• Overview
  • Obesity prevalence
  • Trends over time
  • Population breakdowns
  • Drivers
  • Comorbidities
  • Policies
  • Contextual factors
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Obesity prevalence

Adults, 2013-2014

Survey type:Measured
Age:25-64
Sample size:1240
Area covered:National
References:National Survey of Noncommunicable Diseases in Seychelles 2013-2014 (Seychelles Heart Study IV) available at https://serval.unil.ch/resource/serval:BIB_1233D41F200A.P001/REF.pdf (available at 20.10.20)
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Adults, 2004

Survey type:Measured
Age:25-64
Sample size:1255
Area covered:National
References:Bovet P, Chiolero A, Shamlaye C and Paccaud F. (2008). Prevalence of overweight in the Seychelles:15 year trends and association with socio-economic status. Obesity Reviews, 9: 511 - 517
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Adults, 1994

Survey type:Measured
Age:25-64
Sample size:1059
References:Conen D, Wietlisbach V, Bovet P, Shamlaye C, Riesen W, Paccaud F, Burnier Michel. Prevalence of hyperuricemia and relation of serum uric acid with cardiovascular risk factors in a developing country. BMC Public Health 2004;4:9
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Adults, 1989

Survey type:Measured
Age:25-64
Sample size:1081
References:P. Bovet, A. Chiolero, C. Shamlaye and F. Paccaud. Secular trends in overweight in Seychelles. Obesity Reviews 2008;9:511-517
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Children, 2019

Survey type:Measured
Age:9-16
Sample size:Approx 5000
Area covered:National
References:Mangroo G, Marie G, Bovet P. School Screening Programme: Update of the prevalence of overweight and obesity between 1998 and 2019. Data published in the National Health Strategic Plan 2022-2026 http://www.health.gov.sc/wp-content/uploads/National-Health-Strategic-Plan-2022-2026-Full-Version.pdf
Notes:Please note: Original paper not found, methodology found in earlier publications and methodology assumed to be the same though not confirmed.
Cutoffs:IOTF

Children, 2016

Survey type:Measured
Age:5-16
Sample size:3738
Area covered:National
References:Aly R, Viswanathan B, Mangroo G, Gedeon J, Bovet P. Trends in obesity, overweight, and thinness in children in the seychelles between 1998 and 2016.Obesity (Silver Spring). 2018 Feb 5. doi: 10.1002/oby.22112. [Epub ahead of print]
Notes:Data available between 1998-2016 IOTF International Cut off applied
Cutoffs:IOTF

Children, 2015

Survey type:Self-reported
Age:13-17
Sample size:2540
Area covered:National
References:Global School-based Student Health Survey Fact Sheet, https://www.who.int/ncds/surveillance/gshs/gshs_fs_seychelles_2015.pdf (last accessed 24.11.20)
Cutoffs:WHO

Children, 2014

Survey type:Measured
Age:5-16
Area covered:National
References:Mangroo G, Viswanathan B, Marie G, Bovet P (2017). Overweight, obesity and walking time among children and adolescents: findings from the School Screening Program in 2016 and comparison with findings since 1998. Public Health Authority, Ministry of Health, Seychelles
Cutoffs:IOTF

Children, 2012

Survey type:Measured
Age:5-16
Area covered:National
References:Mangroo G, Viswanathan B, Marie G, Bovet P (2017). Overweight, obesity and walking time among children and adolescents: findings from the School Screening Program in 2016 and comparison with findings since 1998. Public Health Authority, Ministry of Health, Seychelles
Cutoffs:IOTF

Children, 2007

Survey type:Self-reported
Age:13-15
Sample size:1432
Area covered:National
References:Global School-based Student Health Survey https://www.who.int/ncds/surveillance/gshs/Seychelles_2007_GSHS_Fact_Sheet.pdf?ua=1 (last accessed 24.11.20)
Cutoffs:WHO

