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.

Knowledge levels, attitude and beliefs of men towards the Digital Rectal Examinations (DRE): A study in Trinidad

Objective: To determine knowledge levels, attitudes and beliefs of men 40 years and over regarding Digital Rectal Examination (DRE). The investigators considered this crucial following the scourge of prostate cancer in Trinidad and Tobago, and seeming lack of the use of the DRE, a noted method of screening for the condition for early detection. Design and Methodology: A cross-sectional descriptive study was undertaken using all men totaling 216, who were 40 years and over, and who gave their informed consent, attending a central mall in Trinidad in the month of April 2018. Data was collected using researchers'- designed self-administered questionnaire. Data was collected and collated manually but analysed with the aid of the SPSS version 20. Result: Results indicate that the men (a) were knowledgeable (95.8%) about DRE, (b) had positive belief (96.3%) about DRE and its medical significance, and (c) had good attitudes (73.6%) towards DRE. Further, men's knowledge levels and beliefs were not significantly associated with their selected demography, namely age, religion, educational level, marital status and ethnicity (p>0.05. However, their attitudes were associated with their ethnicity only (p<0.03). Conclusion: Results suggest that perhaps the attitudes and beliefs are better predictors of intentions than knowledge. This needs to be explored further given the need to curb the prevalence of prostate cancer among men in Trinidad and Tobago.

Socio-demographic and clinical determinants of dementia in the oldest old: National survey of ageing and cognition in Trinidad

Objective: To determine social and clinical factors associated with dementia in the oldest old (>85 years). Design and Methodology: A survey in a nationally representative sample of people aged 85 years and older using household enumeration was undertaken. Dementia status was ascertained using standardized interviews and algorithms from the 10/66 schedule. Information was also obtained on age, gender, level of education, ethnicity and previous occupation. Self-report on the presence of angina, heart disease, stroke, diabetes, high cholesterol, and hypertension was elicited and corroborated. Results: Of the participants 61.5% were females. The mean age was 89.0 years and dementia was present in 47.2 % persons. Dementia was significantly associated with age >95 (OR=2.02; 95%CI: 0.86- 4.69), female gender (OR=1.31; 95%CI: 0.85- 2.02), East Indian ethnicity (OR=1.45; 95%CI: 0.81-2.60), being widowed (OR=2.05; 95%CI: 0.59-7), Hindu religion (OR=2.10; 95%CI: 1.23- 3.58), history of working in the agricultural sector (OR=3.20; 95%CI: 1.59-6.48). Level of education (OR=0.14; 95%CI: 0.04-0.45), taking vitamins (OR=0.61; 95% CI: 0.37-0.97) and being of mixed ethnicity (African and East Indian) were protective factors. Of the self-reported disease conditions, those with greater than 3 medical co-morbidities were 2 times (OR=2.21; 95%CI: 0.48-9.94) more likely to have dementia than those with0-2 medical comorbidities. Dementia was not more likely to occur in diabetes (OR= 1.03; 95% CI: 0.65-1.64) and hypertension (OR= 0.67; 95% CI: 0.41-1.08). Conclusion: Our study, the first of its kind in Trinidad, supports more tailored policy and better planning of services for a rapidly expanding older population.

Normative values for hand grip strength in Trinidad And Tobago

Objectives: To establish normative Hand Grip Strength (HGS) data for Trinidad and Tobago and to assess factors that may influence hand grip strength within this population. Design and Methodology: A cross sectional study of participants between the ages of 18-80 years was conducted at five distinct geographic regions in Trinidad and Tobago. Demographic data was collected including hand dominance. HGS was measured using a Jamar dynamometer. Descriptive statistics were performed for all direct measurements and Pearson's correlation coefficient used to analyze the relationship between variables. All statistical analysis was performed using the Statistical Package for Social Sciences (SPSS v20) p-value < 0.05 was considered significant. Results: A total of 1354 participants took part in the study, with 121 exclusions leaving 1233 for analysis. There were 561 males (45.5%) and 672 females (54.5%). The mean age of the participants was 42.5 years (SD +/-15.5) and mean body mass index (kg/m2) 27.3 (SD +/- 6.0). The overall mean HGS for our sample was 28.4 kgs. (SD +/- 2.9) with males having a higher overall HGS compared with females. Conclusions: This study presents previously unreported normative data on HGS in a Trinidad and Tobago population. This data will allow for a more objective evaluation of hand function in patients following injury and has implications for the assessment of disability in workmen's compensation.

