Assessment of the knowledge, attitudes and practices toward respiratory tract infections among the Trinidadian population

Respiratory Tract Infections (RTIs) are currently at the forefront of discussions as the world battles the COVID-19 pandemic. It is important that more awareness is raised on RTIs, their causes, the different types, how they are contracted and spread and complications of and risk factors for RTIs. Prevention measures towards RTIs should also be assessed and encouraged, such as proper hand washing, mask wearing, sneezing and coughing etiquette as well as vaccination. Therefore, this investigation was undertaken to assess the knowledge, attitudes, and practices towards Respiratory Tract Infections (RTIs) among Trinidadian population.

Caregivers' practices, knowledge and beliefs of antibiotics in paediatric upper respiratory tract infections in Trinidad and Tobago: a cross-sectional study

BACKGROUND: Antibiotic overuse and misuse for upper respiratory tract infections in children is widespread and fuelled by public attitudes and expectations. This study assessed knowledge, beliefs, and practices regarding antibiotic use for these paediatric infections among children's caregivers' in Trinidad and Tobago in the English speaking Caribbean. METHODS: In a cross-sectional observational study, by random survey children's adult caregivers gave a telephone interview from November 1998 to January 1999. On a pilot-tested evaluation instrument, respondents provided information about their knowledge and beliefs of antibiotics, and their use of these agents to treat recent episodes (< previous 30 days) of upper respiratory tract infections in children under their care. Caregivers were scored on an antibiotic knowledge test and divided based on their score. Differences between those with high and low scores were compared using the chi-square test. RESULTS: Of the 417 caregivers, 70% were female and between 18-40 years, 77% were educated to high school and beyond and 43% lived in urban areas. Two hundred and forty nine (60%) respondents scored high (>or12) on antibiotic knowledge and 149 (34%) had used antibiotics in the preceding year. More caregivers with a high knowledge score had private health insurance (33%), (p < 0.02), high school education (57%) (p < 0.002), and had used antibiotics in the preceding year (p < 0.008) and within the last 30 days (p < 0.05). Caregivers with high scores were less likely to demand antibiotics (p < 0.05) or keep them at home (p < 0.001), but more likely to self-treat with antibiotics (p < 0.001). Caregivers administered antibiotics in 241/288 (84%) self-assessed severe episodes of infection (p < 0.001) and in 59/126 (43%) cough and cold episodes without visiting a health clinic or private physician (p < 0.05). CONCLUSIONS: In Trinidad and Tobago, caregivers scoring low on antibiotic knowledge have erroneous beliefs and use antibiotics inappropriately. Children in their care receive antibiotics for upper respiratory tract infections without visiting a health clinic or a physician. Educational interventions in the community on the consequences of inappropriate antibiotic use in children are recommended. Our findings emphasise the need to address information, training, legislation and education at all levels of the drug delivery system towards discouraging self-medication with antibiotics in children.

Physician behaviour for antimicrobial prescribing for paediatricupper respiratory tract infections: a survey in general practice inTrinidad, West Indies.

Background: Upper respiratory tract infections (URTIs) are among the most frequent reasons for physician office visits in paediatrics. Despite their predominant viral aetiology, URTIs continue to be treated with antimicrobials. We explored general practitioners' (GPs) prescribing behaviour for antimicrobials in children (¡Ü 16 years) with URTIs in Trinidad, using the guidelines from the Centers for Disease Control and Prevention (CDC) as a reference. Methods: A cross-sectional study was conducted on 92 consenting GPs from the 109 contacted in Central and East Trinidad, between January to June 2003. Using a pilot-tested questionnaire, GPs identified the 5 most frequent URTIs they see in office and reported on their antimicrobial prescribing practices for these URTIs to trained research students. Results: The 5 most frequent URTIs presenting in children in general practice, are the common cold, pharyngitis, tonsillitis, sinusitis and acute otitis media (AOM) in rank order. GPs prescribe at least 25 different antibiotics for these URTIs with significant associations for amoxicillin, co-amoxiclav, cefaclor, cefuroxime, erythromycin, clarithromycin and azithromycin (p < 0.001). Amoxicillin alone or with clavulanate was the most frequently prescribed antibiotic for all URTIs. Prescribing variations from the CDC recommendations were observed for all URTIs except for AOM (50 per cent), themost common condition for antibiotics. Doctors practicing for >30 years were more likely to prescribe antibiotics forthe common cold (p = 0.014). Severity (95.7 per cent) and duration of illness(82.5 per cent) influenced doctors' prescribing and over prescribing in general practice was attributed to parent demands (75 per cent) and concern for secondary bacterial infections (70 per cent). Physicians do not request laboratory investigations primarily because they are unnecessary (86 per cent) and the waiting time for results is too long (51 per cent).

