George Madeleine - Academia.edu (original) (raw)
Papers by George Madeleine
Background: Height of individuals has long been considered as a significant index of nutrition an... more Background: Height of individuals has long been considered as a significant index of nutrition and health of a population; still, there is little information regarding the trends of height and weight among developing or transitional countries. We assessed the secular trends in height and weight in children of the Seychelles, a rapidly developing island state in the Indian Ocean (African region). Methods: Height and weight were measured in all students of all schools in four selected school grades (kindergarten, 4 th , 7 th and 10 th grades) for the periods 1998-9 (6391 children) and 2005-6 (8582 children). Data for 1956-7 was extracted from a previously published report. Results: At age 15.5 years, boys/girls were on average 10/13 cm taller and 15/9 kg heavier in 2005-6 than in 1956-7. Height increased in boys/girls by 1.62/0.93 cm/decade between 1956-7 and 1998-9 and by 1.14/1.82 cm/decade between 1998-9 and 2005-6. For weight, the linear increase in boys/ girls was 1.38/1.10 kg/decade between 1956-7 and 1998-9 and 2.21/2.50 kg/decade between 1998-9 and 2005-6. Overall, the relative increase in weight between 1956-7 and 2005-6 was 5-fold higher than the relative increase in height. Conclusion: Height and weight increased markedly over time in children aged <16 years in the Seychelles, consistent with large changes in socioeconomic and nutritional indicators in the considered 50-year interval. The markedly steeper increase in weight than height over time is consistent with an epidemic of overweight and obesity.
<b>Copyright information:</b>Taken from "Secular trends in height and weight amo... more <b>Copyright information:</b>Taken from "Secular trends in height and weight among children and adolescents of the Seychelles, 1956–2006"http://www.biomedcentral.com/1471-2458/8/166BMC Public Health 2008;8():166-166.Published online 19 May 2008PMCID:PMC2405790.
Journal of Hypertension, May 1, 2008
Objective Few studies have examined microalbuminuria (MAU) in non-western populations. We assesse... more Objective Few studies have examined microalbuminuria (MAU) in non-western populations. We assessed the prevalence of MAU in the general population of a middleincome country in the African region and relationships between MAU and selected cardiovascular risk factors. Methods An examination survey was conducted in a sample representative of the entire population aged 25-64 years in the Seychelles. MAU adjusted for urine creatinine concentration was measured on the second morning urine using a semiquantitative point-of-care analyzer. Results A total of 1255 persons attended the survey (participation rate of 80.2%). The age-adjusted prevalence of MAU was 11.4%. At age 25-64 years, the prevalence of MAU was 5% in persons without diabetes and hypertension, 20% in persons with either condition and 41% in persons with both conditions. The overall prevalence of stages 3-4 chronic kidney disease was low at 3.2%. In multivariate analysis, MAU was associated with age [odds ratio (OR) 1.24 for a 10-year increase; 95% confidence interval (CI): 1.02-1.52], hypertension stage I (2.0; 1.1-3.8) and stage II (4.5; 2.3-8.6), obesity (1.7; 1.0-2.8) and diabetes (3.0; 1.9-4.9). These associations were virtually unchanged upon further adjustment for markers of renal function such as serum creatinine, serum cystatin C and calculated renal function. Conclusion The prevalence of MAU was high in this population, and MAU was strongly associated with several cardiovascular risk factors independently of renal function markers. These findings suggest that MAU could be a useful marker of cardiovascular risk in this population and help identify persons in need of a specific cardiovascular risk management.
PubMed, 2002
Objective: To examine the compliance to medication among newly diagnosed hypertensive patients sc... more Objective: To examine the compliance to medication among newly diagnosed hypertensive patients screened from the general population of the Seychelles, a rapidly developing country. Methods: Among the 1067 participants to a population-based survey for cardiovascular risk factors, hypertension was discovered in 50 (previously unaware of having hypertension and having blood pressure > or = 160/95 mmHg over 3 visits). These 50 patients were placed on a daily one-pill regimen of medication (bendrofluazide, atenolol, or a combination of hydrochlorothiazide and atenolol) and compliance to the regimen was assessed over 12 months using electronic pill containers. Satisfactory compliance was defined as taking the medication on 6 or 7 days a week on average (which corresponds to a mean compliance level of > or = 86%). Findings: In the first month, fewer than half (46%) of the new hypertension patients achieved satisfactory compliance, and only about one-quarter (26%) achieved this level by the twelfth month. Compliance was better among the 23 participants who regularly attended medical follow-up, with nearly three-quarters of these patients (74%) achieving satisfactory compliance during the first month and over one-half (55%) by the twelfth month. There was a direct association between mean 12-month compliance level and having a highly skilled occupation; having good health awareness; and regularly attending medical appointments. In contrast, there was an inverse relationship between mean compliance level and heavy drinking. Conclusion: The low proportion of people selected from the general population who were capable of sustaining satisfactory compliance to antihypertension medication may correspond to the maximum effectiveness of medication interventions based on a screening and treatment strategy in the general population. The results stress the need for both high-risk and population approaches to improve hypertension control.
