Comparison of mosquito control programs in seven urban sites in Africa, the Middle East, and the Americas

Mosquito control programs at seven urban sites in Kenya, Egypt, Israel, Costa Rica, and Trinidad are described and compared. Site-specific urban and disease characteristics, organizational diagrams, and strengths, weaknesses, obstacles and threats (SWOT) analysis tools are used to provide a descriptive assessment of each mosquito control program, and provide a comparison of the factors affecting mosquito abatement. The information for SWOT analysis is collected from surveys, focus-group discussions, and personal communication. SWOT analysis identified various issues affecting the efficiency and sustainability of mosquito control operations. The main outcome of our work was the description and comparison of mosquito control operations within the context of each study site's biological, social, political, management, and economic conditions. The issues identified in this study ranged from lack of inter-sector collaboration to operational issues of mosquito control efforts. A lack of sustainable funding for mosquito control was a common problem for most sites. Many unique problems were also identified, which included lack of mosquito surveillance, lack of law enforcement, and negative consequences of human behavior. Identifying common virtues and shortcomings of mosquito control operations is useful in identifying "best practices" for mosquito control operations, thus leading to better control of mosquito biting and mosquito-borne disease transmission.

Perceived efficacy of herbal remedies by users accessing primary healthcare in Trinidad

BACKGROUND: The increasing global popularity of herbal remedies requires further investigation to determine the probable factors driving this burgeoning phenomenon. We propose that the users' perception of efficacy is an important factor and assessed the perceived efficacy of herbal remedies by users accessing primary health facilities throughout Trinidad. Additionally, we determined how these users rated herbal remedies compared to conventional allopathic medicines as being less, equally or more efficacious. METHODS: A descriptive cross-sectional study was undertaken at 16 randomly selected primary healthcare facilities throughout Trinidad during June-August 2005. A de novo, pilot-tested questionnaire was interviewer-administered to confirmed herbal users (previous or current). Stepwise multiple regression analysis was done to determine the influence of predictor variables on perceived efficacy and comparative efficacy with conventional medicines. RESULTS: 265 herbal users entered the study and cited over 100 herbs for the promotion of health/wellness and the management of specific health concerns. Garlic was the most popular herb (in 48.3% of the sample) and was used for the common cold, cough, fever, as 'blood cleansers' and carminatives. It was also used in 20% of hypertension patients. 230 users (86.8%) indicated that herbs were efficacious and perceived that they had equal or greater efficacy than conventional allopathic medicines. Gender, ethnicity, income and years of formal education did not influence patients' perception of herb efficacy; however, age did (p = 0.036). Concomitant use of herbs and allopathic medicines was relatively high at 30%; and most users did not inform their attending physician. CONCLUSION: Most users perceived that herbs were efficacious, and in some instances, more efficacious than conventional medicines. We suggest that this perception may be a major contributing factor influencing the sustained and increasing popularity of herbs. Evidence-based research in the form of randomized controlled clinical trials should direct the proper use of herbs to validate (or otherwise) efficacy and determine safety. In the Caribbean, most indigenous herbs are not well investigated and this points to the urgent need for biomedical investigations to assess the safety profile and efficacy of our popular medicinal herbs.

Knowledge, attitudes and practice of healthcare ethics and law among doctors and nurses in Barbados

BACKGROUND: The aim of the study is to assess the knowledge, attitudes and practices among healthcare professionals in Barbados in relation to healthcare ethics and law in an attempt to assist in guiding their professional conduct and aid in curriculum development. METHODS: A self-administered structured questionnaire about knowledge of healthcare ethics, law and the role of an Ethics Committee in the healthcare system was devised, tested and distributed to all levels of staff at the Queen Elizabeth Hospital in Barbados (a tertiary care teaching hospital) during April and May 2003. RESULTS: The paper analyses 159 responses from doctors and nurses comprising junior doctors, consultants, staff nurses and sisters-in-charge. The frequency with which the respondents encountered ethical or legal problems varied widely from 'daily' to 'yearly'. 52 per cent of senior medical staff and 20 per cent of senior nursing staff knew little of the law pertinent to their work. 11 per cent of the doctors did not know the contents of the Hippocratic Oath whilst a quarter of nurses did not know the Nurses Code. Nuremberg Code and Helsinki Code were known only to a few individuals. 29 per cent of doctors and 37 per cent of nurses had no knowledge of an existing hospital ethics committee. Physicians had a stronger opinion than nurses regarding practice of ethics such as adherence to patients' wishes, confidentiality, paternalism, consent for procedures and treating violent/non-compliant patients (p = 0.01) CONCLUSION: The study highlights the need to identify professionals in the workforce who appear to be indifferent to ethical and legal issues, to devise means to sensitize them to these issues and appropriately training them.

