An investigative study on the perception and acceptability of a COVID-19 Vaccine of the public in Trinidad and Tobago

• The COVID-19 pandemic has had a devastating impact on global morbidity and mortality rates and adversely affected society and economies. • To control this pandemic, mass vaccination is required. • Many countries have reported varying levels of COVID-19 vaccine acceptance. • The public perception of the COVID-19 vaccine and acceptance of the vaccine are unknown in Trinidad and Tobago.

A ten-year profile of cancer in Guyana from 2003–2012

OBJECTIVE: Only one cancer report (2000–2004) on Guyana has ever been published. We sought to establish the profile of cancers in Guyana to assist policy-makers indeveloping a comprehensive cancer programme. SUBJECTS AND METHODS: Data from 2003–2012 from the population-based Guyana Cancer Registry were analysed. Frequencies were determined for each cancer by patient demographics and cancer characteristics. Incidence and mortality rates were calculated using Guyana’s resident 2002 population. RESULTS: A total of 6518 incident cancers were recorded:3956 in females and 2561 in males. Mean age of females was 55.4 years, SD 16.4 and males 62.2 years, SD 18.7 (p< 0.0001). Average annual incidence was 86.8 per 100 000 population (females 105.4, males 68.1), age standardized rate was 139.3 per 100 000 population. In females, the leading sites were breast 1074, cervix uteri 1014 and corpus uteri 325; and in males, prostate 865, colo-rectum 206 and lung 157. By ethnicity, 44.4% of cases were in Afro-Guyanese and 38.4% in Indo-Guyanese. Death occurred in 52.3% (45% of females, 65% of males), for an average annual mortality rate of 48 per 100 000 population(females 47.6 and males 43.4). Lifetime risk of developing cancer was one in eight for females and one in 16 for males. CONCLUSION: Cancers placed a significant burden on the Guyanese population during 2003–2012. Females were affected at a younger age than males. Afro-Guyanese were affected more than other ethnic groups. Significant prevention, treatment and control efforts are required to reduce the morbidity and mortality associated with cancers.

Obstetric care and severe pregnancy complications in Latin America and the Caribbean: an analysis of information from demographic health surveys

OBJECTIVE: To compile, consolidate, and analyze information obtained in surveys conducted by the MEASURE DHS [Demographic and Health Surveys] program, concerning obstetric care and pregnancy complications for women in Latin America and the Caribbean, in the five years before the survey. METHODS: This exploratory study utilized data from demographic surveys carried out in the 1990s in seven countries of Latin America: Bolivia, Brazil, Colombia, the Dominican Republic, Guatemala, Nicaragua and Peru. The study describes the characteristics of the women who were interviewed and of the obstetric care that they received in the five years before the respective survey, and it also estimates the occurance of prolonged labor and of hemorrhagic, hypertensive, and infectious complications in those five years. RESULTS: The median number of prenatal consultations ranged from 4.7 in Bolivia to 6.6 in the Dominican Republic. More than 40 percent of deliveries in Guatemala, Peru, and Bolivia were attended by traditional midwives, relatives, or other persons without formal training. The highest rates of deliveries performed in health care facilities (>90 percent) were in the Dominican Republic and Brazil. In Guatemala, Peru, and Bolivia more than 45 percent of deliveries were at home. The highest rate of cesarean delivery was in Brazil (36.4 percent), and the lowest rates (<12 percent) were in Peru and Guatemala. The rate of pregnancy complications reported by the women surveyed was 16.7 percent in Brazil, 17.9 percent in Guatemala, 42.1 percent in Colombia, 42.5 percent in Nicaragua, 43.0 percent in the Dominican Republic, 51.7 percent in Bolivia, and 51.8 percent in Peru. CONCLUSION: The reported occurance of severe pregnancy complications in the surveys we examined was well above the 15 percent rate reported in other scientific literature, suggesting that these complications may have been overestimated in the MEASURE DHS surveys. Prior validation of the questionnaires used for data collection is extremely important in the generation of high-quality data (AU)

What do we do about the problem of overweight and obesity in the Americas?

