WORLD HEART DAY29TH SEPTEMBER 2018 “YOUR HEART MY HEART”

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Preamble

In May 2012, world leaders committed to reducing global mortality from non-communicable diseases (NCDs) by 25% by 2025.
Cardiovascular disease (CVD) is accountable for nearly half of all NCD deaths making it the world’s number one killer.
World Heart Day is, therefore, the perfect platform for the CVD community to unite in the fight against CVD and reduce the global disease burden.
Created by the World Heart Federation, World Heart Day informs people around the globe that CVD, including heart disease and stroke, is the world’s leading cause of death claiming 17.5 million lives each year,
Highlights the actions that individuals can take to prevent and control CVD.
It aims to drive action to educate people that by controlling risk factors such as tobacco use, unhealthy diet and physical inactivity, at least 80% of premature deaths from heart disease and stroke could be avoided.
World Heart Day is a global campaign during which individuals, families, communities and governments around the world participate in activities to take charge of their heart health and that of others.
Through this campaign, the World Heart Federation unites people from all countries and backgrounds in the fight against the CVD burden, and inspires and drives international action to encourage heart-healthy living across the world.
Impact of CVD
17,500,000 people die every year from CVD, including heart disease and stroke
CVD is the leading cause of death and disability in the world, killing 17.5 million people a year.
That’s a third of all deaths on the planet and half of all non-communicable-disease-related deaths.
Around 80% of these deaths are in low- and middle-income countries where human and financial resources are least able to address the CVD burden.

Rheumatic heart diseaseCommunicable or Non communicable ? FAQ
Beginning is communicable- Group-A Streptococcus (GAS) infection
Development is Non communicable- Immunological response to the GAS infection
National Health Strategic plan 2017-2021
To improve the policy/legal framework for NCDs.
To reduce the incidence and prevalence health of NCDs through health promotion.
To strengthen and orient health systems to address the prevention and control of NCDs and the underlying social determinants through people- centred primary health care and Universal Health Coverage.
To strengthen and scale up the treatment, rehabilitation, care, and support for people suffering from NCDs, in order to reduce morbidity and mortality and improve quality of life.
To ensure availability of essential infrastructure, medical supplies, equipment, and technologies.
Enhance leadership and governance for the social determinants and risk factors for NCDs.
LEGACY GOALS
Introduction of alcohol and drug abuse policies
Halt and reduce Non communicable diseases

Top 10 Causes of Death

University Teaching Hospital (UTH)
1.AIDS
2.Stroke
3.TB
4.Other Non-Communicable Diseases(NCD’s)
5.Malaria
6.Diabetes
7.Pneumonia
8.Other Cardiovascular Diseases
9.Suicide
10.Epilepsy

Levy Mwanawasa General Hospital (LMGH)
1.AIDS
2.Stroke
3.TB
4.Other Cardiovascular Diseases
5.Malaria
6.Diabetes
7.Pneumonia
8.Other Non-Communicable Diseases(NCD’s)
9.Epilepsy
10.Asthma
UN Inter-Agency Task Force on the Prevention and Control of NCDs:
Joint Mission to Zambia, 5 – 9 December 2016
Advocating for a multisectoral Government-led whole-of-society NCD prevention and control response in Zambia

Catalysing an effective UN response to support the Government to develop its response to NCDs

FAO, ILO, UNAIDS, UNDP, UNICEF, UNHCR, UNFPA, UNHABITAT, WFP, WB and WHO
Zambia is a country:
Politically stable with uninterrupted peace and continuous improvement of social-economic conditions since political independence in 1964
With a vision for prosperous middle-income country for 2030
Experiencing the double burden of disease: together with infections now inevitably seeing the scourge of set for diseases driven by globalisation, urbanisation and population ageing

