءارجالا عابتا متيو : نانثا ٢/ ددع لوطل ا سايق طيرش ذخا متي -١ سيل ( ميقتسم طئاح ىلع يوتحي ناكم يف نوكي نا بجي ثيح لوطلا سايق ةيلمع ءارجال مئالملا ناكملا رايتخا متي -٢

. ةلئام ريغ ةيوتسم ضرا ىلعو ) زورب وا روكيد يا هيف

اديج اهب كسميو ض رالا ىلع ةتيفلا عضوب لوالا موقي نيصخش ةطساوب سايقلا طيرش ريفصت ةيلمعب مايقلا متي -٣لوالا صخشلا نم هغالبا متي ىتح ةلئام ريغ ةميقتسم ةروصبو ىلعالا ىلا طيرشلا بحسب يناثلا صخشلا موقيو

طيرشلا تيبثتب يناثلا صخشلا موقيف ، سايقلا ةءارق ةقطنم يف يقفالا طخلا وا رشؤملا ىلع رفص مقرلا تيبثتب ىلعالا ىلا لفسالا نم ةتيفلا بحس متي مث . طيرشلا يف ةدوجومل ا ةصاخلا ةحتفلا يف رامسم ةطساوب طئاحلا ىلع

سايقلاو لامعتسالل ةزهاج نوكتف

نيمدقلا يفاح طئاحلا ىلا فوقولاب هلوط سايق دارملا صخشلا موقي -٤ طئاحلا ىلا هرهظ ادناس (

عم ةميقتسم نيتبكرلا ةقطنمو أكتم وا ينحنم ريغ اميقتسم فوقولاو) اهنع لئام ريغ امامت ةتيفلا لفسا نوكيو اميقتسم رظنلا نوكيو . طئاحلا ىلا ةقصتلم اضياو ضعبلا امهضعب عم نيمدقلا يبعك قاصتلا ىلا ةفاضا مسجلا يقاب

.فلخلا وا مامالل نيلئام وا نيرئاغ ريغ نيبصتنم ةبقرلاو سأرلاو مامالا ىلا قفلا يف درو ام لك نم دكأتلا دعب سايقلاب مئاقلا صخشلا موقي-٥ رسيب لفسالا ىلا ةيتفلا بحسب هالعا ) ٣(ةر

( ةءأرقلاب صاخلا يقفلا طخلل قباطملاو رهاظلا مقرلا ةءأرق متياهدنع سأرلا ىلعا فيفخ طغضب اهتسمالم نيحل صخشلا ىلا ) 174.8الثم ةيرشع ةبترم يا لامها مدع عم ناك ببس يال مقرلا بيرقت وا ةدايز وا صيقنت نود

.ليجستلاب مئاقلا لبق نم نودملا ةءأرق عيجرتب كلذو ليجستلا ةحص نم دكأتلا متيو نيترم ليجستلاب مئاقلا



94

Annex 7-f

............ةحص ةرئادل حسملا جئاتن ةعباتم ريرقت

:يمكارتلا: زجنملا: يلكلا فدهلا : / /خيراتلا

جدول نتائج المسح

المالحظات العدد التفاصيل

األسر المزارة

الزيارات التي تمت الزيارات التي ارجأت الزيارات التي رفضت

الدور المغلقة

الدور الخالية

عدم تواجد الفرد المشمول رفض الفحوصات البدنية

رفض الفحوصات المختبرية تالفحوصات المختبرية التي تم

المبادرات الصعوبات المقترحات

مالحظات أخرى

..)الدور المغلقة، الرفض،عدم وجود الشخص( كتابة رقم األستمارة للزيارة التي لم تنفذ في المالحظات :ةظحالم

مسؤول رصد األمراض غير األنتقالية/ المشرف



95

Annex 7-e

الخطة المحلية لدائرة الصحة

:رف المحلي ممثل دائرة الصحةالمش

:المشرف على فرق المسح الميداني مسؤول رصد األمراض غير األنتقالية

:عدد فرق المسح الميداني

: عدد ايام المسح

:عدد األليات: الهدف الكلي

:يناديملا حسملا قرف ريسل ةيليصفتلا ةطخلاالمناطق المختارة للفريق رمز

الفريق العنوان الوظيفي أسماء أعضاء الفريق

مويلا

١

٢ ٣ ٤



96

Annex 7-f

..............................:..تقریر متابعة المشرف المركزي في دائرة صحة

ةرازملا قطانملا

تاحرتقملا تابوعصلا تايبلسلا تاردابملا



97



ANNEX 8

٢٠٠٦ قارعلا /تاظفاحملا يف ةحصلا رئاودل حسملا جئاتنل ةيمويلا ةيزكرملا ةعباتملاريرقت جذومن