Within the last two decades the prevalence of obesity in the developed world has moved from single digits to near 20 percent. Even more alarming is that within the same time frame the prevalence of overweight in the developing world has exceeded that in the developed countries, with. for example, rates of up to 30 percent in adult females being reported in the Caribbean. This disproportionate increase in the developing world is expected to accelerate even further since individuals, health care providers, and planners have been slow to either recognize or react to the problem. Individuals have been blinded by cultural factors that interpret obesity as desirable and a sign of wealth and economic success. Many planners lack sufficient financial resources and personnel-and, most importantly, adequate local data with which to influence public policy decisions. Clinicians have been coached in the model of acute care, and they operate in environments ill suited to handling chronic, lifestyle-related diseases.

Obesity: diagnosis and prescription for action in the English-speaking Caribbean

Obesity has been the silent global epidemic of the last 30 years. Almost every country that has statistics has documented a progressive, often dramatic increase. And ironically, while obesity was previously associated with perceptions of wealth and plenty, a large and increasing number of victims today are trapped in poverty and are from developing countries with high levels of poverty, particularly in Latin America and the Caribbean. But unlike AIDS, which appeared "out of the blue" and carries the stigma of both infections and fatal features, obesity, as an epidemic, has been insidious, is not infectious in the accepted sense, and leads to death indirectly and surreptitiously. It has therefore been ignored as the major public health problem that it most surely is . This paper will briefly outline the dimensions of the problem in the English-speaking Caribbean; its enormous impact on health, quality of life, morbidity, mortality, and health care costs; its major causes; and a prescription for concerted, urgent regional action (AU)

Health trends in Jamaica: significant progress and a vision for the 21st century

Health trends in Jamaica have improved considerably during the past century. Life expectancy at birth increased from 38 years in 1900 to 72 years in 2000. The crude death and infant mortality rates declined significantly from 35.7 and 174.3 deaths to 5.1 and 24.4 deaths, respectively in the same period. The seven leading causes of death in 1945 were infectious diseases while the main causes of mortality and morbidity are now the chronic non-communicable lifestyles diseases, and injuries. Over the past few decades, considerable progress has been made in controlling vaccine preventable diseases and eliminating poliomyelitis and measles. Rates of infectious syphilis and gonorrhoea have declined significantly in recent years although chlamydia and herpes are common and the HIV/AIDS epidemic is a growing concern. Over the past few decades health expenditure has grown more rapidly in the private health sector than in the public health sector although services in the public sector are provided at significantly lower cost. Jamaica provides good health at low cost. However, more funds are needed to support the public health system. The current health reform process needs to be informed by a better understanding of the factors that have contributed to Jamaica's achievements in health and needs a clear health focus. The Ministry of Health has articulated a vision of health for the 21st century that requires a significant reorientation of health staff as well as empowering people to take responsibility for adopting healthy lifestyles. (AU)

Bicycle spoke injuries: an unnecessary childhood injury

OBJECTIVE: Bicycle spoke injuries represent a peculiar pattern of injury sustained when a child's foot becomes trapped in the spokes of a bicycle. The aim of this study was to higlight the types of injuries sustained and their associated morbidity. METHODS: A retrospective review was made of all children who had sustained a bicycle spoke injury between 1997 and 1999 and who had been admitted to the Bustamante Hospital for Children. Sixty cases were identified but thirteen were excluded, leaving 47 for analysis. Demographic details of each child, along with relevant clinical data, were retrieved. Where indicated, radiographs were reviewed and the data were analysed using the SPSS statistical package. RESULTS: There were 26 males and 21 females (mean age 5 years ñ 22.2 SD; age range 2-10 years). Sixty-four per cent were aged 0-5 years. The mean time to presentation was 4.4 days, although most patients were from the Corporate Area. The commonest injuries (74 percent) were abrasions of varying depths along with lacerations and friction burns. The lateral and medial aspects of the ankle were injured most often (62 percent). Six cases (13 percent) had fractures. Antibotics were required in 77 percent of cases and surgery in 30 percent. Hospitalisation was for a mean of 9 (SD ñ 9.3) days. Time to healing of the soft tissue wounds was a mean of 17 (SD ñ 24.4) days. Two children (4.3 percent) had permanent residual deformities. CONCLUSION: Bicycle spoke injuries caused significant morbidity to the study children. Adequate parental supervision of children on bicylces, along with the recognition that these are not trivial injuries, would go a long way in reducing the associated morbidity.(Au)