What we know about NCDs in Zambia:
NCDs currently account for 23% of all deaths
An 18% probability of dying from NCDs before the age of 70
Road traffic accidents is the third leading cause all deaths
Tobacco use: 19.3% men, 25.6% school students aged 13-15 years, rates climbing among girls
Harmful use of alcohol: 76% men and 23% women consumed alcohol, 42.6% had taken at least once in the past 30 days. Causes 42.3% of mental disorders
Diabetes is estimated to increase twofold (from 70000 to 186000 cases) by 2030
Hypertension increasing: now stands at more 1 in 3 men
Zambia was upgraded to Lower Middle Income Country status in 2012
Significant investments in infrastructure over past 10 years
Focus on continued social and economic development
Preliminary findings and recommendations are:
Based on our observations in country and on our international experience
Evidence-based, cost-effective and feasible
But they require cross-government support, better enforcement of laws and regulations
And they require a more robust approach to managing interference from industry
The mission report will provide an ambitious roadmap for Zambia for HLM on NCDs in 2018, NCD Action Plan 2021 and SDGs 2030, including set of goals, priorities and mechanisms for implementation.
Consistent investment in the health budget, but NCD component remains underfunded
Strong commitment in getting to Universal Health Coverage
Social Health Insurance Bill developed and will be presented to Parliament in beginning 2017
PHC basic services at community level are free to general population through Government Health Facilities
Primary Health Care more tailored to combat communicable disease than NCDs
Treatment and diagnostic services for range of NCDs available at all levels, however a lot still needs to be done to make these services optimal

National NCD Strategic Plan 2013-2016
Some multisectoral actions already at place, e.g. on road safety
Commitment to multisectoral working: plans for new NCD action plan, national NCD committee to cover tobacco and alcohol plus road safety
Commitment to data collection: e.g. STEPS 2017
Coordination and legislation
No mechanism for non-health sectors engagement in health and NCDs, although some obvious progress seen in the area of road safety and mobile health
Current NCD action plan involve the only some non-health sectors
There is inadequate legislation and regulations on key risk factors including tobacco, alcohol and diet
Capacity for law and regulations enforcement are weak due to financial and human resource constraints

 

Tobacco
Zambia has national legislation banning smoking in public places (1992 Public Health Act)
Not all pubic places completely smoke-free
Ban on all form of direct and indirect advertising, but not adequately enforced
Excise tax is only 22% of retail price-much less than recommended 70% international standard
Tobacco control bill drafted in 2010 – reviewed in 2014 not yet adopted but expected asap by MPs (MoJustice needs Economic vs Health arguments)
No Health warnings cover front/back of pack
Industry interference in the policy making process
Alcohol
National Alcohol policy draft and liquor licensing act are initiated
Banning of spirits packaged in small packets (tujilijili)
Resurfacing of ‘tujilijili’ (spirits) in small bottles
Excise tax on all alcoholic beverages lowered!!!
Industry interference/influence on taxation policy (arguing taxes will increase illicit trade and loss of revenue)
Bars near schools and houses (OPEN24/7)
Alcohol contributes to the growing number of road traffic accidents

Healthy Diets
National Food Safety Quality bill will be presented to Parliament in 2017
Increased promotion of dietary diversity and expanded production of nutritious crops
Few updated policies that promote reductions in both under and overnutrition
High rates of consumption of salt, sugar and unhealthy fats; both are widely promoted because of added fortificants (Vitamin A, iodine)
Road Safety
Political commitment to make Zambian roads more safe, lead agency and good strategies in place and forthcoming plans, including emergency call and post crash response system
Unique example of intersectoral cooperation – MoU in place between eight sectors, including health and transport
However under implementation and lack of enforcement are challenges
Civil society very engaged in this area

Physical Activity
Physical inactivity is a growing problem in Zambia, particularly in urban areas
Environment discourages walking, cycling, jogging and other elements of physical activity, i.e. inadequate road safety and low access to safe green spaces
Good but initial ingredients of a compulsory physical education in schools and youth and sport programmes. However, physical actions are not well enforced
Ensure multisectoral NCD policies and mechanism are in place:

Establish national NCD coordinating committee (or equivalent) with membership by all ministries chaired at the senior level (e.g. Vice President)
Develop national multisectoral NCD Action Plan 2017-2021 with full participation of non-health ministries and non-state actors
Establish inter-ministerial group of technical experts to draft new national multisectoral NCD Action Plan 2017-2021
Cost the NCD Action Plan 2017-2021 and define time bound targets with indictors to chart progress
Develop communication strategy for NCD Action Plan 2017-2021

Data on NCDs
Finalize comprehensive STEPS survey covering the entire country be conducted early in 2017 as panned
Strengthen DHIS2 and HMIS to include NCD indicators
Introduce NCD indicators in the next demographic health survey 2018

Legislation
Key legislation on NCDs including the Tobacco and Alcohol Control Bills be finalized and submitted to parliament for approval
Strengthen capacity to enforce existing legislation and regulations.
Explore possibility of expanding the fast track courts (High Court) for violation of traffic laws to other offences such as on alcohol and food
Ensure access to safe pedestrian walkways in all new road projects
Tobacco and Alcohol
The Ministry of Health to work with other Sectors/Ministries to enforce the existing regulations on tobacco and alcohol
The Tobacco Control Bill compliant with the WHO FCTC provisions should be submitted to the national assembly as soon as possible for debate and adoption before enactment
The bill on Alcohol should be completed as soon as possible

