Solid waste disposal in the Caribbean: problems and practices

The disposal of municipal waste in the Caribbean has always been a significant problem for governments in the region. Increases in both population and tourism activity, together with a decrease in the amount of available land suitable for landfilling of waste, have aggravated the situation. Governments are now faced with the fact that solid waste disposal, long taken for granted, now represents a set of problems that are not easy to resolve. This article has looked at some of the main problems and practices in solid waste management in the Caribbean. The main conclusions from this study is that solid waste disposal in the Caribbean will, in all probability, continue to be accomplished by sanitary landfilling for the foreseeable future. Few Caribbean countries are economically or technically capable of installing and operating optional processes, such as incineration. Recycling, and to a lesser extent, composting will continue to play a role in waste quantity reduction; however, neither of there methods is likely to offer a complete solution to the problem. Economic considerations will continue to dominate solid waste disposal decisions, with environmental considerations only viable in cases where the local economy is relatively strong. Long-term change in public attitude be will only achieved through an educational strategy aimed at the general public and, on particular, school pupils (AU)

Seroepidemiology of Helicobacter pylori infection in a Jamaican community

We researched epidemiologic associations between environmental and demographic factors and prevalence of Heliobacter pylori infection in a suburban Jamaican community. Using a clustered sampling technique, 22 domestic yards enclosing 60 separate households were randomly selected from a local community. All household members (n=346) were invited to participate following informed consent; the overall compliance rate ws 58.9 percent. A detect IgG antibodies raised against H. pylori. Environmental and demographic information was obtained by questionnaire. The seroprevalence of H. pylori was 69.9 percent (n=202). Analysis of the independent variables revealed three major components: Component 1 described, collectively, good personal hygiene and sanitation, indoor water supply and absence of straying animals in the peridomestic area; Component 2 included older age, good personal hygiene and large yard size; Component 3 the presence of domestic animals (cats and dogs) and again, large yard size. These three complexes explained 42.2 percent of the variability in the data set. Logistic regression showed that Components 2 and 3 were independently associated with H. pylori seropositivity, indicating that a combination of demographic, environmental and zoonotic factors is involved in the spread of H. pylori infections at the tropical community level. (AU)

Seroepidemiology of Helicobacter pylori infection in a Jamiaican community

We researched epidemiologic associations between environmental and demographic factors and prevalence of Helicobacter pylori infection in a suburban Jamaican community. Using a clustered sampling technique, 22 domestic yards enclosing 60 separate households were randomly selected from a local community. All household members (n=346) were invited to participate following informed consent; the overall compliance rate was 58.9 percent. A commercial enzyme immunoassay (HM-CAP) was used to detect IgG antibodies raised against H. pylori. Environmental and demographic information was obtained by questionnaire. The seroprevalence of H. pylori was 69.9 percent (n=202). Analysis of the independent variables revealed three major components. Component 1 described, collectively, good personal hygiene and sanitation, indoor water supply and absence of straying animals in the peridomestic area; Component 2 included older age, good personal hygiene and large yard size; Component 3 the presence of domestic animals (cats and dogs) and, again large yard size. These three complexes explained 42.2 percent of the variability in the data set. Logistic regression showed that Components 2 and 3 were independently associated with H. pylori seropositivity, indicating that a combination of demographic environmental and zoonotic factors is involved in the spread of H. pylori infections at the tropical community level (AU)

The role of aedes aegypti survelliance and control in relation to the epidemiology. Prevention and control of dengue fever in Jamaica

