1. GARD PROJECT IN CABO VERDE José Rosado Pinto GARD WHO Meeting Beijing 28-29 March 2005 Serviço de Imunoalergologia, Hospital de Dona Estefânia Lisboa, Portugal

2. CABO VERDE

3. 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

4. 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

5. 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

6. Official Collaboration Portugal / Cabo Verde Asthma 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)

7. 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.

8. Stage 1 – Prevalence of Respiratory Diseases at PHC level Specific objectives: a)To assess reported prevalence and severity diseases at PHC level b)To determine spirometric values c)To identify factors associated with Respiratory Diseases d)To assess prevalence of Major Respiratory Diseases at E.R. Departments

9. Stage 1 - Methodology Population: + 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

10. Stage 2 – Management of Respiratory Diseases at Primary Health Care Level Specific objectives: a)To evaluate the management of respiratory diseases at PHC level b)To estimate the under and over diagnosis and the under and over treatment of respiratory diseases at PHC level

11. Stage 2 - Methodolgy Expected: 175 respiratory patients GP Forms Questionnaire: stage 1 Spirometry Evaluation by WHO Expert Team

12. Action Plan - Steps 1.Translation of GARD Document 2.Contact between WHO and Cabo Verde Health Ministry 3.Appointment of a national team of specialists under the responsability of Cabo Verde Health Ministry 4.Training the national team by portuguese experts 5.Starting stage 1 as soon as possible 6.Monitoring of the project by WHO experts

13. 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

14. MADEIRA (EUROPE) 14.6 % 74 % 70 % 54.1 % - The PAC Study CABO 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

15. GARD PROJECT WILL BE A REALITY IN CABO VERDE