Nosocomial infection in an Intensive Care Unit in a private hospital

The nosocomial infection rate in an Intensive care unit (ICU) of a private hospital was assessed during an 18-month survey. From 629 admissions to the ICU, 139 hospital-acquired infections were identified. The rate was 22.1 percent compared to the overall nosocomial infection rate of 15.3 percent for the entire hospital. In the ICU, the main infections occurred in the respiratory tract, 41 (29.5 percent), followed by surgical wounds, 35 (25.2 percent), urinary tract, 28 (20.1 percent) and the blood stream, 24 (17.3 percent). From 165 bacterial isolates, 80 percent of isolates were gram-negative rods, with P aeruginosa, 48 (36.6 percent), being the predominant gram-negative isolate followed by Klebsiella pneumoniae, 27 (20.6 percent), and Enterobacter sp, 22 (16.8 percent). The main gram-positive isolates were S aureus, 23 (41.8 percent), coagulase-negative Staphylococci, 17 (30.9 percent), and Enterococci, 11 (20.0 percent). Of the 23 S aureus strains, 15 (65.2 percent) were methicillin-resistant (MRSA), (8 MRSA were from surgical wounds, 5 from the respiratory tract and 2 from infected urine). Only 2 of the 17 (11.8 percent) coagulase-negative staphylococci were methicillin-resistant, and both were isolated from wounds. Resistance to ampicillin and augmentin (amoxicillin-clavulanic acid) was high, 81.9 percent and 55.4 percent, respectively. Gentamicin, azteronam, piperacillin-tazobactam showed resistance rates of less than 15 percent. Infection control measures aimed at reducing nosocomial infections at the hospital are often frustrated by apathy of hospital administrators who apparently are insensitive to the high nosocomial infection rate. Effort by the infection control team through seminars, lectures and newsletters have begun to show improvements in attitude and awareness of staff to infection control and preventative measures within the institution. (AU)

Clustering of cases of mycobacterium fortuitum infection investigated by molecular typing

Organisms of the mycobacterium fortuitum complex are recognised but uncommon causes of pulmonary disease, primary cutaneous disease and a wide spectrum of nosocomial infections. M fortuitum was isolated from 20 patients over a 15 month period, with a apparent clustering of isolates occurring from January to March 1994. The molecular epidemiology of this clustering eas investigated using an arbitrary primer polymerase chain reaction method (AP-PCR). 21 isolates were studied, which yielded 13 distinct profiles. Multiple isolates from a single patient yielded identical profiles. All of seven isolates recovered during the six week period from January to March 1994 shared a common profile which was distinct from all other isolates, suggesting that a single strain was isolated from specimens from all seven patients. The source of this cluster in uncertain. We can find no epidemilogical basis for an episode of cross-infection within the hospital environment, and it is assumed that contamination of the specimens during collection, transport or processing was responsible for the "pseudo-outbreak" of M fortuitum

