building capacity for heart health in africa

BUILDING CAPACITY FOR HEART HEALTH IN AFRICA

Dr. Kingsley K. AkinroyeVice – President

African Heart NetworkAt

African Heart Network WorkshopMaputo, Mozambique Nov. 20th 2008

RISK FACTORS FOR HEART DISEASE

- High blood pressure

- High cholesterol

- Tobacco use

- Low intake of fruit and vegetables

- Overweight

- Physical inactivity

2005 WHO REPORT

- 17 million people (of the world’s population) die of CVD

- Several millions suffer life-long disability (80% in developing countries)

WHY INVESTING IN HEART HEALTH?

- Decrease in heart disease

- Decrease in strokes

- Lesser disability

WHAT POLICIES COUNTRIES NEED TO ADOPT

- Reducing salt in foods

- Cutting dietary fat

- Promoting Exercise

- Encouraging higher consumption of fruits and vegetables

- Lowering smoking

- Use of affordable, available, locally manufactured drugs.

VARIATIONS IN COUNTRIES & COMMUNITIES

- Economic conditions

- Health Status

- Education

- Culture

- Politics

SUCCESS ‘STORIES’ OF COMMUNITY PROJECTS

- International perspectives

- Africa Region

PAWTUCKET HEART HEALTH PROGRAM (PHHP)

(RHODE ISLAND, USA)- Initiated 1980

- Change behaviour patterns

to prevent and control CVD

- Started in a community hospital

Board of Directors decision to reduce

the city’s high rate of CVD


- Hired a Hospital Director (HD)Background in preventive careHD designed preventive programmes targeted at the population

- PHHP used existing community resourcesto plan for implementation viz:

Social organizationsLocal government


LibrariesSchools (Public + Private)Faith-based organizationsMass MediaSupermarketsLocal business RestaurantsGrocery storesMedical establishments


- The strength of the Pawtucket communityintervention was its VOLUNTEERS.

3,600 people in the community of surrounding areas volunteered their services.40 percent of citizens of 500 organizations in the study community participated in behaviour change programmes


Lesson: - Any community group can be

involved in primary

prevention

- Community efforts can be

used as a model for

replication

STANFORD COMMUNITY HEART HEALTH PROJECTS

- After World War II there was a rise in CVDin the American population

- By late1960s scientists and public health officials recognized the need for primary prevention strategies to reduce the increase in CVD

- With Federal government aid, the Stanford projects started with Cardiologist, a social psychologist and a lipid chemist. (This was the first group in USA to attempt a comprehensive, community wide educational approach in non communicable diseases prevention)


- 1972 – 1975: The three-community study was conducted

1st Community was a control2nd Community received media

education only3rd Community received media

educationResult: 24% decline amongst adults in

estimated risk of future heart attackand strokesMedia – only treatment was effective in achieving significant improvements


From 1978 – 1996: The Five-City project was conducted by adapting the methods of the Three – community study in larger communities.

Result: All risk factors for CVD (except body weight) improved

Benefit: At the conclusion of the Stanford intervention in 1986, there was the successful maintenance of a CVD prevention programme

NORTH KARELIA, FINLAND: COMMUNITY INTERVENTION

- Project was initiated in 1972- Combined educational, environmental and policy

interventions to prevent CVD.- Information that North Karelia had the highest

rate of CVD mortality in the world.- Citizens petition for action to Government

followed by Government support.- Local and National authorities, and experts

backed the project.- Link with WHO


- ActivitiesRisk factor screening programmesProfessional educationInitiatives to effect changes at communitye.g. Low-fat cooking classes

Collaboration with the house-wives association helped to influence dietary habitsCompetition between villages – reductionin cholesterol levels.


Result: - All major risk factors decreased in North Karelia throughout the period of the study.

- CVD mortality rates fell by 57%between 1970 and 1992

- Fat intake was reduced- Fruit and vegetable intake

increased- Smoking among men decreased

PORTUGAL’S EXAMPLE TO IMPLEMENTING COMMUNITY CARDIOVASCULAR DISEASE

PREVENTION

“Heart disease before eighty. It is man’s fault, not God or Nature’s will”

(Paul Dudley White 1952)- Above inspiration touched Fernando de Padua,

a graduate student at Harvard, and the Massachusetts General Hospital

- Back to Portugal- Initiated using Newspapers to disseminate CVD

prevention messages with emphasis on high salt intake of Portuguese diet.


PREVENTION- Health promotion articles were not acceptable in

Europe till 1972, hence he could not publish in journals.

- By 1972, he became a Professor, and started to involve the community in a national fight against hypertension.

- Later – Radio, Movie theatres and national TV.- F. de Padua TV program gained popularity- Volunteers started checking blood pressure in

Subway & train stations + distribution of printed materials in conferences & festivals.


PREVENTION

- Portuguese health authorities were alerted to the CVD challenge

- Base line data were collected, to indicate that 30% of the Portuguese were hypertensive

- Visit of three (3) eminent Cardiovascular epidemiologists to Portugal

- Production of a CVD prevention booklet with Padua plus one-hour long TV interview on the only national TV (was a turning point)


PREVENTION

Result: Portugal stroke mortality decreased by 30%; ischemic heartdisease decreased by 25%Foundations of:- Centre for the study of Preventive Cardiology- Portuguese Heart Foundation- National Institute of Preventive Cardiology

WORKSITE INTERVENTION:ELECTROSTAL, RUSSIA

- CINDI Project

- To reduce hypertension

- Town of Electrostal(Russia) - Project started 1987


Hypertension control programme – for 13,000 employees at a pipe line plantHealth care units, staffed by Nurses in alldepartmentsProgram:

DetectionLifestyle counselingNon pharmacological reduction of

riskfactorsDrug treatment


Results: After 5 – year follow-up- 73% of hypertensive were under

control- 54% maintained blood pressure

<160/90 mm Hg- Absenteeism due to hypertension

and other conditions decreased by 30%

JAPANESE SUCCESS IN REDUCING STROKE MORTALITY

“If I were to put an ultimate valuation on my health, l should probably adopt a Japanese diet, as the Japanese are the longest-lived people in the world”

(G. Rose 1992)

- 1970 - Stroke was the major killer in Japan- Last three decades, Japan has recorded the

largest reduction in stroke mortality in the world.


- Risk factors for stroke in Japan were identified- Diet was recognized as a top priority

Reducing dietary sodiumIncreasing potassium, calcium and other nutriets

- Japan School lunch system- Housewives were provided health education from public

health service organizations, local government and the private sector

- Mass media was used to influence home meal cooking- Free annual health checkups at worksites and all

communities


- The Socialized health care system covered individual medical expenses and therefore encouraged more people to see a doctor – increased early detection and treatment

- Lifestyle pattern modification especially nutritional habits were the most important determinant of the observed reduction in stroke mortality.

AFRICAN REGION EXAMPLES

- Tunisian National Programme to control CVD

- South African Sow-a-Seed Child Programme

- Kenyan Talking Wall Programme

- Nigerian Tobacco Control Programme

- Rheumatic Heart Disease Programme - ASAP

WORLD HEART FEDERATION/ AFRICAN HEART NETWORK

UNIVERSITY

(American Cancer Society University Experience)

AFRICAN HEART NETWORK INITIATIVES

- Opportunities ?

- Challenges ?

THANK YOU

building capacity for heart health in africa

Documents

study community

community study

community group

control2nd community

heart diseasedecrease

community of surrounding

public health officials

risk factors