Pneumatic retinopexy: a case presentation [abstract]

Pneumatic retinopexy is an alternative to scleral buckling for surgical repair of selected retinal detachments. The anatomic success rate is comparable to scleral buckling but the morbidity is less and visual results are better with pneumatic retinopexy. The purpose of this paper is to caution that this procedure is associated with significant morbidity. I have presented the outcomes of two cases to highlight the challenges associated with the procedure and I am suggesting that for all its concerns, the procedure should not be used for simple retinal detachments as suggested by others but reserved for those with tears suitable for external buckling. (AU)

Retrospective and longitudinal study of salmonellosis in captive wildlife in Trinidad

Morbidity and mortality of captive wildlife at the Emperor Valley Zoo, Trinidad from 1993 to 1996 were analysed to determine involvement of Salmonella spp. A 6 mo longitudinal study was conducted to determine the frequency of isolation of Salmonella spp. from apparently healthy, sick and dead wild mammals, birds, and reptiles. The antibiograms of Salmonella isolates were determined using the disc diffusion method. Fecal samples randomly selected from animal enclosures and cloacal swabs of snakes were cultured for Salmonella spp. following enrichment in tetrathionate and selenite cystine broths. For the 1993-96 period, Salmonella spp. was implicated in 17 (12%) of 141 sick or dead animals and the predominant serotype was S. typhimurium. During the 6 mo prospective study in a mean animal population of 1,186, there were 20 (2%) and 14 (1%) animals that were sick and died respectively; Salmonella spp. was implicated in only one mortality. Overall, of 1,012 samples from apparently healthy wildlife cultured, 66 (7%) yielded 24 serotypes of Salmonella. The predominant serotype were S. seigburg (16 isolates), S. gaminara (6 isolates), and S. thompson (6 isolates). None of the samples yielded S. typhimurium. The frequency of isolation of Salmonella spp. in reptiles (14%) was significantly higher than found in either mammals (7%) or birds (3%). Sixty-five (99%) of 66 Salmonella spp. isolates exhibited resistance to one or more of the nine antimicrobial agents tested. Resistance was high to cephalothin (92%), moderate to streptomycin (35%) and tetracycline (29%), but significantly low to gentamicin (2%), chloramphenicol (0%), and sulphamethoxazole/trimethoprim (0%). The prevalence of asymptomatic infections by Salmonella spp. in zoo animals was high and the very high prevalence of antimicrobial resistance could be a problem when treating salmonellosis.

The changing face of paediatrics in the English-speaking Caribbean

Childhood mortality and morbidity patterns in the English-speaking Caribbean have changed significantly over the past 40 years. Acute respiratory illness, physical injury and conditions originating in the perinatal period have replaced malnutrition, gastroenteritis and other infectious diseases as major causes of illness and death in Caribbean children. Although population growth has slowed down, about one-third of the population of the English-speaking Caribbean remains under the age of 15 years. Infant mortality rates have also fallen but the major contributor to this decline has been a reduction in post-neonatal deaths. The decrease in mortality and morbidity from infectious diseases has led to a prominence of disorders originating in the perinatal period, psychosocial problems and chronic childhood disorders. Adverse economic conditions are held culpable for the re-emergence of protein energy malnutrition (PEM) and pulmonary tubercolosis in some territories. There is an urgent need to focus attention on the areas of perinatal and adolescent health, childhood disability, accidental and non-accidental injury, sexual abuse and human immunodeficiency virus (HIV) infection. Immunization programmes also require continuing support and expansion. These tasks cannot be accomplished without meaningful long term investment of financial and human resources in the health and educational services of the region (AU)

