Hypertension Prevalence Based on Blood Pressure Measurements on Two vs. One Visits: A Community-Based Screening Programme and a Narrative Review.

We assessed the difference in the prevalence of hypertension in community surveys when blood pressure (BP) was measured on two vs. one visits and its impact on hypertension awareness, treatment and control proportions. A community-based BP screening programme was conducted in public places in the Seychelles (619 adults) and BP was rechecked a few days later among untreated participants with high BP (≥140/90 mmHg). A narrative review of the literature on this question was also conducted. Only 64% of untreated participants with high BP still had high BP at the second visit. The prevalence of hypertension in the whole sample decreased by 13% (from 33.8% to 29.5%) when BP was measured on two vs. one visits. These results concurred with our findings in our narrative review based on 10 surveys. In conclusion, the prevalence of hypertension can be markedly overestimated in community surveys when BP is measured on two vs. one visits. The overestimation could be addressed by measuring BP on a second visit among untreated individuals with high BP or, possibly, by taking more readings at the first visit. These findings have relevance for clinical practice, policy and surveillance

Compliance of hospitality premises to the ban on smoking in all enclosed public places in the Seychelles

In Seychelles, comprehensive tobacco control legislation enacted in 2009, and subsequent regulations, ban smoking in all enclosed places (defined as any area under a fixed or transient roof). A survey in October-November 2014 assessed i) the compliance to the Act and these regulations in 63 restaurants, bars or discotheques and ii) knowledge of the Tobacco control Act and these regulations of supervisors and managers of these hospitality premises; (47 agreed to answer). No person was found smoking in 92% of all premises. However, "no smoking" signs did not conform to regulations in >70% of premises, and ashtrays were seen in 17% of enclosed premises. All supervisors and managers (100%) knew that smoking is banned in enclosed premises but <15% knew the fines liable to persons, respective owners of enclosed places, when a person smokes in an enclosed premise. Furthermore, 60% of supervisors were not aware that no smoking signs must comply with a specific regulation and 40% were not aware that ashtrays are not permitted in enclosed premises. In conclusion, the positive finding is that few persons smoke in restaurants, bars and discotheques, but the survey also showed that several aspects of regulations for tobacco control in enclosed premises are not well implemented. This calls for further information campaigns targeting both the public and the managers of hospitality premises, but also for strengthening enforcement measures, including fines for offenses. Scaling up comprehensive tobacco control measures, including full enforcement of clean air policy, is of paramount importance to meet the national target of 30% reduction of the smoking prevalence between 2010 and 2025

Physical Fighting and Associated Factors among Adolescents Aged 13-15 Years in Six Western Pacific Countries.

Youth violence is an important public health challenge around the world, yet the literature on this problem in low- and middle-income countries (LMICs) has been limited. The present study aims to examine the prevalence of adolescent physical fighting (defined as having been involved in at least one physical fight during the past 12 months) in selected LMICs, and its relations with potential risk factors. We included 6377 school-going adolescents aged 13-15 years from six Western Pacific (WP) countries that had recently conducted a Global School-based Student Health Survey. Information was gathered through a self-administered anonymous closed-ended questionnaire. The prevalence of adolescent physical fighting varied across countries, ranging from 34.5% in Kiribati to 63.3% in Samoa. The prevalence was higher in boys than in girls, and lower at age 15 than 13-14 years. Physical fighting was significantly associated (pooled odds ratios (ORs), 95% confidence intervals (CIs)) with smoking (1.78, 1.53-2.06), drinking (1.57, 1.33-1.85), drug use (1.72, 1.33-2.23), and missing school (1.72, 1.51-1.95). The association with physical fighting increased with increasing number of joint adverse behaviors (increased from 1.99 (1.73-2.29) for one risk behavior to 4.95 (4.03-6.07) for at least 3 risk behaviors, versus having none of the 4 risk behaviors). The high prevalence of physical fighting and the associations with risk behaviors emphasize the need for comprehensive prevention programs to reduce youth violence and associated risk behaviors

Weight status, body image and bullying among adolescents in the Seychelles.

