Addressing non-communicable diseases in the Seychelles: towards a comprehensive plan of action

Interventions and policies aimed at improving nutrition in Small Island Developing States: a rapid review

Objective.

To describe features of nutritional interventions implemented in Small Island Developing States (SIDS) in the past 20 years.

Methods.

A rapid scoping review was conducted by searching PubMed and Web of Science databases for interventions conducted in SIDS that sought to improve the nutrition of their populations between 2000 and 2019 inclusive. The Noncommunicable diseases progress monitor 2020 was also examined to assess nutritional policies in SIDS.

Results.

A total of 174 interventions were implemented in 49 of the 58 SIDS. The greatest proportion were conducted in the Caribbean (75 interventions; 43%), with the Pacific region, and the Atlantic, Indian Ocean, Mediterranean and South China Sea region each implementing about 30% of interventions. Using the NOURISHING framework, most interventions (67%) were implemented at the community and national or policy level, using multiple components of the framework. The greatest proportion of interventions (35%) were educational and awareness raising. Restrictions on physical availability of and increased taxation on alcohol were the most commonly reported policies that were partially or fully achieved; restrictions on fats were the least commonly reported. These findings were generally consistent across the SIDS regions.

Conclusions.

There is a paucity of nutritional policies in SIDS; the reasons may be linked to their social, economic, and environmental vulnerabilities. Interventions should be expanded beyond education to encompass multiple components of the NOURISHING framework, with multisectoral inclusion to ensure stronger stakeholder collaboration and buy-in. A systematic review is warranted using a fuller range of sources to assess the effectiveness of interventions.

Prevalence and Correlates of Behavioral Non-Communicable Diseases Risk Factors among Adolescents in the Seychelles: Results of a National School Survey in 2015

The aim of this study was to investigate the prevalence and correlates of behavioral non-communicable disease (NCD) risk factors among a national sample of school-going adolescents in the Seychelles. Cross-sectional data were analyzed from 2540 school adolescents (median age 14 years, interquartile range = 2), in the Seychelles "Global School-Based Student Health Survey (GSHS)" in 2015. Behavioral NCD risk factors (current tobacco use, current alcohol use, inadequate fruit and vegetable consumption, soft drink consumption, overweight or obesity, physical inactivity, and leisure-time sedentary behavior) were assessed by self-report. Among the seven individual behavioral risk factors, the highest prevalence was physical inactivity (82.7%), followed by daily soft drink consumption (68.3%), inadequate fruit and vegetable consumption (60.9%), leisure-time sedentary behavior (51.0%), current alcohol use (47.6%), overweight or obesity (28.2%), and current tobacco use (23.4%). The total mean number of behavioral NCD risk factors was 3.6 (Standard Deviation = 1.3), and the proportion of co-occurrence of having three or more behavioral NCD risk factors was 80.7%. In adjusted linear regression analysis, male sex, older age, and psychological distress were positively, and school attendance and peer support were negatively associated with the total number of behavioral NCD risk factors. A high prevalence of multiple behavioral NCD risk factors were found and several associated factors were identified, such as male sex, older age, psychological distress, school truancy, and lack of peer support, which may help in aiding intervention programs in this population.

Global Updates on Cardiovascular Disease Mortality Trends and Attribution of Traditional Risk Factors

PURPOSE OF REVIEW

The last 2-3 decades have witnessed a decline in age-standardized cardiovascular mortality rates in high-income regions, whereas this has only slightly decreased or even increased in most of the low- and middle-income countries. A systematic comparison of global CVD mortality by regions attributable to various modifiable risk factors such as diabetes, obesity, hypertension, poor diet, and physical inactivity is not available.

RECENT FINDINGS

We present a summary of time trends and heterogeneity in the distribution of global CVD mortality and the attribution of risk factors between 1990 and 2017 using the Global Burden of Disease (GBD) 2017 study. Globally, an estimated ~ 17.8 million (233.1 per 100,000) people died of CVD in 2017. The rate of CVD death was decreased in high-income countries (1990: 271.8 (95% UI (uncertainty interval), 270.9-273.5); 2017: 128.5 (95% UI, 126.4-130.7) per 100,000)) whereas it remained the same in lower- and middle-income countries (1990: 368.2 (95% UI, 335.6-383.3); 2017: 316.9 (95% UI, 307.0-325.5) per 100,000). Among the various traditional risk factors, high systolic blood pressure, unhealthy diet, high fasting plasma glucose, and high low-density lipoprotein levels were attributed to most of the CVD death and disability-adjusted life year lost. We also observed gender variations in tobacco and increased alcohol consumption. In addition to the traditional risk factors, poor air quality is associated with increased CVD burden in developing countries. Surveillance, country-specific guidelines, evidence-based policies, reinforcement of multisectoral health systems, and innovative solutions are urgently needed in resource-challenged settings to curb CVD risk factors and overall burden.

