Belize SARSCOV2 Lab Screenings 23rd April 2020

This document is an infographic of COVID-19, detailing Belize SARSCOV2 Lab Screening relating to Tests Done, Negative Tests, Positive Tests, Recovered, Deaths, and the cases Under Investigation for the period 23rd April 2020 (AU)

Screening for lead exposure in children in Belize

OBJECTIVES: The objectives of this pilot study were to determine the blood lead levels in children in Belize and to try to relate these findings to demographic variables. METHODS: With permission from parents, capillary blood was collected from the fingers of 164 children with an age range of 2 to 8 years, living and attending school in the spring of 2002 in four towns: Belize City, San Pedro, Orange Walk, and Benque Viejo. The sample represents 0.4 percent of all children in Belize in that age range. Lead levels were analyzed by the method of anodic stripping voltammetry using the ESA LeadCare analyzer. RESULTS: The mean blood lead level for the children in the sample was 4.94 micrograms per deciliter (mg/dL) with a standard deviation of 2.46. However, 11 children (7 percent) had blood lead in the range of 10.1-13.8 mg/dL, which is the level of concern according to guidelines of the Centers for Disease Control and Prevention. Children living in the large urban centers of Belize City and Orange Walk town had higher lead levels (mean 5.80 and 5.74 mg/dL) than children living in the smaller towns of Benque Viejo and San Pedro (mean 4.17 and 4.63 mg/dL). There were no statistically significant differences between male and female children. CONCLUSIONS: These data indicate that children in Belize are being exposed to lead and suggest that this pilot study be followed up with a comprehensive study with a larger sample and correlation of the findings to socioeconomic characteristics, to children's behavior, and to the home and school environment.

Hyperlipidaemia screening among patients with both diabetes mellitus and hypertension-experience at a public health centre

OBJECTIVE: To assess the frequency of screening for hyperlipidaemia among patients with both diabetes mellitus and hypertension who attended a public health centre in Jamaica between June 1997 and December 2000. METHODS: This study was conducted among all patients with both diabetes mellitus and hypertension who attended the Hermitage August Town Health centre between June 1997 and December 2000. Subjects were identified from the clinic daily register using the International Classification of Disease (ICD-9) codes for hypertension (ICD-401) and diabetes mellitus (ICD-250). Patients' dockets were reviewed to identify those who had any test for hyperlipidaemia during this period. Results of these tests were noted. Abnormal blood lipid results (in mmol/l) were assessed as: total cholestorol> 6.50; low density lipoprotein> 3.60; triglycerides> 2.37; high density lipoprotein< 1.17. RESULTS: For the period of the study, 127 persons with both diabetes mellitus and hypertension were seen at the clinic (78 percent females and 22 percent males) ranging in age from 37 to 91 years with a median age of 61 years. Only 17 (13.4 percent) patients had a screening test for cholesterol over the study period. Six patients were screened only for cholesterol and 11 screened for both cholesterol and triglycerides. Screening frequency was slightly among persons older than 60 years compared to those less than 60 years (14.2 percent vs 12 percemnt; p> 0.05). Men were more likely to be screened than women (17 percent vs 12 percent; p> 0.05). Of the 17 patients screened, 46 percent had hypercholesterolaemia (total cholesterol> 6.5 mmol/l). CONCLUSIONS: Screening frequency for abnormal lipid profiles was extremely low in this sample of patients. The results of this study, though not generizable to all health centres, highlight what may be a major public health deficit in the control of atherosclerotic-related chronic non-communicable disease in Jamaica. (AU)

Perception of susceptibility to prostate cancer and screening behaviour - insights from a case-control study [abstract]