Asymptomatic 'normal' subjects may have a respiratory health burden as assessed by the St Georges Respiratory Questionnaire (SGRQ)

Objectives: The Burden of Obstructive Lung Disease study in Trinidad and Tobago identified subjects with obstruction and no symptoms in approximately 5% of the general population over 40 years old. We reviewed data from a previously published study involving asymptomatic subjects to determine respiratory health burden and relation to lung function. Results: Subject characteristics were: 16 (64%) males, Mean (SD) age 64.8 (6.78) years, forced expiratory volume (FEV1) 2.25 (0.77)L, forced vital capacity (FVC) 2.91 (1.02) L, FEV1/FVC 78.1 (8.31)%. Parameters assessed were FEV1 (1.21 to 3.69 L); FVC (1.32 to 4.88 L); FEV1/FVC (65.2 - 94.7%); SGRQ Total Score (0 to 20.8). Three subjects (12%) had a FEV1/FVC ratio of less than 70%. The correlations (rho, p) of total SGRQ scores were FEV1 (-0.62, 0.001), FEV1% (-0.52, 0.008); FVC (-0.69, < 0.001). Conclusion: Asymptomatic normal elderly subjects had significant respiratory health burden as measured by the SGRQ and this was worse in those with a lower FEV1%. This may apply to elderly persons in the general population.

Health status and risk factors for dementia in the middle old in Trinidad: Findings from a nationally representative survey

Objective: To investigate self-reported health status and risk factors for dementia in middle old (75-84 years) individuals. Design and Methodology: This study used the validated 10/66 door- to-door interview protocols. All individuals (836 persons) 75-84 years old were approached. The modified 10/66 dementia algorithm produced output in 811 (97%). Dementia diagnosis was made according to 10/66 criteria from: (1) cognitive tests, the Community Screening Instrument for Dementia (CSI'D), (2) EURO-D depression scale (3) informant interview. Demographic data included information on accommodation, social network, level of impairment and instrumental activities of daily living. Data were analyzed using multilevel logistic regression models. Results: Of the 811 participants, 55% were females. The mean age was 78.9±6.3 years and dementia was present in 198 (24.4%). High level of education, professional employment and having no comorbidities were significant protective factors. In multivariate analyses those with stroke were nearly 5 times more likely (OR=4.81, 95% CI: 2.72, 8.53) to have dementia, and those with diabetes were 2.5 times (OR=2.55; 95% CI: 1.71-3.78) more likely to have dementia than those without these comorbities. Impairment in climbing stairs walking and sight was more common in the dementia group than the non-demented. Individuals with dementia were more likely to be unable to perform all seven instrumental activities of daily living (IADL) and were less active compared with their non-demented counterparts. Conclusion: In the middle old population in Trinidad having diabetes and stroke with varying levels of impairment as well as a sedentary lifestyle puts an individual at increased risk of dementia.

Factors associated with quality of life impairment among asthma patients attending specialty clinics in Trinidad

Objectives: To examine factors associated with asthma related quality of life impairment (AQLI) among patient attending asthma clinics in Trinidad. Design and Methodology: A consecutive sample of 428 patients, ≥18 years, attending asthma clinics in Trinidad were recruited. Data were collected using intervieweradministered questionnaires which captured demography, comorbidities, triggers, hospital admissions and emergency department (ED) visits. AQLI was evaluated using the Juniper Mini AQL questionnaire to capture both the physical and emotional impact of the disease. The data were analysed using Chi-square test and multivariable logistic regression (SPSS Version 25). Results: Majority of patients were female (81%), ≥40 years (80.4%), of Indo-Caribbean descent (61.9%), and overweight (71.7%). The most commonly reported health conditions were gastrooesophageal reflux (53.0%), hypertension (47.2%), allergic rhinitis (45.1%), anxiety (42.8%), sleep apnoea (35.0%), and depression (32.5%). Environmental allergens (73.8%) were the most commonly reported trigger factor. The prevalence of moderate to severe AQLI was 60% and significantly associated variables were: age group (p=.0003), ethnicity (p<.0001), trigger factors (p=.013), sleep apnoea (OR=3.07, p=.001), gastrooesophageal reflux (OR=2, p=.014), depression (OR=3.59, p=.001) and anxiety (OR=2.52, p=.003), frequent (two or more) exacerbations (OR=4.07, p<.001) and having ever visited the ED (OR=4.78, p<.001) in the last 12 months. Independent predictors of AQLI were age, ethnicity, sleep apnoea and ED visits (Nagelkerke's pseudo R2=41%). Conclusion: Asthmatics demonstrate a high prevalence of moderate to severe quality of life impairment associated with demography and co-morbidities. Understanding these factors may improve doctor patient interactions, treatment and management.

Does the Chronic Disease Assistance Program promote equity or increases the socioeconomic divide?