Dietary determinants of serum total cholesterol among middle-aged and older adults: a population-based cross-sectional study in Dar es Salaam, Tanzania

OBJECTIVE

To assess the dietary determinants of serum total cholesterol.

DESIGN

Cross-sectional population-based study.

SETTING

Peri-urban region of Dar es Salaam, Tanzania.

PARTICIPANTS

347 adults aged 40 years and older from the Dar es Salaam Urban Cohort Hypertension Study.

MAIN OUTCOME MEASURE

Serum total cholesterol measured using a point-of-care device.

RESULTS

Mean serum total cholesterol level was 204 mg/dL (IQR 169-236 mg/dL) in women and 185 mg/dL (IQR 152-216 mg/dL) in men. After adjusting for demographic, socioeconomic, lifestyle and dietary factors, participants who reported using palm oil as the major cooking oil had serum total cholesterol higher by 15 mg/dL (95% CI 1 to 29 mg/dL) compared with those who reported using sunflower oil. Consumption of one or more servings of meat per day (p for trend=0.017) and less than five servings of fruits and vegetables per day (p for trend=0.024) were also associated with higher serum total cholesterol. A combination of using palm oil for cooking, eating more than one serving of meat per day and fewer than five servings of fruits and vegetables per day, was associated with 46 mg/dL (95% CI 16 to 76 mg/dL) higher serum total cholesterol.

CONCLUSIONS

Using palm oil for cooking was associated with higher serum total cholesterol levels in this peri-urban population in Dar es Salaam. Reduction of saturated fat content of edible oil may be considered as a population-based strategy for primary prevention of cardiovascular diseases.

Nutrition transition in a middle-income country: 22-year trends in the Seychelles

BACKGROUND/OBJECTIVES

There is little objective information regarding nutrition transition in African countries. We assessed trends in nutrition patterns in the Seychelles between 1989 and 2011.

SUBJECTS/METHODS

Population-based samples were obtained in 1989, 1994 and 2011 and participants aged 25-44 are considered in this study (n=493, 599 and 471, respectively). Similar, although not identical, food frequency questionnaires (FFQs) were used in each survey and the variables were collapsed into homogenous categories for the purpose of this study.

RESULTS

Between 1989 and 2011, consumption frequency of fish (5+/week) decreased from 93 to 74%, whereas the following increased: meat (5+/week) 25 to 51%, fruits (1+/week) 48 to 94%, salty snacks (1+/week) 22 to 64% and sweet snacks (1+/week) 38 to 67% (P<0.001 for all). Consumption frequency decreased for home-brewed alcoholic drinks (1+/week) 16 to 1%, but increased for wine (1+/week) 5 to 33% (both P<0.001). Between 2004 and 2011, consumption frequency decreased for rice (2/day) 62 to 57% and tea (1+/day) 72 to 68%, increased for poultry (1+/week) 86 to 96% (all P<0.01), and did not change for vegetables (70.3 to 69.8%, P=0.65).

CONCLUSIONS

Seychelles is experiencing nutrition transition characterized by a decreased consumption frequency of traditional staple foods (fish, polished rice), beverages (tea) and of inexpensive home brews, and increased consumption frequency of meat, poultry and snacks. Food patterns also became more varied along with a broader availability of products in the 22-year interval. The health impact of these changes should be further studied.

CARRS Surveillance study: design and methods to assess burdens from multiple perspectives

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.

Aims: 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

Design: 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.

Discussion

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.

Declining stroke and myocardial infarction mortality between 1989 and 2010 in a country of the african region

BACKGROUND AND PURPOSE

In low- and middle-income countries, the total burden of cardiovascular diseases is expected to increase due to demographic and epidemiological transitions. However, data on cause-specific mortality are lacking in sub-Saharan Africa. Seychelles is one of the few countries in the region where all deaths are registered and medically certified. In this study, we examine trends in mortality for stroke and myocardial infarction (MI) between 1989 and 2010.

METHODS

Based on vital statistics, we ascertained stroke and MI as the cause of death if appearing in any of the 4 fields for immediate, intermediate, underlying, and contributory causes in death certificates.

RESULTS

Mortality rates (per 100 000, age-standardized to World Health Organization standard population) decreased from 1669/710 (men/women) in 1989 to 1991 to 1113/535 in 2008-10 for all causes, from 250/140 to 141/86 for stroke, and from 117/51 to 59/24 for MI, corresponding to proportionate decreases of 33%/25% for all-cause mortality, 44%/39% for stroke, and 50%/53% for MI over 22 years. The absolute number of stroke and MI deaths did not increase over time. In 2008 to 2010, the median age of death was 65/78 years (men/women) for all causes, 68/78 for stroke, and 66/73 for MI.

CONCLUSIONS

Between 1989 and 2010, age-standardized stroke and MI mortality decreased markedly and more rapidly than all-cause mortality. The absolute number of cardiovascular disease deaths did not increase over time because the impact of population aging was fully compensated by the decline in cardiovascular disease mortality. Stroke mortality remained high, emphasizing the need to strengthen cardiovascular disease prevention and control.