: / /التاريخ: ................................. التراكمي: .............................. المنجز.... : .........................الهدف الكلي

حسملا جئاتن لودجةحصلا رئاود

عومجم يذ ناسيم ةيناميلس كوهد ليبرا را

ةرصب كوكرك ىلايد رابنا كدادغب ردادغب لباب ءالبرك طساو حالص فجن ةيناويد ىنثم ىونين النتائج

الزيارات التي تمت األسر المزارة

الزيارات التي ارجأت الزيارات التي رفضت الدور المغلقة

عدم تواجد الفرد المشمول الدورالخالية رفض الفحوصات البدنية رفض الفحوصات

الفحوصات المختبرية التي المختبرية سبة الزيارات التي تمتن تمت

نسبة الفحوصات المختبرية التي تمت



Annex 9

لقنلا طئاسوو نييلحملا نيفرشملاو حسملا قرف عيزوت بسح حسملا ذيفنت ةلحرمل ةيزكرملا ةطخلا ٢٠٠٦قرعلا /

نييلحملا نيفرشملا ددع قرفلل بولطملا يحصلا و يبطلا كالملا تارايسلا ددع ةحصلا ةرئادل لوؤسم

قرفلا ةرئادلا لثمم

لمعلا مايأ ددع قيرفلكل يناديملا يربتخم دعاسم نواعم

ضرمم/يبط بيبط

قرفلا ددع

١٠ ١٠ ١٠ ١٠ ١٦ ١ ١ ١١ ٣ ٣ ٣ ٣ ١٠ ١ ١ ٤ ٦ ٦ ٦ ٦ ١٤ ١ ١ ٧ ٦ ٦ ٦ ٦ ١٤ ١ ١ ٧

٢٤ ٢٤ ٢٤ ٢٤ ١٧ ٢ ٤ ٢٨ ٦ ٦ ٦ ٦ ١٧ ١ ١ ٧ ٣ ٣ ٣ ٣ ١٧ ١ ١ ٤ ٤ ٤ ٤ ٤ ١٥ ١ ١ ٥ ٤ ٤ ٤ ٤ ١٧ ١ ١ ٥ ٤ ٤ ٤ ٤ ١٥ ١ ١ ٥ ٤ ٤ ٤ ٤ ١٤ ١ ١ ٥ ٢ ٢ ٢ ٢ ١٧ ١ ١ ٣ ٦ ٦ ٦ ٦ ١٥ ١ ١ ٧ ٣ ٣ ٣ ٣ ١٧ ١ ١ ٤ ٧ ٧ ٧ ٧ ١٥ ١ ١ ٨ ٢ ٢ ٢ ٢ ١٤ ١ ١ ٣ ٦ ٦ ٦ ٦ ١٤ ١ ١ ٧ ٧ ٧ ٧ ٧ ١٥ ١ ١ ٨



100

Annex (10) Distribution of the respondents according to governorates by age

groups and gender, Iraq 2006

Age groups

Du

hok

Nin

awa

Sul

aim

ani

ya

Kir

kuk

Dia

la

Al-

anba

r

Bag

hdad

Bab

il

Ker

bala

Was

it

Sal

ahad

di

n

Al-

Naj

af

Diw

aniy

a

Al

Mut

hann

a

Thi Q

ar

Mis

an

Bas

ra

Tota

l

%

25-34

0.6 3.2 2.2 1.3 2.3 0.9 6.3 2.0 1.3 1.1 1.6 1.4 1.2 0.9 2.0 0.7 1.8 31.1

35-44

0.5 3.3 2.6 1.2 1.7 0.8 6.4 2.3 0.9 1.4 1.5 1.0 1.1 0.5 2.1 0.8 2.5 30.7

45-54

0.6 2.2 1.9 0.7 1.2 1.3 4.7 1.2 0.5 0.8 1.0 0.7 0.9 0.4 1.3 0.9 2.2 22.6

55-65

0.4 1.6 0.9 0.4 1.2 0.9 3.7 0.9 0.6 0.8 0.3 0.6 0.6 0.4 0.9 0.2 1.3 15.6

Fem

ale

(N=

25

57

)

T 25-65

2.1 10.3 7.6 3.6 6.3 4.0 21.2 6.5 3.4 4.2 4.4 3.8 3.8 2.2 6.2 2.6 7.9 100

25-34

0.5 2.8 1.8 1.3 1.2 2.2 7.8 1.8 1.3 1.6 0.9 1.0 1.1 0.5 1.7 1.3 2.0 31.0

35-44

0.6 3.8 2.2 0.8 1.5 2.3 8.0 1.5 0.8 1.0 1.8 1.1 1.7 0.9 2.2 1.0 2.0 33.1

45-54

0.4 2.1 1.2 0.8 1.2 1.0 5.9 0.9 0.5 0.6 0.9 0.6 0.5 0.5 0.7 0.8 1.1 19.6

55-65

0.7 1.5 1.1 0.2 1.0 1.5 4.1 0.7 0.4 0.6 0.5 0.8 0.5 0.3 0.8 0.5 1.6 16.3

Mal

e (N

=1

94

6)

