GARD WHO Meeting Beijing 28-29 March 2005. GARD PROJECT IN CABO VERDE. José Rosado Pinto. Serviço de Imunoalergologia, Hospital de Dona Estefânia Lisboa, Portugal. CABO VERDE. CABO VERDE. 483.000 inhabitants Santiago: 240.000. S. Vicente 67.000 GIP 5.214 USD per capita
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GARD WHO Meeting Beijing 28-29 March 2005 GARD PROJECT IN CABO VERDE José Rosado Pinto Serviço de Imunoalergologia, Hospital de Dona Estefânia Lisboa, Portugal
CABO VERDE • 483.000 inhabitants • Santiago: 240.000. S. Vicente 67.000 • GIP 5.214 USD per capita • Population under 15 y: 40,5% • Live expectancy at birth: 70,4 years • Infantile mortality rate 35/1.000 newborns • Tuberculosis 328/100.000 inhabitants UNPD 2005 • Phsysicians 340: 228 GP; 2 Pneumologists; 1 Allergologist
Cabo Verde Health System 1 - Central Hospitals: 2 Regional Units: 2 2 - Health Delegacies: 17 Sub-units dependences 3 - Basic Sanitary Units Sanitary agents Hospital network Primary care system
Health System: Response to CRD • Available outpatient facilities • Available outpatient hospital consultation (spirometry in each hospital) • Emergency treatment guidelines • Nebulizers and spacers available • Essential drugs available
Official Collaboration Portugal / Cabo Verde Asthma and Allergic Diseases (Coordination: Hospital de Dona Estefânia – Serviço de Imunoalergologia) Targets: • Clinical assistance care • Educational activities • Research projects • 25 cooperation activities (involving physicians, psychologists, technicians)
Protocol for Assessment of Prevalence of Major Respiratory Diseases in Cabo Verde Isabella Annesi-Maesano, Nikolai Khaltaev and Paulo Matricardi Objectives: • Assessment of prevalence and severity of R.D. • Assessment of under diagnosis and management of R.D.
Stage 1 – Prevalence of Respiratory Diseases at PHC level Specific objectives: • To assess reported prevalence and severity diseases at PHC level • To determine spirometric values • To identify factors associated with Respiratory Diseases • To assess prevalence of Major Respiratory Diseases at E.R. Departments
Stage 1 - Methodology Population: + 4.000 responders are expected in Santiago and S. Vicente Islands Questionnaire: COPD, Asthma, Allergic Rhinitis, TP and Pneumonia. Factors considered: Tobacco consumption, Toxic occupational agents, allergens and social class. Migration factors Spirometry: (sub sample) Emmergency Room Forms Evaluation by WHO Expert Team
Stage 2 – Management of Respiratory Diseases at Primary Health Care Level Specific objectives: • To evaluate the management of respiratory diseases at PHC level • To estimate the under and over diagnosis and the under and over treatment of respiratory diseases at PHC level
Stage 2 - Methodolgy • Expected: 175 respiratory patients • GP Forms • Questionnaire: stage 1 • Spirometry • Evaluation by WHO Expert Team
Action Plan - Steps • Translation of GARD Document • Contact between WHO and Cabo Verde Health Ministry • Appointment of a national team of specialists under the responsability of Cabo Verde Health Ministry • Training the national team by portuguese experts • Starting stage 1 as soon as possible • Monitoring of the project by WHO experts
Time Schedule: • Validation of the Portuguese version of the questionnaire – January 2005 • Meeting of GARD representatives, with local WHO and Cabo Verde Minister of Health and his staff – November 2005 • Training the national team – November 2005 • Visit to the PHC Delegacies in Cabo Verde – November 2005 • Implementation of GARD local organization – December 2005 / January 2006 • Expected date to start the project – January 2006 • Difficulties: delay of WHO GARD financial support
The PAC Study CABO VERDE (AFRICA) MADEIRA (EUROPE) MACAU (ASIA) ACTIVE ASTHMA 8.0 % 14.6 % 1.3 % % positive SPT 27 % 74 % 86 % % positive BHR test 50 % 70 % 88 % GLOBAL POPULATION % positive SPT 9 % 54.1 % 48.6 % % positive BHR test 15 % Ped.Pulm. 2001 Sup 23: 35-7 - 10 %