Health situation and issues in the Seychelles in 2012.

Located off the coast of Kenya, the Republic of the Seychelles is an island archipelago nation whose citizens are mostly of African origin. The population, independent from the United Kingdom since 1976, has largely completed its demographic and epidemiological transitions. Major investments in infrastructure and social services have fostered a steady economic growth. Health services and education are free. The predominance of chronic non-communicable diseases and rapid aging of the population cause significant new challenges for public health and the health system. However, like the other small island states in the region, the Seychelles remains under the threat of outbreaks, particularly of arboviruses. Health indicators from 2012 are generally very good. There are concerns, however, about the future of health care in the country. Geographic isolation, the small and aging population and limited resources provide major challenges for maintaining and sustaining an effective workforce of health professionals, a constantly evolving technical platform and an increasing number of available medications. This is true particularly in view of the increasing burden of chronic diseases and the continued threat to the population of current or emerging infectious diseases. The purpose of this article is to provide a brief introduction to the geography, history, and political context of Seychelles to provide an account of the current situation regarding major diseases in the Seychelles and to review health priorities of the last few decades. To our knowledge, no comprehensive inventory of sporadic, endemic or epidemic events has been attempted before, except for a remarkable report from the 1950s [1]. Using health data from the past few decades, information from health personnel who live and practice in the Indian Ocean, we attempt to identify major current and future health challenges in the Seychelles.

[Health situation and issues in the Seychelles in 2012]. / Situation et enjeux sanitaires aux Seychelles en 2012.

Off the coast of Kenya, the Seychelles, home to 87,400 inhabitants mostly of African origin, have largely completed their demographic and epidemiologic transitions. Major investments in infrastructure and social services have fostered steady economic growth. Health care and education are free. The predominance of chronic non-communicable diseases and rapid aging of the population nonetheless present significant challenges for public health and the health system. Like the other small island states in the region, the Seychelles continue to be threatened by arbovirus outbreaks. Health indicators are good, but the geographic isolation, the small and aging population, and limited resources make a major challenge maintaining and sustaining an effective workforce of health professionals, a constantly evolving technical platform, and increasing amount of medications particularly in view of the increasing burden of chronic diseases.

Prenatal methyl mercury exposure in relation to neurodevelopment and behavior at 19 years of age in the Seychelles Child Development Study.

BACKGROUND: Fish are important sources of protein and contain a variety of nutrients, such as n-3 long-chain polyunsaturated fatty acids (PUFA), essential for normal brain development. Nevertheless, all fish also contain methyl mercury (MeHg), a known neurotoxicant in adequate dosage. Our studies of the Seychelles Child Development Study (SCDS) Main Cohort enrolled in 1989-1990 (n=779) have found no consistent pattern of adverse MeHg effects at exposures achieved by daily fish consumption. Rather, we have observed evidence of improved performance on some cognitive endpoints as prenatal MeHg exposure increases in the range studied. These observations cannot be related to MeHg and may reflect the role of unmeasured covariates such as essential nutrients present in fish. To determine if these associations persist into young adulthood, we examined the relationship between prenatal MeHg exposure, recent PUFA exposure and subjects' neurodevelopment and behavior at 19 years of age. METHODS: We examined 533 participants using the following test battery: the Profile of Mood States-Bipolar (POMS-Bi); Finger Tapping; Kaufman Brief Intelligence Test (K-BIT); measures of Fine Motor Control and Complex Perceptual Motor Control; and Visual Spatial Contrast Sensitivity. We collected the following covariates: maternal IQ, family life course stressors, socioeconomic status, and subjects' recent postnatal MeHg, sex, and computer use. Primary analyses (based on N=392-475) examined covariate-adjusted associations in multiple linear regression models with prenatal MeHg as the primary exposure measure. Secondary analyses additionally adjusted for total n-6 and fish-related n-3 PUFA measured in the subjects' serum at the 19-year examination. RESULTS: Study participants had a mean prenatal MeHg exposure of 6.9 ppm, and a mean recent postnatal exposure of 10.3 ppm. There were no adverse associations between prenatal MeHg and any of the measured endpoints. For recent postnatal MeHg exposure, however, adverse associations were observed for Finger Tapping (non-dominant hand) among women and for the K-BIT Matrices for both sexes, with or without adjustment for PUFA. CONCLUSION: Our findings continue to provide no evidence for an adverse effect of prenatal MeHg exposure on development in a cohort that consumes fish daily. Observations for postnatal MeHg exposure will need to be confirmed using more comprehensive exposure measures.