Children, 2006

Survey type:Measured
Age:5-16
Area covered:National
References:Mangroo G, Viswanathan B, Marie G, Bovet P (2017). Overweight, obesity and walking time among children and adolescents: findings from the School Screening Program in 2016 and comparison with findings since 1998. Public Health Authority, Ministry of Health, Seychelles
Cutoffs:IOTF

Children, 2004

Survey type:Measured
Age:5-16
Area covered:National
References:Mangroo G, Viswanathan B, Marie G, Bovet P (2017). Overweight, obesity and walking time among children and adolescents: findings from the School Screening Program in 2016 and comparison with findings since 1998. Public Health Authority, Ministry of Health, Seychelles
Cutoffs:IOTF

Children, 2004-2006

Survey type:Measured
Age:9-15
Sample size:8462
Area covered:National
References:Bovet P, Chiolero A, Madeleine G, Paccaud F. Prevalence of overweight and underweight in public and private schools in the Seychelles. IJPO 2010;5:274-278
Notes:IOTF Cut off. Reference: Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard definition for child overweight and obesity worldwide: International survey. BMJ. 2000 May 6;320(7244):1240-3. The survey looks specifically at schools and therefore the total sample may not be truly representative, though currently the best available.
Cutoffs:IOTF

Children, 2002

Survey type:Measured
Age:5-16
Area covered:National
References:Mangroo G, Viswanathan B, Marie G, Bovet P (2017). Overweight, obesity and walking time among children and adolescents: findings from the School Screening Program in 2016 and comparison with findings since 1998. Public Health Authority, Ministry of Health, Seychelles
Cutoffs:IOTF

Children, 2000

Survey type:Measured
Age:5-16
Area covered:National
References:Mangroo G, Viswanathan B, Marie G, Bovet P (2017). Overweight, obesity and walking time among children and adolescents: findings from the School Screening Program in 2016 and comparison with findings since 1998. Public Health Authority, Ministry of Health, Seychelles
Cutoffs:IOTF

Children, 1999

Survey type:Measured
Age:17
Sample size:5514
Area covered:National
References:Steller N, Bover P, Shamlaye H, Zemel BS, Stallings VA, Paccaud F. Prevalence and risk factors for overweight and obesity in children from Seychelles, a country in rapid transition: the importance of early growth. International Journal of Obesity. 2002;26:214-219
Cutoffs:IOTF

Children, 1998

Survey type:Measured
Age:5-16
Area covered:National
References:Mangroo G, Viswanathan B, Marie G, Bovet P (2017). Overweight, obesity and walking time among children and adolescents: findings from the School Screening Program in 2016 and comparison with findings since 1998. Public Health Authority, Ministry of Health, Seychelles
Cutoffs:IOTF

Overweight/obesity by age

Children, 1999

Survey type:Measured
Sample size:5514
Area covered:National
References:Steller N, Bover P, Shamlaye H, Zemel BS, Stallings VA, Paccaud F. Prevalence and risk factors for overweight and obesity in children from Seychelles, a country in rapid transition: the importance of early growth. International Journal of Obesity. 2002;26:214-219
Cutoffs:IOTF

Insufficient physical activity

Adults, 2016

References:Guthold R, Stevens GA, Riley LM, Bull FC. Worldwide trends in insufficient physical activity from 2001 to 2016: a pooled analysis of 358 population-based surveys with 1.9 million participants. Lancet 2018 http://dx.doi.org/10.1016/S2214-109X(18)30357-7

Men, 2016

References:Guthold R, Stevens GA, Riley LM, Bull FC. Worldwide trends in insufficient physical activity from 2001 to 2016: a pooled analysis of 358 population-based surveys with 1.9 million participants. Lancet 2018 http://dx.doi.org/10.1016/S2214-109X(18)30357-7

Women, 2016

References:Guthold R, Stevens GA, Riley LM, Bull FC. Worldwide trends in insufficient physical activity from 2001 to 2016: a pooled analysis of 358 population-based surveys with 1.9 million participants. Lancet 2018 http://dx.doi.org/10.1016/S2214-109X(18)30357-7