Healthy Diets
Consider setting up import taxes for the foods rich of sugar, salt and unhealthy fats
Collaborate with other sectors to determine entry points for nutritious foods, especially fruit, including through targeting young children
Engage transparently and constructively with the private sector to reformulate unhealthy products
Increase local production of healthy foods and access to local markets

Physical Activity
Raise awareness through the media, education, workplaces/other settings
Make physical activity easy and safe choice, i.e. bettering road safety, embedding space for PA in infrastructure development, and better access to safe green spaces
Enforce physical activity requirements in schools and build upon youth and sport programmes

Integrate lessons learned from HIV into NCDs
Consider the links between infections and NCDs in health sector responses and overlapping social determinants
Explore how NCD civil society can be supported in line with how HIV civil society networks are
Approach development partners that have traditionally worked on HIV to assess their interest in supporting work on co-morbidities
An investment case should be undertaken to show the burden of NCDs (with special focus on tobacco use effects) and return on investment of cost-effective interventions
Continue raising awareness and sensitizing among non-health ministries on the burden of NCDs, how that affects them and what they can do
Prioritize NCDs in discussions with Development Partners, especially in how they relate to current donor priorities
An NCD forum for non-governmental organizations and academia to strengthen coordination and action across civil society
Strengthen NCD-related training for frontline health workers
Incorporate information on NCD risk factors into the schools curriculum
The UN Development Partnership Framework 2017-2021, which includes NCDs in its results based framework
By establishing a platform (Working Group or equivalent) on health within the UNCT with NCDs as a permanent agenda item
Advocate among development partners to support national efforts on NCDs
Align 2017-21 NCD strategic plan with Global NCD Action Plan 2013-2020, Vision 2030, the SDGs targets 2030 and Seventh National Development Plan 2017-2021
STEPS SURVEY RESULTS FOR Zambia. [2017]

Wilbroad Mutale, PI
Roma Chilengi, Co-PI
Overview

Brief introduction of STEPS

What was done in Zambia

Key results
Response rates and respondent characteristics
Tobacco and alcohol
Diet
Physical activity & measurements
Biochemical measurements
CVD Risk
Oral & mental health
Recommendations
What is STEPS?
System for surveillance of NCD risk factors
Designed for implementation in low- and middle income countries
Objectives of STEPS
Gather information on NCD risk factors to help plan programmes and interventions

Collect standardized risk factor data to enable comparisons, but allow flexibility

Provide an entry point for low- and middle income countries to get started on NCD surveillance

Build capacity in countries

Integrated approach an therefore relatively low cost
Methodology
Study design
Study design: three-stage stratified population-based household survey

Target population: men and women age 18-69 years old

Sample size & sampling:  5, 791 households drawn from existing ZAMPHIA household list.
Survey instruments
Different levels of risk factor assessment:
STEP 1 – questionnaire
STEP 2 – physical measurements
STEP 3 – blood and urine samples
Behavioural Risk Factors
Tobacco use
Harmful alcohol consumption
Unhealthy diet (low fruit and vegetable consumption / high salt intake)
Physical inactivity
Biological Risk Factors
Overweight and obesity
Raised blood pressure
Raised blood glucose
Abnormal blood lipids
Training & pre-test
RA training was successfully conducted 10th-14th of July 2017
Training graced by Dr Bwalya (Dir-HP)
Trainers from Zambia and Geneva (Leanne & Lubna)
Pre-test conducted in Chongwe
The closing of the training: Dr Mandhlate (WR)
Team send off officiated by Dr Malama (Dir-PH)
Main field work
Started on 22nd July within Lusaka –October,2017
Teams divided across most Lusaka Province sites initially
After Lusaka teams sent to provinces
Vehicles provided by MoH
Drivers provided by MoH
Laboratory done at UTH
Key results
Response Rate

The response rate of the Zambia STEPS survey was calculated using two approaches.
The first approach which used the WHO STEPS convention gave a response rate of 74.3% (=4302/5791),

The second approach gave a response rate of 77.7% (4302/5536), which used the same numerator as the first approach but the denominator was based on the number of eligible members selected for the survey.

