National communicable diseases digest: Epidemiological week 16

This communicable diseases digest offers a summary of incidence rates for the Ministry of Health's epidemiological week 16. It draws on weekly data retrieved through the Belize Health Information System (BHIS) which seeks to improve individual health outcomes and public health performance as well as to optimize resource utilization. Using graphics, national, seasonal and weekly trends are compared for the following: Acute Respiratory Infections (ARIs), a leading cause of death among children under the age of five; Severe Acute Respiratory Infections (SARIs), which have the potential for large scale epidemics; Gastrointestinal Diseases; Vector Borne Diseases; Sexually Transmitted Infections (STIs); and Other Communicable Diseases/Outbreaks/Public Health related incidents.

National communicable diseases digest: Epidemiological week 17

This communicable diseases digest offers a summary of incidence rates for the Ministry of Health's epidemiological week 17. It draws on weekly data retrieved through the Belize Health Information System (BHIS) which seeks to improve individual health outcomes and public health performance as well as to optimize resource utilization. Using graphics, national, seasonal and weekly trends are compared for the following: Acute Respiratory Infections (ARIs), a leading cause of death among children under the age of five; Severe Acute Respiratory Infections (SARIs), which have the potential for large scale epidemics; Gastrointestinal Diseases; Vector Borne Diseases; Sexually Transmitted Infections (STIs); and Other Communicable Diseases/Outbreaks/Public Health related incidents.

National communicable diseases digest: Epidemiological week 19

This communicable diseases digest offers a summary of incidence rates for the Ministry of Health's epidemiological week 19. It draws on weekly data retrieved through the Belize Health Information System (BHIS) which seeks to improve individual health outcomes and public health performance as well as to optimize resource utilization. Using graphics, national, seasonal and weekly trends are compared for the following: Acute Respiratory Infections (ARIs), a leading cause of death among children under the age of five; Severe Acute Respiratory Infections (SARIs), which have the potential for large scale epidemics; Gastrointestinal Diseases; Vector Borne Diseases; Sexually Transmitted Infections (STIs); and other Communicable Diseases/Outbreaks/Public Health related incidents.

National communicable diseases digest: Epidemiological week 20

This communicable diseases digest offers a summary of incidence rates for the Ministry of Health's epidemiological week 20. It draws on weekly data retrieved through the Belize Health Information System (BHIS) which seeks to improve individual health outcomes and public health performance as well as to optimize resource utilization. Using graphics, national, seasonal and weekly trends are compared for the following: Acute Respiratory Infections (ARIs), a leading cause of death among children under the age of five; Severe Acute Respiratory Infections (SARIs), which have the potential for large scale epidemics; Gastrointestinal Diseases; Vector Borne Diseases; Sexually Transmitted Infections (STIs); and other Communicable Diseases/Outbreaks/Public Health related incidents.

Occurence of Cryptosporidium oocysts and Giardia cysts in water supplies of San Pedro Sula, Honduras

During June 1996, water supplies of the city of San Pedro Sula, Honduras, were sampled to obtain an assessment of Cryptosporidium oocyst and Guardia cyst concentrations. Each sample was concentrated and stained with an indirect immunofluorescent antibody, and parasites were counted through microscopic analysis. In three surface water supplies, Crytosporidium oocyst concentrations ranged from 58 to 260 oocysts per 100 L, and Giardia cysts were present in concentrations ranging 380 to 2100 cysts per 100 L. Unlike the surface water samples, groundwater acquifer protects the water supply more effectively from larger Giardia cysts. Cryptosporidium oocyst concentrations are within the typical range for surface water supplies in North America whereas Giardia cyst concentrations are elevated. Efforts should be made to protect raw water from sources of contamination (AU)

A longitudinal study of the persence of gastrointestinal tract parasitic infections in children of St. Kitts over the 15-year period, 1982-1997