Children, 2016

Survey type:Self-reported
Age:11-17
References:Global Health Observatory data repository, World Health Organisation, https://apps.who.int/gho/data/node.main.A893ADO?lang=en (last accessed 16.03.21)
Notes:% of school going adolescents not meeting WHO recommendations on Physical Activity for Health, i.e. doing less than 60 minutes of moderate- to vigorous-intensity physical activity daily.
Definitions:% Adolescents insufficiently active (age standardised estimate)

Boys, 2016

Survey type:Self-reported
Age:11-17
References:Global Health Observatory data repository, World Health Organisation, https://apps.who.int/gho/data/node.main.A893ADO?lang=en (last accessed 16.03.21)
Notes:% of school going adolescents not meeting WHO recommendations on Physical Activity for Health, i.e. doing less than 60 minutes of moderate- to vigorous-intensity physical activity daily.
Definitions:% Adolescents insufficiently active (age standardised estimate)

Girls, 2016

Survey type:Self-reported
Age:11-17
References:Global Health Observatory data repository, World Health Organisation, https://apps.who.int/gho/data/node.main.A893ADO?lang=en (last accessed 16.03.21)
Notes:% of school going adolescents not meeting WHO recommendations on Physical Activity for Health, i.e. doing less than 60 minutes of moderate- to vigorous-intensity physical activity daily.
Definitions:% Adolescents insufficiently active (age standardised estimate)

Children, 2010

Age:11-17
References:Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A893?lang=en
Notes:% of school going adolescents not meeting WHO recommendations on Physical Activity for Health, i.e. doing less than 60 minutes of moderate- to vigorous-intensity physical activity daily.
Definitions:% Adolescents insufficiently active (age standardised estimate)

Boys, 2010

Age:11-17
References:Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A893?lang=en
Notes:% of school going adolescents not meeting WHO recommendations on Physical Activity for Health, i.e. doing less than 60 minutes of moderate- to vigorous-intensity physical activity daily.
Definitions:% Adolescents insufficiently active (age standardised estimate)

Girls, 2010

Age:11-17
References:Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A893?lang=en
Notes:% of school going adolescents not meeting WHO recommendations on Physical Activity for Health, i.e. doing less than 60 minutes of moderate- to vigorous-intensity physical activity daily.
Definitions:% Adolescents insufficiently active (age standardised estimate)

Average daily frequency of carbonated soft drink consumption

Children, 2009-2015

Survey type:Measured
Age:12-17
References:Beal et al. (2019). Global Patterns of Adolescent Fruit, Vegetable, Carbonated Soft Drink, and Fast-food consumption: A meta-analysis of global school-based student health surveys. Food and Nutrition Bulletin. https://doi.org/10.1177/0379572119848287 sourced from Food Systems Dashboard http://www.foodsystemsdashboard.org/food-system

Estimated per capita fruit intake

Adults, 2017

Survey type:Measured
Age:25+
References:Global Burden of Disease, the Institute for Health Metrics and Evaluation http://ghdx.healthdata.org/
Definitions:Estimated per-capita fruit intake (g/day)

Prevalence of less than daily fruit consumption

Children, 2009-2015

Survey type:Measured
Age:12-17
References:Global School-based Student Health Surveys. Beal et al (2019). Global Patterns of Adolescent Fruit, Vegetable, Carbonated Soft Drink, and Fast-food consumption: A meta-analysis of global school-based student health surveys. Food and Nutrition Bulletin. https://doi.org/10.1177/0379572119848287. Sourced from Food Systems Dashboard http://www.foodsystemsdashboard.org/food-system
Definitions:Prevalence of less-than-daily fruit consumption (% less-than-daily fruit consumption)

Prevalence of less than daily vegetable consumption

Children, 2009-2015

Survey type:Measured
Age:12-17
References:Beal et al. (2019). Global Patterns of Adolescent Fruit, Vegetable, Carbonated Soft Drink, and Fast-food consumption: A meta-analysis of global school-based student health surveys. Food and Nutrition Bulletin. https://doi.org/10.1177/0379572119848287 sourced from Food Systems Dashboard http://www.foodsystemsdashboard.org/food-system
Definitions:Prevalence of less-than-daily vegetable consumption (% less-than-daily vegetable consumption)

