Verocytotoxigenic Escherichia coli (VTEC)-associated risk factors in livestock, pet animals, dairy farmers and the environment in two major dairy areas in Trinidad.

The study was conducted in two major dairy areas of Carlsen field and Waller field to assess the prevalence of risk factors for infection with verocytotoxigenic Escherichia coli (VTEC) by determination of selected management practices and the distribution of animal and human populations in two areas in Trinidad. Most farms in both farming areas were in the range of 11 to 25 acres in size and there was no statistically significant difference (p = 0.8) between areas. Most dairy farms, 62.1 and 48.3 per cent in Waller field and Carlsen field respectively, fell within the range of 1 to 20 cows per farm with the differences not being statistically significant (p = 0.1). In Waller field, 58 (87.9 per cent) farmers stated that they had very close contact with their pets compared with 40 (69.0 per cent) in Carlsen field. The difference was statistically significant (p = 0.01). There was a statistically significant difference (P<0.05; x2) in the distribution of persons in households between Waller field and Carlsen field. Most farms in both areas claimed to practise hand washing before and after milking, 98.5 per cent in Waller field and 100 per cent in Carlsen field. The Water and Sewerage Authority (WASA) accounted for 63.6 and 48.3 per cent of the water supply in Waller field and Carlsen field respectively, but the difference was not statistically significant (p = 0.08). Most farms in Waller field (83.3 per cent) and Carlsen field (94.8 per cent) indicated that they used the state veterinary services. It was concluded that variation in management practices on farms would affect the prevalence of VTEC across sources and species.

Inequities in access to and use of drinking water services in Latin America and the Caribbean

Objective: To identify and evaluate inequities in access to drinking water services as reflected in household per capita expenditure on water, and to determine what proportion of household expenditures is spent on water in 11 countries of Latin America and the Caribbean. Methods: Using data from multi-purpose household surveys (such as the Living Standards Measurement Survey Study) conducted in 11 countries from 1995 to 1999, the availability of drinking water as well as total and per capita households expenditures on drinking water were analyzed in light of socioeconomic parameters, such as urban vs. rural setting, household income, type and regularity of water supply service, time spent obtaining water in homes not served by running water, and type of water-purifying treatment, if any. Results: Access to drinking water as well as total and per capita household expenditures on drinking water show an association with household income, economic conditions of the household, and location. The access of the rural population to drinking water services is much more restricted than that of the urban population for groups having similar income. The proportion of families having a household water supply system is comparable in the higher-income rural population and the lower-income urban population. Families without a household water supply system spend a considerable amount of time getting water. For poorer families, this implies additional costs. Low-income families that lack a household water supply spend as much money on water as do families with better income. Access to household water disinfection methods is very limited among poor families due to its relatively high cost, which results in poorer drinking water quality in the lower-income population. Conclusions: Multi-purpose household surveys conducted from the consumer's point of view are important tools for research on equity and health, especially when studying unequal access to, use of, and expenditures on drinking water. It is recommended that countries improve their portion of the surveys that deals with water and sanitation in order to facilitate national health assessments and the establishment of more equitable subsidy programs (AU)

Microbial quality of water in rural communities of Trinidad

A cross-sectional study was conducted in four rural communities of northeastern Trinidad to determine the microbial quality of water supply to households and that quality's relationship to source and storage device. Of the 167 household water samples tested, total coliforms were detected in 132 of the samples (79.0 percent), fecal coliforms in 102 (61.1 percent), and E. coli in 111 (66.5 percent). There were significant differences among the towns in the proportions of the samples contaminated with coliforms (P <0.001) and E. coli (P <0.001). Of 253 strains of E. coli studied, 4 (1.6 percent) were mucoid, 9 (3.6 percent) were hemolytic, and 37 (14.6 percent) were nonsorbitol fermenters. Of 69 isolates of E. coli tested, 10 (14.5 percent) were verocytotoxigenic. Twenty-eight (14.0 percent) of 200 E. coli isolates tested belonged to enteropathogenic serogroups. Standpipe, the most common water source, was utilized by 57 (34.1 percent) of the 167 households. Treated water (pipeborne in homes, standpipes, or truckborne) was supplied to 119 households (71.3 percent) while 48 households (28.7 percent) used water from untreated sources (rain, river/stream, or well) as their primary water supply. The type of household storage device was associated with coliform contamination. Water stored in drums, barrels, or buckets was more likely to harbor fecal coliforms (74.2 percent of supplies) than was water stored in tanks (53.3 percent of samples), even after controlling for water source (P=0.04). Compared with water from other sources, water piped into homes was significantly less likely to be contaminated with total coliforms (56.9 percent versus 88.8 percent, P <0.001) and fecal coliforms (41.2 percent versus 69.8 percent, P <0.01), even when the type of storage device was taken into account. However, fecal contamination was not associated with whether the water came from a treated or untreated source. We concluded that the drinking water in rural communities in Trinidad was grossly unfit for human consumption, due both to contamination of various water sources and during household water storage (AU)

Social inequalities in morbidity from diabetes mellitus in public primary care clinics in Trinidad and Tobago