The Barbados AIDS audit: a profile of first respiratory admissions

Lower respiratory tract infections (LRTI) are the commonest cause of HIV-related hospital admissions to the Queen Elizabeth Hospital in Barbados. The medical records and available chest X-rays of 225 patients with LRT1 on their first admission during the period 1989-1995 were reviewed. The mortality among the patients was 26 percent and did not vary over the period under study. The radiologist's report on the CXR film was present in the records of 122 patients and eighty-six (70 percent) were reported as showing bilateral interstitial infiltrates. Twenty-one out of 28 (75 percent) deaths occurred in patients with bilateral interstitial infiltrates treated with the recommended dose of co-trimoxazole for Pneumocystis carinii pneumonia (PCP). Review of CXR films for nine patients with proven PCP confirmed that all had a "classical PCP" on CXR (i.e., bilateral mid-zone / diffuse fine reticulonadular or "ground glass" appearances). However, five of 11 patients with proven bacterial LRT1 (5 coliforms, 3 S.aureus, and 3 Pseudomonas sp.) also had "classical PCP" on CXR. We conclude that the high mortality may relate in part to the treatment of bacterial LRT1 with high dose co-trimoxazole. Empirical treatment should begin with gentamicin and ampicillin, with a switch to high-dose co-trimoxazole if patients fail to improve (AU)

True apenas as a first symptom of viral upper respiratory tract infection in preterm infants on home documented event monitors - abstract

Between January, 1992 and September, 1994 all preterm infants followed in the Neonatal High-risk Follow-up Clinic were prospectively evaluated for apneas and/or bradycardias associated with upper respiratory tract infection (URI). 52 infants (mean post-conceptional age 39.2 weeks) had increased apneas with URI. All infants had nasal stuffiness; dry cough was present in 10 (19 percent) and 12 (23 percent) had low grade fever, 16 (31 percent) slept more and had to be awakened for feeds. Respiratory syncytial virus (RSV) antigen was negative in 40; 12 were RSV positive. All bacterial cultures were negative. Hospitalization was necessary in 23 infants (5 with RSV and 19 without RSV). The 9 infants on xanthine therapy had therapeutic levels. The onset of apneas and bradycardias was abrupt, apneas (by report and monitor data) preceded parental suspicion of URI. Monitor data showed 0-5 apneas > 20 sec. per during URI. In addition, 22 percent of infants demonstrated bradycardias with heart rates < 80 minute with URI. Continous pulse oximetry on hospitalized infants showed baseline levels of 93-98 percent with frequent desaturations as low as 78 percent, requiring O 2 supplementation in 14 infants and Xanthine therapy in 16. None of the infants expired. Ex-preterm infants on home monitoring for persistence of apnea of prematurity may be at a high risk for severe apneas and bradycardias with viral upper respiratory infection, and require close surveillance whenever exposed. The relationship of this to SIDS/ALTE needs to be investigated (AU)

The effect of nutritional supplementation and stunting on morbidity in young children: the Jamaican study

Infection and undernutrition in young children are thought to act synergistically. However, studies of the relationship between low height-for age (stunting) and morbidity in young children have had inconsistent findings and there are few adequate data on the effects of nutritional supplimentation on morbidity. 129 stunted and 21 non-stunted children aged between 9 and 24 months, from poor Kingston neighbourhoods, identified from a house to house survey, were studied. The stunted children were randomly assigned to supplementation or no supplementation. Every week for 24 months the mothers were asked about the occurrence of any symptoms of illness. Supplementation had no consistent effect on the incidence or duration of symptoms. The stunted children had significantly more attacks of diarrhoea, fever, anorexia and apathy than the non-stunted children. The difference remained after controlling for social background and previous attacks of diarrhoea. There was also some indication of more severe illness in the stunted than the non-stunted children (AU)

The Kingston Project. III. the effects of high energy supplement and metronidazole on malnourished children rehabilitated in the community: morbidity and growth

In the Kingston Project malnourished children referred from public health clinics to a metabolic ward were treated at home using community health aides within the existing health service. We have previously provided anthropometric results showing significantly greater gains in weight and length for groups given a high energy supplement (3.31 MJ daily) for 3 months during treatment, and greatest gains for a group treated with metronidazole at the beginning of supplementation [Heikens et al., Eur. J. Clin. Nutr. 43, 145-160 (1989); 47, 160-173 (1993)]. We now present findings on morbidity and relate these to the separate interventions and to growth velocities. Although referral was solely on nutritional criteria, 65 percent of the sample were found to have additional illnesses at enrolment. During the study period (6 months) upper respiratory tract infections (URTI) were the commonest illness in all groups; there were significantly more gastroenteric infections in the group given the supplement, but not the antibiotic treatment; the children who received only the standard health service care were ill more often and for longer periods than children in the other groups. Diarrhoea, fever and dysentery prevalences were all found to relate significantly to weight velocity, and although prevalences differed between treatment groups, the detrimental effect on velocity was similar whichever the group (AU)