A comparison of career satisfaction amongst dental healthcare professionals across three health care systems: comparison of data from the United Kingdom, New Zealand and Trinidad & Tobago

BACKGROUND: The aim of this study was to compare the expressed levels of career satisfaction of three groups of comparable dental healthcare professionals, working in Trinidad, the United Kingdom and New Zealand. METHODS: Three questionnaire surveys were carried out of comparable dental healthcare professionals. Dental nurses in Trinidad and dental therapists in the UK and New Zealand. Questionnaires were sent to all registered dental nurses or dental therapists. RESULTS: Career satisfaction was lowest amongst Dental Therapists working in Trinidad and Tobago. Approximately 59 per cent of the Therapists working in New Zealand reported stated that they felt they were not a valued member of the dental team, the corresponding proportion in the United Kingdom was 32 per cent, and for Trinidad 39 per cent. CONCLUSION: Dental therapists working in different healthcare systems report different levels of satisfaction with their career.

The Saba health study: methodology and main results

'The Saba Health Study' is the first large scale health interview survey of the island. This book presents the main results of the study. It discusses the population's health status, use of health services, and satisfaction with health care. Known health risks, such as smoking, alcohol consumption, and overweight are evaluated and compared with situations on the sister island of Curacao and in western countries. Attention is focused on the identification of risk groups in need of specific policy interventions and health promotion programs (AU)

Topical use of Papaya in chronic skin ulcer therapy in Jamaica

The objective of the study was to determine the prevalence of the use of the fruit (papaya) or Carica papaya as topical ulcer dressings by registered nurses in the Spanish Town Hospital (STH), Kingston Public Hospital (KPH) and the University Hospital of the West Indies (UHWI), Jamaica. A ten-item pre-tested self-administered questionnaire was distributed to 285 randomly selected registered nurses at the UHWI, KPH and STH. There was a 72 percent response rate. The prevalence of topical papaya use among the respondents was 75 percent. Comments from the users of papaya suggested that topical application of the unripe fruit promoted desloughing, granulation and healing and reduced odour in chronic skin ulcers. It was cost effective. Papaya was considered to be more effective than other topical applications in the treatment of chronic ulcers. There was some difficulty in preparation of the fruit and occasionally a standardised procedure but there were no reports of wound infection from its use. Papaya is widely used by nurses as a form of dressing for chronic ulcers and there is need for standardisation of its preparation and application.(Au)

Vitamin A deficiency in Latin America and the Caribbean: an overview

Vitamin A deficiency (VAD) has been known to exist in Latin America and the Caribbean since the mid-1960's; however, except for pioneering work by the Institute of Nutrition of Central America and Panama/Pan American Health Organization on sugar fortification in Central America, there was little interest in controlling it because of the low frequency of clinical findings. More recently, implications of the effect of subclinical VAD on child health and survival has generated increased interest in assessing the problem and a greater commitment to controlling it. The information available by mid-1997 on the magnitude of VAD in countries of the Region was extensively reviewed. Internationally accepted methods and cutoff points for prevalence estimations were used to compile information from relevant dietary, biochemical, and clinical studies carried out between 1985 and 1997 in samples of at least 100 individuals. VAD in the Region of Latin America and the Caribbean is mostly subclinical. The national prevalence of subclinical VAD (serum retinol < 20 mole g/dl) in children under 5 years of age ranges between 6 percent in Panama and 36 percent in El Salvador. The problem is severe in five countries, moderate in six, and mild in four. There are no recent data from Chile, Haiti, Paraguay, Uruguay, Venezuela, and the English-speaking Caribbean. The population affected amounts to about 14.5 million children under 5 years of age (25 percent of that age group). Schoolchildren and adult women may also have significant VAD. Actions currently implemented to control VAD include (a) universal or targeted supplementation, with sustained high coverage rates through national immunization days in some countries; (b) sugar fortification, which is well established in El Salvador, Guatemala, and Honduras (a significant effect has been documented in Guatemala and Honduras) and is under negotiation in Bolivia, Colombia, Costa Rica (to be resumed), Ecuador, Nicaragua, and Peru; and (c) limited dietary diversification activities (AU)