Manual on CARDIOVASCULAR DISEASES
Table of Contents Non Communicable Diseases What are NCDs? The Role of youth in NCDs IFMSA Budva Youth Declaration: A call to action on NCDs Cardiovascular Diseases What are CVDs and their types Causes and Risk Factors The Public Health Perspective and Disease Burden Activities, a brief “How To Start” Before starting any Activity, on any topic Start giving your Activity a skeleton What you can do Projects on NCDs and CVDs MEDSAR Rwanda IFMSA Brazil Evaluate your work, a brief “How To End” Feedback Data gathering Measuring the change in participants' Knowledge or Behaviour Measuring Impact on a higher level: how we measure impact as a Federation Externals UN HLM on NCDs NCD Alliance
MANUAL ON CARDIOVASCULAR DISEASE
Message from SCOPH Director Dear IFMSA Members and SCOPHeroes, Welcome to the Manual of Cardiovascular Diseases. NCDs has been a priority in SCOPH for as long we can remember and still its relevance increases every year. The global NCDs burden is increasing and we as health advocates and future health professional need to involved. This Manual has a comprehensive bit on NCDs and CVDs Knowledge and detailed skills knowledge on activity and advocacy. We hope you find this manual useful and we are looking forward to hearing about you activities and advocacy stories on Non Communicable and Cardiovascular Diseases. Enjoy Reading!
Nishwa Azeem SCOPH Director 2017-18 scophd@ifmsa.org
Message from Regional Assistant Dear all, We are very excited to present this manual to you, which is purely the work of the International Federation of Medical Students’ Associations (IFMSA), under its Small Working Group on Regional Priority for Africa 2017-18 ‘“Promoting Healthy Lifestyles in Prevention of Cardiovascular Disease” for months on this project with the common goal of raising awareness about CVD as well as encouraging students all over the world to take an active role in the fight against CVD. I, Nishwa and the SWG realized that there was a lack of resources for young professionals who were interested in leading educational activities. The primary objective of this manual is to provide a concise overview of CVD.. We have gathered academic knowledge, field experience and a youth dynamism in one single resource, made easily available for whoever is interested in learning about and leading capacity building and preventive activities. Please feel free to share this manual with as many people as you would like, and Christophe W. Ngendahayo remember that we all can make a difference SCOPH Regional Assistant for Africa ra.scoph.africa@ifmsa.org
Meet the team A MESSAGE FROM THE SMALL WORKING GROUP Dear SCOPHeroes, It is not news that in today's world NCDs, in particular CVDs are the leading cause of death and are on the rise. However, we as the small working group on this manual are not convinced that this has to be the future for Africa, and we truly believe that the power to change lies with us. Cardiovascular diseases, cancers, chronic respiratory diseases and diabetes are diseases that have been widely studied, and as such, we are already well armed with knowledge on what critical risk factors can be modified to provide a better outcome. The interventions that are necessary are not difficult, per se - they only require commitment and immediate action. This guide is targeted at painting a comprehensive picture of all you need to know about CVDs in Africa, and providing you with a large variety of ideas that you can implement wherever you are to start making a change today. NCDs and CVDs can be beaten, and the challenge is unto us to see that the Africa of tomorrow is healthier than it ever has been. The future is in our hands. We can do it! Orange Hugs, Your SWG on CVDs
Aditi Nalinkumar Vakil MSAKE-KENYA
In this complex world, CVD prevention is actually one of the easier things to do - we have no excuse so let's start now.
Acho Fon Abongwa CAMSA-IFMSA
Carole Bigirimana ABEM-Burundi
Show your heart some love; eat healthy, exercise more!'
The future is Africa
Meet the team Mukangenzi Florencel MEDSAR RWANDA
Joselyne Rugambwa MEDSAR RWANDA
Panashe Freeman Nhop ZIMSA-Zimbabwe
A line to Africa :"A healthy attitude is contagious, but dont wait to catch it from others, be a carrier"
Our Africa Region has different public health issues and CVDs is a big burden to us then it is our responsibility
Lets work together to bring an end to CVDs, its possible
Mercy Muhadia Okova MSAKE-Kenya
Kizza Jimmy FUMSA-Uganda
Non communicable diseases have caught up with us but we can fight them, our little daily and consistent efforts like physical fitness will help us reach our dream
As africans, we have to rise up and fight this burden of NCDs. We are already challenged by infectious diseases'
Neddy Makonza ZIMSA-Zimbabwe
1. Non Communicable DiseaseÂ
a) Introduction-What are NCDs: Non communicable diseases (NCDs), also known as chronic diseases account for 71% of all deaths worldwide. Globally, NCDs kill 41 million people every year. Â Of those deaths, 15 million people die in the prime of life, between the ages of 30 and 70 years. Most f these premature deaths can be prevented or delayed. They are the result of a combination of genetic, physiological, environmental and behaviours factors and they cannot be transmitted from one person to another. The NCDs cause more death than all other causes combined and they are projected to increase to 52 million by 2030. Cardiovascular Disease (CVD) are the leading cause of death globally, killing more people than any other cause. The main types of NCDs are cardiovascular diseases (like heart attacks and stroke), cancers, chronic respiratory diseases and diabetes and these account for 82% of all deaths due to NCDs. In 2012, CVD was the leading cause of NCD deaths with 17.5 million deaths (42% of NCD deaths). In 2015 there were 422.7 million cases of CVD leading to 17.92 million deaths. The annual CVD mortality is projected to increase to 22.2 million in 2030. Globally, Ischemic Heart Disease and Stroke respectively were the leading causes. The other causes listed in decreasing order included, Hypertension, Cardiomyopathies, Rheumatic heart disease, Aortic aneurysm, atrial fibrillation and flutter, Endocarditis and peripheral vascular disease NCDs are not only a major cause of mortality, but also a significant economic burden on health systems and households. WHO identified NCDs as a major obstacle to poverty alleviation and sustainable development and included the fight against NCDs in the Sustainable Development goals. Sadly, the mortality of NCDs is not evenly distributed with respect to geographical regions or population age structure. [1] (NCDs WHO 2014 Report)
MANUAL ON CARDIOVASCULAR DISEASE
b)Youth interprofessional Collaboration in the CVD Response a. We need to become Public health leaders The prevention and control of NCDs, and CVDs in particular require leadership and coordinated multi-stakeholder engagement for health both at government level and at the level of a wide range of actors, with such engagement and action including, as appropriate, health-in-all-policies and whole-of-government approaches that cut across sectors such as health, agriculture, communication, education, employment, energy, environment, finance, food, foreign affairs, housing, justice and security, legislature, social welfare, social and economic development, sports, tax and revenue, trade and industry, transport, urban planning and youth affairs. These require partnership with relevant civil society and private sector entities.Healthin-all-policies and whole-of-government and whole-of-society approaches are a recognized multisectoral mechanism that can help in the prevention and control of CVDs. .
