Group for Cardiovascular Disease and Epidemiological Transition : G.C.T.
This research and prevention program is described in some detail in several published articles, for example in CVD Prevention 1999;2:261-72 Cardio Update (New Delhi) 1996;July:10-22; Soz Praventivmed 1995;40:35-43; Wrld Hlth Statist Q 1993; 46(No. 2); 108-12; and Soz Praeventivmed 1991; 36(Suppl. 1): S30-33, Insight Health (May 2001). More specific issues and results have been reported in ~20 other publications (abstracts and full texts are available in the ‘CVD Papers’ section elsewhere in this site).
A CVD research and prevention program has been initiated since 1989 as a joint project between IUMSP and the Ministry of Health of the Republic of Seychelles. The program aims at describing the cardiovascular disease situation in a country experiencing rapid health transition and at developing corresponding prevention and control strategies. Population-based surveys in 1989 and 1994 showed high levels of several main risk factors, particularly hypertension. High prevalence of peripheral atherosclerosis was also found (as measured by high performance ultrasonography). A Unit for Prevention and Control of Cardiovascular Disease was set up in 1992 in the Ministry of Health of Seychelles and several public health measures were developed and implemented. This includes media campaigns to rise public awareness, public health policy instruments, integration of health education focusing on non-communicable diseases within the regular curriculum in schools, screening programs and ‘heart health clubs’ targeting high risk individuals, surveillance systems such as a national register of hypertension and diabetes among adults (within all primary health centers) and at school level (screening program in schools). Ongoing studies include a cohort study of risk factors, surveillance of risk factors integrated in school programs, relationship of risk factors in children with birth data and a study of genetic determinants of hypertension. Further policy development includes the formulation of a comprehensive CVD program including guidelines for the management CVD and risk factors.
The Ministry of Health of the Republic of Seychelles has set up a Unit of Prevention and Control of CVD within the Ministry of Health that is staffed with 5 local health workers and which is complemented with consultants from IUMSP. Projects have benefited from funding and resources from the Swiss National Science Foundation, various divisions and departments of the Faculty of Medicine of the University of Lausanne (Switzerland), the Service des Hospices Cantonaux (Vaud), the Swiss Canton of Jura, and the Swiss Agency for Development and Cooperation.
IUMSP: Pascal Bovet, Murielle Bochud, Catherine Falconnet, Jean-Pierre Gervasoni, Fred Paccaud.
Unit for Prevention and Control of Cardiovascular Disease, Ministry of Health, Seychelles:
Pascal Bovet (consultant), Anne Marie Bibi, George Madeleine, Bharathi Viswanathan, Nadia Ciseau,
Murielle Bochud (coordinator of TANDEM Hypertension Study), Catherine Falconnet (TANDEM hypertension
study), Norma Both (TANDEM hypertension study).
A summary of main interventions is tabulated in the paper CVD Prevention 1999;2:261-72 and a brief description of the prevention program in Seychelles appears in ID21 Insight Health. Some specific interventions are mentioned briefly thereafter:
The Heart Health Program is a comprehensive teaching program integrated in the regular school curriculum in 1993 (with UPCCD) and consists of 10-20 heart health class hours per year from first to sixth level, backed by level-specific colorful books available to each scholar (books originate from Singapore). This program aims at sensitizing children on heart health and healthy lifestyles and help them acquiring the skills to adopt healthy lifestyle early in life when norms and behaviors are being internalized. The program is accompanied by relevant workshops for the teachers. Since 1998, the programs includes a systematic and routine screening of all (~6000 children) children attending kindergarten, fourth, seventh and tenth levels of obligatory school. Screening includes duplicate measurement of blood pressure, weight, height, smoking habits, physical exercise and consumption of alcohol, as well socioeconomic and birth data.
Heart health education through the radio and television has been central in raising public awareness on cardiovascular health and is mediated through specific programs in magazines, news, spots, contests, quiz, interviews of opinion leaders, and ‘keep fit’ sessions. High coverage by radio and TV programs has been ensured by broadcasts at prime time by the one channel TV and radio stations.
Using its own up-to-date production equipment, UPCCD designs and publishes culturally-sound leaflets and posters on heart health targeting specific population groups. The leaflets are available in district clinics and are used in other ongoing CVD control activities (e.g. Heart Health Clubs, risk factors screening in public or work places). Printing of large amounts of these leaflets is often supported by sponsors (e.g., the employers of work places where screenings are offered to the employees). Leaflets include "Hypertension the silent killer", "How to measure blood pressure", "What you should know about diabetes", Cholesterol and your heart", "How to quit smoking", "How other people’s smoke harms you", "Reduce your risk of cardiovascular disease".
Tobacco control policies are being developed and include policies at local or ministerial levels (e.g., no-smoking policies in all premises of the Ministry of Health and Ministry of Education, and ban on advertisement in the mass media. A comprehensive legislation is being prepared within a National Committee on Tobacco Control set up in 2001. UPCCD concentrates many tobacco control activities around the World No Smoking Day as the support by WHO provides a good opportunity to access the mass media. Activities are however organized in a way to largely precede and follow the day itself in a context relevant to the country. The activities are largely financed by local sponsors and WHO and have included the organization of a national contest of mural in public places by the schools, a contest on knowledge on tobacco-related health and marketing in all schools, the organization of no-smoking badge wearing competition (themes: kiss a non-smoker enjoy the difference; put a (k)not in it, etc.) at the national level (event referred in a WHO Tobacco Alert, Oct 95), smoking-free family cycling promenades. All events were largely covered by the media and provoked special programs.
The Heart Health Club aims at providing relevant health education and skills to adopt healthy lifestyles and comply to treatment to selected high risk individuals (i.e. persons with hypertension and diabetes). The program promotes an integrated approach to risk factors ("total burden of risk") rather than addressing risk factors in isolation. This approach acknowledges the underlying facts that (1) CHD has a multifactorial etiology, (2) multiple risk factors have multiplicative effects, and (3) modifiable CVD risk factors share several common prevention measures. The seminars take place on a regular basis in primary health care clinics with PHC staff and are attended by 5-15 high risk patients usually either referred by their district doctors/nurses or subsequently to screening programs in public or work places.
An ambitious, large-scale program to reduce CVD risk in high risk patients is needed due to the particularly high prevalence of hypertension, diabetes and other risk factors in Seychelles. The multifactorial etiology of CVD, the multiplicative effects of multiple risk factors, and the modifiable nature of several CVD risk factors provide the rationale to include, in the medical file of every patient at increased risk for CVD, a regularly updated form summarizing the major CVD risk factor levels. This form permits the doctor to better treat his/her patient by quickly assessing the absolute CVD risk and for potential control measures. In addition, the regular computerized update of such forms at a clinic level and at a national level permits to estimate the frequency of risk factors in the community and is therefore useful for planning.
Screening is a cost effective strategy for highly prevalent conditions which can be controlled effectively and at low cost (e.g. hypertension). Screening high-risk persons also benefits the general population as screened individuals generally share the received information with their families (mean in Seychelles =5.5 persons per house) and as these community events provoke the broadcast of complementary TV/radio educational programs. Screenings have also been conducted on a systematic basis in work places since 1996 as workers may face stressful situations and may have limited opportunities to attend medical services compared to the non-working population.