We investigated the relationship between being bullied and measured body weight and perceived body weight among adolescents of a middle-income sub Saharan African country. Our data originated from the Global School-based Health Survey, which targets adolescents aged 13-15 years. Student weights and heights were measured before administrating the questionnaire which included questions about personal data, health behaviors and being bullied. Standard criteria were used to assess thinness, overweight and obesity. Among 1,006 participants who had complete data, 16.5% (95%CI 13.3-20.2) reported being bullied ≥ 3 days during the past 30 days; 13.4% were thin, 16.8% were overweight and 7.6% were obese. Categories of actual weight and of perceived weight correlated only moderately (Spearman correlation coefficient 0.37 for boys and 0.57 for girls; p < 0.001). In univariate analysis, both actual obesity (OR 1.76; p = 0.051) and perception of high weight (OR 1.63 for "slightly overweight"; OR 2.74 for "very overweight", both p < 0.05) were associated with being bullied. In multivariate analysis, ORs for categories of perceived overweight were virtually unchanged while ORs for actual overweight and obesity were substantially attenuated, suggesting a substantial role of perceived weight in the association with being bullied. Actual underweight and perceived thinness also tended to be associated with being bullied, although not significantly. Our findings suggest that more research attention be given to disentangling the significant association between body image, overweight and bullying among adolescents. Further studies in diverse populations are warranted

National Survey of Noncommunicable Diseases in Seychelles, 2013-2014 (Seychelles Heart Study IV) : methods and main findings

This report provides information on selected summary results of the National Survey of Noncommunicable Diseases in Seychelles in 2013‐2014 (Seychelles Heart Study IV). The survey is also referred shortly as the "2013 Survey" in this report. Overall crude results were reported in a comprehensive report in November 2014. Further detailed analyses and recommendations on particular topics will be performed separately

Performance of different adiposity measures for predicting cardiovascular risk in adolescents.

This study aims to compare the performance of body mass index (BMI), waist circumference (WC), and waist-to-height-ratio (WHtR) to predict the presence of at least 3 main CV risk factors in US adolescents. A total of 3621 adolescents (boys: 49.9%) aged 12-17 years from the US National Health and Nutrition Examination Survey (1999-2012) were included in this study. Measured CV risk factors included systolic/diastolic blood pressure, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and fasting plasma glucose. The AUC of BMI-z score, WC-z score and WHtR-z score to predict at least three CV risk factors were similar (~0.85), irrespective of criteria used to define abnormal levels of CV risk factors. A 1-SD increase in any of three indices to predict CV risk was also similar for the three adiposity scores. For instance, a 1-SD increase risk in BMI-z score, WC-z score and WHtR-z score was 3.32 (95%CI 2.53-4.36), 3.43 (95%CI 2.64-4.46), and 3.45 (95%CI 2.64-4.52), respectively, in the total population using the International Diabetes Federation definition. In addition, the most efficient WHtR cut-off for screening CV risk was ~0.50 in US adolescents. In summary, BMI, WC and WHtR performed similarly well to predict the presence of at least 3 main CV risk factors among US adolescents

2015 Seychelles global school-based student health survey

Introduction : Risky behaviors in school‐aged children, such as unhealthy dietary patterns, lack of physical activity, cigarette smoking, alcohol and substance use, sexual behavior, can impact their health in the short and long terms. This survey aimed to assess the prevalence of selected risk behaviors and protective factors in students aged 13‐15 years. Methods: The Global School‐based Student Health Survey (GSHS) was conducted in September 2015 in Seychelles. Methods followed the standard methodology of GSHS developed by the World Health Organization, the Centers of Disease Prevention and Control (Atlanta, USA) and other international agencies. A two‐stage cluster sample was used to include a random sample of students in grades S1 to S5, i.e. students aged 11 to 17 years. Students completed a self reported questionnaire, which was anonymous, which included questions from several standard modules of GSHS. In addition, weight and height was measured on the day before the survey and students were asked to report their results in their anonymous response forms