Febrile morbidity and hospital stay in high risk caesarian section patients at a non-teaching hospital

This was a retrospective chart review of all patients who had Caesarian section between January 1995 and December 1996. The objective was to determine the incidence of post operative febrile morbidity, and to relate this to hospital stay in a high risk indigent population treated at a private non-teaching hospital. Discharge summaries, antepartum progress notes and laboratory results were reviewed for each patient. 5 of 257 charts reviewed were inadequate. All but 5 patients had labour after ruptured membranes of 12 hours of more. Four had a prolonged second stage. Board certified surgeons performed a nd assisted in the operations. 21 patients had scant prenatal care and 6 had no prenatal care. In all cases the abdomen was scrubbed with "Betadine" soap prior to painting. No shaving was done. Gloves were changed after closure of the uterine incision. The pelvis was copiously irrigated with 3-4 litres of saline. The subcutaneous layer was irrigated from a height of 1" to 12" with 0.5 to 1 litre of fluid. After this step, this layer was not touched by any thing from the operating field. Of 162 patients with primary Caesarian sections, 20 (12.3 percent) had post operative fever, 18 due to endometritis and 2 due to wound infections. Two of 28 failed VBACs had fever whereas none of 59 patients with elective repeat Caesarian sections became febrile. The mean hospital stay was 4.4 days for febrile patients and 2.7 days for afebrile patients. The incidence of fever in the entire study group of 249 was 8.8 percent, and the incidence of wound infections was 0.8 percent. This study demonstrates that the adoption of the simple measures described above can dramatically decrease the incidence and severity of post Caesarian fever and wound infection, thereby allowing safe, early hospital discharge.(AU)

Zinc supplementation, morbidity and growth in stunted Jamaican children

We investigated whether there was a morbidity or growth response to zinc supplementation of nutrition clinic attenders in Kingston, which would indicate zinc deficiency. Children selected were singletons aged 6 to 24 months and stunted (<2.0 sd length for age, NCHS references). They were stratified by gender and age (6-11, 12-17, 18-24 mo.) and randomly assigned to receive zinc supplementation (n=31) (5mg elemental zinc), or placebo (n=30) daily for 12 weeks. Adequately nourished comparison children (n=24) were recruited from a well-baby clinic. Caretakers were interviewed to obtain social background data. Anthropometric measurements were done on enrolment and after 6 weeks, 12 weeks and 12 months. A weekly questionnaire to determine the stunted children's health was given to the caretakers during the supplementation period. The zinc supplemented and placebo groups were very similar on enrolment. The adequately nourished children were significantly better socio-economic circumstances. Five placebo children, but no zinc supplemented children, were hospitalized during the supplemented period (Fisher's exact test, two-tailed, p=0.02), indicating reduced severity of illness with supplementation, which suggests a response to zinc deficiency. There were no significant differences in hair zinc content among the three groups. Regression analyses showed that there were no significant effects of supplementation of length, height or head circumference, or on the incidence of any symptom. Mean duration of the episodes were significantly shorter for skin rashes in the supplemented group compared with the placebo group (ANCOVA, P=0.02), and longer for vomiting (ANCOVA, p=0.02).(AU)

Zinc supplementation: effects on the growth and morbidity of undernourished Jamaican children