Associations between soci-economic status and non-communicable diseases in middle income countries have received little study. We conducted an interview survey to evaluate the asociations of morbidity with social conditions among people attending government primary care health centres with diabetes mellitus in Trinidad. Data collected included morbidity from hyperglycaemia, foot problems, visual problems and cardiovascular disease, as well as social demographic variables. Of 622 subjects, 35 percent were aged > or = 65 years, 54 percent were Indo-Trinidadian, 13 percent had no schooling, only 11 percent were in full-time employment, and 33 percent had no piped drinking water supply in the home. Prevalent symptoms included itching, reported by 215 (35 percent), nocturia in 315 (51 percent), burning or numbness in the feet in 350 (56 percent), and difficulty with eyesight in 363 (58 percent). A morbidity summary score was used as dependent variable in regression analyses. Comparing those with no schooling with those with secondary education, the mean difference in morbidity score was 1.77 (95 percent CI 1.15-2.39), attenuated to 0.71 (0.06-1.37) after adjusting for age, gender, ethnic group and diabetes duration. The equivalent differences for those with no piped water supply in the house, compared with those with, were 0.53 (0.17-0.88) and 0.57 (0.24-0.89). For the unemployed, compared with those in full-time jobs, at ages 15-59 years difference were 0.85 (0.14-1.56) and 0.58 (-0.11-1.27). We conclude that morbidity in persons with diabetes is associated with indicators of lower socio-economic status and that this association is partly explained by confounding with older age, female gender, longer duration of diabetes and Indo-Trinidadian ethnic group. A negative association between socio-economic status and morbidity from diabetes contributes to a justification for investment of public health resources in the control of diabetes and other non-communicable diseases(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)

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)

Helminthiasis in Montserrat after the parasite control programme and hurricane Hugo - abstract

The Parasite Control Programme of Montserrat, West Indies, was a child-targeted chemotherapeutic control programme which ran from August 1986 to July 1989. The Programme involved the delivery of a broad spectrum antihelminthic to children (2-15 years old) once every school term. Two months after the end of the Programme, Hurricane Hugo devastated Montserrat on September 17, 1989. The Health Department (Montserrat) felt that the reductions in prevalence and intensity of Trichuris trichiura and Ascaris lumbricoides gained as a result of the Programme would be compromised by the disruption to sanitation and water supply caused by Hugo. In December 1989, a cycle of treatment was therefore administered to the child target group using the same infrastructure and procedure as that used in the Control Programme. The treatment compliance was 97.0 percent of the student population (n=2,125). Six months later, an age-stratified survey was done to assess the level of infection in the population and the age-standardised prevalence of T. trichiura for the overall population. Changes in the age-standardised intensity of both helminths before and after Hugo were recorded for the overall population: for T. trichiura the intensity went from 0.8 to 1.5 epg-faeces, while for A. lumbricoides the intensity rose from 1.2 to 1.7 epg.faeces. The observed rise in the infection levels of the overall population not statistically significant. The changes seen in the prevalence and intensity of both parasites taken from the surveys before and after Hugo were all found to be non-significant. There appeared to have been a non-significant increase in parasitic infection levels 9 months after Hugo to levels seen in the latter part of the Control Programme (AU)

The ecology of health services utilization in Grenada, West Indies

Few empirical investigations into the nature of health services utilization fully acknowledge that the home environment may act as a socio-geographical focus of both disease transmission and of learned health behaviour. This paper examines the role of the home environment, as well as of personal characteristics and accessibility, in the utilization of health services in Grenada, West Indies. Bivarite and logit analysis of household survey data are employed to identify markers of high user individuals and households. Aspects of each domain of the home environment (physical and behavioral environment, demographies, and residential mobility) emerge as contributors to the utilization phenomenon in the study communities. Both etiological and socio-economic linkages are postulated to underlie the observed relationships. The implications of this work for health planning in developing countries is discussed. (AU)

Bacteriological aspects of a hatchery and a meat processing plant in Jamaica

In this thesis, the sanitation and bacteriological aspects of a hatchery and a meat processing plant were examined. The levels of bacterial contamination throughout the hatchery were determined. The microflora of each room of the hatchery and the effect of washing on them was examined by identification of 370 bacterial isolates before and after washing. The effectiveness of the quaternary ammonium sanitizer and other cleaning agents used for washing was examined. The microbiological quality of the hatchery's water supply was also investigated. The results indicate that washing and sanitizing did not affect the gram-negative bacteria although gram-positive bacteria were killed. Pseudomonas, Plesiomonas and Enterobacter therefore dominated the post-washing flora. The water supply of the hatchery was found to be contaminated. It is postulated that the high numbers of these bacteria may reduce the efficiency of the hatchery by causing high chick mortality and infertility due to bacterial contamination. Bacteriological conditions of a frankfurter processing operation in one of the meat processing plants were investigated. The sanitary state of the equipment, packages and workers' hands in the processing plant were examined. Bacterial levels of the meat at various stages of processing and the bacterial population in its environments were determined by identification of 350 bacterial isolates. The effect of processing on the bacterial count in frankfurters and the heat resistance of surviving bacteria after cooking were examined. The cooking/smoking operation of frankfurter production was shown to be ineffective because of poor process control. Sanitation at the plant was poor, resulting in an unsafe product which was contaminated with staphylococci and thermoduric, antibiotic-resistant enterococci. It is highly recommended that regular bacteriological checks on the sanitation programme and the finished product should be undertaken to ensure a safe and high quality product (AU)