Prevalence of bacteriuria in pregnant women attending antenatal clinics of Trinidad and Tobago

Urinary tract infection (UTIs) are one of the most common infectious diseases ranking next to upper respiratory tract infection and are often linked with significant morbidity and mortality. They are caused by the colonization of pathogenic microbes along urinary tract as well as tissue invasion of any part of the urinary tract. Microbes that cause UTIs include bacteria, fungi, parasites, protozoa and viruses. Bacteriuria is a problem among the pregnant women. The UTI's in pregnancy has been associated with morbidities such as cystitis, pyelonephrities, pre-eclampsia, polyhydramnios, pre-term birth and low birth weight. This research was undertaken to determine the prevalence of bacteriuria among the pregnant women of Trinidad.

Post­World War II epidemiological transitions in Caribbean Societies: Interpretive insights based on age-associated mortality profiles

Objective: Life expectancy at birth is a robust indicator of the mortality profile in any spatial unit. The paper draws on age-associated life expectancy estimates from six Caribbean nations between 1950 and 2015 to assess variable gain in longevity of life at various stages of human lifespan and make claims about the variable impact of nation-specific sociomedical interventions as well as likely lessons to be learned. Design and Methodology: Using Mixed Methodology, secondary data are drawn from the United Nations Population Databases that reflect mortality profiles at national and regional levels. The data relate to six Caribbean nations ­ Cuba, Barbados, Jamaica, Trinidad and Tobago, Guyana and Haiti and permit the detection of changes in age-associated life expectancy over 20-year intervals including four time points ­ 1955, 1975, 1995 and 2015. Descriptive statistics are used to discern variable national trends that could be understood drawing on qualitative evidence obtained from documentary research and elite interviews. Results: Three distinct mortality profiles emerge with the most favourable being in Cuba and Barbados, the least favourable in Guyana and Haiti, and Jamaica and Trinidad and Tobago being located between the two extremes. The timing and magnitude of gains in infant, child, adult and geriatric health states can be discerned from the results. Conclusion: The paper is heuristic and constitutes a basis comparing the effectiveness of primary, secondary and tertiary health care in promoting human resilience to mortality. As such, the paper provides important ameliorative lessons that have implications for critically informing the administration of health policies.

Universal access to screening and management of diabetes in pregnancy in Trinidad using an ICT solution

Objective: Undetected diabetes in pregnancy (DiP) can lead to deleterious consequences. Strengthening health systems and implementing national standardized protocols for screening and management can improve outcomes. This study aimed to achieve consensus on clinical guidelines and facilitate universal screening using standardized testing and an app. Design and Methodology: An integrated care model was developed and antenatal caregivers were trained on screening and management of DiP. A secure Information and Communication Technologies (ICT) solution for real-time communication of results was designed and piloted as the reporting system. The app provided automatic alerts to patients and doctors facilitating timely intervention and offered self-management tools. Pregnant women ≥ 18 years, n = 655 at two antenatal clinics in Trinidad (1 public and 1 private hospital) were screened using a standard 75g 2-hour oral glucose tolerance test (OGTT) after an overnight fast. Seven lab technologists and 24 doctors were trained to use the app. Cost-effectiveness was assessed. Results: National consensus was achieved with 197 antenatal caregivers, for universal screening for DiP. The app facilitated a reporting system of blood glucose results and delivered real-time SMS text and e-mail alerts to participants. 10.1% of participants had abnormal fasting glucose and 14.1% had at least one abnormal reading between 0hr to 2hrs. Universal screening for GDM was cost-effective in the local setting. Results: National consensus was achieved with 197 antenatal caregivers, for universal screening for DiP. The app facilitated a reporting system of blood glucose results and delivered real-time SMS text and e-mail alerts to participants. 10.1% of participants had abnormal fasting glucose and 14.1% had at least one abnormal reading between 0hr to 2hrs. Universal screening for GDM was cost-effective in the local setting. Conclusions: The high prevalence of DiP in T&T justifies the need for universal screening and related health systems change. Training healthcare teams in DiP screening and ICT-enabled management are essential elements of a standardized health system which features real-time reporting.