Objectives: The objective of the study was to assess the extent to which the Chronic Disease Assistance Programme (CDAP)was able to meet the needs of different risk groups within the Trinidad and Tobago population. The study sought to answer the research question how does the healthcare strategy of risk group segmentation (RGS) interact with the country context to create legitimacy for CDAP. It was hypothesised that the implementation of a RGS strategy improves CDAP's legitimacy to allocate and manage resources. Design and Methodology: A sample of 161 pharmacists were surveyed via face to face interviews and telephone calls using a convenient sampling method. The instrument determined the extent to which the six dimensions of RGS were utilized in CDAP and three performance construct were assessed. Two pharmacists from each pharmacy were interviewed to reduce common method bias. Descriptive measures such as mean, standard deviation and Pearson bivariate correlations for the purpose of simple summaries of the dominant views and relationships were done and hypothesis testing was conducted using three-stage hierarchical regression analysis. Results: RSG was seen as an empowering tool for the patients and was needed, but not addressed. It was found to be desirable but not implemented. Its non implementation reduced the socio-political legitimacy of the program. Conclusions: CDAP in its current form does not address the risk faced by various groups in Trinidad and Tobago. This has led to the socio-political legitimacy of the program being reduced. It may be inferred its ability to create true health equality is compromised.

Belize Vector and Ecology Center monthly activity report March 2018

The Belize Vector and Ecology Center has embarked on vector surveillance initiatives that will allow us to determine changes in distribution and density of vectors and obtain information about population changes. In turn, this will allows us to monitor and evaluate adequate control methods. In this report, we have outlined the various activities that we have been conducting for the month of March.The Household Container Mapping is being conducted by teams consisting of BVEC employees and Vector Control representatives. So far, we have mapped approximately 20.61% of the total structures in Orange Walk Town. Mapping data was updated for the month of March based on the amount of structures we did. Ovitrap Surveillance is being done in which 120 oviposition cups are set out to 60 pre-consented homes in Orange Walk Town. The hatch rate has been determined to be about 40% to 60%, and there is interesting variation in the number of eggs collected per zone which may also be related to the position of ovicups and climatic conditions.The BG Sentinel Surveillance is being conducted in order to collect live adult Aedes mosquitoes in the field. There are 12 BG Sentinels in the town at 12 pre-consented homes. The traps so far have collected a number of Aedes mosquitoes as well as some from the Culex species and other types of flies.The adult Aedes mosquitoes collected in the traps are then sorted, identified and stored for testing using the Dengue Antigen Kit. Tests conducted so far have turned up negative and testing will continue while working on a pooling strategy depending on the number of adult females collected in the field. Larval Resistance Testing is another key component to the surveillance which will be done in conjunction with the ovitrap surveillance initiative. Currently eggs are being pooled and hatched so that there is enough larvae to meet the standard testing methods. BVEC also does Presentations and Training sessions in which we collaborate with schools and other groups to foster community engagement.

Belize Vector and Ecology Center monthly activity report February 2018

The Belize Vector and Ecology Center has embarked on vector surveillance initiatives that will allow us to determine changes in distribution and density of vectors and obtain information about population changes. In turn, this will allows us to monitor and evaluate adequate control methods. In this report, we have outlined the various activities that we have been conducting for the month of February.The Household Container Mapping is being conducted by teams consisting of BVEC employees and Vector Control representatives. So far we have mapped approximately 19.19% of the total structures in Orange Walk Town. Mapping data was updated for the month of February based on the amount of structures we did. Ovitrap Surveillance is being done in which 120 oviposition cups are set out to 60 pre-consented homes in Orange Walk Town. The hatch rate has been determined to be about 40% to 60% and there is interesting variation in the number of eggs collected per zone which may also be related to the position of ovicups and climatic conditions. The BG Sentinel Surveillance is being conducted in order to collect live adult Aedes mosquitoes in the field. There are 12 BG Sentinels in the town at 12 pre-consented homes. The traps so far have collected a number of Aedes mosquitoes as well as some from the Culex species and other types of flies. The adult Aedes mosquitoes collected in the traps are then sorted, identified and stored for testing using the Dengue Antigen Kit. Tests conducted so far have turned up negative which is a good sign and will continue testing while working on a pooling strategy depending on the number of adult females collected in the field. Larval Resistance Testing is another key component to the surveillance which will be done in conjunction with the ovitrap surveillance initiative. Currently eggs are being pooled and hatched so that there is enough larvae to meet the standard testing methods. BVEC also does Presentations and Training sessions in which we collaborate with schools and other groups to foster community engagement.