b. Young people are crucial for the NCDs response In 2012, 42% of all NCD deaths occured before the age of 70, which represents 16 million deaths, of which CVDs represented 37% of the deaths. A 30-year-old individual had a 19% chance of dying from one of the main NCDs before his or her 70th birthday. This represents an improvement over 2000, when the same 30-year-old individual would have had a 23% chance of dying from these diseases. Young people are vulnerable and at a high risk of dying from a NCD, CVD in particular. Youth represents the next generation that will be at risk of dying from NCDs by 2030, especially those in their twenties. Therefore, they are the ones that should be targeted in order to prevent CVDs. Prevention of heart attacks and strokes through a total cardiovascular risk approach is more cost-effective than treatment decisions based on individual risk factor threshold only. Heart attacks and strokes can be prevented if high-risk individuals are detected early and treated.
Together further Togetherwe we will will gogo further Inform people on how everyone can be involved in the fight against CVDs. Involve people from all walks of life to participate in fighting CVDs e.g. religious , political individuals etc. Create a movement against CVDs. In the form of campaigns, projects, advocacy etc. Provide stories showing how different individuals or organizations participated in the fight against CVDs to motive more people to join the campaign. National Officers on Public Health to organize campaigns involving different communities and have the campaigns published.
b)IFMSA Budva youth declaration: A call to action on NCDs The International Federation of Medical Students’ Association held the 66th General Assembly, March Meeting 2017 in Budva, Montenegro on the Theme of Non Communicable Diseases and released a Youth Declaration which reads as follows: We, the members of the International Federation of Medical Students’ Associations (IFMSA), having met at the 66th General Assembly in Budva, Montenegro, have organised a Youth Caucus on Noncommunicable Diseases (NCDs). We unite to highlight the importance of addressing the growing burden of NCDs in order to achieve the Sustainable Development Goals (SDGs) and ensure healthy lifestyles and promote wellbeing for all people, at all ages. In particular, we look towards SDG target 3.4 which calls for a reduction by one third of premature mortality from NCDs through prevention and treatment by 2030, and the promotion of mental health and well-being. Fundamentally, we implore all policymakers, all sectors of government, civil society members, non-governmental organisations (NGOs) and other stakeholders to recognise that measures to prevent and control NCDs are financially sound and economically prudent. NCDs already pose a substantial economic burden; for the period of 20112025, NCDs, including but not limited to cardiovascular disease, chronic respiratory disease, cancer, diabetes and mental health, are projected to contribute a cumulative output loss of US$ 47 trillion1. Investing in action to address NCDs now has the potential to dramatically curb the economic impact of these diseases in the future.
WE'RE A PASSIONATE FEDERATION FILLED WITH PASSIONATE INDIVIDUALS
MANUAL ON CARDIOVASCULAR DISEASE
Globally, funding to implement cost-effective interventions for NCDs, from domestic and international resources, is grossly inadequate compared to the relative burden of disease that these diseases contribute. Consensus is growing that the SDGs will not be primarily financed through international aid budgets, and countries require catalytic funds to build national capacity to address NCDs. Despite the fact that NCDs account for almost 70% of global deaths (many of which are premature)2 , donor support for programs such as communicable disease and maternal and child health greatly outweighs that for NCDs3 .
Our Call We call for bolder measures, increased investment and greater policy coherence in 6 key areas: ● Financing NCD prevention and control ● Protecting health in the urban environment ● Empowering vulnerable populations and reducing inequity ● Youth and NCDs ● Health systems for NCDs ● Investing in the health workforce
2. Cardiovascular disease a) Cardiovascular Diseases and their types: Definition: Cardiovascular disease (CVD) is a group of disorders of the heart and blood vessels WHO divides Cardiovascular Diseases in the following types: coronary heart disease stroke other cardiovascular diseases hypertensive heart disease inflammatory heart disease rheumatic heart disease
1. Coronary heart disease Disease of the blood vessels supplying the heart muscle e.g atherosclerosis, angina, myocardial infarction and sudden cardiac death
2. Cerebrovascular disease (Stroke) Disease of the blood vessels supplying the brain Strokes are caused by disruption of blood supply to the brain. This may result from either blockage (ischaemic stroke) or rupture of a blood vessel (haemorrhagic stroke). Coronary heart disease kills more than 7 million people each year, and strokes kill nearly 6 million. Most of these deaths are in developing countries.