Recommendations on tobacco & Alcohol
Tobacco:
Consider increasing excise taxes and prices on tobacco products
Standardized packaging with clear warning with graphical pictures on the dangers of smoking and consequences.
Enforce the law against smoking in public and indoor to reduce exposure to second-hand tobacco smoke in workplaces, public places, and public transport
Implement mass media campaigns to educate the public about the harms of smoking and second hand smoke

Alcohol:
Policy on alcohol should be consisted with a commitment to generally increase excise taxes on alcoholic beverages in Zambia.
Consider enacting and enforcing restrictions on exposure to alcohol advertising in the public and private media.
Enforcing restrictions to reduce physical availability and access to alcohol, and particularly for youths given the finding that age of debut in Zambia is early.

REPUBLIC OF ZAMBIA
National Alcohol Policy
FINAL DRAFT
AUGUST 2018
Ministry of Heath
This year we’re asking people around the world to make a promise … for my heart, for your heart, for all our hearts
A promise as an individual to cook and eat more healthily, to do more exercise
Encourage your children to be more active, to say no to smoking and help your loved ones to stop.
A promise as a healthcare professional to save more lives.
A promise as a politician to implement an NCD action plan.
Because………..
Cardiovascular disease is the world’s number one killer today.
By making just a few small changes to our lives, we can reduce our risk of heart disease and stroke, as well as improving our quality of life
Setting a good example for the next generation.
It’s about saying to yourself, the people you care about and individuals all around the world, “what can I do right now to look after MY HEART… and YOUR HEART?”
Impact of CVD
17,500,000 people die every year from CVD, including heart disease and stroke
CVD is the leading cause of death and disability in the world, killing 17.5 million people a year.
That’s a third of all deaths on the planet and half of all non-communicable-disease-related deaths.
Around 80% of these deaths are in low- and middle-income countries where human and financial resources are least able to address the CVD burden.
World Heart Day
World Heart Day plays a crucial role in changing all of this.
It is a vital global platform that we, as well as our members and supporters, can use to raise awareness and encourage individuals, families, communities and governments to take action now.
Together we have the power to reduce the burden of, and premature deaths from, CVD, helping people everywhere to live longer, better, heart-healthy lives.

What should be done……..
Individuals must take control of their own heart health, sharing the power by understanding their own and their families’ risk of CVD and acting to improve it.
Governments and Ministries of Health must accurately understand the scale of the problem by investing in CVD surveillance and monitoring.
Countries should also implement population-wide interventions to reduce CVD, including: Comprehensive tobacco control policies
Taxes to reduce the intake of foods that are high in fat, sugar and salt
Walking and cycle paths to increase physical activity
Strategies to reduce harmful use of alcohol

Healthy school meals for children
Know Your Risk
Looking after your heart starts with understanding your risk so make sure you know all your health numbers.
Check your blood glucose levels
High blood glucose (blood sugar) can be indicative of diabetes.
CVD accounts for 60% of all deaths in people with diabetes so if it’s left undiagnosed and untreated it can put you at increased risk of heart disease and stroke.
Check your blood pressure
High blood pressure is the number one risk factor for CVD.
It’s called the ‘silent killer’ because it usually has no warning signs or symptoms, and many people don’t realize they have it.
Check your numbers
Visit your healthcare professional and ask them to measure your:
cholesterol levels
weight
body mass index (BMI)
blood pressure
blood glucose.
Get advise you on your CVD risk so you can plan to improve your heart health.
Understand the signs and symptoms of a heart attack
Over 70% of all cardiac and breathing emergencies occur in the home when a family member is present and could help a victim.
Cardiopulmonary resuscitation (CPR) courses so you can help a loved-one in the event of a heart attack.
If you suspect a family member is having a heart attack or stroke, seek medical help immediately.
By making just a few small changes to our lives, we can all live longer, better, more heart-healthy lives
Promise to eat well and drink wisely
Cut down on sugary beverages and fruit juices – choose water or unsweetened juices instead
Swap sweet, sugary treats for fresh fruit as a healthy alternative
Try to eat 5 portions (about a handful each) of fruit and veg a day – they can be fresh, frozen,
tinned or dried
Keep the amount of alcohol you drink within recommended guidelines
Try to limit processed and prepackaged foods that are often high in salt, sugar and fat
Make your own healthy school or work lunches at home
Sub-Saharan Africa remains a hotspot for rheumatic fever and rheumatic heart disease.

It is the only truly preventable chronic cardiac condition, yet still reigns rampant in poor countries years after virtual eradication in developed nations.

Rheumatic heart disease is a major killer of children, adolescents and young adults.