OBJECTIVE: The aim of this study was to assess the perception of Jamaican men regarding their susceptibility to prostate cancer and to determine how this perception is associated with their decision to attend for screening of this condition. METHODS: A case-control study was conducted among 200 men between the ages of 40 and 75 years attending three health-related clinics in Kingston, Jamaica. A case was defined as any male who had a digital rectal examination or prostate specific antigen (PSA) within the last two years as a check for prostate cancer. Controls were men who did not have any of these screening tests. Factors affecting decision to attend for screening for prostate cancer were assessed through a structured interview. Specifically, participants were asked whether they perceived themselves at risk for prostate cancer. In-depth discussions were done to obtain additional insights about screening. RESULTS: The majority of screeners (70 percent) perceived themselves as being at risk of getting prostate cancer compared to 45 percent of non-screeners. Men who perceived themselves as being at risk were more likely to attend for screening than were men who did not perceive or were unsure about their risk Odds Ratio (OR) (2.85, 95 percent) Confidence Interval (CI) (1.59,3.02). There was no significant association between age and perception of risk (p> 0.05). Men felt that screening for prostate cancer was not given the level of promotion which cancers of women was given. Men who were screened were also likely to have had screening recommended by a physician (un-adjusted OR 44, 95 percent CI 17.9,108. CONCLUSIONS: Consistent with a construct of the health belief model of behaviour change, perception of susceptibility to prostate cancer appears to influence screening behaviour among men in this study. Well-designed cancer screening promotion with due consideration to screening barriers, and physician's advice are likely cues to getting screened. (AU)

Lessons from reporting 100, 000 Jamaican electrocardiograms

The screening programme of the Heart Foundation of Jamaica has found hypertension in 71 percent of women and 47 percent of men. Of these patients, 13 percent were newly discovered hypertensives. Left ventricular hyperthrophy was present in 18 percent of hypertensive women and 27 percent of men. Inadequate control of raised blood pressure was a frequent finding. Ischaemic electrocardiographic (ECG) changes were only found in 4 percent of the 14,739 patients seen in the past two years but this is an underestimation of the prevalence of ischaemic heart disease. Arrhythmias seen over 15 years were usually benign, of sinus origin or ectopics in the absence of heart disease. Uncontrolled atrial fibrillation remains the most serious arrhythmia encountered and usually in hypertensive patients. Obesity found in 80 percent of women is a problem requiring public education. `Silent' ischaemia in diabetic and left ventricular hypertrophy indicate the need for ECG examination in all newly diagnosed patients with either condition, and annual ECGs thereafter. (AU)

Necrotising enterocolitis: A management protocol for developing countries

28 cases of necrotising enterocolitis (NEC) comprising 11 term and 17 preterm patients were diagnosed between January 1990 and December 1995 at the University Hospital of the West Indies (UHWI). Treatment was in accordance with a management protocol which emphasised aggressive screening of potential cases, early laparotomy for bowel perforation and primary anastomosis after small bowel resection. There were three deaths among the 13 cases of bowel perforation. Centres in developing countries can achieve rates of survival comparable to those in the developed world in babies with NEC weighing over 1000 grams by adopting the UHWI management protocol.(AU)

Barriers to early detection of breast cancer among women in a Caribbean population

The purpose of this descriptive study was to identify and describe barriers to early detection of breast cancer, as well as current breast cancer screening behaviors and attitudes regarding the disease, among women aged 20 and older on the Caribbean island of Tobago. Tobago is smaller of the two islands that make up the nation of Trinidad and Tobago. Between February and June 1996, 265 women fitting the age criteria completed a structured survey questionnaire. Women of African descent made up 89 percent of the respondents. In terms of age, 48 percent of those surveyed were between 20 and 39, 40 percent were between 40 and 59, and 12 percent were 60 or older. Barriers to early detection identified were a low level of breast self-examination, infrequent clinical breast examinations as part of regular care, unavailability of mammography services on Tobago, cost of screening, and difficulty of travelling to Trinidad for mammography. Furthermore, only a minority of the study participants had ever attended early detection or public awareness programs. The results were nearly the same for individuals with a family history of breast cancer, who would have a higher risk of occurrence of the disease. In addition, the majority of the respondents reported what can be considered a cultural barrier to early detection practices, a belief that no matter what they did, if they were to get breast cancer, they would get it. The authors recommend that mammography services be made available on Tobago. The authors also intend to use findings to help develop an appropriate, culturally sensitive breast cancer awareness and early detection program for women on this island.(Au)

