title: CARRS Surveillance study: design and methods to assess burdens from multiple perspectives.
abstract: BACKGROUND
  Cardio-metabolic diseases (CMDs) are a growing public health problem, but data on incidence, trends, and costs in developing countries is scarce. Comprehensive and standardised surveillance for non-communicable diseases was recommended at the United Nations High-level meeting in 2011.
  
  
  OBJECTIVE
  To develop a model surveillance system for CMDs and risk factors that could be adopted for continued assessment of burdens from multiple perspectives in South-Asian countries.
  
  
  METHODS
  
  
  
  METHODS
  Hybrid model with two cross-sectional serial surveys three years apart to monitor trend, with a three-year prospective follow-up of the first cohort.Sites: Three urban settings (Chennai and New Delhi in India; Karachi in Pakistan), 4000 participants in each site stratified by gender and age.Sampling methodology: Multi-stage cluster random sampling; followed by within-household participant selection through a combination of Health Information National Trends Study (HINTS) and Kish methods.Culturally-appropriate and methodologically-relevant data collection instruments were developed to gather information on CMDs and their risk factors; quality of life, health-care utilisation and costs, along with objective measures of anthropometric, clinical and biochemical parameters. The cohort follow-up is designed as a pilot study to understand the feasibility of estimating incidence of risk factors, disease events, morbidity, and mortality.
  
  
  RESULTS
  The overall participant response rate in the first cross-sectional survey was 94.1% (Chennai 92.4%, n = 4943; Delhi 95.7%, n = 4425; Karachi 94.3%, n = 4016). 51.8% of the participants were females, 61.6% < 45years, 27.5% 45-60years and 10.9% >60 years.
  
  
  CONCLUSIONS
  This surveillance model will generate data on prevalence and trends; help study the complex life-course patterns of CMDs, and provide a platform for developing and testing interventions and tools for prevention and control of CMDs in South-Asia. It will also help understanding the challenges and opportunities in establishing a surveillance system across countries.
authors.affiliation: Public Health Foundation of India (PHFI), New Delhi & CoE-CARRS, PHFI, New Delhi, India.
authors.forename: Manisha
authors.initials: M
authors.lastname: Nair
authors.forename: Mohammed K
authors.initials: MK
authors.lastname: Ali
authors.forename: Vamadevan S
authors.initials: VS
authors.lastname: Ajay
authors.forename: Roopa
authors.initials: R
authors.lastname: Shivashankar
authors.forename: Viswanathan
authors.initials: V
authors.lastname: Mohan
authors.forename: Rajendra
authors.initials: R
authors.lastname: Pradeepa
authors.forename: Mohan
authors.initials: M
authors.lastname: Deepa
authors.forename: Hassan M
authors.initials: HM
authors.lastname: Khan
authors.forename: Muhammad M
authors.initials: MM
authors.lastname: Kadir
authors.forename: Zafar A
authors.initials: ZA
authors.lastname: Fatmi
authors.forename: K Srinath
authors.initials: KS
authors.lastname: Reddy
authors.forename: Nikhil
authors.initials: N
authors.lastname: Tandon
authors.forename: K M Venkat
authors.initials: KM
authors.lastname: Narayan
authors.forename: Dorairaj
authors.initials: D
authors.lastname: Prabhakaran
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007194:India; D008297:Male; D008659:Metabolic Diseases / Q000453:epidemiology*; D008875:Middle Aged; D017146:Models, Organizational; D010154:Pakistan / Q000453:epidemiology; D011159:Population Surveillance / Q000379:methods*; D011446:Prospective Studies; D012307:Risk Factors