Knowledge of Zika and Its Implications: A Study Of Women Attending the Antenatal Clinic at the Sangre Grande Health Center, Trinidad

Background and Aim: The ZIKV is a major public health concern and has the potential to cause a pandemic. Health knowledge is a critical factor in the prevention of the ZIKV. This study aims to ascertain the knowledge levels of the antenatal women attending the antenatal clinic at the Sangre Grande Health Center Trinidad, regarding the ZIKV and its implications as well as to determine the socio-demographic factors that influence their knowledge. Material and Methods: A descriptive study was conducted. 69 pregnant women were randomly selected from registers of attendance at the clinic on days of data collection. The researchers-designed and pre-tested questionnaire was utilized for data collection. Using the SPSS version 20, results were presented as frequencies. Results: Most of the participants (98.6%) were of the reproductive age, 18 to 40 years and mainly of mixed ethnicity. The majority of the population had secondary school education and mostly married or in common law relationships. Knowledge of the ZIKV was mostly adjudged moderate; the majority had low knowledge on the implications of the ZIKV. A weak positive correlation (p≤ 0.05) was noted between the educational levels of the participants and their knowledge of the ZIKV as well as between ages of the participants and their levels of knowledge of the implications of ZIKV (p≤ 0.050). Conclusion: The study showed that the pregnant women had moderate knowledge levels of Zika but not a corresponding knowledge on the implications of the conditions. Healthcare geared at increasing the knowledge level of ZIKV and its implications among the populace is recommended. The development of health education and health promotion programs that target disease prevention and control are principal components necessary for success against the ZIKV and its implications.

A Quantitative Analysis of Non-Compliance with Dietary Regimen amongst Pregnant Women with Diabetes

Background: Compliance with Dietary Regimen amongst Pregnant Women with Diabetes. is a key behaviour that determines the future of the woman as well as to the feotus wellbeing. The control of dietary intake is a crucial element of the diabetes treatment regimen, and is used for the purpose of normalizing blood glucose levels. Pregnant women with diabetes often experience difficulties in remaining compliant with their dietary regimen. The social support system and limited level of knowledge regarding their diabetes dietary management may also contribute to this problem. Although, clinical support may be provided through health care institutions if the clients did not access these services, this may also result in them having a knowledge deficit regarding the importance of dietary restriction. Objective: The objectives of this study are: are: (i) To identify whether there was an association between socioeconomic factors and compliance with prescribed dietary regimen (ii) To identify whether knowledge affected compliance with diet regimen (iii) To identify cultural and lifestyle issues which may influence compliance with prescribed dietary management (iv) To identify whether clinical support services, contributed to the level of compliance to prescribed dietary regimen. Method: A cross-sectional descriptive quantitative study, was conducted to obtain survey data from a sample of 60 participants. This study was conducted to examine different factors influencing dietary compliance amongst pregnant women diagnosed with diabetes and are attending antenatal clinic at the Port of Spain General Hospital, San Fernando General Hospital and Mt Hope Women Hospital. Data collection was done using a semi-structured questionnaire among 20 participants from each hospital. This design was selected, because it allowed the researcher to collect data at a specific point in time from a representative subset of the population. The data gathered were then analysed using SPSS version 20. Results: The study showed that 28 (41.7%) respondents had pre gestational diabetes while 32 (58.3%) had gestational diabetes. Respondents had adequate knowledge of diabetes management, had attended a consultation with a dietician; however, most of the information regarding diabetes management was given by the Doctor. Being taught about blood glucose levels was positively correlated to management of hyperglycaemia (0.455, p0.01) and hypoglycaemia (0.383, p0.01). Further, confidence to eat recommended meals daily was positively correlated to eating appropriate foods (0.372, p0.01) while their management of hyperglycaemia was positively correlated to the emotional experiences (0.371, p0.01). While they had good levels of knowledge, they generally had difficulty complying with recommended dietary recommendations. Conclusion: This study highlights the fact that DM is a growing phenomenal amongst pregnant women. It further identifies factors that contribute either positively or negatively to the client's compliance to their recommended dietary regimen. Although the women express the importance of dietary compliance, it was noted that these women do struggle with complying to their diet in some way or the other.

Surgeries in public hospitals

This publication presents a special feature on surgeries performed in public hospitals for the reference period, January to March 2017. Readers will find the 22% percent reduction in live births (compared to similar period in 2016) an interesting observation, particularly when viewed against the background of the Zika outbreak and the encouragement to families to delay pregnancies.

Zika update, June 9, 2017 Suriname

The update reports on surveillance with regard to the Zika virus from its inception in Suriname in November 2015, to June 2017. It comprises of statistical data inclusive of a map and several charts representing suspected and confirmed cases of Zika. Brief information on Guillain-Barre Syndrome, Congenital Syndrome and Zika associated deaths due to other pre-existing illnesses are also contained in the report.

Psychological support for pregnant women, persons with Guillain-Barre syndrome and / or families affected by the Zika virus

The incidence of Microcephaly and / or Guillain-Barré syndrome (GBS) has increased in several countries, concurrent with a Zika virus outbreak. Physicians, nurses and other healthcare providers must be aware of the strategies to be utilized when consulting with the following groups of persons and their families: pregnant women; pregnant women with suspected or confirmed Zika virus infection; pregnant women who know they carry a child with suspected microcephaly; caregivers and families of an infant with microcephaly; and persons with GBS and other neurological disorders. Psychosocial support is the process of addressing the psychological and social issues associated with a particular crisis. In this instance, the crisis is related to the Zika virus outbreak. The team involved in the provision of psychological support includes but is not limited to the: primary healthcare provider; Obstetrician / Gynaecologist; Paediatrician; Registered Nurse / Midwife; Neurologist, or other physician or surgeon.