The control of dengue fever depends on the level of Aedes aegypti infestation and thus relies heavily on the measures of controlling the vector. ... The vector apparently has adapted to or resisted most of the control methods. The failure of Aedes aegypti control programmes has been blamed on the vector's biological features fostering the development of species resistance to chemical control or environment factors favouring the increase of the Aedes aegypti population at a faster rate than the control methods can reduce them. Nevertheless, many Aedes aegypti control programmes are improperly planned and implemented or the control measures are often used as reactive methods of controlling dengue fever outbreaks, rather than as continuous proactive strategies for preventing the disease. Aedes aegypti breeding is basically a problem of domestic sanitation and therefore communities have an essential role to play in source reduction activities. The activities of some governmental departments, non govermental organizations and the private sector may encourage the increase of Aedes aegypti mosquitoes or play a positive role in vector control. Consequently, intra sectoral and intersectoral in vector control are very important. This study examined the control measures applied by the Jamaican Ministry of Health, Vector Control Department and the community for Aedes aegypti surveillance and control, and determined the effectiveness of and obstacles to the mosquito control activities presently being applied. The aim of the study was achieved through the execution of an entomology survey, an environmental survey, an insecticide susceptibility test, key informant interviews with vector control staff from the Ministry of Health and the administration of a Knowledge-Attitude-practice survey. The research results showed that the environmental conditions in the study area were conducive to Aedes aegypti breeding and proliferation, especially during the months July to October. Aedes aegypti mosquitoes were present throughout the study area, with a higher density ... Most of the community members in the study area had a poor attitude towards Aedes aegypti control and relied heavily on government to control... The attitude and practices of the community members relating to Aedes aegypti control were greatly influenced by whether the community was severly affected by mosquitoes or by the level of vector control attention given to the community by the government (AU)

An investigation into the methods of disposal of certain types of biohazard materials at some hospitals and medical laboratories

Biomedical waste represents a small proportion of the total volume of waste generated by health care facilities. Such waste requires proper handling and disposal because of enviromental, aesthetic, and occupational concerns, as well as risks to human health. Improper management of infectious medical waste can trigger notable adverse public health impact. This study focuses on how body parts, limbs and blood are disposed of in Kingston, St. Andrew and St. Catherine and how this differs from the standards set in the "Guidelines for the Management of Biomedical Waste in Canada". It was conducted using the entire population (18) of medical laboratories in the selected parishes along with the entire six public hospitals also located there. Permission was granted for four hospitals and sixteen laboratories. At each hospital the head of maintenace (HOM) and a the maintenance worker that does the actual disposal of body parts and limbs were interviewed separately. At each medical laboratory the chief medical technologist and the laboratory attendant were also interviewed separately. A different questionnaire was prepared for each group. During the interviews the data was filled in by the sole investigator. 79 percent of medical laboratory formulated their own policy and procedures and the other followed the CAREC guidelines. 67 percent of the hospitals also formunlated their own policies and procedures. Incineration was the main method (75 percent)practised by hospitals for the disposal of body parts and limbs. 50 percent of the lab attendants dispose of the blood by incineration, 44 percent by pouring it down the sink after decontaminating it with either bleach or autoclaving and the other 6 percent by burial. The above results are acceptable according to the gold standards. Despite the fair results of the study, the government needs to formulate policies to structure the management of medical waste. This policy process should start by developing a Procedure Manual. Adherence will then need to be monitored by the relevant authority (AU)

An analysis of the bacterial flora of meat carcasses

Meat production at the Kingston and St. Andrew and Orchard Farm Abattoir is undertaken under grossly unsatisfactorily conditions. Extensive microbial contamination could have adverse implications for the health of consumers of meat produced at the abattoirs. This study sought to determine the microbial quality and safety of the carcasses produced at the abattoirs as well as the knowledge, attitude and practice of abattoir workers with respect to sanitary slaughter and processing of animals. Samples were taken from approximately 25 percent bovine and porcine carcasses produced at the abattoir over a two-week period. Laboratory analyses were performed on these samples to determine the coliform count, E. coli count and the presence of salmonella. The condition under which slaughtering took place was observed. Informal interviews with butchers to determine their knowledge, attitude and practice with respect to sanitary slaughter were also conducted. The results showed extensive contamination of the carcasses produced. The E. coli count on carcasses, fell well outside acceptable standards. The presence of Salmonella also fell outside the limits of acceptable standards at one of the abattoirs. The presence of salmonella was detected on meat from the other abattoir though within acceptable limits. Poorly maintained facilities and equipment and lack of aseptic technique in processing and the use of untreated water in the abattoir were factors which impacted on the quality of meat produced. The study concluded that the meat produced at the Kingston and St. Andrew and Orchard Farm abattoirs places consumers at risk of contracting food borne disease. There were no significant differences between quality and safety of meat produced at the two establishments. There is need for effective quality control systems to be established in the abattoirs with a view to correcting process defects and ultimately reduce the levels of contamination of the carcass.(Au)