Bacterial meningitis in children in Barbados: a decade later - abstract

Forty-eight paediatric patients admitted with bacterial meningitis during a 10-year period, comprising 22 males (46 percent) and 26 females (54 percent), were reviewed. Ages ranged between 7 weeks and 12 years (mean 2.7 years). The mean 10-year incidence was 29/10,000 ward admissions, with a peak incidence of 69/10,000 admissions in 1989. The highest seasonal prevalence occurred during the dry months. Twenty-five patients (52 percent) were less than 2 years of age. Predominant symptoms were fever (85 percent), gastrointestinal (65 percent), and lethargy (40 percent). Frequently associated illnesses included upper respiratory infections in 21 (44 percent), and otitis media in 5(10 percent) of cases. H. influenzae was cultured from the cerebrospinal fluid in 34 cases (71 percent), S. pneumoniae in 4 cases (8 percent), and no organism in 10 cases (21 percent). Thirteen patients (27 percent) had received antibiotic therapy within a week of admission. Initial therapy consisted of parenteral ampicillin and chloramphenicol in 37 cases (77 percent), penicillin and chloramphenicol in 9 cases (19 percent) chlodramphenicol in 1 (2 percent), and trimethoprin/sulfamethoxazole in 1 case (2 percent). These data support a case for routine administration of H. influenzae B vaccine which will lead to the eradication of, or reduction of the overall incidence of bacterial meningitis in childhood (AU)

Acute respiratory infections in ambulatory malnourished children: a serological study - abstract

Fifteen million children under five years of age die each year. Ninety-six per cent of them in "The Third World", and the majority die of acute respiratory infection (ARIs) and/or malnutrition. We therefore studied the aetiological agents of acute respiratory infections occurring in an ambulatory population of 83 malnourished Jamaican-born children, aged 6 to 32 months, using serological methods for the diagnosis. In 60 per cent (38/63) of symptomatic children and in 25 per cent (5/20) of those without reported disease, the following micro-organisms were observed: para influenza viruses in 15 children, influenza viruses in 12, adeno viruses in 10, respiratory syncitial viruses in 7 and Mycoplasma pnuemoniae in 7 children. The prevalence of the viral ARIs increased with the severity of malnutrition. This probably reflects the T-cell immunodeficiency which accompanies protein-energy malnutrition (AU)

Acute respiratory infections in ambulatory malnourished children: a serological study

We studied the aetiological agents of acute respiratory infections occuring in an ambulatory population of 83 malnourished Jamaican-born children aged 6 to 32 months using serological methods for diagnosis. In 60 percent (38/63) of symptomatic children and in 25 percent (5/20) those without reported disease the following microorganisms were observed: parainfluenza viruses in 15 children, influenza viruses in 12, adenovirus in 10, respiratory syncitial virus in 7 and Mycoplasma pneumoniae in 7 children. The prevalence of the viral infections apparently increased with the severity of malnutrition. (AU)

Nosocomial and community acquired infections in malnourished children

A total of 206 community-acquired and 73 nosocomial infections in 50 malnourished Jamaican children were studied prospectively. Predominantly community-acquired infections in the 50 children, included gastroenteritis (68 percent), otitis media (60 percent), rhinopharyngitis (60 percent), oral candidiasis (46 percent), skin infections (40 percent), pneumonia (28 percent), bacteraemia (24 percent) and bacteriuria (18 percent). The most frequent nosocomial infections were rhinopharyngitis (34 percent), lower respiratory tract infections (24 percent) and septicaemia (18 percent). In those infections where an aetiological agent was identified, Giardia lamblia was the commonest enteric pathogen, Staphylococcus epidermidis, the most frequent blood culture isolate and Klebsiella sp. were recovered from the majority of urines. The lack of clinical signs and symptoms and atypical clinical presentation in some infected malnourished children were attributed to impairment of the acute inflammatory response. Diagnosis of infection in these children required a high index of suspicion and a comprehensive screening system. Nasal throat and axial swabs taken on admission revealed significant colonization with coliforms and pneumococcus; however, these swabs were not useful as indicators of potentially infective organisms. Four of the fifty children died and two of these deaths were attributed to infection. (AU)