BMC Public Health, May 19, 2008
Background: Height of individuals has long been considered as a significant index of nutrition an... more Background: Height of individuals has long been considered as a significant index of nutrition and health of a population; still, there is little information regarding the trends of height and weight among developing or transitional countries. We assessed the secular trends in height and weight in children of the Seychelles, a rapidly developing island state in the Indian Ocean (African region). Methods: Height and weight were measured in all students of all schools in four selected school grades (kindergarten, 4 th , 7 th and 10 th grades) for the periods 1998-9 (6391 children) and 2005-6 (8582 children). Data for 1956-7 was extracted from a previously published report. Results: At age 15.5 years, boys/girls were on average 10/13 cm taller and 15/9 kg heavier in 2005-6 than in 1956-7. Height increased in boys/girls by 1.62/0.93 cm/decade between 1956-7 and 1998-9 and by 1.14/1.82 cm/decade between 1998-9 and 2005-6. For weight, the linear increase in boys/ girls was 1.38/1.10 kg/decade between 1956-7 and 1998-9 and 2.21/2.50 kg/decade between 1998-9 and 2005-6. Overall, the relative increase in weight between 1956-7 and 2005-6 was 5-fold higher than the relative increase in height. Conclusion: Height and weight increased markedly over time in children aged <16 years in the Seychelles, consistent with large changes in socioeconomic and nutritional indicators in the considered 50-year interval. The markedly steeper increase in weight than height over time is consistent with an epidemic of overweight and obesity.
Hypertension, Jul 1, 2000
ECG criteria for left ventricular hypertrophy (LVH) have been almost exclusively elaborated and c... more ECG criteria for left ventricular hypertrophy (LVH) have been almost exclusively elaborated and calibrated in white populations. Because several interethnic differences in ECG characteristics have been found, the applicability of these criteria to African individuals remains to be demonstrated. We therefore investigated the performance of classic ECG criteria for LVH detection in an African population. Digitized 12-lead ECG tracings were obtained from 334 African individuals randomly selected from the general population of the Republic of Seychelles (Indian Ocean). Left ventricular mass was calculated with M-mode echocardiography and indexed to body height. LVH was defined by taking the 95th percentile of body height-indexed LVM values in a reference subgroup. In the entire study sample, 16 men and 15 women (prevalence 9.3%) were finally declared to have LVH, of whom 9 were of the reference subgroup. Sensitivity, specificity, accuracy, and positive and negative predictive values for LVH were calculated for 9 classic ECG criteria, and receiver operating characteristic curves were computed. We also generated a new composite time-voltage criterion with stepwise multiple linear regression: weighted time-voltage criterionϭ(0.2366R aVL ϩ0.0551R V5 ϩ 0.0785S V3 ϩ 0.2993T V1)ϫQRS duration. The Sokolow-Lyon criterion reached the highest sensitivity (61%) and the R aVL voltage criterion reached the highest specificity (97%) when evaluated at their traditional partition value. However, at a fixed specificity of 95%, the sensitivity of these 10 criteria ranged from 16% to 32%. Best accuracy was obtained with the R aVL voltage criterion and the new composite time-voltage criterion (89% for both). Positive and negative predictive values varied considerably depending on the concomitant presence of 3 clinical risk factors for LVH (hypertension, age Ն50 years, overweight). Median positive and negative predictive values of the 10 ECG criteria were 15% and 95%, respectively, for subjects with none or 1 of these risk factors compared with 63% and 76% for subjects with all of them. In conclusion, the performance of classic ECG criteria for LVH detection was largely disparate and appeared to be lower in this population of East African origin than in white subjects. A newly generated composite time-voltage criterion might provide improved performance. The predictive value of ECG criteria for LVH was considerably enhanced with the integration of information on concomitant clinical risk factors for LVH. (Hypertension. 2000;36:54-61.) Key Words: left ventricle Ⅲ hypertrophy Ⅲ ethnic groups Ⅲ electrocardiography Ⅲ echocardiography L eft ventricular hypertrophy (LVH) is associated with a substantially increased risk of cardiac morbidity and mortality, 1-4 so its detection is of major importance, especially for individuals with hypertension or other cardiovascular risk factors. Although echocardiography has become the gold standard for LVH detection in clinical practice, ECG remains widely used due to its simplicity and accessibility. Caution should nevertheless be taken when using ECG criteria for LVH detection because they exhibit only limited accuracy (generally due to poor sensitivity). 5-8 Furthermore, their unrestricted applicability to nonwhite individuals remains to be demonstrated; historically, these criteria have been almost exclusively elaborated on and calibrated in white (or mixed) populations, and several interethnic differences in ECG characteristics have been demonstrated, especially in African individuals. 9-12 In the present study, we examined the performance of 9 classic ECG criteria for LVH prediction in a random sample of the African population of the Seychelles, with the use of echocardiography as the gold standard. Methods Study Population The present study was conducted in the Republic of Seychelles, which consists of 115 islets in the Indian Ocean, located 1800 km east of Kenya. The first inhabitants settled in Seychelles in the 1770s and were of French and African origin (from Madagascar and East Africa); they were later joined by small numbers of Chinese and
Nutrition Journal, Jun 9, 2011
Background: Thinness in children and adolescents is largely under studied, a contrast with abunda... more Background: Thinness in children and adolescents is largely under studied, a contrast with abundant literature on under-nutrition in infants and on overweight in children and adolescents. The aim of this study is to compare the prevalence of thinness using two recently developed growth references, among children and adolescents living in the Seychelles, an economically rapidly developing country in the African region. Methods: Weight and height were measured every year in all children of 4 grades (age range: 5 to 16 years) of all schools in the Seychelles as part of a routine school-based surveillance program. In this study we used data collected in 16,672 boys and 16,668 girls examined from 1998 to 2004. Thinness was estimated according to two growth references: i) an international survey (IS), defining three grades of thinness corresponding to a BMI of 18.5, 17.0 and 16.0 kg/m 2 at age 18 and ii) the WHO reference, defined here as three categories of thinness (-1,-2 and-3 SD of BMI for age) with the second and third named "thinness" and "severe thinness", respectively. Results: The prevalence of thinness was 21.4%, 6.4% and 2.0% based on the three IS cutoffs and 27.7%, 6.7% and 1.2% based on the WHO cutoffs. The prevalence of thinness categories tended to decrease according to age for both sexes for the IS reference and among girls for the WHO reference.