OBJECTIVE: We investigated whether there was a growth or morbidity response to zinc supplementation. DESIGN: The study was randomized, placebo-controlled, and double-blind. SETTING: Children were recruited at clinics in Kingston, Jamaica, and supplemented at home. SUBJECTS: Children selected were singletons aged 6-24 months, and stunted (< -2.0 s.d. length for age, NCHS references). They were stratified by sex and age and randomly assigned to receive zinc supplement (n = 31) or placebo (n = 30). Four children were excluded because of hospitalization; all others had all measurements. Adequately nourished children (n = 24) were recruited from a well-baby clinic. INTERVENTIONS: The supplement provided 5 mg elemental zinc in a syrup daily for 12 weeks; the placebo comprised the syrup only. MAIN OUTCOME MEASURES: Caretakers were interviewed to obtain social background data, number of clinic visits and hospitalizations. Anthropometric measurements were done on enrolment, and after 6 weeks, 12 weeks and 12 months. Children's health was determined by weekly questionnaire to caretakers of the undernourished groups during the supplementation period. RESULTS: The supplemented and placebo groups were similar on enrolment. The adequately nourished children were from significantly better socio-economic circumstances. Mean initial hair zinc content was 5.5 +/- 4.8 mumol/g (supplemented group) and 6.7 +/1 12.1 mumol/g (placebo) (n.s.). Regression analyses showed that there were no significant effects of supplementation on length, height or head circumference, nor on the incidence of any morbidity symptom. Mean duration of the episodes was significantly shorter for skin rashes in the supplemented group compared with the control group (ANCOVA, P = 0.02), and longer for vomiting (P = 0.02). The incidence of hospitalization was significantly greater in the control group (Fisher's exact test, P = 0.02). CONCLUSIONS: Zinc supplementation reduced the hospitalizations which probably reflect severity of morbidity, but did not improve growth.(Au)

Social environment, morbidity and use of health care among people with diabetes mellitus in Trinidad

BACKGROUND: This study aimed to identify social characteristics associated with higher levels of morbidity from diabetes and their relationship to health care utilization. METHODS: During a 6-month period 1149/1447 (79 percent) subjects admitted to Port of Spain Hospital, Trinidad with diabetes responded to a structured interview. Data collection included social factors, diabetes-related morbidity and health care utilization. Analyses were adjusted for age, sex, ethnic group and self-reported diabetes duration. RESULTS: Of 12 indicators of morbidity, nine were more frequently in subjects with no schooling compared with those with secondary education. At ages 15-59 years, nine morbidity indicators were less frequently among subjects in full-time jobs compared with those not in employment. The association of educational attainment was explained by confounding with age, sex, ethnic group and diabetes duration but five morbidity indicators were associated with employment status after adjusting for confounding. The type of water supply in the home was generally not associated with morbidity. Each of the indicators of lower socioeconomic status was associated with less use of private doctors and with more use of government health centres. CONCLUSIONS: Morbidity from diabetes was greater in groups with lower socioeconomic status. While morbidity associated with lower educational attainment was mostly explained by older age; the results suggested the possibility that diabetes may contribute to unemployment of those in the labour force. Private care was less accessible to social groups with higher levels of morbidity and the availabiltiy of government funded health services was important for reducing inequalities in health care utilization.(AU)

Jamaican Health Ministry reports AIDS cases rising fast

Reports on the state of AIDS transmission in Jamaica. Population distribution of AIDS cases; Increasing number of women and pediatric cases; Number of pediatric cases

Morbidity from diabetes mellitus in Trinidad: identification of vulnerable groups

To evaluate health problems experienced by people with diabetes mellitus in Trinidad we conducted an interview survey of 622 randomly selected patients attending 17 government health centres. We enquired after typical symptoms of diabetes mellitus and combined the responses into a score which was used as the dependent variable in multiple regression analyses. Itching was reported by 215 (35 percent), polyuria 315 (51 percent), burning or numbness in the feet 350 (56 percent) history of foot ulcer 69 (11 percent) previous minor amputation 29 (5 percent), major amputation 10(2 percent), difficulty with eyesight 397 (64 percent), vision reduced to light perception only in both eyes 32 (5 percent). A past stroke was reported by 55 (9 percent), heart attack by 54 (9), and other heart trouble 103 (17 percent). Increasing burden of illness was associated with increasing age, Indo-Trinidadian ethnic background, environmental factors such as absence of piped water supply and social factors, e.g., not being employed in full-time work. Hyperglycaemic symptoms were more strongly associated with lower socio-economic status while foot and eye symptoms were associated with lower socio-economic status and increasing duration of diabetes. Cardiovascular disease was associated with increasing age and Indo-Trinidadian ethnic-origin. We concluded that people with diabetes mellitus in Trinidad experience high levels of symptoms and illness. The elderly, those with longer duration of disease, the unemployed and persons of Indo-Trinidadian ethnic background were more vulnerable to the above complications of diabetes mellitus (AU)