Zika virus infection clinical management protocol: Paediatrics

A clinical management protocol for the Zika Virus was prepared for medical professionals by the Emergency, Disaster Management and Special Services Branch of the Ministry of Health, Jamaica. This protocol outlines clinical features, symptoms, and management procedures for medical and health personnel and the way they should respond to suspected cases of ZIka among pregnant women.

The management of Guillain-Barre Syndrome

This document discusses how the Guillain­Barre syndrome should be handled medical professionals in Jamaica. In addition to an overview of the disease, the clinical presentation, case definition, a sample laboratory diagnosis, treatment and complications are mentioned.

Zika - epidemiological report Barbados, September 2017

This PAHO/WHO report traces the epidemiology of the Zika and Dengue viruses in Barbados for the period 2017-2017. The first case of Zika was laboratory-confirmed in 2016, and the number of confirmed cases rose to a high of 92 and fell to 25 in 2017. The report also presents statistical data for Dengue, Zika-related pregnancies, Zika-virus-associated Guillain Barre syndrome, Congenital Syndrome associated with Zika Virus infection, and Zika-related deaths

Zika in Suriname: Emerging virus ­ Established vector

This Power Point presentation by the Suriname Director of Health, addresses the Zika outbreak in Suriname, the progression of the spread of the virus and the response of the Surinamese government with respect to containing the spread of the disease. The presentation outlines steps taken in preparation for an outbreak of Zika, after the virus' first appearance in Brazil in 2015. Strategies adopted at the entomological, epidemiological, surveillance and vector control levels in Suriname are outlined. The presentation also addresses prenatal consultation and monitoring, antenatal monitoring of Zika positive pregnancies, and updating of Aedes material to include Zika-V information for use in schools and other training. Finally, the presentation addresses the drafting of new risk communication strategies and Zika response strategies at the national level, the lessons learned, and the challenges associated with the Zika virus.

Repeat pregnancy study in HIV positive and negative women in selected health facilities in Regions 3, 4, 6 and 10 in Guyana, South America

OBJECTIVES: To determine factors influencing repeat pregnancies in HIV positive and negative women in Regions 3, 4, 6 and 10. SUBJECTS AND METHODS: A descriptive cross-sectional survey was conducted using cohorts of HIV positive and negative women in the age group 18–44 years (n = 222). Stratified random sampling was used, where, for every one HIV positive woman, four HIV negative women were selected at each health facility until the total sample size was obtained. Data on repeat pregnancies and family planning (n = 58) were collected through interviews using questionnaires.Epi Info, version 7 was used to do data input and analysis. Fisher test or Chi-squared tests were used to test the significance of a variable. A qualitative assessment was also done to glean more from the quantitative data. RESULTS: The pregnancies of HIV+ mothers were intentional and there was high uptake in antiretroviral (ARV) drugs. It was notable that most women knew their HIV status prior to pregnancy. Sixty-three per cent of the respondents felt that an HIV+ woman should get pregnant if wanted. For protection of the unborn child, answers were adherence to ARV drugs and treatment, abstaining from breast feeding and abstaining from sex or having sex with a condom. CONCLUSIONS: Respondents clearly showed that the decision to have a baby is a fundamental human right, with other determinants being their confidence in adherence to ARV treatment regime and abstention from breast feeding. There is the need for more health promotion activities to reduce unwanted pregnancies among this special population.

Emergence of zika virus epidemic and the national response in Jamaica

BACKGROUND: Jamaica, along with the Americas, experienced major epidemics of arboviral diseases transmitted by the Aedes aegypti mosquito in recent years. These include dengue fever in 2012, Chikungunya fever in 2014 and Zika virus infection (ZIKV) in 2016. We present the emergence of the ZIKV epidemic in Jamaica and outline the national response. METHODS: The Ministry of Health's preparedness included: heightened surveillance, clinical management guidance, vector control and management, laboratory capacity strengthening, training and staffing, risk communication and public education, social mobilization, inter-sectoral collaboration, resource mobilization and international cooperation. RESULTS: The first case of ZIKV was confirmed on January 29, 2016 with date of onset of January 17, 2016. From January 3 to July 30, 2016 (Epidemiological Week (EW) 1-30), 4648 cases of ZIKV were recorded (4576 suspected, 72 laboratory-confirmed). Leading symptoms were similar among suspected and confirmed cases: rash (71% and 88%), fever (65% and 53%) and joint pains (47% and 38%). There were 17 suspected cases of Guillain Barre syndrome; 383 were reported in pregnant women, with no reports of microcephaly to date. Zika and dengue viruses were circulating predominantly in 2016. At EW30, 1744 cases of dengue were recorded (1661 suspected and 83 confirmed). Dengue serotypes 3 and 4 were circulating with 121 reports of dengue haemorrhagic fever...(AU) CONCLUSION:The possibility exists for endemicity of ZIKV similar to dengue and chikungunya in Jamaica. A ZIKV vaccine, similar to the dengue and chikungunya vaccines, is needed to be fast-tracked into clinical trials to mitigate the effects of this disease.