School screening program: update of the prevalence of overweight and obesity between 1996 and 2017

Within the School Screening Program, around 16 school nurses measure selected health indicators every year, including weight, height and selected other lifestyles variables in all ~5800 students in the C2, P4, S1 and S4 grades in all schools. • Overweight and obesity are defined along standard age and sex specific criteria by the International Obesity Task Force (IOTF). • In 2017, weight and height were measured in 3351 students from 5760 eligible students, a participation rate of only 58%. The disappointingly low participation rate in 2017, and in recent years in general, seems to be partially related to the fact that school nurses often cannot run the school program because of concurrent duties in health centers. This issue should be addressed urgently if the screening program is to be sustained in 2018. • The prevalence of overweight or obesity in children aged 9-16 years (P4, S1 and S4) increased by more than two times, between 1998 and 2017, from 9.3% to 26.4% in boys and from 12.9% in 1998 to 28.5% in girls. The current levels are extremely high by international comparison. The steep linear increase over time, including in recent years, underlies a major public health problem

Validity of silhouette showcards as a measure of body size and obesity in a population in the African region : a practical research tool for general-purpose surveys.

BACKGROUND: The purpose of this study is to validate the Pulvers silhouette showcard as a measure of weight status in a population in the African region. This tool is particularly beneficial when scarce resources do not allow for direct anthropometric measurements due to limited survey time or lack of measurement technology in face-to-face general-purpose surveys or in mailed, online, or mobile device-based surveys. METHODS: A cross-sectional study was conducted in the Republic of Seychelles with a sample of 1240 adults. We compared self-reported body sizes measured by Pulvers' silhouette showcards to four measurements of body size and adiposity: body mass index (BMI), body fat percent measured, waist circumference, and waist to height ratio. The accuracy of silhouettes as an obesity indicator was examined using sex-specific receiver operator curve (ROC) analysis and the reliability of this tool to detect socioeconomic gradients in obesity was compared to BMI-based measurements. RESULTS: Our study supports silhouette body size showcards as a valid and reliable survey tool to measure self-reported body size and adiposity in an African population. The mean correlation coefficients of self-reported silhouettes with measured BMI were 0.80 in men and 0.81 in women (P < 0.001). The silhouette showcards also showed high accuracy for detecting obesity as per a BMI ≥ 30 (Area under curve, AUC: 0.91/0.89, SE: 0.01), which was comparable to other measured adiposity indicators: fat percent (AUC: 0.94/0.94, SE: 0.01), waist circumference (AUC: 0.95/0.94, SE: 0.01), and waist to height ratio (AUC: 0.95/0.94, SE: 0.01) amongst men and women, respectively. The use of silhouettes in detecting obesity differences among different socioeconomic groups resulted in similar magnitude, direction, and significance of association between obesity and socioeconomic status as when using measured BMI. CONCLUSIONS: This study highlights the validity and reliability of silhouettes as a survey tool for measuring obesity in a population in the African region. The ease of use and cost-effectiveness of this tool makes it an attractive alternative to measured BMI in the design of non-face-to-face online- or mobile device-based surveys as well as in-person general-purpose surveys of obesity in social sciences, where limited resources do not allow for direct anthropometric measurements

2015 Seychelles Global Youth Tobacco Survey and comparison with GYTS in 2007 and 2002

OBJECTIVES: The Global Youth Tobacco Survey (GYTS) is aimed to assess behaviors, knowledge, beliefs, opinions and other variables related to tobacco use among students of secondary schools aged 13‐15 years in countries worldwide using a standard methodology and questionnaire. METHODS: We present the main findings of GYTS performed in Seychelles in 2015 and compare results with results of two previous GYTS surveys done in Seychelles in 2007 and 2002 in order to identify trends over time. In each GYTS, a two‐stage cluster sample design was used to produce a representative sample of all students in grades S1, S2, S3, S4 and S5 from all public and private schools in Seychelles. Participants completed a standard self‐administered questionnaire in schools on an anonymous and voluntary basis