Early results of a diabetes mellitus survey in eight communities in Jamaica

Diabetes mellitus is a major cause of mortality in Jamaica and ranks fourth as the prinicpal cause of death among Jamaicans during the period 1990 to 1994 (PAHO/WHO, 1996). This is probably due to its high prevalence, with 50 percent previously undiagnosed, and poor control among those who were previously diagnosed. The data being presented were derived from a two day mass screening of residents in one urban and seven rural communities in four parishes in the south east region of Jamaica in October 1997. A total of 1 726 persons aged 15 years and older revealed an estimated point prevalences of 17.6 percent (304/1726). More than half of the persons with diabetes were not previously diagnosed. Of known diabetics who had fasting blood sugar measurement, more than half (51.4 percent, 18/35) had abnormally elevated blood glucose levels. 30/118 (25.5 percent) known diabetics considered themselves non-complaint to regular treatment for their condition. This report underlined the importance of screening, instituting proper management and regular follow up by the health team and compliance by patients.(AU)

Hearing screening in Jamaica: prevalence of otitis media with effusion

Hearing screening is well established in most developed countries, and the data extensively published. However, little information has been presented by the developing, nonwhite populations. A screening study was carried out on 2202 Jamaican children age 5 to 7 years. This involved typanometry and pure-tone audiometry (frequencies of 0.5, 1, and 2 kHz.) Failure was considered to have occurred if a type B or C curve was obtained or if the threshold of hearing was greater than 20 dB. These children were further evaluated by a full ear, nose and throat examination, inclusive of pneumatic otoscopy, and audiologic testing. The prevalence of hearing impairment was 4.9 percent. Otitis media with effusion (OME) was present in 1.9 percent. The prevalence of OME in Jamaica is low when compared with that of the same age-group in the developed countries(AU)

The decentralization of syphilis screening for improved care in Jamaican public clinics: Collaborative Working Group on Decentralization Syphilis Screening

OBJECTIVES: This study examined the decentralization of syphilis screening for improved care in Jamaican public clinics. METHODS: One of every five serum samples tested at the six peripheral sites was frozen and retested at the central laboratory in Kingston. Patient files and laboratory logbooks were compared over a 3-month period. RESULTS: Between May 1993 and December 1994, 15.5 percent of 32913 patients with sexually transmitted disease and 8.3 percent of 8914 women seeking prenatal care were found syphilis seroreactive. Of 2001 samples evaluated, 1933 (96.6 percent) had been correctly reported at the peripheral sites. Of 129 syphilis seroreactors detected at the peripheral sites, 88 (68 percent) were treated the same day and 21 (16 percent) more within 3 days after testing. CONCLUSIONS: Syphilis seroreactors were accurately detected and quickly treated at the peripheral sites. If these efforts can be sustained, Jamaican syphilis rates should decrease.(AU)

Seroprevalence of hepatitis B virus among school-age children in the Stann Creek District of Belize, Central America

Adults in the Stann Creek district of Belize have a high prevalence of hepatitis B virus (HBV) infection, but the age of onset of these infections is unclear. We conducted a seroprevalence study of hepatitis B markers among Stann Creek school-age children to provide information for planning a hepatitis B vaccine program. The overall prevalence in 587 students was high for antibody to hepatitis B core antigen (anti-HBc) (43.3percent) and hepatitis B surface antigen (HBsAg) (7.7 percent). There was marked variation of anti-HBc by school and by the predominant ethnic groups attending those schools. Maya had the highest prevalence (76 percent), followed by Mestizo (50 percent), Garifuna (37 percent), and Creole (25 percent). Children less than nine years of age attending the rural primary schools (mostly Garifuna and Creole) (p< 0.05). Anti-HBc was found in 42 percent and 36 percent of students at the two high schools. Of the five schools tested, only at the urban primary school did anti-HBc positivity increase with age. Based on an analysis of the cost of serologic screening before immunization compared with mass vaccination, preimmunization serologic screening resulted in vaccine program cost savings in four of the five schools. Because most children in the rural areas contract hepatitis B before entering school, immunization against HBV should be integrated into the routine infant immunization program (AU)