T 25-65

2.3 10.1 6.4 3.1 4.9 7.0 25.8 4.8 3.0 3.8 4.0 3.4 3.8 2.2 5.3 3.5 6.6 100

25-34

0.6 3.1 2.1 1.3 1.8 1.5 7.0 1.9 1.3 1.3 1.3 1.2 1.2 0.8 1.9 1.0 1.9 31.0

35-44

0.5 3.5 2.4 1.0 1.6 1.5 7.1 2.0 0.9 1.2 1.6 1.0 1.4 0.7 2.1 0.9 2.3 31.7

45-54

0.5 2.1 1.6 0.8 1.2 1.2 5.2 1.1 0.5 0.7 1.0 0.7 0.7 0.4 1.0 0.8 1.7 21.3

55-65

0.6 1.6 1.0 0.3 1.1 1.2 3.9 0.7 0.6 0.7 0.3 0.6 0.5 0.3 0.8 0.3 1.4 15.9

Bot

h s

exes

(N

=4

503

)

T 25-65

2.2 10.2 7.1 3.4 5.7 5.3 23.2 5.7 3.2 4.0 4.2 3.6 3.8 2.2 5.8 3.0 7.3 100



101

Annex 11 Distribution of the participants according to the highest level of education by age groups and gender, Iraq, 2006

No response

Illiterate

Read and

write

Completed Primary School

Completed Intermedia te school

Completed Secondary

School

Institute Diploma

Universi ty Degree

Post Graduate-

degree

others Age groups

n=6 %

n=125 %

n=714 %

n=1149 %

n=425 %

n=344 %

n=322 %

n=258 %

n=29 %

n=5 %

25-34 0.1 6.0 5.6 11.8 3.2 1.1 1.9 1.4 0.0 0. 35-44 0.1 8.2 6.2 7.9 2.7 2.7 1.9 0.9 0.1 0 45-54 0 12.6 4.0 2.5 0.9 0.9 1.1 0.6 0 0.0 55-65 0.1 10.8 1.7 1.5 0.4 0.4 0.2 0.3 0.0 0 Fe

mal

e (N

=2

55

7)

25-65 0.2 37.6 17.5 23.8 7.1 23.8 5.1 3.1 0.2 0.1 25-34 0 2.8 4.1 10.0 4.5 3.1 3.3 2.9 0.3 0.1 35-44 0 3.4 3.5 9.7 4.5 5.0 3.5 2.9 0.6 0 45-54 0 3.3 3.1 4.9 2.1 2.0 2.1 2.0 0.2 0.1 55-65 0 5.4 3.0 3.3 1.5 0.7 1.0 1.3 0.2 0.1 M

ale

(N=

19

46

)

25-65 0 14.9 13.7 27.8 12.5 10.8 9.8 9.1 1.2 0.2 25-34 0.0 4.6 5.0 11.0 3.7 2.0 2.5 2.1 0.2 0.0 35-44 0.0 6.1 5.0 8.7 3.4 3.7 2.6 1.8 0.3 0 45-54 0 8.5 3.6 3.6 1.4 1.4 1.5 1.2 0.1 0.0 55-65 0.0 8.5 2.2 2.3 0.9 0.6 0.5 0.7 0.1 0.0 B

oth

se

xes

(N=

450

3)

25-65 0.1 27.8 15.9 15.9 9.4 7.6 7.2 5.7 0.6 0.1



102

References 1. World Health Organization report, 2006. Why move for health, Geneva: WHO. 2. WHO, 2000, Global Strategy for the prevention and control of non-communicable

diseases.A53/17. documentation of the 53 World Health Assembly. 3. Alwan A.Health in Iraq. MOH. 2004 4. MOH statistics, Biostatistics 2003 5. Ministry of Planning and Development Cooperation /UNDP 2005. Iraq Living

Conditions Survey ILCS 2004. UNDP 6. Ministry of Planning and Development Cooperation /WFP 2005. Food Security and

Vulnerability Analysis in Iraq 2005. 7. WHO, Preventing chronic diseases: A vital investment, Geneva: WHO;2005. 8. Ministry of Planning and Development Cooperation /UNICEF. Iraq Multiple Indicator

Cluster Survey. UNICEF: 2006. 9. The WHO STEPwise approach to chronic diseases risk factor surveillance.

Geneva:WHO;2005.



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