GARD PROJECT IN CABO VERDE

José Rosado Pinto

GARD WHO MeetingBeijing 28-29 March 2005

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• 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 VerdeAsthma 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:a) To assess reported prevalence and severity diseases

at PHC levelb) To determine spirometric valuesc) To identify factors associated with Respiratory

Diseasesd) To assess prevalence of Major Respiratory Diseases at

E.R. Departments

Stage 1 - MethodologyPopulation: + 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 LevelSpecific objectives:

a) To evaluate the management of respiratory diseases

at PHC levelb) 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

1. Translation of GARD Document2. Contact between WHO and Cabo Verde Health Ministry3. Appointment of a national team of specialists under

the responsability of Cabo Verde Health Ministry4. Training the national team by portuguese experts5. Starting stage 1 as soon as possible6. 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

MADEIRA(EUROPE)

14.6 %

74 %

70 %

54.1 %

-

The PAC StudyCABO VERDE (AFRICA)

8.0 %

27 %

50 %

9 %

15 %

MACAU(ASIA)

1.3 %

86 %

88 %

48.6 %

10 %

Ped.Pulm. 2001 Sup 23: 35-7

ACTIVE ASTHMA

% positive SPT

% positive BHR test

GLOBAL POPULATION

% positive SPT % positive BHR test

GARD PROJECT WILL BE A REALITY IN CABO VERDE