Journal of Human Hypertension, Nov 30, 2006
We assessed the prevalence of elevated blood pressure (BP) and the association with excess body w... more We assessed the prevalence of elevated blood pressure (BP) and the association with excess body weight among a large sample of children in the Seychelles, a middle-income rapidly developing country in the African region. Weight, height and BP were measured in all children of four school grades in the Seychelles (Indian Ocean). Excess weight categories ('overweight' and 'obesity') were defined according to the criteria of the International Obesity Task Force. Two BP readings were obtained on one occasion. 'Elevated BP' was defined based on US reference tables. Data were available in 15 612 (86%) of 18 119 eligible children aged 5-16 years in 2002-2004. In all, 13.0% of Boys and 18.8% of girls were overweight or obese. The prevalence of elevated BP was 9.1% in boys and 10.1% in girls. Both systolic and diastolic BP were strongly associated with body mass index (BMI) in boys and in girls. In children with 'normal weight', 'overweight (and not obesity)' and 'obesity', respectively, proportions with elevated BP were 7.5, 16.9 and 25.2% in boys, and 7.5, 16.1 and 33.2% in girls. Overweight (including obesity) could account for 18% of cases of elevated BP in boys and 26% in girls. Further studies should examine the impact of the relationship between BMI and elevated BP on the burden of hypertension in the context of the epidemic of paediatric obesity.
Journal of Hypertension, Oct 1, 2011
Objective We assessed the association between birth weight, weight change, and current blood pres... more Objective We assessed the association between birth weight, weight change, and current blood pressure (BP) across the entire age-span of childhood and adolescence in large school-based cohorts in the Seychelles, an island state in the African region. Methods Three cohorts were analyzed: 1004 children examined at age 5.5 and 9.1 years, 1886 children at 9.1 and 12.5, and 1575 children at 12.5 and 15.5, respectively. Birth and 1-year anthropometric data were gathered from medical files. The outcome was BP at age 5.5, 9.1, 12.5 or 15.5 years, respectively. Conditional linear regression analysis was used to estimate the relative contribution of changes in weight (expressed in z-score) during different age periods on BP. All analyses were adjusted for height. Results At all ages, current BP was strongly associated with current weight. Birth weight was not significantly associated with current BP. Upon adjustment for current weight, the association between birth weight and current BP tended to become negative. Conditional linear regression analyses indicated that changes in weight during successive age periods since birth contributed substantially to current BP at all ages. The strength of the association between weight change and current BP increased throughout successive age periods. Conclusion Weight changes during any age period since birth have substantial impact on BP during childhood and adolescence, with BP being more responsive to recent than earlier weight changes.
Background: Chronic diseases (NCD), and more specifically cardiovascular disease (CVD), are the l... more Background: Chronic diseases (NCD), and more specifically cardiovascular disease (CVD), are the leading causes of the morbidity and mortality burden worldwide and in the Seychelles. CVD accounts for approximately 40% of all deaths in Seychelles. NCD, and particularly CVD, are strongly related to a few lifestyles and physiological risk factors. Detrimental lifestyles include smoking, unhealthy nutrition (mostly high intake of saturated fats, salt, and low intake of fruit and vegetables) and sedentary habits. Physiological risk factors, which are strongly linked to lifestyles, include overweight, high blood pressure (HBP), blood lipid disorders (e.g. high blood cholesterol) and diabetes. It is well established that up to 80% of cases of premature CVD, and a substantial proportion of other chronic diseases (e.g. lung cancer, renal failure) could be prevented or delayed if these few risk factors were kept at favorable levels throughout life in the population, using strategies targeting both the entire population and high risk individuals. Aim of the survey: To assess, in a representative sample of the adult population, the levels of major risk factors of chronic diseases and gather information on related knowledge, attitudes and practices (KAP). Methods: The methodology of the survey followed the STEPwise approach advised by the World Heath Organization (core, expanded and optional modules). The sampling frame consisted of a sex-and agestratified random sample of the entire population aged 25-64 selected from national population census data. A structured questionnaire was administered to all participants (see appendix in this report). Questions assessed tobacco use, physical activity, nutrition and alcohol intake, socioeconomic variables and KAP. Blood pressure, weight, height and waist circumference were measured. Blood glucose, cholesterol, microalbuminuria and A1c were measured with point-of-care analyzers and results given on same day while a broad range of other biological factors were analyzed later on frozen serum (blood lipids, renal function markers, insulin, CRP, etc). B-mode ultrasound was performed to assess vasculature characteristics (artery thickness-IMT-and atherosclerosis plaques) in carotid and femoral arteries. Scope of this report: This report presents an overview of the main results with minimal comments on their significance. Data in 2004 are compared with results from a similar population-based survey in 1989 to identify trends over time. Separate other reports present selected issues of particular interest, e.g. diabetes, hypertension, microalbuminuria, findings on peripheral atherosclerosis, etc (see appendix in this report).