Average weekly frequency of fast food consumption

Children, 2009-2015

Age:12-17
References:Beal et al. (2019). Global Patterns of Adolescent Fruit, Vegetable, Carbonated Soft Drink, and Fast-food consumption: A meta-analysis of global school-based student health surveys. Food and Nutrition Bulletin. https://doi.org/10.1177/0379572119848287 sourced from Food Systems Dashboard http://www.foodsystemsdashboard.org/food-system

Estimated per-capita processed meat intake

Adults, 2017

Survey type:Measured
Age:25+
References:Global Burden of Disease, the Institute for Health Metrics and Evaluation http://ghdx.healthdata.org/
Definitions:Estimated per-capita processed meat intake (g per day)

Estimated per capita whole grains intake

Adults, 2017

Survey type:Measured
Age:25+
References:Global Burden of Disease, the Institute for Health Metrics and Evaluation http://ghdx.healthdata.org/
Definitions:Estimated per-capita whole grains intake (g/day)

Mental health - depression disorders

Adults, 2015

References:Prevalence data from Global Burden of Disease study 2015 (http://ghdx.healthdata.org) published in: Depression and Other Common Mental Disorders: Global Health Estimates. Geneva:World Health Organization; 2017. Licence: CC BY-NC-SA 3.0 IGO.
Definitions:% of population with depression disorders

Mental health - anxiety disorders

Adults, 2015

References:Prevalence data from Global Burden of Disease study 2015 (http://ghdx.healthdata.org) published in: Depression and Other Common Mental Disorders: Global Health Estimates. Geneva:World Health Organization; 2017. Licence: CC BY-NC-SA 3.0 IGO.
Definitions:% of population with anxiety disorders

Raised blood pressure

Adults, 2015

References:Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A875?lang=en
Definitions:Age Standardised estimated % Raised blood pressure 2015 (SBP>=140 OR DBP>=90).

Men, 2015

References:Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A875?lang=en
Definitions:Age Standardised estimated % Raised blood pressure 2015 (SBP>=140 OR DBP>=90).

Women, 2015

References:Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A875?lang=en
Definitions:Age Standardised estimated % Raised blood pressure 2015 (SBP>=140 OR DBP>=90).

Raised cholesterol

Adults, 2008

References:Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A885
Definitions:% Raised total cholesterol (>= 5.0 mmol/L) (age-standardized estimate).

Men, 2008

References:Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A885
Definitions:% Raised total cholesterol (>= 5.0 mmol/L) (age-standardized estimate).

Women, 2008

References:Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A885
Definitions:% Raised total cholesterol (>= 5.0 mmol/L) (age-standardized estimate).

Raised fasting blood glucose

Men, 2014

References:Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A869?lang=en
Definitions:Age Standardised % raised fasting blood glucose (>= 7.0 mmol/L or on medication).

Women, 2014

References:Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A869?lang=en
Definitions:Age Standardised % raised fasting blood glucose (>= 7.0 mmol/L or on medication).

Diabetes prevalence

Adults, 2021

Age:20-79
Area covered:National
References:Reproduced with kind permission International Diabetes Federation.  IDF Diabetes Atlas, 10th edn. Brussels, Belgium:International Diabetes Federation, 2021. http://www.diabetesatlas.org
Definitions:Age-adjusted comparative prevalence of diabetes, %

Adults, 2019

Age:20-79
References:Reproduced with kind permission International Diabetes Federation. IDF Diabetes Atlas, 9th edn. Brussels,Belgium: 2019. Available at: https://www.diabetesatlas.org
Definitions:Diabetes age-adjusted comparative prevalence (%).

Adults, 2017

References:Reproduced with kind permission of IDF, International Diabetes Federation. IDF Diabetes Atlas, 8th edition. Brussels, Belgium: International Diabetes Federation, 2017. http://www.diabetesatlas.org
Definitions:Diabetes age-adjusted comparative prevalence (%).