The prevalence of nasal carriage of streptococcus pneumoniae and haemophilus influenzae in children from birth to three years of age attending immunization clinics - abstract

The population comprised ninety-six "well" children less than three years of age attending routine immunization clinics in four health centres in the Port-of-Spain area. The aim was to determine nasal carriage levels of pneumococcus and haemophilus influenzae amongst these children. The children were "well" and had not received antibiotics within two weeks of sampling. Swab were taken, using nasal and per-nasal seabs and innoculated immediately on growth media. They were then cultured and the organisms identified and sub typed. The population had an average age of 9.6 months: 52 percent were male. Fifty-three per cent of the children had a history of having had an upper respiratory tract infection within the 2 weeks preceding the specimen collection. Positive isolation of pneumococcus was obtained in 23 percent of the children. This result is surprisingly low and contrasts with levels ranging from 48 percent in North Carolina (Lada et al, 1974), and 53 percent in Dakar, Senegal to 100 percent in Papua, New Guinea (Gratten et al, 1984). Twenty-two per cent of the children yielded positive isolates of haemophilus influenzae. This again is a surprisingly low yield level. The accuracy of these results needs confirmation or refutation by further studies. Furthermore, the presence of other organisms, which could perhaps be the dominant organisms and which were not specifically cultured for in this study, needs to be considered (AU)

Primary health care delivery in Carriacou, Grenada

The people of Carriacou utilize curative more than preventative services. Over a four month period of study a total of 1349 patients made encounters at the District Medical Officer's clinics. Most of the encounters were for problems which required treatment e.g. circulatory system diseases, respiratory system diseases, musculo-skeletal system diseases. Other clinics, including the chronic disease, dental, dressing clinics and casualty, were also involved in curative work. However, the low percentage of check-ups (2.2 percent), the limited number of Pap smears done (91 or 5.7 percent of females over 15 years old), the poor immunisation status and low contraceptive use all express the need for preventive care. The distribution of health problems in this lesser developed country appears to be similar to more developed countries. Problems which tend to affect developing countries such as infective and parasitic disease are not a cause of significant morbidity on this island. These illnesses rank seventh in the list of most common diseases. Hypertension, upper respiratory tract infections, and dyspepsia are among the three most common health problems. The position dyspepsia occupies is unlike findings in other countries. This may be the result of dietary factors, alcohol abuse or excessive use of aspirin. The problem needs further investigation. There appears to be rational drug prescribing in Carriacou. No prescriptions were written for more than three drugs during the study and 3.4 percent of prescriptions were for three drugs. Poly-pharmacy is avoided. Compared to some more developed countries there is limited use of psychotropic drugs. There is a need for back-up services in instituting health measures. This is brought out by the cessation of clinics at times when the health personnel assigned to certain duties is absent. Immunisation was one such activity that was affected. Carriacou has great potential to become a healthier nation in the Caribbean. One must, therefore alert health planners of the need for: (1) Upgrading the present system of disease reporting (2) Health education programs (3) Cancer screening activities (4) Improved maternal and child health activities (AU)

Community rehabilitation of malnourished children: effects of nutritional supplementation on morbidity - abstract