Cardiovascular journal of South Africa : official journal for Southern Africa Cardiac Society [and] South African Society of Cardiac Practitioners, Mar 28, 2013
The prevalence of abdominal aortic aneurysm (AAA) and its risk factors are well known in Western ... more The prevalence of abdominal aortic aneurysm (AAA) and its risk factors are well known in Western countries but few data are available from low-and middle-income countries. We are not aware of systematically collected population-based data on AAA in the African region. We evaluated the prevalence of AAA in a population-based cardiovascular survey conducted in the Republic of Seychelles in 2004 (Indian Ocean, African region). Among the 353 participants aged 50 to 64 years and screened with ultrasound, the prevalence of AAA was 0.3% (95% CI: 0-0.9) and the prevalence of ectatic dilatations of the abdominal aorta was 1.5% (95% CI: 0.2-2.8). The prevalence of AAA in the general population seemed lower in Seychelles than in Western countries, despite a high prevalence in Seychelles of risk factors of AAA, such as smoking (in men), high blood pressure and hypercholesterolaemia.
Background: Blood pressure (BP) is strongly associated with body weight and there is concern that... more Background: Blood pressure (BP) is strongly associated with body weight and there is concern that the pediatric overweight epidemic could lead to an increase in children's mean BP. Objectives: We analyzed BP trends from 1998 to 2006 among children of the Seychelles, a rapidly developing middle-income country in Africa. Methods: Serial school-based surveys of weight, height and BP were conducted yearly between 1998-2006 among all students of the country in four school grades (kindergarten, 4th, 7th and 10th years of compulsory school). We used the CDC criteria to define "overweight" (BMI _95th sex-, and age-specific percentile) and the NHBPEP criteria for "elevated BP" (BP _95th sex-, age-, and height specific percentile). Methods for height, weight, and BP measurements were identical over the study period. The trends in mean BMI and mean systolic/diastolic BP were assessed with linear regression. Results: 27,703 children aged 4-18 years (participation rate: 7...
Background: The relative contribution of body weight change at different ages on the level of cur... more Background: The relative contribution of body weight change at different ages on the level of current blood pressure (BP) during childhood and adolescence remains unclear. We assessed the association between birth weight, weight change, and current BP across the entire age-span of childhood and adolescence in large school-based cohorts in the Seychelles, an Island state in the African region. Method: Three cohorts of children were analyzed: 1606 whose weight was
Bulletin of the World Health Organization, 2002
To examine the compliance to medication among newly diagnosed hypertensive patients screened from... more To examine the compliance to medication among newly diagnosed hypertensive patients screened from the general population of the Seychelles, a rapidly developing country. Among the 1067 participants to a population-based survey for cardiovascular risk factors, hypertension was discovered in 50 (previously unaware of having hypertension and having blood pressure > or = 160/95 mmHg over 3 visits). These 50 patients were placed on a daily one-pill regimen of medication (bendrofluazide, atenolol, or a combination of hydrochlorothiazide and atenolol) and compliance to the regimen was assessed over 12 months using electronic pill containers. Satisfactory compliance was defined as taking the medication on 6 or 7 days a week on average (which corresponds to a mean compliance level of > or = 86%). In the first month, fewer than half (46%) of the new hypertension patients achieved satisfactory compliance, and only about one-quarter (26%) achieved this level by the twelfth month. Complian...
Background. There are few data on overweight in children in developing countries. Such data are i... more Background. There are few data on overweight in children in developing countries. Such data are important to guide public health policy. We assessed trends in the prevalence of overweight and obesity in children from the Seychelles, a middle-income island state in the Indian Ocean. Methods. Multiple cross-sectional surveys were conducted each year between 1998 and 2004 on all students of all schools in four selected school grades (crèche, 4th, 7th and 10th years of mandatory school). Weight and height were measured and children were asked about walking time and frequency of physical exercise at leisure time. Excess weight categories were defined according to the criteria of the International Obesity Task Force (IOTF) and the U.S. Centers for Disease Control and Prevention (CDC). Results. Data were available for 33 340 observations in 1998 2004, corresponding to 23 459 individual children measured once or several times. Based on IOTF criteria, the prevalence of ‘overweight ’ or ‘obe...
Marked increase in the prevalence of obesity in children of the Seychelles, a rapidly developing
<b>Copyright information:</b>Taken from "Secular trends in height and weight amo... more <b>Copyright information:</b>Taken from "Secular trends in height and weight among children and adolescents of the Seychelles, 1956–2006"http://www.biomedcentral.com/1471-2458/8/166BMC Public Health 2008;8():166-166.Published online 19 May 2008PMCID:PMC2405790.