Cervical cancer screening: meeting the needs of minority ethnic women

Understanding of the uptake of cervical screening among women from minority ethnic groups, and how acceptable they find the process, still requires some considerable progress. This paper attempts to review the material available, identify the issues and discuss ways in which progress might be made in future. Mortality from cervical cancer is higher among women born in the Caribbean Commonwealth than the standardised rate for women living in England and Wales. By contrast, mortality among women born in the Indian subcontinent and African Commonwealth is comparatively lower. Data about the incidence of cervical cancer among minority ethnic women are in short supply and some research findings are contradictory. For instance, Asian women may have either higher or lower rates of cervical cancer than the rest of the female population. Clearly further work is needed to establish whether Asian or other minority populations are high risk groups and why. There is also a need to assess trends regularly to see what impact migration has on incidence and mortality rates. Recent publication by the Health Education Authority of the results of its survey of health and lifestyles among black and minority ethnic groups in England provided welcome information about their uptake of cervical screening. Rates differ considerably between the different minority groups surveyed and the challenge now is to use all this information to inform the process of developing an approach to increasing uptake that is culturally appropriate. (AU)

Evaluation of a pilot study for breast and cervical cancer screening with Bradford's minority ethnic women; a community development approach, 1991-93

The objectives were to provide information about breast and cervical cancer and related screening services to minority ethnic women, to enable them to make well informed decisions and choices; to adopt a health education strategy based on a community development approach, augmented by a local publicity campaign; and to evaluate both the direct and indirect effects of this project. To this end a community development intervention study was made over 18 months from October 1991 to March 1993 in Bradford, a multicultural city with 87,000 residents from minority ethnic groups. The subjects of the study were 1,628 women from minority ethnic groups in three geographical areas of Bradford. A stratified sample of 1,000 women (670 South Asian, 163 African-Caribbean, 96 Eastern European and 71 other) was interviewed at the beginning of the project and six months after the health promotion intervention. Two specifically trained Health Promotion Facilitators from minority ethnic groups undertook community development work within three neighbourhoods in Bradford with the largest minority ethnic populations. There were group sessions in both formal and informal settings, which included the health education about breast and cervical cancer and the associated screening programmes. These sessions were in the women's preferred languages and audio-visual material and a specially designed teaching pack were used. There were significant differences in the baseline levels of knowledge about cervical cancer and breast cancer and breast across the different minority ethnic groups. The South Asian women had the lowest levels of knowledge and also showed the most significant improvements. Significant increases in attendance for cervical smear and breastcancer screening were self-reported. These were confirmed by anecdotal views of local health professionals. In addition, a local self-help group for South Asian women was established; also the contacts with other related organisations and professionals has help to raise the issues of ethnically sensitive services within the voluntary and statutory sectors. A community development approach to health promotion is particularly valuable in communities with low levels of knowledge about a disease/s or health service provision. Community development approaches often produce outcomes that had not been predicted. (AU)

An audit of sickle cell screening in a paediatric hospital population

Current UK guidelines for the detection of sickle cell disease (SSD) recommend pre-operative screening of patients of African or Afro-Caribbean descent and of patients of Middle East, South Italy, Greece and India. These recommendations have considerable cost implication for the NHS. We have undertaken a retrospective audit of the use of SSD screening in our own institution. Between January 1987 and August 1992, 1305 patients under 15 years of age (mean 3.8 years) underwent screening for SSD. Surgical patients accounted for 1120 tests (85.8 percent). The majority of patients tested were of Asian descent (n = 995; 73 percent); only 350 (27 percent) were of African or Afro-Caribbean descent. Only four patients (0.3 percent) tested positive (all sickle cell trait): three of Afro-Caribbean descent and one from Bahrain. We conclude that, in our population, the incidence of Hbs is low. Patients of African or Afro-Caribbean descent should continue to be tested but a selective policy may be indicated in other ethnic groups (AU).