Montserrat. Managing health care in a volcanic crisis

The volcano on Montserrat, after being dormant for over 400 years, has been active for the past two years, last erupting on 27 June, 1997. With the capital, Plymouth, in the unsafe zone, major dislocation of people, facilities and services has occurred. The Health Department is splintered over five sites across an eight mile span and the temporary 30 bed hospital, sited at a primary school, is separated from its Casualty and Out-patient Department and Operating Theatre by 0.25 mile. In order to maintain continuity of care for communities, efforts have been made to keep evacuated clients and their community health workers as close together as possible. The mass emigration has depleted the health services, creating severe stress for those remaining. Elderly relatives have frequently been left behind, necessitating the establishment of special geriatric care facilities to cater to their needs. Increased and continuous health surveillance and mass media education have been integral to the prevention of major disease outbreak - particularly with added challenges to food safety, and management of liquid and solid waste disposal. Cooperation from neighbouring states, particularly Antigua, Barbados and Guadeloupe, as well as from the United Kingdom, has been critical in the management of the continuing crisis.(Au)

Knowledge, attitude and practice towards risk reduction of typhoid in Western Jamaica

The study was conducted to determine the knowledge, attitude and practice in relation to risk reduction of typhoid in two selected communities in Western Jamaica. It also examined the knowledge, attitude and practice of health of providers at the primary and secondary levels relative to prevention, patient care and control of typhoid fever. Two sets of questionnaires were designed to collect the necessary data. A total of 150 responses were obtained from the two selected communities and 52 from health workers. There were almost equal numbers of male and female the community respondents (76 males and 74 females) while, female was the dominant gender in the health care respondents (40/52). The modal age group was 40-49 years in both groups. The study revealed that: (1) The unavailability of clean safe water was one of the important issues. (2) There was no statistically significant difference between communities relative to knowledge. (3) Most respondents with good/fair knowledge had good/fair attitude. (4) Both community members and health workers were knowledgeable, obtained good attitude scores but the practice was not concommitant with their knowledge. (5) Most community members indicated confidence in the work and worth of the health providers. Some recommendations are made to foster the transition between knowledge and desired behaviour change (Au)

Pupal index: an epidemiologically significant surveillance method for aedes aegypti: an example using data from Trinidad

We report the results of a country-wide pupal survey of Aedes aegypti (L.) in Trinidad designed to identify the most important Aedes aegypti-producing containers, importance being a function of a container's abundance and productivity. Numerically, the most common loci were outdoor drums, water storage tanks and buckets, laundry tubs, discarded tyres and small miscellaneous containers. The average number of foci per hectare was 287 (range 65 to 499). The average standing crop per container of Ae.aegypti pupae was 9.5 and ranged 12-fold, the most and least productive being the flower pot (> 30) and the small indoor vase (<3), respectively. Seven of the 11 types were responsible for < 10 percent of all Ae.aegypti pupae and the remaining 4 types, outdoor drums, tubs, buckets and small containers, accounted for > 90 percent. If targeted, source reduction programmes were directed by the importance of various container types, efforts designed to eliminate the ubiquitous small receptacle and tyres would reduce mosquito densities by 43 percent and the provision of an adequate water supply, precluding the need for water storage, could eliminate an additional 38 percent for a total of > 80 percent of Ae.aegypti in the country. The traditional Stegomyia indices used to document the density of Ae.aegypti and predict the threat of transmission - the house, container, and Breteau indices - were seen to have virtually no correspondence with the actual number of pupae per hectare or per person. We conclude that pupal survey is more appropriate for assessing risk and directing control operations (AU)

Port health surveillance of imported meats at Port Bustamante Kingston Jamaica and a comparison with Port of Spain Trindad