Belize Vector and Ecology Center monthly activity report January 2018

The Belize Vector and Ecology Center has embarked on vector surveillance initiatives that will allow us to determine changes in distribution and density of vectors and obtain information about population changes. In turn this will allows us to monitor and evaluate adequate control methods. In this report, we have outlined the various activities that we have been conducting for the month of January. The Household Container Mapping is being conducted by teams consisting of BVEC employees and Vector Control representatives. So far we have mapped approximately 17.73% of the total structures in Orange Walk Town. Mapping data was updated for the month of January based on the amount of structures we did. Ovitrap Surveillance is being done in which 120 oviposition cups are set out to 60 pre-consented homes in Orange Walk Town. The hatch rate has been determined to be about 40 to 60% and there is interesting variation in the number of eggs collected per zone which may also be related to the position of ovicups and climatic conditions. The BG Sentinel Surveillance is being conducted in order to collect live adult Aedes mosquitoes in the field. There are 12 BG Sentinels in the town at 12 pre-consented homes. The traps so far have collected a number of Aedes mosquitoes as well as some from the Culex species and other types of flies. The adult Aedes mosquitoes collected in the traps are then sorted, identified and stored for testing using the Dengue Antigen Kit. Tests conducted so far have turned up negative which is a good sign and will continue testing while working on a pooling strategy depending on the number of adult females collected in the field. Larval Resistance Testing is another key component to the surveillance which will be done in conjunction with the ovitrap surveillance initiative. Currently eggs are being pooled and hatched so that there is enough larvae to meet the standard testing methods. For this month some resistance curves were established for some of the zones as the contamination issues were addressed. BVEC also does Presentations and Training sessions in which we collaborate with schools and other groups to foster community engagement.

Muskieten-bestrijding hospitalen en verzorgingstehuizen / Mosquito - control of hospitals and care houses

The information provided in this document by the Suriname Bureau of Public Health (BOG), is intended for the management and staff of hospitals and care homes with regard to the prevention and control of mosquito breeding sites. It focuses on the mosquitoes, and more specifically, the Aedes mosquito, which is a carrier of serious diseases such as Dengue, Chikungunya and Zika viruses. Symptoms of these viruses include fever, headaches, joint and muscle aches, and skin rashes. The core intent of the information is to prevent the spread of diseases carried by this insect vector via elimination of breeding grounds and the environment in which they thrive, such as small water objects like cups, cans, trays, vases, flower pot coasters, car tires and water barrels to name a few. Systematic, sustained implementation of an anti-mosquito program is crucial to the successful control of Dengue, Chikungunya and Zika viruses, particularly for hospitals and care homes. The key rationale is to raise awareness of the danger of transmission, and encourage widespread participation towards control and eventual elimination of the breeding grounds. A comprehensive list of strategies to eliminate breeding grounds is included in the publication...(AU)

Muskieten-bestrijding overheidsgebouwen / Mosquito - Control of government buildings

The information provided in this document by the Department of Entomology of the Suriname Bureau of Public Health (BOG), is intended for the management and staff of government buildings as relates to the prevention and control of mosquito breeding sites. It focuses on the Aedes Aegypti mosquito. The insect vector responsible for transmission of Dengue, Chikungunya and Zika viruses. The intent of the information bulletin is to provide information and greater awareness towards prevention of the spread of diseases carried by this insect vector and assist in the effort towards elimination of breeding grounds and environments in which the mosquito thrives.

Aedes insecticide resistance surveillance protocol

The establishment of the Aedes mosquito in Guyana has raised public health concerns in the ten administrative regions where conditions are suitable for their existence. Recently, studies were conducted in Georgetown to determine the risk of transmission in the city using the Breteau Index tool. This research (unpolished data) has revealed regional epidemic risks and transmission risks in most areas. To contribute in a sustained way the improvement of the entomological surveillance programs, supporting the implementation of a consensual strategy for the monitoring and management of insecticide resistance in the main disease vectors in Guyana.

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.

Corozal zika classification by age group 2017

The document is a compilation of the weekly surveillance of the confirmed and suspected (clinical and test) cases of Zika in the Corozal district recorded by the EPI Unit of the Ministry of Health, Belize for 2017. This information is captured and reported according to age group.

Orange Walk zika classification by age group 2017

The document is a compilation of the weekly surveillance of the confirmed and suspected (clinical and test) cases of Zika in the Orange Walk district recorded by the EPI Unit of the Ministry of Health, Belize for 2017. This information is captured and reported according to age group.

Belize zika classification by age group 2017

The document is a compilation of the weekly surveillance of the confirmed and suspected (clinical and test) cases of Zika in Belize recorded by the EPI Unit of the Ministry of Health, Belize for 2017. This information is captured and reported according age group.

Cayo zika classification by age group 2017

The document is a compilation of the weekly surveillance of the confirmed and suspected (clinical and test) cases of Zika in the Cayo district recorded by the EPI Unit of the Ministry of Health, Belize for 2017. This information is captured and reported according to age group.

Stann Creek zika classification by age group 2017

The document is a compilation of the weekly surveillance of the confirmed and suspected (clinical and test) cases of Zika in the Stann Creek district recorded by the EPI Unit of the Ministry of Health, Belize for 2017. This information is captured and reported according to age group.