When 188 (1962), 266 (1991) and 222 (1997) five and nine year old children in St. Kitts were assessed for the presence of parasitic infections, there were significant reductions in the prevalence of trichurias from 83 percent through 58 percent to 27 percent, of ascariasis from 24 percent through 8.6 percent to 0.9 percent and of giardiasis from 15 percent through 9.4 percent to 5 percent, respectively; over the 15 year period. Anthelminthic use, which appeared to be the most important responsible intervention tool, remained roughly at the same level at 59-51 percent. However, the types of anthelminthics used changed over the period. Piperazine citrate, which was used by 66 percent in 1982, had only 35 percent usage in 1991 and 11.3 percent in 1197. Albendazole, which was not used at all in 1982, was taken by 32 percent of the children in 1991 and 45.9 percent in 1997, and at the same time use of laevo-tetramisole increase by 20 percent in 1991 from 14 percent in 1982, to 42.9 percent in 1997. Details are given of a proposed island-wide parasitic infection with the assistance of identified private and public sector partners.(AU)

The intestinal permeability test applied to the diagnosis of food allergy in paediatrics

Intestinal permeability was evaluated in 17 healthy children (control group), aged 4.3 ñ 1.9 years (mean ñ SD), weight 15.4 ñ 5.5 kg and in 11 infants with food allergy (allergic group, aged 2.3 ñ 1.6 years, weight 9.5 ñ 1.5 kg). In the two groups, the urinary excretion of two non-metabolized sugars (mannitol, lactulose) was measured by gas-chromatography after oral administration. Measurement of urinary content of these sugars 5 hours after administration in the control group showed a clearance of 20.2 ñ 8.6 percent for mannitol and 0.44 ñ 0.81 percent for lactulose. The lactulose/mannitol ratio in the same group presented a normal mannitol urinary excretion (16.5 ñ 13.4 percent, p = NS, Student's t-test) and an increase in the lactulose excretion (1.36 ñ 0.92 percent, p<0.001). Moreover, the allergic group showed a lactulose/mannitol ratio that was significantly different (0.105 ñ 0.071,p<0.001). The intestinal permeability test for the diagnosis of food allergies seems to be sensitive and non-invasive test that is well suited to the paediatric practice (AU)

Helicobacter pylori in patients undergoing upper endoscopy in Jamaica

One hundred and two consecutive patients undergoing upper gastrointestinal endoscopy were tested for H. pylori by a rapid urease test, using antral biopsy specimens. There were 60 men (mean age 54 yrs) and 42 women (mean age 49 yrs). Fifty-six patients (55 percent) were positive for H. pylori. Of male patients, 36 (60 percent) and of female patients, 20 (48 percent) tested positive. Sixty-eight per cent of patients with antral gastritis, 65 percent with duodenal ulcer and 60 percent with gastric ulcer had H. pylori. Thirty-nine patients (70 percent) positive for H. pylori were from major urban areas, and 17 (30 percent) were from rural areas of Jamaica. In patients without H. pylori, 61 percent and 39 percent were from urban and rural areas respectively. Forty-four patients (79 percent) with H. pylori and 40 (87 percent) without H. pylori had piped water in their homes. Ninety-three per cent of all patients had electricity and 88 percent had refrigeration. There was no difference between patients positive or negative for H. pylori with regard to the use of alcohol, marijuana or tobacco. There was also no difference between both groups in exposure to domestic animals in the home environment. H. pylori is associated with antral gastritis and peptic ulcer disease in Jamaican patients. There are no specific environmental or social factors that seem to predispose to infection (AU)

Clinical nutrition: gastro-intestinal disorders

Advises on various diets for the treatment of gastrointestinal diseases

Changes in gastrointestinal tract parasitic infections in St. Kitts children - abstract

When 239 (1982) and 361 (1991) 5- and 9-year-old children in St.Kitts were assessed for the presence of parasitic infections there were significant reductions in the prevalence of trichuriasis from 83 percent to 58 percent, of ascariasis from 24 percent to 8.6 percent and of giardiasis from 15 percent to 9.4 percent. Health education appeared to be the most important responsible intervention tool. Anthelmintic use remained roughly at the same level. However, the types of anthelmintics used changed over the period. Piperazine citrate, which was used by 66 percent in 1982, only had 35 percent usage in 1991. Albendazole which was not used at all in 1982 was taken by 32 percent of the children in 1991, and, at the same time, use of laevotetramisole increased by 20 percent from 14 percent (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)

Sedation for upper gastrointestinal endoscopy: a comparative study of midazolam and diazepam