Background: Height of individuals has long been considered as a significant index of nutrition an... more Background: Height of individuals has long been considered as a significant index of nutrition and health of a population; still, there is little information regarding the trends of height and weight among developing or transitional countries. We assessed the secular trends in height and weight in children of the Seychelles, a rapidly developing island state in the Indian Ocean (African region). Methods: Height and weight were measured in all students of all schools in four selected school grades (kindergarten, 4 th , 7 th and 10 th grades) for the periods 1998-9 (6391 children) and 2005-6 (8582 children). Data for 1956-7 was extracted from a previously published report. Results: At age 15.5 years, boys/girls were on average 10/13 cm taller and 15/9 kg heavier in 2005-6 than in 1956-7. Height increased in boys/girls by 1.62/0.93 cm/decade between 1956-7 and 1998-9 and by 1.14/1.82 cm/decade between 1998-9 and 2005-6. For weight, the linear increase in boys/ girls was 1.38/1.10 kg/decade between 1956-7 and 1998-9 and 2.21/2.50 kg/decade between 1998-9 and 2005-6. Overall, the relative increase in weight between 1956-7 and 2005-6 was 5-fold higher than the relative increase in height. Conclusion: Height and weight increased markedly over time in children aged <16 years in the Seychelles, consistent with large changes in socioeconomic and nutritional indicators in the considered 50-year interval. The markedly steeper increase in weight than height over time is consistent with an epidemic of overweight and obesity.
<b>Copyright information:</b>Taken from "Secular trends in height and weight amo... more <b>Copyright information:</b>Taken from "Secular trends in height and weight among children and adolescents of the Seychelles, 1956–2006"http://www.biomedcentral.com/1471-2458/8/166BMC Public Health 2008;8():166-166.Published online 19 May 2008PMCID:PMC2405790.
Journal of Hypertension, May 1, 2008
Objective Few studies have examined microalbuminuria (MAU) in non-western populations. We assesse... more Objective Few studies have examined microalbuminuria (MAU) in non-western populations. We assessed the prevalence of MAU in the general population of a middleincome country in the African region and relationships between MAU and selected cardiovascular risk factors. Methods An examination survey was conducted in a sample representative of the entire population aged 25-64 years in the Seychelles. MAU adjusted for urine creatinine concentration was measured on the second morning urine using a semiquantitative point-of-care analyzer. Results A total of 1255 persons attended the survey (participation rate of 80.2%). The age-adjusted prevalence of MAU was 11.4%. At age 25-64 years, the prevalence of MAU was 5% in persons without diabetes and hypertension, 20% in persons with either condition and 41% in persons with both conditions. The overall prevalence of stages 3-4 chronic kidney disease was low at 3.2%. In multivariate analysis, MAU was associated with age [odds ratio (OR) 1.24 for a 10-year increase; 95% confidence interval (CI): 1.02-1.52], hypertension stage I (2.0; 1.1-3.8) and stage II (4.5; 2.3-8.6), obesity (1.7; 1.0-2.8) and diabetes (3.0; 1.9-4.9). These associations were virtually unchanged upon further adjustment for markers of renal function such as serum creatinine, serum cystatin C and calculated renal function. Conclusion The prevalence of MAU was high in this population, and MAU was strongly associated with several cardiovascular risk factors independently of renal function markers. These findings suggest that MAU could be a useful marker of cardiovascular risk in this population and help identify persons in need of a specific cardiovascular risk management.
PubMed, 2002
Objective: To examine the compliance to medication among newly diagnosed hypertensive patients sc... more Objective: To examine the compliance to medication among newly diagnosed hypertensive patients screened from the general population of the Seychelles, a rapidly developing country. Methods: Among the 1067 participants to a population-based survey for cardiovascular risk factors, hypertension was discovered in 50 (previously unaware of having hypertension and having blood pressure > or = 160/95 mmHg over 3 visits). These 50 patients were placed on a daily one-pill regimen of medication (bendrofluazide, atenolol, or a combination of hydrochlorothiazide and atenolol) and compliance to the regimen was assessed over 12 months using electronic pill containers. Satisfactory compliance was defined as taking the medication on 6 or 7 days a week on average (which corresponds to a mean compliance level of > or = 86%). Findings: In the first month, fewer than half (46%) of the new hypertension patients achieved satisfactory compliance, and only about one-quarter (26%) achieved this level by the twelfth month. Compliance was better among the 23 participants who regularly attended medical follow-up, with nearly three-quarters of these patients (74%) achieving satisfactory compliance during the first month and over one-half (55%) by the twelfth month. There was a direct association between mean 12-month compliance level and having a highly skilled occupation; having good health awareness; and regularly attending medical appointments. In contrast, there was an inverse relationship between mean compliance level and heavy drinking. Conclusion: The low proportion of people selected from the general population who were capable of sustaining satisfactory compliance to antihypertension medication may correspond to the maximum effectiveness of medication interventions based on a screening and treatment strategy in the general population. The results stress the need for both high-risk and population approaches to improve hypertension control.