MANUAL ON CARDIOVASCULAR DISEASE
3. Peripheral arterial disease Disease of blood vessels supplying the arms and legs. Risk factors as for coronary heart disease.
4. Congenital heart disease Malformations of heart structures existing at birth, which may be caused by genetic factors or by adverse exposures during gestation. Examples include: holes in the heart, abnormal valves, and abnormal heart chambers.
SANDY JONES
AIMEE BECKHAM
LORENZ LIM
PAUL SANDERS
5. Deep Venous Thrombosis (DVT) and Pulmonary Embolism (PE) Blood clots in the leg veins, which can dislodge and move to the heart and lungs.
6. Aortic aneurysm and dissection
Dilatation and rupture of the aorta.
7. Other cardiovascular diseases Tumours of the heart; vascular tumours of the brain; disorders of heart muscle (cardiomyopathy); heart valve diseases; disorders of the lining of the heart. Other factors that can damage the heart and blood vessel system:
b) Understanding Risk Factors and their Importance :
Risk Factors are conditions that increase the probability of developing a certain disease. Some of these conditions are in the patients’ control called Modifiable Risk Factors. Others cannot be altered tangibly called Non-Modifiable Risk Factors. Importance: In diseases like NCDs where we do not have a tangible cure yet lifetime management, we need to realise and understand these risk factors to prevent and curb them.
The most important behavioural risk factors of heart disease and stroke are unhealthy diet, physical inactivity, tobacco use and harmful use of alcohol. The effects of behavioural risk factors may show up in individuals as raised blood pressure, raised blood glucose, raised blood lipids, and overweight and obesity. These “intermediate risks factors” can be measured in primary care facilities and indicate an increased risk of developing a heart attack, stroke, heart failure and other complications. Cessation of tobacco use, reduction of salt in the diet, consuming fruits and vegetables, regular physical activity and avoiding harmful use of alcohol have been shown to reduce the risk of cardiovascular disease. In addition, drug treatment of diabetes, hypertension and high blood lipids may be necessary to reduce cardiovascular risk and prevent heart attacks and strokes. Health policies that create conducive environments for making healthy choices affordable and available are essential for motivating people to adopt and sustain healthy behaviour. There are also a number of underlying determinants of CVDs or "the causes of the causes". These are a reflection of the major forces driving social, economic and cultural change – globalization, urbanization and population ageing. Other determinants of CVDs include poverty, stress and hereditary factors.
C) Global, Regional, and National Burden of CVD C a r d i o v a s c u l a r d i s e a s e s i n p a r t i c u:l a r a c c o u n t f o r t h e m a j o r i t y o f d e a t h s a n d costs due to NCDs. The global burden of CVDs, as for NCDs, was disproportionately distributed, with low income countries having a significantly higher age standardized prevalence than high-income countries. Furthermore, low-income countries account for over three quarters of CVD deaths. In fact, only high and middle-income countries have witnessed a decline in their age standardized prevalence of CVDs between 1990 – 2015.
Why are cardiovascular diseases a development issue in Africa and other low and middle income countries? At least three quarters of the world's deaths from CVDs occur in low- and middle-income countries. People in low- and middle-income countries often do not have the benefit of integrated primary health care programmes for early detection and treatment of people with risk factors compared to people in high-income countries. People in low- and middle-income countries who suffer from CVDs and other noncommunicable diseases have less access to effective and equitable health care services which respond to their needs. As a result, many people in low- and middle-income countries are detected late in the course of the disease and die younger from CVDs and other noncommunicable diseases, often in their most productive years. The poorest people in low- and middle-income countries are affected most. At the household level, sufficient evidence is emerging to prove that CVDs and other noncommunicable diseases contribute to poverty due to catastrophic health spending and high out-of-pocket expenditure. At macroeconomic level, CVDs place a heavy burden on the economies of low- and middle-income countries.
Figure 2: Global Map, Age-Standardized Prevalence of CVD in 2015Â
In Sub Saharan Africa (SSA), the age-standardized mortality rate for CVDs has not witnessed any decline, contrasting sharply with the significant declines that have been recorded in other world regions, especially the high-income countries. Furthermore, the principal cause of CVD mortality in SSA is stroke and not ischemic heart disease as in the other regions. Lamentably, women account for a greater proportion of deaths from CVDs than men in this region. CVD surveillance efforts in SSA is challenged by a very limited number of data sources and low reporting of certain CVDs.
3. Activities, a brief "How to start" Before starting an activity a. Before starting any Activity ask: “Is the issue you are about to tackle, really an issue?” We want to make sure there is a need and the activity would not be a waste. Asking this would determine if cardiovascular disease burden is really a problem and if it is a Public Health issue in one’s country/city/locality. . Example answers: Yes, it is a good start and that your efforts will not be meaningless. Statistics in this manual and further research can help you to further prove that cardiovascular diseases truly are a Global Public Health issue also if present in your country. No, you need to broaden your search, find more sources, reconsider the topic you are working on altogether..