Fifty-one moderately and severely malnourished children were studied in the community. They were randomly allocated to receive either medical care and an energy dense dietary supplement for three mons and then medical care alone for a further three months (supplemented) or to receive medical care alone for the six months (unsupplemented). All children were seen at two-weekly intervals, alternately in their homes by community Health Aides and in the clinic by a paediatrician. At each visit, a morvidity questionnaire was administered to obtain the mother's history of the child's illness during the previous two weeks. Weight was measured every two weeks and height monthly. Clinical assessment was done montly. During the first 3 months, growth velocity was higher in the supplemented than the unsupplemented children (2.4 and 1.2 times normal growth rate). During the second 3 months, growth rate was equal in the two groups (1.1 times normal growth rate). The mean ñ SD number of days of respiratory illness and diarrhoea (3 or more loose stools daily) were as follows: FOLLOW-UP PERIOD: Respiratory infection: (1-3 MONTHS - Unsuppl. 22ñ17, Suppl. 23ñ12), (4-6 MONTHS - Unsuppl. 15ñ13, Suppl. 20ñ15); Diarrhoea: (1-3 MONTHS - Unsuppl. 6ñ9), (4-6 MONTHS: Unsuppl. 2ñ3, Suppl. 8ñ12): No. Of Children With > 7 Days: (1-3 MONTHS: Unsuppl. 8/25, Suppl. 18/26), (4-6 MONTHS: Unsuppl. 1/24, Suppl. 7/25). In the first three months, the supplement was not associated with any significant decrease or increase in morbidity from respiratory illness or diarrhoea. Although more of the children had diarrhoea lasting for over seven days, these latter children did not show a diminution in rate of weight gain. In the second three-month period, there were fewer days of both respiratory illness and of diarrhoea in the unsupplemented children than in the children who had been supplemented during the previous three months. There were fewer children who had diarrhoea for more than seven days in the three-month period amongst the unsupplemented than the previously supplemented. Their preliminary analysis shows that dietary supplementation with an energy dense formula does not lead to a reduction in morbidity in malnourished children. It is possible that the supplement is associated with an increased in incidence of diarrhoea following its cessation (AU)

The epidemiology of infantile gastroenteritis in the Eastern Caribbean with special reference to the role of rotavirus infection

The objectives of this work were (1) to determine the relative importance of rotavirus, cytopathic viruses, selected bacteria and faecal parasites in infantile gastroenteritis in Guyana, Trinidad and St. Vincent; (2) to study the occurrence and distribution of rotavirus gastroenteritis and the clinical course of the disease; (3) to investigate transmission of faecal micro-organisms in families; (4) to assess the influence of malnutrition and respiratory disease on the course of illness; (5) to explore the role played by maternal characteristics, environment and economic status in this continuing problem; (6) to seek for rotavirus in calves in Trinidad. Human study subjects were 397 hospitalized gastroenteritis cases under three years of age. Healthy controls, registered at district health offices, were matched by age, sex and approximate home address. Data were collected from hospital records and by questionnaire. Weights were taken during hospitalization and follow-up. Stool samples were tested for viruses, bacteria and parasites. Rotavirus was detected by counterimmuno electrophoresis and ELISA with confirmation by electron microscopy. Forty-seven random family pairs were used for transmission data and samples of five-year old children were screened for rotavirus antibody. Rotavirus, the most prevalent pathogen, occurred in 21 percent of cases and one percent of controls. It was found more frequently in children 6-35 months old and not in premature newborn infants. Eighty-four percent of five-year olds had antibody. The illness was generally mild, but 5 of 30 fatal cases excreted rotavirus. Significantly increased morbidity and mortality were associated with age (<6 months), low birth weight (<2.5 kg), malnutrition (Gomez 11 or 111) and little or no breast-feeding (<1 month). Gastroenteritis cases had mothers with less education and interest in health services and fathers with more unskilled jobs and lower incomes. Case families were similar in size and structure to controls but had more diarrhoeal illness, more gastrointestinal infections and less pipe-borne water at home. Rotavirus was detected in calves with and without diarrhoea. Persistence in the environment was suspected (AU)

Aspiration in seriously ill patients: a study of amylase in bronchial secretions

Bronchial secretions from 21 patients with moderate to severe chest infections were obtained by transtracheal aspiration. Six seriously ill patients showed greatly increased levels of amylase activity in the bronchial secretions compared with those found in the 15 less ill patients. This amylase was almost certainly derived from oropharyngeal contents and its presence suggests that aspiration may be more common in comatose and semi-comatose patients than is generally appreciated. (Summary)