Policies, Interventions and Actions

National Health Strategic Plan 2022-2026

This National Health Strategic Plan aims to Declare obesity as a public health emergency and introduce population-based and multi-level approaches to gain participation from multiple actors Develop national framework to prevent and manage obesity

Categories:Evidence of Nutritional or Health Strategy/ Guidelines/Policy/Action plan
Categories (partial):Evidence of National Obesity Strategy/Policy or Action plan
Year(s):2022-2026
Find out more:www.health.gov.sc

Food Based Dietary Guideline

Preface: The new Food-Based Dietary Guidelines (FBDGs) for Seychelles translate the most up-to-date scientific evidence into layman/everyday terms for the target population. It takes into account Seychellois culture and specifies the recommended dietary intake across the life course. It seeks to promote greater awareness and knowledge that encourage healthy food choices as part of a healthier lifestyle and as a means of reducing the risk of diet-related diseases.

Categories:Evidence of Nutritional or Health Strategy/ Guidelines/Policy/Action plan
Year(s):2020 (ongoing)
Target age group:Adults and children
Organisation:Ministry of Health
Find out more:www.health.gov.sc
References:SEYCHELLES Food-Based DietAry GUIDELINES: 2020. Minisry of Health, FAO

Food Act (Labelling of Pre-Packaged Foods) Regulations, 2019

Mandatory national labelling guidelines for pre-packaged food approved by the Minister Of Family Affairs and adopted from March 2019. (Available only in English language)

Categories:Labelling Regulation/Guidelines
Year(s):2019 (ongoing)
Target age group:Adults and children
Organisation:Minister Of Family Affairs
Linked document:Download linked document
References:Information provided with kind permission of WHO Global database on the Implementation of Nutrition Action (GINA): https://extranet.who.int/nutrition/gina/en/node/41882 (last accessed 03.08.22)

Sugar Tax Seychelles

As of 1st April 2019, additional rates will be applied under Excise Tax as Sugar Tax, as specified in the Statutory Instrument (SI) 14 of 2019, Excise Tax (Imposition of sugar tax on Drinks) Regulations, 2019. The Sugar Tax apply to drinks containing sugar content exceeding 5 grams per 100ml, including flavored milk. Sugar Tax will not apply to fresh local fruits drinks without any additives and plain milk. Link will direct you to foods liable for sugar tax

Categories:Taxation/Subsidies on Food or Beverages or law relating to public health
Year(s):2019 (ongoing)
Target age group:Adults and children
Organisation:Seychelles Revenue Commission
Find out more:www.src.gov.sc
Linked document:Download linked document

NCD Country Profiles 2018 (Obesity Targets)

The profiles also provide data on the key metabolic risk factors, namely raised blood pressure, raised blood glucose and obesity and National Targets on Obesity (as of 2017)

Categories:Evidence of Obesity Target
Year(s):2017 (ongoing)
Target age group:Adults and children
Organisation:World Health Organisation
References:Noncommunicable diseases country profiles 2018. Geneva: World Health Organization; 2018. Licence: CC BY-NC-SA 3.0 IGO.

Seychelles Strategy for the Prevention and Control of Noncommunicable Diseases, 2016-2025

Categories:Evidence of NCD strategy
Year(s):2016-2025
Target age group:Adults and children
Organisation:Ministry of Health
Find out more:www.health.gov.sc

Seychelles Strategy for the Prevention and Control of Non-Communicable Diseases 2016-2025

This Noncommunicable diseases strategy refers to four main noncommunicable diseases (cardiovascular disease, cancer, diabetes and obstructive pulmonary disease), which account for more than 65% of all deaths in Seychelles, and to four main underlying risk behaviours (tobacco use, unhealthy nutrition,physical inactivity and harmful us of alcohol)

Categories:Evidence of NCD strategy
Year(s):2016-2025
Target age group:Adults and children
Organisation:Ministry of Health
Find out more:www.health.gov.sc
Linked document:Download linked document

Sports Strategic Plan 2014 2018

Comprehensive Physical Activity strategy/plan. (Available only in English language)