b. To Identify the reasons why you are addressing the issue ask: “Why are we tackling CVD Burden and Why are we organizing it during a theme day? Answering the ‘Why’ questions can be one of the hardest parts of your Activity, but once you have, you will have a clearer perspective on the Activity you want to organize. . Example answers: Why Cardiovascular Diseases: Because it is a major Public Health concern in my country and globally. Why organize an Activity during a theme day: Because on this day multiple stakeholders as well as colleagues are also celebrating the event, and by organizing the event together, we have a louder voice and stronger impact. (Example: World Health Day, 7th April, World No Tobacco Day: May, 31st, World Health Heart day: Sept 29th and World No Alcohol day: Oct 2nd every year). Why we are tackling it as Medical Students: Because we are following a vision to make this world a healthier place as the IFMSA Vision/Mission or Because we are health leaders of tomorrow and we care about the health of the societies we will work in as doctors.
c. To define a Vision for your Activity ask: Example answers: What is the ideal situation that you would like to be in, about the topic you are tackling? A vision is a seemingly idealistic statement, which constitutes the core of why you are doing something. The ‘why questions can help you identify the vision. .
General: We believe in a world in which nobody is ever affected by Cardiovascular Disease More Specific: We believe in a world in which each individual is aware about the risk factors and means of prevention of cardiovascular disease
Before starting an activity Goals and Objectives are the “What” and “How” of your Activity. They will help you know exactly what is going to happen and help when you will evaluate your Activity. a. Define Goals A Goal embodies “How” you will follow your vision. You have already defined that cardiovascular diseases burden is a global health issue, that as a medical student you believe in making the world healthier place. You have to keep in mind the resources (human, financial, etc.) you have for your Activity so you do not shoot way higher than you can reach. A series of Goals which have unity between them will give shape to your Activity. Your Goals could be endless and span from: Raising awareness about Cardiovascular Diseases. Advocate for theoretical and practical training in for tackling NCDs on ground level Campaign against risk factors tobacco, obesity etc. Teaching children about healthy lifestyles Encouraging the general population to do Physical Activity b. Identify Objectives Objectives are the specific list of “What” you are going to do to achieve your Goals. Defining a list of Objectives related to each Goal is a crucial point of activity planning it can make all the difference between complete success and failure. Objectives have to be based on what your resources are and how much time you have to achieve your goals.
Before starting an activity To define your objectives with the SMART acronym; objectives have to be: S: Specific (Key Questions: “who”, “what”, “when”, “where”, “how”) WRONG: Encourage people to do physical activity. [unclear exactly what we want these people to do!] RIGHT: Get at least 60 adults aged between 35-55 to participate in moderate aerobic cardio within 12 hours [Here it is very clear what is going to happen!] M: Measurable (Key Question: Start thinking about how you are going to be measuring these) RIGHT: Get at least 60 adults aged between 35-55 to run through the official Cardiovascular disease event obstacle course within 12 hours. [Easily measurable - we just have to count!] A: Attainable WRONG: Get at least 3000 adults aged between 90-95 to run through the official Cardiovascular disease event obstacle course within 2 hours. [Define an objective that you will be able to obtain within the time you have and the resources you have] RIGHT: Get at least 60 adults aged between 35-55 to run through the official Cardiovascular disease event obstacle course within 12 hours. [This sounds more realistic than the previous one] R: Relevant WRONG: Get at least 60 adults aged between 35-55 to draw 1 picture of a fish during CVD event. [This has nothing to do with tackling our issue!] RIGHT: Get at least 60 adults aged between 35-55 to run through the official Cardiovascular disease event obstacle course within 12 hours. [Physical activity helps lower blood sugar, and prevent Diabetes (risk to Heart failure) and also ensure relaxation of blood vessels by burning cholesterol. Teaching people about it can help them develop this habit thus this is relevant!] T: Time Bound WRONG: Get at least 60 adults aged between 35-55 to run through the official Cardiovascular disease event obstacle course. [When? In how long? Will this Activity last a month? A decade? 12 hours?] RIGHT: Get at least 60 adults aged between 35-55 to run through the official Cardiovascular disease event obstacle course within 12 hours. [Knowing by when you have to be done will aid you in effectively organizing your activity as well as measuring your results at the end]
Take Home Message: Identify the issue [Is it really an issue?] Ask yourself why? [Why this? Why you?] Define your Vision [What do you believe in?] Set Goals and Objectives [How and What are you going to do to follow your vision?]
Before starting an activity Other important preparations that can help you: Timeline: Define a specific timeline for all the elements of your Activity including preparation time, the activity itself and the follow-up period. Stakeholder: Create a stakeholder map to identify the people and organizations that could help you or hinder you in your Activity. Risk Management: Evaluate all the risks tied to the planning and executing of your activity example if you need a sunny day or if your colleagues could get sick or if your main sponsor could pull out at the last moment. Recognizing what would the consequences be and as a follow-up, for each risk, consider firstly, how likely it is to happen and secondly, how much damage it would make if it did happen. Finally plan what you can do to both prevent it, or handle it if it happens. Resource Management: For each SMART objective you will swiftly be able to determine and list what resources you need. Subsequently you can make a plan to obtain them and then you can start your Activity! Additionally, needed resources can also be less tangible things, like “obtaining permission from the City to set up a stand in the main square”, or “obtain permission from the school to not attend classes on the day of your Activity”.
Now you are ready to get your Activity going! What you can do Prevention Promoting awareness can have a strong impact. The awareness can be directed towards changing people’s Knowledge, Behavior or Perception of an issue. All of these domains can contribute to people developing healthier lifestyles, and paying attention to the risk and other factors of diseases. Awareness is therefore a close synonym to Prevention. In a strategic Activity design it is important to keep these three domains in mind when defining objectives and when defining evaluation methods so we can impact people holistically. Examples of these changes: Knowledge: Following your activity, a person learns about the methods to age actively. Behavior: Following your activity, an older person develops the habit of exercising and participating in social and economic activities regularly. Perception: Following your activity, a person does not consider ageing synonymous to isolation and decrease in productivity.
