The total population of Seychelles is 80,000 and an estimated 5,000 people with diabetes and 5,000 with pre-diabetes live on the archipelago in the Indian Ocean.For the past two decades, non-communicable diseases (NCDs) have become the leading cause of mortality and morbidity in Seychelles. In particular, the age-standardised prevalence of diabetes in the population aged 25-64 has risen from approximately 6.2% in 1989 to 9.5% in 2004.The rapid increase in NCDs and diabetes is compatible with the rapid socio-economic development of the country and subsequent changes in lifestyles.Within the National Health System, primary health care is provided through 17 district health centres throughout the country while secondary health care is provided at the main hospital in the capital of Victoria and in 3 smaller cottage hospitals on the 3 main islands. Tertiary health care is provided only at the main hospital in Victoria.Recognising this new disease pattern, the Ministry of Health has set up a Unit of Prevention and Control of Cardiovascular Diseases (CVD) in existence since 1989 and a Section for NCDs in existence since 2005, which have led activities for the prevention and control of NCDs such as surveillance, awareness campaigns, screening and training programs for health professionals and the development of guidelines.In Seychelles, health care (treatment, medication and support) is mainly delivered through a National Health System at no direct cost to the inhabitants.Health care for NCDs and diabetes is provided at district health centres level, including diagnosis of diabetes and related conditions and the provision of anti-diabetic, antihypertensive and lipid lowering medications.However, diabetes control remains limited, as evidenced in a national survey in Seychelles in 2004 showing poor control of glucose, blood pressure and blood lipids among a majority of diabetic patients.The objective is setting up a specialist clinic for NCDs and diabetes in Victoria to improve quality of diabetes treatment
This project aims at setting up a specialist clinic of NCDs and Diabetes.While the district health centre level remains the entry point for primary health care for diabetes and NCDs, the specialist ‘Diabetes/ NCD Clinic’ will help set treatment standards and provide comprehensive health care to selected diabetic patients referred by district health centres because of limited control.The specialist clinic will be established at the main hospital of Victoria, the only hospital in the country offering secondary and tertiary care.The clinic is expected to help setting proper standards for management of diabetes and NCDs as well as provide specialist support to doctors in the primary health care system.In addition, the clinic will complement the district health centres with focus on diabetes patients with special problems as well as patients with poor cardio-metabolic control.The clinic will be equipped and staffed so that overall cardio-metabolic risk can be assessed and treatment can be adjusted at the same visit and the clinic will work in close collaboration with the laboratory of the hospital. All running costs related to the clinic are covered by the MoH.
• An NCD clinic has been established at Victoria Hospital.• More than 1,000 patients have been registered at the clinic and some patients are reached through outreach activities.• Equipment and reagents to test blood sugar, lipids and microalbuminuria have been procured, and basic equipment such as weighing scales and blood pressure machines have been made available.• 40 nurses have received training on foot care with assistance of the Diabetes Society of Seychelles and IDF.• Treatment guidelines have been developed.