Mahalla Cardiac Center

Ministry of Health and Population

Health

Education Programs

In Mahalla Cardiac Center

Preparation and supervision

Dr. Maher Abdel-Latife Rashed

Mahalla Cardiac Center Manager

Dr. Mahmoud Hamza

2001

  Introduction:

Cardiovascular diseases are responsible for around 20% of all deaths worldwide (approximately 14 million). They diseases are the principal cause of death in all developed countries and are also emerging as a prominent public health problem in developing countries ranking third with approximately 16% of all deaths. They are already become the first cause of death in some developing countries. Although all deaths in developed countries are due to cardiovascular diseases, numerically, the developing world experiences more cardiovascular deaths than the industerialized world (The Curative care sector, 1999).

Of the various components of non-communicable diseases, that of cardiovascular origin is becoming of increasing importance and major concern. Cardiovascular diseases accounted for 5,88% of all discharges (6.9% in males and 4.8 in females) in Egypt in 1993 with a rate of 63.59 per 10.000 population (The Curative care sector, 1999).

Rheumatic heart disease was reported to be the most common cause of cardiovascular death in the first five decades of life in many countries (WHO, 1986). Adnan, (1997) has further reported that rheumatic fever is the most common cause of acquired heart disease in children and young adults worldwide.

Rheumatic fever and rheumatic heart disease are major causes of death and disability in the inhabitants of developing countries. It is typically associated with poverty, in particular with poor housing and overcrowding, both of which favor the spread of streptococcal upper respiratory infections (The Curative care sector, 1999), or that usually include the general aspects occurring after pharyngitis, due to group A-b hemolytic streptococcus (Congeni et al., 1987).

Rheumatic Fever and Rheumatic heart disease still form a major health problem in developing countries including Egypt, where many socioeconomic factors predispose to its occurrence (Mahfouz et al., 1989). However, although rheumatic fever was reported to be relatively uncommon in the United States but it is a common cause of heart disease in underdeveloped countries. In recent years, new small outbreaks of this disease have been reported in the United States (Park, 1996).

In Egypt also, rheumatic fever remains the most common cause of cardiovascular disease in children, adolescents, and adults with an incidence peak among 5-12 years of age and unfortunately causing serious cardiovascular diseases requiring surgery in children (The Curative care sector, 1999).

On the other hand, The Framingham Heart Study launched in 1948 and numerous subsequent studies firmly documented that the prevalence of coronary heart disease is associated with the following modifiable and immutable risk factors: advanced age, male gender, family history of coronary disease, hypercholesterolemia, low high-density lipoprotein cholesterol, tobacco use, hypertension, diabetes mellitus, and sedentary lifestyle (The Framingham Heart Study, 1990).

From the same point of view, the 27th Bethesda Conference report recommends categorizing on the basis of evidence that management of a given risk factor favorably affects outcome (27th Bethesda Conference, 1996).

However, factors affecting health problems are varied: 1) The prevalence and ecology of infectious agents and their hosts. 2) Climate and geography. 3) Agricultural resources and practices. 4) Educational, economic, social, and cultural considerations. 5) Stage of industrialization and urbanization. 6) Gene frequencies for some disorders (Richard Behrman, 1996).

Preventive cardiovascular disease:

On the other hand, most adult cardiovascular diseases, including coronary heart disease, are both highly prevalent and preventable. Despite recent declines in age-adjusted mortality, cardiovascular disease accounts for 42% of all deaths (Miller and Vogel, 1996).

Assessing risk factors and discriminating between primary and secondary prevention have become important concerns in the management of patients with potential or established coronary heart disease. Modifying risks in those without established disease is called primary prevention (Tsevat et al., 1991).

The secondary prevention of coronary heart disease involves management of cardiovascular risk factors in the patient with established coronary artery disease. This effort is directed at lowering the risk of future cardiovascular events. In general, the presence of established cardiovascular disease increases the risk for a subsequent cardiovascular event approximately six-fold in patients with equivalent coronary risk factors (Pearson and others, 1994).

Primary, secondary or tertiary prevention must be considered a constant, ongoing process rather than an episodic one. Therefore, preventive visits must be described both in terms of the individual visit and within the context of continuing care, through promotion of health within the family and community (Osborn L, 1996).

The preventive health visit was reported to have three separate components, and each must be carefully considered and systematically delivered (Osborn L, 1996): 1) Screening; 2) Health promotion and disease prevention; and 3) Patient management and follow-up.

Screening procedures include gathering of historical data, physical examination including vision and hearing testing, observation of the patient and his or her parents, and laboratory testing. Screening questionnaires that parents can complete in the waiting room have also been shown to be useful. The purpose of screening is to define a population that needs further evaluation (Osborn L, 1996).

Health promotion has been defined in healthy people as "the development of community and individual measures, which can help people to develop lifestyles that can maintain and enhance the state of well-being." Health promotion activities, because they involve lifestyle, are virtually always related to behavior (Osborn L, 1996).

Health Education Programs and Health Care

Definition:

Health Education Programs are planned and organized series of health education activities or procedures implanted with an educational specialist assigned primary responsibility, a budget, an integrated set of objectives to allow evaluation and administrative support (U.S. Department of Education, 1993).

Health education aimed at fostering health-promoting lifestyles. Behrman R (1996) determined it as a part of goals of child health care.

Principles of Child Health Care Education Programs (Brooks, 1983):

* Human motivation

* The development process

* The nature of learning

* Social health needs.

Types of health education program (Gilbert and Sawyer (1995):

1) Community health education :

It is channeled to the healthy population. it takes the form of:

* teaching school children

* Advising antenatal parents

* Running weight loss classes

* Instruction in breast fed exam.           