Chemical burns as assault injuries in Jamaica

A three-fold greater incidence of chemical burn injuries in Jamaican hospitals, compared to burn centers in other industrial countries, underscores the problem of the use of common chemicals for assault weapons in this country. With the increased availability of guns for personal use, many Jamaicans learned the value of carrying household chemicals such as sulphuric acid from batteries or sodium hydroxide obtained from cleaning supplies. Chemical carried in a container, such as one might carry mace, afforded a means of defence among the lower socioeconomic groups who could not afford handguns. The use of dangerous chemicals for defensive weapons has extended to the use of chemicals for assault. The pattern of chemical injury differs significantly from most reports in the literature in both prevalence and aetiology. This review was prepared to examine these injuries with a view to planning strategies for prevention. (AU)

A structured epidemic model incorporating geographic mobility among regions

A model for the spread of infectious diseases among discrete geographic regions is presented that incorporates a mobility process that describes how contact occurs between individuals from different regions. The general formulation of the mobility process is described, and it is shown that the formulation encapsulates a range of mobility behavior from complete isolation of all regions (no mobility) to permanent migration between regions. It is then shown how this mobility process fits into an SIR epidemic model, and two examples are given extending its use. The examples include a model for disease transmission in a population with two distinct mobility patterns operating and a model developed to describe a 1984 measles epidemic on the Caribbean island of Dominica (AU)

A structured epidemic model incorporating geographic mobility among regions

A model for the spread of infectious diseases among discrete geographic regions is presented that incorporates a mobility process that describes how contact occurs between individuals from different regions. The general formulation of the mobility process is described, and it is shown that the formulation encapsulates a range of mobility behaviour from complete isolation of all regions (no mobility) to permanent migration between regions. It is then shown how this mobility process fits into an SIR epidemic model, and two examples are given extending its use. The examples include a model for disease transmission in a population with two distinct mobility patterns operating and a model developed to describe a 1984 measles epidemic on the Caribbean island of Dominica(AU)

Under-users of antenatal care: a comparison of non-attenders and late attenders for antenatal care, with early attenders

Demographic, behavioural, environmental, economic and obstetric history data from the Jamaican Perinatal Morbidity and Mortality Survey were examined to identify characteristics of women who do not attend for antenatal care, or present late instead of early for care, using multiple logistic regression. Non-attenders were more likley to be teenagers, unmarried, in unions of very short duration, smokers and women who felt that friends and relatives were not supportive. Multigravid non-attenders often had short inter-pregnancy intervals and included women who had experienced a post neonatal death. They were often drawn from deprived environments (lack of sanitation, water supplies). Late attenders shared features common to non-attenders (teenagers, unmarried, multigravid). Many however were self employed and did not fit the depressed profile of the non-attender. Most multigravidae who attended late had had previously uneventful pregnancies, including this one. Early attenders had little in common with not-attenders and late attenders. They were older, many had a secondary or tertiary education, were married and were generally middle class women. The group however included high risk multigravidae who had previous pregnancy complications or bad outcomes. Programmes aimed at reaching non-attenders must focus on the wider social and economic needs of these women and must give them a sense of their own power to effect change in their lives. Reaching the late attender will be more difficult and may be unnecessary with the possible exception of the teenager. She needs to be treated in a more sympathetic and non-judgmental way as this is often a high risk pregnancy. More fundamental changes require improved educational and employment opportunities for women as the best consumer is an educated consumer (AU)