Examples of Activities 1. CVD Information Stand: Distribute flyers, stickers, pins and information about Cardiovascular Diseases, either in your University or City. For this kind of an event, a solid evaluation system is essential to measure the impact you have. Performing a pre- and post- questionnaire to evaluate people’s knowledge before and after you in tract with them, will help evaluate your activity. Ideas you can include:
Organize sports events e.g. marathons and Zumba dances to encourage people to exercise Encourage people to take walks to work or to school A w a r e n e s s c a m p a i g n s a g a i n s t t o b a c c o s m o k i n g b y s h o w i n g p e o p l e t h e harms of tobacco and pointing out the reasons teens pick up smoking Encourage healthy diets reduced alcohol intake that do not predispose to CVDs. Encourage people to undergo screening for regular body checkups and hypertension frequently, especially those from families with history of those diseases Challenge people to solve a quiz about the topic you are promoting Measure blood glucose with glucometers, and check people’s blood pressure ppii(Screening). Encourage people at risk to see a doctor Offer people an apple in exchange for their cigarette, to promote healthy lifestyles two ways CVDs walk campaigns in urban centers with banners and T-Shirts containing CVDs messages
TIPS Create eye-catching infographics for flyers you could try using piktochart.com or canva.com. Choose few messages, but very clear ones that you want to share with your target group. Join the fight against adverse perceptions on noncommunicable diseases. Encourage people to take picture be active on social media and use relevant campaigns.
MANUAL ON CARDIOVASCULAR DISEASE
2. WNTD or WHD Party: Organizing a party at your university will help both raise funds and awareness about your cause. It can be the perfect prelude to the organization of a conference or recruitment of motivated students who could help you with your project in the future. Make the theme of the party clear Have healthy snacks at the party, to promote by example healthy diet Give the guests something creative to promote your theme (e.g. Theme could be red for the heart etc.) Make sure your theme has thematic props, and a photo corner, so you will be able to promote the success of your party also after the event, and market it in the future. Ensure you have a solid strategy, planning and timeline for follow-up 3. Capacity Building Opportunities and WNTD Conference: A Conference’s target group will be smaller compared to that of an Information Stand, but would be advantageous as more information can be transmitted to the participants. Inviting medical students and elder people can help both increase visibility of your NMO within the student community as well as recruit motivated students to take part in other interventions you will be organizing. It also gives a chance for increased interaction between civil society and medical students and a forum for voices of people to be heard and inculcating a sense of relevance for them. By inviting important members of your community, you can increase the visibility of the event, and make some noise for a follow-up Activity such as an Info Stand. Training workshops about CVDs for medical students, organized by LMOs Inclusion of CVDs during SCOPH sessions at Meetings Training of community leaders and upcountry health workers on screening and SANDY JONES AIMEE LORENZ LIM PAUL SANDERS prevention of CVDs BECKHAM Training workshops in higher institutions of learning and secondary schools to increase knowledge about CVDs
4. Online Campaign: The main benefits of an Online Campaign are that the potential outreach of a single post can be gigantic, and the efforts put into it can be minimal, compared to other Activities. A Media Campaign can help have a greater impact in terms of visibility of your message, or can simply help you create an atmosphere of cohesion between you and your team, if everyone is participating. It can also aid the international work of multiple organizations, if you take part in their Media Campaign, instead of organizing your own e.g. Selfie Apps, Facebook Frames, Challenges to make photos with and use them as Profile Pictures. This Activity could be a good choice if time is limited, as well as other resources. Any of these can either be made by you, or you can share ones already created by someone else. What you can post on Social Media, to promote your campaign:
Photos Videos Articles Posts (Facebook, Twitter, Instagram etc.) Polls
MANUAL ON CARDIOVASCULAR DISEASE
5. Fundraising: The bottom line is that fundraisers are about raising money for a great cause, but also to have a good time. Play to your strengths, and involve something you love as part of your easy fundraiser idea – whether that’s socializing, getting physical, getting an overdue spring-clean over and done with, or anything else. If your NMO would like to raise money for NCD awareness, there are a number of ways to solicit donations.
Change jar at local restaurants: Ask restaurant to put out a jar for donations of spare change. Coin drop: Speak with your community and arrange a coin drop on one of the more active streets. Create signs and let them know who you’re fundraising for! Local Business with Heart: Ask the local pool, bowling alley, golf course, indoor children’s play center, etc. to designate a single day as a fundraiser for the event and donate all profits, % of sales for the day, or specific dollar amount. Ask local media to help with the promotion. Cover Charge at Local Venue: See if a local venue (comedy store, club) would be willing to have the cover charge for a particular night. Conduct a Sports Event or Tournament: Karaoke Night: Ask a local bar who offers Karaoke to designate one night “Heart Night” and ask for a donation as admission Talent show: Get friends, family and colleagues together for a talent show! SANDY JONES AIMEE LORENZ LIM PAUL SANDERS Raise money through ticket sales to help fund lifesaving research. BECKHAM Celebrity Show: Find celebrities of your country who volunteers to talk show, Raise money through ticket sales. University challenge -Take on your local university for the challenge and invite students, friends and family to donate for tickets to the event. Talk to the student's union to see if they can help organize.