2) Patient clinical education :

which has the criteria of sensitization, publicity, education and  also motivation. It takes the form of :

* Promotion and maintenance of health.

* Change life-style

* Specific risk factor

* Change in worker health behavior

* Deal with health contradiction in workplace environment

* Focusing on disease entity.

Components of Health Education Programs (Bedworth and Bedworth, 1992 and Daver, 1980):

1) Health education philosophy and practice.

2) Educational process, determined by the behavioral science

3) Information content , is provided by health science.

Education Health Program Varieties (Sheal, 1992 and Brooks, 1983):

A) Target: person-family-work place-community.

B) Intensity: Distribution of pamphlets - home visits - programs that persons attend.

C) Programs improve quality of life - better coping skills about each individual – enhance modification of life style – clear the scientific information of a disease. etc.

D) Locale.

References

The Curative care sector (1999):

MOHP in collaboration with WHO-Emro 1999; Introduction; Reumatic fever and Rhuematic heart disease manual; Standards of care and clinical practice Guidelines for the management of coronary heart disease: P 78).

WHO (1986):

Community prevention and control of cardiovascular disease.

Report of the WHO Tech. Rep. Ser., 732.

Adnan S D (1997):

Rheumatic fever.

Braunwalld Heart Diseases, Texetbook of Cardiovascular Medicine III (55):1769.

Congeni G., Rizzo C., Congeni J., and Steevansan V,. (1987):

Outbreak of acute Rheumatic fever in northeast Ohio.

J. Pediatrics, 111, 176.

Mahfouz M.H., Abu-El-Naga A.M., Zidan H.A., Abdel-Khalek E.R., Ibrahim M.H.M. and Khidr H.E. (1989):

The prevalence of rheumatic heart disease in school children in Shrkia.

The Egyptian Heart Journal, 31:37.

Park K. Myung (1996):

Acute rheumatic fever.

Pediadric Cardiology, Mosby-Year Book, inc, third ed., Ch. 20: 302.

The Feamingham Heart Study (1990):

Circulation 1990;82:1616-1628.

27th Bethesda Conference (1996):

Matching the Intensity of Risk Factor Management with the Hazard for Coronary Disease Events. September 14-15, 1995. J Am Coll Cardiol;2:957-1047.

Behrman R (1996):

Overview of pediatrics.

Nelson Textbook of Pediatrics; 15th ed. ch 1.

Miller M, Vogel RA (1996):

Temporal changes in coronary risk factors

The practice of coronary disease prevention; Baltimore:Williams and Willkins.

Tsevat J,  Weinstein MC, Williams LW, Tosteson AN, Goldman L. (1991):

Expected gains in life expectancy from various coronary heart disease risk factor modifications. Circulation;83:1194-201.

Pearson T, Rapaport E, Criqui M, Furberg C, (1994):

Optimal risk factor management in the patient after coronary revascularization. A statement for healthcare professionals from an American Heart Association Writing Group. Circulation;90:3125-33.

Osborn L.M. (1996):

Preventive pediatrics.

Nelson Textbook of Pediatrics; 15th ed., ch.5.

U.S. Department of Education (1993):

The Condition of Education: Washington, DC: National Center for Education Statistics.

Brooks SM (1983) :

Professional and community health. The ST. Louis. The CV Mosby Co.

Gilbert GG and Sawyer RG (1995) :

Health education.

Creating strategies for school and community health. Boston:Jones and Barlitt.

Bedworth AE and Bedworth DA (1992) :

The profession and practice of health education, New York:Wmc publishers

Daver RS (1980) :

Principle of management.

The progressive Corporation Private Limited, , Bomby.

Sheal P (1992 ) :

An action guideline for managers and supervisors.

The staff development handbook, London: Guilford Ltd.

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       Mahalla Cardiac Center

Ministry of Health and Population

Health Education Program

Protocol "no. 1”

Hypertension

Preparation and supervision

Dr. Maher Abdel-Latife Rashed

Mahalla Cardiac Center Manager

Dr. Mahmoud Hamza

2001

Health Education Program

Protocol "No. 1"

Aim:

- Promotion and maintenance of health.

- Fostering health-promoting lifestyles.

Time:

- May 2001: October 2001.

Feedback:

- Quality control assessment reports.

Target:

- Patients attending outpatient clinic and their families.

Intensity:

- Lectures that persons attend.

- Slides

- Pamphlets.

Program:

- Clear the scientific information of Hypertension.

- Preventive cardiovascular disease measures:

* Primary prevention: Modifying risks in those without established disease.

* Secondary prevention: Management of cardiovascular risk factors in the patient with established disease.

* Tertiary prevention: Rehabilitation of complicated conditions.

 Members and Activity:

- Health Educator.

* Planning and assist the community to organize itself for health education.

* Consult with and guide individual and community group in developing and improving the health educational aspects of their activities.

* Prepare with technical help, organize and assist in conducting meetings and conferences.

- Physicians and nurses.

* Conductance of scientific information and medical advise.

-          - Social worker

* Provide counseling about health-related and other problems.

* Help us obtain financing and other needed services.

-          - Dietitian

* Planning the special dietary needs of patients.

* Provision of teaching, source of information.

* Advice to physician).

Locale:

- Mahalla Cardiac Center, Outpatient Clinic.

Educational process:

* Sensitization of enhancement of life style.

* Publicity of health problem and varieties of prevention and/or control.

* Education of life style modification, keeping adherent diet regimen and drug intake with medical follow-up.

* Motivation.

Applied Forms of Educational process:

* Change life-style

* Specific risk factor.

* Change in worker health behavior.

* Deal with health contradiction in workplace environment.

* Focusing on disease entity.