Categories:Evidence of Physical Activity Guidelines/Policy
Year(s):2014-2018
Target age group:Adults and children
Linked document:Download linked document

National Food and Nutrition Security Policy (NFNSP)

Comprehensive Nutrition strategy (including overweight/obesity). (Available only in English language)

Categories:Evidence of Nutritional or Health Strategy/ Guidelines/Policy/Action plan
Year(s):2013 (ongoing)
Target age group:Adults and children
Linked document:Download linked document
References:Information provided with kind permission of WHO Global database on the Implementation of Nutrition Action (GINA): https://extranet.who.int/nutrition/gina/en/node/38227 (last accessed 05.08.22)

The Seychelles Dietary Guidelines

The Seychelles dietary guidelines were developed by the Nutrition Unit of the Ministry of Health. They have been endorsed by the Government of Seychelles. (Available only in English language)

Categories:Evidence of Nutritional or Health Strategy/ Guidelines/Policy/Action plan
Year(s):2006 (ongoing)
Target age group:Adults and children
Organisation:Ministry of Health
Linked document:Download linked document
References:https://www.fao.org/nutrition/education/food-dietary-guidelines/regions/countries/seychelles/en/

GNPR 2016-17 (q7) Breastfeeeding promotion and/or counselling

WHO Global Nutrition Policy Review 2016-2017 reported the evidence of breastfeeding promotion and/or counselling (q7)

Categories:Evidence of Breastfeeding promotion or related activity
Target age group:Adults
Organisation:Ministry of Health (information provided by the GINA progam)
Find out more:extranet.who.int
References:Information provided with kind permission of WHO Global database on the Implementation of Nutrition Action (GINA): https://extranet.who.int/nutrition/gina/en

No actions could be found for the above criteria.

Contextual factors

Disclaimer: These contextual factors should be interpreted with care. Results are updated as regularly as possible and use very specific criteria. The criteria used and full definitions are available for download at the bottom of this page.

Tap on a tick to find out more about policies influencing this factor.

Labelling

Is there mandatory nutrition labelling?Present
Front-of-package labelling?Absent
Back-of-pack nutrition declaration?Present
Color coding?Absent
Warning label?Absent

Regulation and marketing

Are there fiscal policies on unhealthy products?Present
Tax on unhealthy foods?Absent
Tax on unhealthy drinks?Present
Are there fiscal policies on healthy products?Absent
Subsidy on fruits?Absent
Subsidy on vegetables?Absent
Subsidy on other healthy products?Absent
Mandatory limit or ban of trans fat (all settings)?Incoming
Mandatory limit of trans fats in place (all settings)? Incoming
Ban on trans-fats or phos in place (all settings)? Absent
Are there any mandatory policies/marketing restrictions on the promotion of unhealthy food/drinks to children?Absent
Mandatory restriction on broadcast media?Absent
Mandatory restriction on non-broadcast media?Absent
Voluntary policies/marketing restrictions on the promotion of unhealthy food/drinks to children?Absent
Are there mandatory standards for food in schools?Absent
Are there any mandatory nutrient limits in any manufactured food products?Absent
Nutrition standards for public sector procurement?Absent

Political will and support

National obesity strategy or nutrition and physical activity national strategy?Present
National obesity strategy?Absent
National childhood obesity strategy?Absent
Comprehensive nutrition strategy?Present
Comprehensive physical activity strategy?Unknown
Evidence-based dietary guidelines and/or RDAs?Present
National target(s) on reducing obesity?Present
Guidelines/policy on obesity treatment?Present
Promotion of breastfeeding?Present

Monitoring and surveillance

Monitoring of the prevalence and incidence for the main obesity-related NCDs and risk factors?Present
Within 5 years?Absent

Governance and resource

Multi-sectoral national co-ordination mechanism for obesity or nutrition (including obesity)?Absent

Key

Present
Present (voluntary)
Incoming
Absent
Unknown

Last updated October 19, 2022

See more policies here

Download contextual factors as a PDF Contextual factors definitions

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