TIPS Some videos and images are protected by Copyright! Make sure you check the sources of all of your materials to make sure that uploading them yourself will not lead to problems for you. Very often you can check Copyright terms by scrolling to the very bottom of websites and clicking on “Terms of Use”. There are strict rules about how IFMSA logos can be used. Please consult the IFMSA Corporate Identity Manual to make sure you are not using Federation logos the wrong way. Choosing to organize a Media Campaign as an Activity alone does not mean that you do not need a Vision, Goals and clear Objectives - these are always useful and crucial to a successful Campaign!
4. Projects and NCDs 1. YOUTH EDUCATION ACTIVITIES ON NCDs (YEAN PROJECT) - MEDSAR RWANDA :
Problem Statement: Non communicable diseases (NCDs) are one of the biggest public health challenges of the 21st century. The social and economic impact of NCDs are threatening progress towards sustainable development. NCDs are the leading causes of death. Global estimates suggest that 40 million deaths, or 75% of the 53 million deaths that occurred globally in 2010, were due to non-communicable diseases and injuries, comprising mainly of cardiovascular diseases (30%), cancers (15%), chronic respiratory diseases (7%) and diabetes (2%). WHO estimates that deaths from NCDs are likely to increase globally by 17% over the next 10 years. In Rwanda, NCDs accounted for at least 51.86% of all District Hospital outpatients’ consultation and 22.3% of District Hospital hospitalization (HMIS, 2013). Description: NCDs especially lifestyle diseases emerge after a longtime exposure to unhealthy standard of living commonly acquired in adolescence like tobacco use, alcohol consumption, lack of regular physical activity and unhealthy diet. The main goal of the project is to improve the healthy lifestyle of Rwandan youth. This is being done by improving the knowledge about Non-Communicable Diseases (NCDs) in 5 high schools in Kigali and the Southern Province of Rwanda, at Healthcare Centres, and at Community works. We are also improving the knowledge on healthy diet and NCDs among high school students and implement kitchen gardens at the same high schools where we are teaching NCDs. In addition we have already advocated for monthly sports days and are still advocating for implementation of smoking areas at the University of Rwanda to avoid passive smoking. In order to achieve this, meetings are being conducted with high schools, the University in Rwanda and local authorities. Related to capacity building we are focus on expanding the position of women in MEDSAR by conducting special women nights and expanding the members’ knowledge on leadership
Description of Team members and target group: The Project is a partnership between MEDSAR and IMCC Rwanda and is made of three parts, Education, Advocacy and capacity building. The project coordination Team is made of 8 people one Coordinator, 3 vice coordinators one on each part, 3 secretaries and 3 treasurers. The primary target group are medical students who were trained and are training others in high schools (Secondary target group). The last is with the communities around which are aimed at being reached in the projects including other university students for which we will advocate for smoke free places and monthly sports days which are already achieved.
Project design: As said above, the project is designed in 3 parts and expected to work for 2 years. Initially a pretest to assess the already possessed knowledge and attitudes towards NCDs was made and will do others throughout and at the end of the project to analytically compare them for effective evaluation and impact measurement. Initial Impressions and challenges, next steps: The project came in need to fill the gap in taking measure of NCDs. The challenge is that the University has not yet accepted the smoking areas but we are mitigating to find other possible approaches.
2. GENERAL PUBLIC AWARENESS ON STROKE IDENTIFICATION - IFMSA-Brazil C o n s i d e r i n g t h e B r a z i l i a n r e a l i t y , f o r 2 0 y e a r:s , s t r o k e w a s a m a j o r c a u s e o f m o r b i d i t y a n d
mortality, and since 2011 it has lost only to acute coronary syndromes¹. It is a problem that can occur suddenly in any age, sex or, social class. Often it affects not only the patient, but also their family, and they can leave sequels that prevent basic activities of daily life without the aid of a helper, modifying personal services, professionals, and habits2,3. Motor and cognitive disabilities strokes-related issues can be mitigated with correct early approach4. Linked to this, it is important to know the risk factors that are: age, sex, cardiovascular diseases, smoking, diabetes, sedentarism, alcohol, drugs, and use of oral contraceptives4,5. Some of them are in great proportions in the Brazilian population, making the group of users with a greater risk of permanent disability. It shows a situation in which you must be informed about the risks and how to prevent and reduce the number of bad outcomes caused by strokes. For this reason, a stroke campaign is planned and organized to increase awareness of the population passing through the downtown of Pelotas, which is sometimes not aware of what can lead to a stroke. According to the study by Costa et al. in 2008, which evaluated the knowledge of 486 people living in Pelotas in the state of Rio Grande do Sul of Brazil, 71% did not know the signs and symptoms of stroke and 54% have inadequate knowledge about risk factors6. Therefore, a stroke campaign conducted by the IFMSA UFPel local committee had its fifth edition. In order to present the results and show the importance of the campaign carried out for a general population, this experience report tries to share with all IFMSA related groups an activity with good potential for a great impact on the general population. .
The AVC campaign was carried out between April and June 2017, and auxiliary material was made available through “Rede Brasil AVC”7 – a Brazilian nonprofit organization dedicated to the reduction of death and disability from stroke. Publicity was achived by means of posters by the Federal University of Pelotas (UFPel) and by social networks, with the intention of reaching the largest number of academics of health courses. .
"CONSIDERING THE BRAZILIAN REALITY, FOR 20 YEARS, STROKE WAS A MAJOR CAUSE OF MORBIDITY AND MORTALITY."