During recent years surveillance has assumed greater importance in the prevention and control of imported diseases. The increasing numbers of infectionsand the emergence of new diseases gives rise to increases of selected specific factors known to be associated with these infections. International movement of foods is increasing in the Caribbean region hence the need for continuous scutiny of the factors that determine the occurence and distribution of diseases. International cooperation is needed in avoiding low quality products and in dealing with re-shipment of rejected foodstuffs. A survey was done amongst a total of 146 workers consisting of 35 sanitation workers, 66 cold storage strippers and 45 public health inspectors. Information was sought in order to assess the level of surveillance of imported meats and factors that impact on the prevention and control of foodbourne diseases. Sanitation was generally satisfactory at both ports. It was found that the mean practice scores of all categories of workers were greater than their mean knowledge scores at both ports. Mean knowledge scores for cold storage strippers were less than 60 percent at both ports. The regular cleaning and maintenance of the ports ensure a safe environment and assist in prevention of contamination. This does not mean that safety is assured as the port is an ideal place for the harbourage of rats and insects pests. The low knowledge scores of cold storage strippers may be the result of not having any formal training in the handling and storage of meats. Surveillance of meats through inspection should be accompanied by regular sampling. (AU)

Why wash

An essential part of safety in the health care field is the practice of good hygiene on a daily basis. One of the most common practices taken for granted is the technique of good hand washing. THe need to strictly adhere to good hand washing techniques becomes even more apparent in our own laboratory setting where contaminated hands can easily pass potential pathogens, compiled by LCDC, that could readily be passed by an unsuspecting pair of hands that have contacted a contaminated surface (AU)

Development of a questionnaire for assessing the school environment

This article describes the development of a school environment questionnaire to assess student's perception of their school environment. The dimensions and internal consistency reliability were examined ulitlzing various statistical methods - factor analysis and alpha coefficient. The sample consisted of 705 students from two high schools with ages ranging from ten to nineteen years. Results showed that the students perceived their school as having various aspects, rather than a global point of view. Factor analysis identified seven dimensions in the school environment: external characteristics of the environment, aesthetic and functional elements of the classroom, students' bathroom, the canteen and staffroom, the aesthetic and functional elements of the school as a whole and sanitation. Overall the internal reliability of the factors was high. Implications for school health programs are addressed. (au)

Water storage and dengue in Trinidad and Tobago: community perception and reality - abstract

A knowledge, attitude and practices (KAP) survey of 591 householders and inspection of 753 households for production of the dengue vector Aedes aegypti revealed that as many as 78 percent of households in Trinidad and Tobago stored water. Tanks (63 percent), drums/barrels (29 percent) and buckets (26 percent) were the commonest potential vector production sites, while drums >cans>buckets>tyres, proved to be the major actual producers of Ae aegypti. However, most of these were perceived as "useful by 100 percent of the population; 60 percent thought that old tyres were "useful" and only containers such as coconut shells and small bottles were perceived by 40 percent of the population as "garbage". Special messages of mosquito source reduction will need to be designed. Dengue was recognized as a "serious" illness but only 54 percent were aware of its manifestations. The urban population of Woodbrook where the experience of dengue (16.3 percent) was highest could better tell of the symptoms of dengue (56.8 percent). Conversely, in Tobago with no history of the disease, only 18.3 percent knew of any symptom of the illness. The community that had experienced the highest dengue prevalence as a whole showed least mosquito production - based on the house, container and Breteau indices for the whole country. The authors conclude that health education messages which emphasize the symptoms of Dengue and especially Dengue Haemorrhagic Fever (DHF) and link the transmission of these diseases to the nuisance mosquito, Ae, aegypti, may be one of the most important tools encouraging behaviour modification. This could lead to reduced mosquito production and a mitigation of dengue transmission (AU)

Integrated vector control program: knowledge, attitudes and practices baseline survey

In recent years there has been an increase in the number of cases with clinical symptoms of dengue fever and a large and growing mosquito population. This study is aimed at providing valuable information on which to base community participation strategies for the control of aedes aegypti mosquito in order to avoid a serious outbreak of dengue fever and to prevent the occurrence of its more deadly form, dengue hemorrhagic fever. The survey examines two components: (a)knowledge, attitude and practice. Data was collected by personal interviews; (b)an entomology survey which was essentially a household inspection to measure observed practices. The entire survey for both components was conducted in two different rural areas (the villages of Crochu and Chantimelle) with a sample of 200. Results indicate a tremendous need for community education on all aspects of general sanitation, water storage management and pest control as they relate to the transmission and prevention of dengue fever

Children of the Americas: child survival, protection and integrated development in the 1990s

Focuses on children in Latin America and the Caribbean. Looks at children in relation to sustainable development, poverty, health, nutrition