Zika virus infection clinical management protocol: Pregnant women

This document outlines the clinical management protocol Jamaican medical professionals should employ for suspected cases of pregnant women infected with the Zika virus. Clinical features, case definitions, testing procedures, symptoms and pregnancy management are included in this article.

Environmental management and personal protection for the protection of Zika

This document prepared by Kim Bautista vector control Chief of Operations is a close physical comparison of the two Aedes vectors capable of transmitting Zika, Dengue and Chikungunya (the Aedes aegypti and the Aedes albopictus mosquito). It compares the habitat, flight range, biting habits, and environmental conditions under which these vectors thrive. The document also deals with several aspects of environmental control and personal protection at various levels, such as mosquito nets, clothing, insect repellent and condoms to protect against sexual transmission of the virus and also to prevent pregnancy during an outbreak of Zika, which can lead to birth defects when the virus is passed on to unborn babies.

Introduction of Chikungunya & Zika

This document outlines several facts concerning the Chikungunya and Zika viruses, including their symptoms, sources of origin and insect vectors. It is comprehensive in nature, and also lists epidemiological data for Belize and the Central American region for the period 2014-2015. Also featured are transmission cycles, information on habitat and biting habits of the vectors along with a variety of illustrative and educational materials in the form of charts, photos and tables.

Malaria treatment guideline for health facilities in Guyana

In response to the malaria challenge in Guyana, the Ministry of Public Health of Guyana outlines the best standardized treatment of malaria for the public and private sector by promoting the development of one strategy for early diagnosis and treatment for malaria patients. This is a review of the first version developed in 2004 which now includes updated content on further complicated treatment guidelines and malaria in pregnancy. The manual includes the epidemiological situation of malaria in Guyana up to 2014; the antimalarial treatment policy; and the timely diagnosis and adequate doses of the treatment for complicated and uncomplicated malaria cases

Effect of overweight and obesity on pregnancy and birth outcomes

OBJECTIVES: To determine the effect of maternal overweight and obesity on pregnancy and birth outcome. DESIGN AND METHODS: This prospective study invited 160 women who attended their first antenatal visit at the University Hospital of the West Indies to participate in the study between June 2012 and February 2013. Maternal demographics, socioeconomic status, past medical and obstetric history, complications in pregnancy and birth outcome were collected. Body mass index (BMI) categories were created. Descriptive statistics reporting means ñ SD, Analysis of Variance (ANOVA), Chi Squared Test and regression analyses to determine whether maternal BMI or weight were independent predictors of birth and placental size were performed. RESULTS: Of the 160 women recruited, 126 (78.8%) were used for final analysis. There was an even distribution of mothers in each BMI category. A significant difference in blood pressure was seen between normal weight and obese women (systolic BP: p = 0.002, diastolic BP: p = 0.01). There was no statistical difference in women who developed an illness in pregnancy and in the admission rates across BMI categories (p = 0.92; p = 0.09 respectively). There was no significant difference in birth outcome across BMI categories. CONCLUSION: Overweight or class I obese women did not have an increased risk of adverse maternal and birth outcomes as compared to women with a normal BMI.

Zika update

This issue is a reminder that prevention is better than cure: prevention in the form of immunization, leading a healthy lifestyle and regular medical evaluation. Prevention ensures the health of individuals, families, communities and the health system and leads to a healthy population for development. Jamaica has made great gains in the prevention of communicable diseases through immunization. Diseases such as polio, measles, rubella and diphtheria have not been seen in Jamaica for decades, eliminating deaths and disabilities associated with these illnesses, and decreasing childhood mortality rates. In 2016, the vaccination coverage for all but one vaccine was the best that it had been in five years. This achievement required the involvement of the public and private health sectors in giving, recording and reporting vaccine administration; and parents, guardians and teachers being vigilant to ensure that our children are appropriately vaccinated. Continued vigilance is required, as many countries still have these diseases which may be imported and spread if less than 95% of the population is immunized.