The training was given by a professor of the Medical School – UFPel, where the participating students learned about strokes and how to educate the general population. The campaign took place on June 1, in downtown Pelotas in the morning and afternoon. Pamphlets were distributed with a mnemonic "SAMU" (Scale of Cincinnati adapted): Smile; A hug; Music and, Urgency; for a search for signs like a fall of the lip rhyme, a loss of strength in one of the limbs, a difficulty in speech, and if one of these symptoms, ask for help. In the end, we asked for feedback of the campaign from the students and the population, through the response of a questionnaire with a scale of subjective impact of the campaign. We attended with 38 students from health and education courses and 934 lay people, mostly adults and elderly. Of these, 623 (67%) accepted to listen on the causes, symptoms, and complications of the stroke. The other 311 received only the pamphlets. Among those who received the guidelines, 74% said they already know the disease, also said they knew at least one risk factor, and among the risk factors, hypertension was the most known, with 95 people mentioning it. It is followed by smoking, where 74 people said they knew to be a risk factor. With the participating students, the questionnaire presented 22 answers. About the pathophysiology, 15 participants answered that learned as “reasonable”, 3 “less than expected” and 4 “more than expected”. About signs and symptoms, 11 participants responding to the knowledge increase as “reasonable”, 8 “more than expected”, 2 “less than expected” and 1 “nothing more”. On the topic of prevention and risk factors, 15 students reported their gain as “reasonable” and 7 “more than expected”. When asked how much they improved in relation to communication with a population, 16 reported that they improved “more than expected”, 4 “reasonably” and 2 “less than expected”. Therefore, it was concluded that the campaign was successful since it contributed to the knowledge of laymen and academics, as well as new editions, in which new date will be collected in order to carry out an evaluation of the development of the campaign. .
5. evaluate your work " How to End " Evaluating your projects is crucial in order to compare the results with the initial objectives and measure the impact created. It is useful to know the things that have worked, and the things to be changes for the next time.It is important to include the members who took part in preparing your activity in the evaluation process, as the lessons learnt from this project will serve as a basis for future ones. In 3 key points, it is important to perform an evaluation about your Activity: So you know if you are making an impact So you are aware of unintended outcomes So to build organizational resilience within the team So you can improve your Activity in the future Provide evidence of impact is essential for successful organisations. This can be done by gathering, analyzing and presenting scientific data which prove that work was performed, activities implemented and a difference was made in society through it.
Proof of Impact can be achieved in multiple ways: .
1. Feedback is a subjective way of gaining important information about the design, implementation and impact of your Activity from the population’s perspective, from the organizers, the collaborators and others. When gathering feedback from the public, they generally feel comfortable with medical students as a model for health promotion and do not have difficulties in sharing their thoughts and engaging in campaigns.Also consider adding an open question to your feedback survey, giving participants space to share anything they might feel they want to add and let you know about what they think. To add ‘qualitative’ rather than ‘quantitative’ evaluation information about your Activity, you can also randomly organize slightly longer interviews with certain members of your Target Group. This will allow you to explore the opinions of your participants or collaborators more in-depth, and can result in very useful information to improve your Activity in the future.
Example Questions Do you feel like you learned valuable information about Heart diseases? Yes / No Do you feel like you have learned about the principal risk factors for heart diseases? Yes/No Do you think you will change something in your lifestyle after experiencing this Activity? Yes/No Please rate from 1 to 10 how important you thought awareness about heart diseases was before experiencing this Activity Please rate from 1 to 10 how important you think awareness about heart diseases is after experiencing this Activity Do you have any comments you would like to share with us?
TIPS When you create feedback surveys, make sure they are adapted to the people you are presenting them to (a survey for your colleagues might have to be different than a survey for participants!). Do not include too many questions in your survey, and keep the questions short (also ask questions that can have short answer)! People do not like to spend more than 1-3 minutes on a survey. Limit the number of questions to the strict essential, less is more!
2. Data gathering is an objective method of evaluating your Activity. It will give you a clear idea about the magnitude of your Activity, and help realize whether you have met your objectives or not. If you are to organize massive outreach campaigns targeting the general population (e.g screening campaigns), you can analyze the data collected in a form of a retrospective study that will show correlations in the results found, but also provide recommendations for further campaigns in the methodology used. Examples of Data Gathering: Number of people who participated in your Activity Number of people who answered your surveys Number of screening tests performed Number of flyers distributed Screening values
3. Measuring change Measuring the change in the participants’ Knowledge or Behaviour is also an objective method of evaluating your Activity. Often evaluating knowledge can be easier than analyzing behavioural changes. There are however multiple difficulties tied to both types of this evaluation.
Methods: “Pre-” and ”post-” surveys: For any Activity you conduct, you can perform this type of evaluation. If you are to conduct workshops or conferences, it would be good to share pre-surveys to assess the preliminary knowledge of participants related to the topic of the event. At the end, assess if their opinion and responses have changed following the event, to evaluate the level of comprehension and whether the take-home messages were impactful.The questions included in the Pre- survey, have to be the same as in the Post- survey, so you can evaluate the difference in response, and therefore the difference in knowledge. The distance between a Pre- and Post- survey can vary between a few minutes and months. They can be delivered right at the start and then the end of your Activity, or can be sent to your participants 1 month before, and then again 1 month after the Activity. How this happens will depend on the number of participants, your contact with them, and the objectives of your Activity. To include behavior in this type of evaluation you can include questions like: Example of Questions: - Describe your dietary habits and your physical activity routine - From 1 to 10, how much attention do you pay to buying healthy food? - How many times a week do you perform sports?