BMC Public Health, May 19, 2008
Background: Height of individuals has long been considered as a significant index of nutrition an... more Background: Height of individuals has long been considered as a significant index of nutrition and health of a population; still, there is little information regarding the trends of height and weight among developing or transitional countries. We assessed the secular trends in height and weight in children of the Seychelles, a rapidly developing island state in the Indian Ocean (African region). Methods: Height and weight were measured in all students of all schools in four selected school grades (kindergarten, 4 th , 7 th and 10 th grades) for the periods 1998-9 (6391 children) and 2005-6 (8582 children). Data for 1956-7 was extracted from a previously published report. Results: At age 15.5 years, boys/girls were on average 10/13 cm taller and 15/9 kg heavier in 2005-6 than in 1956-7. Height increased in boys/girls by 1.62/0.93 cm/decade between 1956-7 and 1998-9 and by 1.14/1.82 cm/decade between 1998-9 and 2005-6. For weight, the linear increase in boys/ girls was 1.38/1.10 kg/decade between 1956-7 and 1998-9 and 2.21/2.50 kg/decade between 1998-9 and 2005-6. Overall, the relative increase in weight between 1956-7 and 2005-6 was 5-fold higher than the relative increase in height. Conclusion: Height and weight increased markedly over time in children aged <16 years in the Seychelles, consistent with large changes in socioeconomic and nutritional indicators in the considered 50-year interval. The markedly steeper increase in weight than height over time is consistent with an epidemic of overweight and obesity.
Hypertension, Jul 1, 2000
ECG criteria for left ventricular hypertrophy (LVH) have been almost exclusively elaborated and c... more ECG criteria for left ventricular hypertrophy (LVH) have been almost exclusively elaborated and calibrated in white populations. Because several interethnic differences in ECG characteristics have been found, the applicability of these criteria to African individuals remains to be demonstrated. We therefore investigated the performance of classic ECG criteria for LVH detection in an African population. Digitized 12-lead ECG tracings were obtained from 334 African individuals randomly selected from the general population of the Republic of Seychelles (Indian Ocean). Left ventricular mass was calculated with M-mode echocardiography and indexed to body height. LVH was defined by taking the 95th percentile of body height-indexed LVM values in a reference subgroup. In the entire study sample, 16 men and 15 women (prevalence 9.3%) were finally declared to have LVH, of whom 9 were of the reference subgroup. Sensitivity, specificity, accuracy, and positive and negative predictive values for LVH were calculated for 9 classic ECG criteria, and receiver operating characteristic curves were computed. We also generated a new composite time-voltage criterion with stepwise multiple linear regression: weighted time-voltage criterionϭ(0.2366R aVL ϩ0.0551R V5 ϩ 0.0785S V3 ϩ 0.2993T V1)ϫQRS duration. The Sokolow-Lyon criterion reached the highest sensitivity (61%) and the R aVL voltage criterion reached the highest specificity (97%) when evaluated at their traditional partition value. However, at a fixed specificity of 95%, the sensitivity of these 10 criteria ranged from 16% to 32%. Best accuracy was obtained with the R aVL voltage criterion and the new composite time-voltage criterion (89% for both). Positive and negative predictive values varied considerably depending on the concomitant presence of 3 clinical risk factors for LVH (hypertension, age Ն50 years, overweight). Median positive and negative predictive values of the 10 ECG criteria were 15% and 95%, respectively, for subjects with none or 1 of these risk factors compared with 63% and 76% for subjects with all of them. In conclusion, the performance of classic ECG criteria for LVH detection was largely disparate and appeared to be lower in this population of East African origin than in white subjects. A newly generated composite time-voltage criterion might provide improved performance. The predictive value of ECG criteria for LVH was considerably enhanced with the integration of information on concomitant clinical risk factors for LVH. (Hypertension. 2000;36:54-61.) Key Words: left ventricle Ⅲ hypertrophy Ⅲ ethnic groups Ⅲ electrocardiography Ⅲ echocardiography L eft ventricular hypertrophy (LVH) is associated with a substantially increased risk of cardiac morbidity and mortality, 1-4 so its detection is of major importance, especially for individuals with hypertension or other cardiovascular risk factors. Although echocardiography has become the gold standard for LVH detection in clinical practice, ECG remains widely used due to its simplicity and accessibility. Caution should nevertheless be taken when using ECG criteria for LVH detection because they exhibit only limited accuracy (generally due to poor sensitivity). 5-8 Furthermore, their unrestricted applicability to nonwhite individuals remains to be demonstrated; historically, these criteria have been almost exclusively elaborated on and calibrated in white (or mixed) populations, and several interethnic differences in ECG characteristics have been demonstrated, especially in African individuals. 9-12 In the present study, we examined the performance of 9 classic ECG criteria for LVH prediction in a random sample of the African population of the Seychelles, with the use of echocardiography as the gold standard. Methods Study Population The present study was conducted in the Republic of Seychelles, which consists of 115 islets in the Indian Ocean, located 1800 km east of Kenya. The first inhabitants settled in Seychelles in the 1770s and were of French and African origin (from Madagascar and East Africa); they were later joined by small numbers of Chinese and
Nutrition Journal, Jun 9, 2011
Background: Thinness in children and adolescents is largely under studied, a contrast with abunda... more Background: Thinness in children and adolescents is largely under studied, a contrast with abundant literature on under-nutrition in infants and on overweight in children and adolescents. The aim of this study is to compare the prevalence of thinness using two recently developed growth references, among children and adolescents living in the Seychelles, an economically rapidly developing country in the African region. Methods: Weight and height were measured every year in all children of 4 grades (age range: 5 to 16 years) of all schools in the Seychelles as part of a routine school-based surveillance program. In this study we used data collected in 16,672 boys and 16,668 girls examined from 1998 to 2004. Thinness was estimated according to two growth references: i) an international survey (IS), defining three grades of thinness corresponding to a BMI of 18.5, 17.0 and 16.0 kg/m 2 at age 18 and ii) the WHO reference, defined here as three categories of thinness (-1,-2 and-3 SD of BMI for age) with the second and third named "thinness" and "severe thinness", respectively. Results: The prevalence of thinness was 21.4%, 6.4% and 2.0% based on the three IS cutoffs and 27.7%, 6.7% and 1.2% based on the WHO cutoffs. The prevalence of thinness categories tended to decrease according to age for both sexes for the IS reference and among girls for the WHO reference.