Comparison of the ease of upper endoscopy, patient tolerance, and amnestic effect, using diazepam, midazolam, or no sedation, was performed on 149 patients. Midazolam and diazepam sedation produced better conditions and improved patient acceptability. Midazolam was associated with better patient tolerance, less thrombophlebitis, and more amnesia than diazepam, but shared a similar recovery time. Midazolam should replace diazepam as the drug of choice in those patients requiring sedation for upper endoscopy. (AU)

Does Crohn's disease occur in Jamaica? - abstract

Crohn's disease is one of the most frequently encountered chronic digestive diseases in areas of North America and Europe with a marked rise in incidence over the past 20 years. However, there is considerable geographical variation in incidence of this disease. It seems to be relatively rare in Jamaica and the Caribbean. Twenty patients with Crohn's disease seen over the past 20 years at the University Hospital, Kingston, Jamaica are reported. There were 14 female and 6 males. The mean age at presentation was 37 years (range 8-67), and symptoms were present for a mean of 12 months (range 1 day-4 yrs). Fourteen patients presented with lower abdominal pain and diarrhoea was present in eleven. Lower gastrointestinal bleeding was the presenting feature in two. Ten patients had weight loss. Four patients had a tender mass in the right lower quadrant of the abdomen and in a fifth patient the mass was located in the lower umbilical region. Thirteen of the twenty patients were anaemic (Hb less than 11 grams/dl) and 9 had hypoalbuminaemia at presentation. The primary distribution of disease was ileal in six and eight had colonic involvement. Three patients had ileocolitis and one perianal disease. One patient had invlovement of the entire small intestine and ascending colon and another had skip lesions involving several areas of the small intestine. Surgical resection was performed in five patients. Three other patients required laparotomy for intestinal obstruction and another for drainage of an inflammatory mass. Three patients developed entero-enteric fistulas and two entero-cutaneous fistulas. Of the 15 patients medically treated 6 have remained well while 8 have had recurrent episodes of relapse. Except for two deaths, the other patients have remained well. Crohn's disease, although uncommon, has been seen in Jamaica for the past 20 years and should be considered in West Indian patients presenting with inflammatory bowel disease. In contrast to other series, most of our patients were black with a female preponderance, but the clinical features, anatomic involvement and course appear similar to those reported elsewhere (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)

Diet-related gastrointestinal disease at Georgetown Hospital, Guyana: a preliminary report (1980-1984) - abstract

Guyana has 2 predominant ethnic groups, Indo-Guyanese (51 percent) and Afro-Guyanese (30.0 percent). The dietary pattern is different in these two groups. The prevalence of some disorders, diabetes mellitus and ischaemic heart disease in particular, seems to be related to ethnic origin. Is there a difference in the spectrum of gastrointestinal disorders in these two groups? What relationship is there to dietary pattern? Before undertaking prospective studies to answer the above questions, a preliminary study using records from Georgetown Hospital, 1980-1984, was undertaken. Peptic ulcer disease, which was almost exclusively duodenal ulcer, was the commonest disorder; there were over 200 cases seen annually. It occurred mainly in Afro-Guyanese males. Appendicitis (ruptured, 157: inflammed, 167: normal, 17) was more prevalent in Indo-Guyanese; gallstones (59) were twice as common in Indo- as in Afro-Guyanese; gastric cancer (37) was relatively common; diverticular disease (36) affected the Afro-Guyanese; 5 of the 7 cases of ulcerative colitis were of African origin whereas 3 of 4 cases of Crohn's disease were of Indian origin; colonic cancer was frequently suspected. However, only 8 cases (6 African and 2 Indian) were diagnosed over the 5-year period. Using the population of the catchment area for Georgetown as the denominator, appropriate adjustments were made for population ethnic distribution. There seems to be some indication of a pattern of distribution in gastrointestinal disease related to ethnic origin, and perhaps dietary intake. Prospective work with improved diagnostic techniques is needed to investigate this further (AU)

A community-based study of gastrointestinal helminth and protozoan infection in Western Jamaica

A study of gastrointestinal parasitic infection was conducted in four communities in the Parish of Westmoreland, Jamaica. All blood smears (n=1,025) were negative and 63.7 percent of stool specimens (n=696) contained ova/cysts of one or more of 7 helminth and 9 protozoan species. Trichuris and Giardia were the most prevalent species. Prevalence was markedly age-dependent, with infection occurring most commonly in children. It is concluded that gastrointestinal parasitic infections persist at intensity and prevalence levels likely to have a significant impact on community health (AU)