TIP: To effectively evaluate changes in knowledge and behavior, it would be ideal to plan a considerable distance between your Pre- and Post- survey. Answering a knowledge survey 5 minutes after hearing information is not the same as having to answer the same survey 2 weeks later. Similarly, it takes time to modify habits, and evaluating behaviour changes can be a lot more meaningful if it is done a few weeks after the Activity.
4. Evaluation Strategy It is crucial t to define an evaluation strategy before you start your Activity. To ensure it is clear how you will measure whether your objectives have been reached or not. For example: If your objective is “Talk to at least 60 adults aged between 35-75 about practices for healthy lifestyle for 4 hours to spread awareness’ , you will have to make sure to put someone in charge of counting participants, asking them their age, and someone keeping track of time. You will also have to make sure there is a way for you to easily access this information after the Activity. For each objective, analyze what evaluation tools you can and will use, and make sure to prepare for them carefully.Remember to plan a timeline also for the evaluation and follow-up of your Activity - do not forget that quality evaluation can take time.Once your evaluation is complete, make sure you can use the analysis of your data to improve your Activity in the future, as well as approach other parties with the proof of your impact, to increase the support you will have in the future. Be sure to plan a solid evaluation strategy.
MANUAL ON CARDIOVASCUALR DISEASE
"GENIUS IS IN THE IDEA. IMPACT, HOWEVER, COMES FROM ACTION! "
Measuring Impact on a higher level: how we measure impact as a Federation a. Centralizing activities: The IFMSA NCDs and Healthy Lifestyles Program Programs in IFMSA exist in order to help you set the basics for your Activity in terms of project management, to help you measure the impact on the federation level and to showcase your activity with the NMOs and potentially to externals. Programs represent a series of platforms, each gathering all the Activities related to specific topics. In this context, Cardiovascular Diseases fall under the Healthy Lifestyles and Non communicable Diseases Program whose Program Coordinator is appointed to gather all the Activities, projects and actions , as well as analyzing the data collected. The Program Coordinator can also provide you with best examples of Activities performed in this domain as well as give advice on project management. .
b. How to enroll your Activity in the Program? To enroll your activity, you have to send the Candidature Form, signed and stamped by your NMO president and complete the Enrollment Form with basic information about your Activity. You can contact the Program Coordinator or visit ifmsa.org to get the Enrollment and Candidature Forms to allow your NMO to include all their Activities into the Program. After your Activity, you have to submit the Report Form (also supplied by the Program Coordinator) to show how your activity was conducted, and supply IFMSA with data about its impact. This is how we can review your Activity and measure the impact of it, of your NMO and adding up the single impacts of all the enrolled Activities, we can finally evaluate the impact we have as a Federation. If you want to know more about Programs consult the Programs Toolkit.
c. Receiving support from the Program Coordinators One of the most important things Programs are here for, is to teach coordinators how to conduct and evaluate Activities. Program Coordinators can support members both with Activity enrollment as well as with the content of the Activity itself, the starting resources, structure, etc. IFMSA Programs will be effective and gain more visibility only when all the IFMSA members are well introduced to the work of Programs and are aware about how to participate in them. Fortunately, it is simple and we look forward to gathering all the events being done for cardiovascular diseases and their risk factors. For any support feel free to send an Email to the NCDs and Healthy Lifestyles Program Coordinator (ncd@ifmsa.org)
6. External stakeholders NCDs
a) Third UN High-level Meeting on NCDs: On September 27th 2018, the United Nations General Assembly is staging the third Highlevel Meeting on the prevention and control of NCDs, which will undertake a comprehensive review of the global and national progress achieved in putting measures in place that protect people from dying too young from heart and lung diseases, cancers and diabetes. In the preparation process several events have already passed and are planned to happen. In addition two advice groups to the WHO director general have been formed: WHO Independent High-Level Commission on NCDs Established in october 2017 for 2 years. The commission aims to advise the WHO Director-General on how to accelarate progress towards SDG target 3.4 and to make recommendations on ensuring the UN HLM will be a tipping for the response, how to operationalise commitments for the UN HLM. Their first report will be published in May 2018. WHO Civil society Working Group on NCDs - This working group aims to represent the broad variety of Civil Society and has the mandate to advise the WHO Director General on meaningful engagement of civil society in the UN HLM and to help mobilise high-level attendance and a network of political champions.
The negotiations on the outcome document for the 3rd UN HLM on NCDs have started among member states from March 2018 and a first outcome document is expected around the end of May. A civil society hearing on this document will be held in July 2018. For more information visit: http://www.who.int/ncds/governance/third-un-meeting/en/
b) NCD Alliance: T h e N C D A i s a n: a l l i a n c e , f o u n d e d b y f o u r N G O s : t h e I n t e r n a t i o n a l U n i o n a g a i n s t C a n c e r (UICC), the International Diabetes Federation (IDF), the World Heart Federation (WHF) and the International Union against Lung Disease and Tuberculosis (The Union), and it was created in May 2009. The NCDA tackles the four main NCDs outlined in the World Health Organization’s 2008-2013 Action Plan for NCDs: Cardiovascular Diseases (CVDs) Cancer Chronic Respiratory Diseases and Diabetes. They also represent the four shared risk factors, namely, tobacco use, harmful use of alcohol, physical inactivity and unhealthy diets. The NCDA works towards the recognition of NCDs as a major cause of poverty, a barrier to economic development and as a global emergency. ⇒ NCDA also has national and regional branches you are welcome to collaborate with. You can also join their campaigns. You can find them here.
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