• Research Review
• Journal Summary

Authors: P Bovet, B Viswanathan, C Shamlaye, S Romain, J Gedeon

Reference: Global Health Promotion 2010; 17(2):37-40 (open access)
http://ped.sagepub.com/content/17/2_suppl/37.full.pdf+html

Reviewer: Carlos Mendoza Montano, PhD, ProCor contributing editor; President, Guatemalan Association for the Prevention of Heart Diseases (APRECOR), Guatemala City, Guatemala

Reviewer comments: Seychelles, a rapidly developing small island state in the African region, has experienced the processes related to chronic, non-communicable disease (NCD) prevention and control, characterized as a pragmatic and incremental approach. The island program against NCD was initiated in the late 1980s and might be taken as a model for NCD prevention and control programs in other developing countries. The fight against NCD in Seychelles included the development of early population-based risk factor surveillance mechanisms and a variety of programs and policies, which eventually led to the need for a comprehensive and multi-sectoral policy response to NCD. Here, it is presented a summary of the background and strategies employed in the Seychelles to develop the NCD national prevention and control program.

Burden of disease
Vital statistics indicate that cardiovascular disease and cancer account for approximately 40% and 20% of all deaths, respectively. Age-specific rates of stroke and heart attack mortality have tended to decrease during the past two decades but remain high by international standards. An increase of the total burden of NCD is expected in view of the rapid demographic transition.

Surveillance
The first national examination surveys of NCD risk factors in 1989, and repeat surveys in 1994 and 2004, showed high prevalence of several risk factors, including obesity, smoking, sedentary habits, hypertension, dyslipidemia, diabetes, and smoking. An ongoing school-based surveillance mechanism showed marked upward trends in overweight among children. These surveillance data have been instrumental for raising awareness and initiating ad hoc programs and policies.

Development of programs for the prevention of NCD
Emphasis was first given to awareness campaigns targeting the general population through dozens of programs every year aired on the national radio and TV. An NCD-related school curriculum, with components for both teachers and students, has been worked out with the Ministry of Education. A variety of programs have targeted high-risk individuals, including hypertension and diabetes screening in public places and workplaces. Health care given to NCD patients at primary health care level has been strengthened. Hypertension and diabetes are managed in all district health centers in the country. Recently, specialized NCD nurses have been trained and they now play a prominent role in providing health care to NCD patients in health centers.

Development of a NCD-related policy
At the clinical level, local guidelines for the diagnosis and treatment of hypertension, diabetes, and blood lipid disorders were developed to guide standard care to NCD patients. A Tobacco Control Act was enacted and included, among various provisions, total bans on tobacco advertising and on smoking in enclosed public places and workplaces. Taxes on tobacco are as high as 60%-70% of the retail price of cigarettes packets. A National School Nutrition Policy has been adopted and includes a ban on sugar-sweetened soft drinks in schools and it restricts the sale of other foods of low nutritional value.

Need for a comprehensive and multi-sectoral policy framework for the prevention of NCDs
The different pieces of programs and policies taken in Seychelles have successfully addressed several problems. Tobacco use has markedly decreased over the past 15 years. However, overweight and diabetes have increased and constitute a major health challenge for the future. Policy makers have recognized that control of NCDs must encompass broader policy and structural changes aimed at molding an environment that is conducive to healthy behaviors. Overall, essential components to successful development and implementation of policies to address NCD in Seychelles have included: good use of surveillance mechanisms; generating broad interest and consensus; mobilizing leadership and commitment at all levels; involving local and international experts; building on existing efforts; and seeking integrated, multidisciplinary, and multi-sector approaches.

Additional References:
P Bovet, C Shamlaye, A Kitua, W Riesen, et al. High prevalence of cardiovascular risk factors in the Seychelles (Indian Ocean). Arterioscl Thrombos 1991; 11:1730-1736 (open access) http://atvb.ahajournals.org/cgi/reprint/11/6/1730

D Faeh, J William, C Shamlaye, L Tappy, et al. Prevalence, awareness and control of diabetes in the Seychelles and relationship with excess body weight. BMC Public Health 2007; 7:163 (open access) http://www.biomedcentral.com/1471-2458/7/163