Journal of Human Hypertension, Nov 30, 2006
We assessed the prevalence of elevated blood pressure (BP) and the association with excess body w... more We assessed the prevalence of elevated blood pressure (BP) and the association with excess body weight among a large sample of children in the Seychelles, a middle-income rapidly developing country in the African region. Weight, height and BP were measured in all children of four school grades in the Seychelles (Indian Ocean). Excess weight categories ('overweight' and 'obesity') were defined according to the criteria of the International Obesity Task Force. Two BP readings were obtained on one occasion. 'Elevated BP' was defined based on US reference tables. Data were available in 15 612 (86%) of 18 119 eligible children aged 5-16 years in 2002-2004. In all, 13.0% of Boys and 18.8% of girls were overweight or obese. The prevalence of elevated BP was 9.1% in boys and 10.1% in girls. Both systolic and diastolic BP were strongly associated with body mass index (BMI) in boys and in girls. In children with 'normal weight', 'overweight (and not obesity)' and 'obesity', respectively, proportions with elevated BP were 7.5, 16.9 and 25.2% in boys, and 7.5, 16.1 and 33.2% in girls. Overweight (including obesity) could account for 18% of cases of elevated BP in boys and 26% in girls. Further studies should examine the impact of the relationship between BMI and elevated BP on the burden of hypertension in the context of the epidemic of paediatric obesity.
Journal of Hypertension, Oct 1, 2011
Objective We assessed the association between birth weight, weight change, and current blood pres... more Objective We assessed the association between birth weight, weight change, and current blood pressure (BP) across the entire age-span of childhood and adolescence in large school-based cohorts in the Seychelles, an island state in the African region. Methods Three cohorts were analyzed: 1004 children examined at age 5.5 and 9.1 years, 1886 children at 9.1 and 12.5, and 1575 children at 12.5 and 15.5, respectively. Birth and 1-year anthropometric data were gathered from medical files. The outcome was BP at age 5.5, 9.1, 12.5 or 15.5 years, respectively. Conditional linear regression analysis was used to estimate the relative contribution of changes in weight (expressed in z-score) during different age periods on BP. All analyses were adjusted for height. Results At all ages, current BP was strongly associated with current weight. Birth weight was not significantly associated with current BP. Upon adjustment for current weight, the association between birth weight and current BP tended to become negative. Conditional linear regression analyses indicated that changes in weight during successive age periods since birth contributed substantially to current BP at all ages. The strength of the association between weight change and current BP increased throughout successive age periods. Conclusion Weight changes during any age period since birth have substantial impact on BP during childhood and adolescence, with BP being more responsive to recent than earlier weight changes.
Background: Chronic diseases (NCD), and more specifically cardiovascular disease (CVD), are the l... more Background: Chronic diseases (NCD), and more specifically cardiovascular disease (CVD), are the leading causes of the morbidity and mortality burden worldwide and in the Seychelles. CVD accounts for approximately 40% of all deaths in Seychelles. NCD, and particularly CVD, are strongly related to a few lifestyles and physiological risk factors. Detrimental lifestyles include smoking, unhealthy nutrition (mostly high intake of saturated fats, salt, and low intake of fruit and vegetables) and sedentary habits. Physiological risk factors, which are strongly linked to lifestyles, include overweight, high blood pressure (HBP), blood lipid disorders (e.g. high blood cholesterol) and diabetes. It is well established that up to 80% of cases of premature CVD, and a substantial proportion of other chronic diseases (e.g. lung cancer, renal failure) could be prevented or delayed if these few risk factors were kept at favorable levels throughout life in the population, using strategies targeting both the entire population and high risk individuals. Aim of the survey: To assess, in a representative sample of the adult population, the levels of major risk factors of chronic diseases and gather information on related knowledge, attitudes and practices (KAP). Methods: The methodology of the survey followed the STEPwise approach advised by the World Heath Organization (core, expanded and optional modules). The sampling frame consisted of a sex-and agestratified random sample of the entire population aged 25-64 selected from national population census data. A structured questionnaire was administered to all participants (see appendix in this report). Questions assessed tobacco use, physical activity, nutrition and alcohol intake, socioeconomic variables and KAP. Blood pressure, weight, height and waist circumference were measured. Blood glucose, cholesterol, microalbuminuria and A1c were measured with point-of-care analyzers and results given on same day while a broad range of other biological factors were analyzed later on frozen serum (blood lipids, renal function markers, insulin, CRP, etc). B-mode ultrasound was performed to assess vasculature characteristics (artery thickness-IMT-and atherosclerosis plaques) in carotid and femoral arteries. Scope of this report: This report presents an overview of the main results with minimal comments on their significance. Data in 2004 are compared with results from a similar population-based survey in 1989 to identify trends over time. Separate other reports present selected issues of particular interest, e.g. diabetes, hypertension, microalbuminuria, findings on peripheral atherosclerosis, etc (see appendix in this report).