Recent developments in low-cost screening and assessment of childhood disabilities in Jamaica. Part 2: Assessment

This paper summarise the requirements and criteria for assessment of childhood disabilities. It reviews recent research carried out in Jamaica and outlines procedures for medical and psychological assessment used in the International Epidemiological Study of Childhood and Disability as well as local experience in community-based rehabilitation. While the medical assessment procedures were considered to be validated, there is an urgent need for local research and development in psychological assessment. These approaches, while not perfect as yet, bring the possibility of local community capability closer. They will require changes in professional attitudes, training of health and educational personnel, and changes in the service systems, so that screening and assessment can be integrated into existing services. However, although this will obviate the need for new, specialised administrations, improved linkages and lines of referral will be necessary. (AU)

Recent developments in low-cost screening and assessment of childhood disabilities in Jamaica: part 1 screening

This paper reviews and summarises the requirements and criteria for the screening of childhood disabilities. It reviews recent advances in research carried out in Jamaica and outlines available techniques for the screening of cognitive, motor, speech, hearing and visual disabilities and fits. The availability of validated, simple, low-cost techniques that can be used by community workers facilitates the conduct of surveys for the planning of programmes and the identification of cases for rehabilitation. (AU)

Screening for childhood disabilities in Jamaica: the use of ten question screen in Clarendon - abstract

No screening test for childhood disability in Jamaica has previously been formally evaluated. The present report describes the validity of the Ten Question Screen (TQ) used by community workers in Jamaican component of the International Epidemiology Study of Childhood Disability, done in the parish of Clarendon. It was previously reported by this study that approximately nine per cent of children aged 2-9 years had mild, moderate or severe disabilities (one or more of: motor, visual, hearing speech or cognitive disabilities, or fits). In Clarendon, 5,461 children were screened, using the TQ and a sub-sample of 993 was subsequently assessed by a doctor and a psychologist for the presence of disabilities. The TQ proved to be an acceptable, reliable instrument and was relatively quick and easy to administer. Sensitivity was 41 percent overall, and 64 percent for moderate/severe disability. Specificity was high, at 87 percent and 86 percent, respectively. Due to the low prevalence, the false-positive rates were high, 75 percent and 90 percent, respectively. False-negative rates varied from 2 to 12 percent in the different age/sex groups, with overall rates of 6 percent for all disabilities, combined and 1 percent in serious disabilities. The lack of sensitivity was mainly due to failure to identify disabilities , especially mild cognitive disabilities, in older boys. The unacceptably high rate of false positives on the screening test indicates the need for a second level of screening to decrease the false-positive rates (increase the positive predictive value) of the test. The reasons for the high rate of false-positive results in using the Ten Question Screen and the possibility of reducing thisby using probes and an additional questionnaire were also investigated. In the 522 false-positive cases, analyses were performed of concordance of responses for three different categories of interviewer, of other disabilities not among the ones being detected, impairments, handicaps and the possibility of the parent being excessively worried about the child's health. The use of probes in TQ positive cases and the Activities of Daily Living Questionnaire (ADLQ) were tested to determine whether false positives could be reduced. Forty-four per cent of respondents in false-positive cases changed their response from positive to the community worker to negative to the doctor. Forty-eight per cent of false-positive cases had other disabilities or impairments and 4 percent had developmental handicaps. Worry was slightly more common among mothers of false-positive cases. Use of the probes and ADLQ reduced the false-positive rate (AU)