Cardiovascular journal of South Africa : official journal for Southern Africa Cardiac Society [and] South African Society of Cardiac Practitioners, Mar 28, 2013
The prevalence of abdominal aortic aneurysm (AAA) and its risk factors are well known in Western ... more The prevalence of abdominal aortic aneurysm (AAA) and its risk factors are well known in Western countries but few data are available from low-and middle-income countries. We are not aware of systematically collected population-based data on AAA in the African region. We evaluated the prevalence of AAA in a population-based cardiovascular survey conducted in the Republic of Seychelles in 2004 (Indian Ocean, African region). Among the 353 participants aged 50 to 64 years and screened with ultrasound, the prevalence of AAA was 0.3% (95% CI: 0-0.9) and the prevalence of ectatic dilatations of the abdominal aorta was 1.5% (95% CI: 0.2-2.8). The prevalence of AAA in the general population seemed lower in Seychelles than in Western countries, despite a high prevalence in Seychelles of risk factors of AAA, such as smoking (in men), high blood pressure and hypercholesterolaemia.
Background: Blood pressure (BP) is strongly associated with body weight and there is concern that... more Background: Blood pressure (BP) is strongly associated with body weight and there is concern that the pediatric overweight epidemic could lead to an increase in children's mean BP. Objectives: We analyzed BP trends from 1998 to 2006 among children of the Seychelles, a rapidly developing middle-income country in Africa. Methods: Serial school-based surveys of weight, height and BP were conducted yearly between 1998-2006 among all students of the country in four school grades (kindergarten, 4th, 7th and 10th years of compulsory school). We used the CDC criteria to define "overweight" (BMI _95th sex-, and age-specific percentile) and the NHBPEP criteria for "elevated BP" (BP _95th sex-, age-, and height specific percentile). Methods for height, weight, and BP measurements were identical over the study period. The trends in mean BMI and mean systolic/diastolic BP were assessed with linear regression. Results: 27,703 children aged 4-18 years (participation rate: 7...
Background: The relative contribution of body weight change at different ages on the level of cur... more Background: The relative contribution of body weight change at different ages on the level of current blood pressure (BP) during childhood and adolescence remains unclear. We assessed the association between birth weight, weight change, and current BP across the entire age-span of childhood and adolescence in large school-based cohorts in the Seychelles, an Island state in the African region. Method: Three cohorts of children were analyzed: 1606 whose weight was
Bulletin of the World Health Organization, 2002
To examine the compliance to medication among newly diagnosed hypertensive patients screened from... more To examine the compliance to medication among newly diagnosed hypertensive patients screened from the general population of the Seychelles, a rapidly developing country. Among the 1067 participants to a population-based survey for cardiovascular risk factors, hypertension was discovered in 50 (previously unaware of having hypertension and having blood pressure > or = 160/95 mmHg over 3 visits). These 50 patients were placed on a daily one-pill regimen of medication (bendrofluazide, atenolol, or a combination of hydrochlorothiazide and atenolol) and compliance to the regimen was assessed over 12 months using electronic pill containers. Satisfactory compliance was defined as taking the medication on 6 or 7 days a week on average (which corresponds to a mean compliance level of > or = 86%). In the first month, fewer than half (46%) of the new hypertension patients achieved satisfactory compliance, and only about one-quarter (26%) achieved this level by the twelfth month. Complian...
Background. There are few data on overweight in children in developing countries. Such data are i... more Background. There are few data on overweight in children in developing countries. Such data are important to guide public health policy. We assessed trends in the prevalence of overweight and obesity in children from the Seychelles, a middle-income island state in the Indian Ocean. Methods. Multiple cross-sectional surveys were conducted each year between 1998 and 2004 on all students of all schools in four selected school grades (crèche, 4th, 7th and 10th years of mandatory school). Weight and height were measured and children were asked about walking time and frequency of physical exercise at leisure time. Excess weight categories were defined according to the criteria of the International Obesity Task Force (IOTF) and the U.S. Centers for Disease Control and Prevention (CDC). Results. Data were available for 33 340 observations in 1998 2004, corresponding to 23 459 individual children measured once or several times. Based on IOTF criteria, the prevalence of ‘overweight ’ or ‘obe...
Marked increase in the prevalence of obesity in children of the Seychelles, a rapidly developing
<b>Copyright information:</b>Taken from "Secular trends in height and weight amo... more <b>Copyright information:</b>Taken from "Secular trends in height and weight among children and adolescents of the Seychelles, 1956–2006"http://www.biomedcentral.com/1471-2458/8/166BMC Public Health 2008;8():166-166.Published online 19 May 2008PMCID:PMC2405790.