Chronic diseases - facing a public health challenge

Middle income countries like those in the Caribbean can feel proud of their achievements in health care. There has been a dramatic fall-off in infant mortality and crude mortality rates along with significant improvements in life expectancy at birth. However, these countries now find themselves grappling with the burden of chronic non-communicable diseases such as heart disease, stroke, hypertension, diabetes mellitus and cancer. There are good data to support the view that some of these diseases, in particular diabetes mellitus, have assumed epidemic proportions and there is concern that this fact may have been missed by many because of the surreptitious onset, as is the nature of the chronic diseases. The impact of this epidemic may have suffered because of the higher profile of more tropical issues like HIV/AIDS even though the former makes a larger contribution to morbidity and mortality statistics. It is now obvious that despite the impact of other factors, lifestyles changes are the major contributors to the epidemic. In populations of similar genetic stock, living in significantly different socio-economic circumstances, the impact of increased dietary salt, increasing obesity and decreased physical activity on the prevalence of hypertension, diabetes mellitus and lipid disorders is unequivocal. Data from the developed world, which has already been through this epidemic of chronic diseases, have shown that increasing technological advances in medical care is an efficient way to respond to the situation. A multi-sectoral approach is required to tackle this epidemic, including the provision of incentives for healthy eating and widespread opportunities for increased exercise and other physical activities. Continued research into the evolution of the epidemic, including reliable estimates via surveillance methods is a necessary component of our response. The problems and the solutions are not only the responsibilities of the health officials but must involve education, agriculture and other sectors of the economy. (AU)

Ethnographic study of communities in Jamaica, St. Lucia and St. Vincent

Reports on the results of an integrated vector control programme aimed at introducing or strengthening community participation in the control of all vectors of disease in three Caribbean countries. Specifically the study's objectives were to, obtain information on community beliefs relating to the use and possible classification of the word "fever"; febrile illness and their causes and treatments; dengue and its symptoms; transmission of illnesses by mosquitoes, rodents and other pest; methods employed to prevent disease transmission, especially dengue; methods employed in the home to control mosquitoes, rodents and pests. Examines how health status and environmental conditions are perceived by the informant; the links between health and actions undertaken at the household levels as a result of these perceptions; and the role Government and the Community can play in vector control as well as the perceived effectiveness of Government activities. Identifies and investigates topics that might be specific to the study area, such as the distinction between dengue and cholera and dengue and influenza. The countries selected for the ethnographic study were St. Lucia, St. Vincent and Jamaica. (AU)

Evolution of legionnaires' disease in an urban hospital - abstract

Ongoing epidemiological surveillance for nosocomial Legionnaires' Disease (LD) was initiated after control of an initial outbreak involving eight cases at a Nova Scotia Hospital in 1984. All cases of nosocomial pneumonia were screened for LD, and water samples were cultured for Legionella at intervals. No clinical cases of LD were identified until April, 1987, although there were occasional positive cultures from water samples in different areas of the hospital. Subsequently, six to seven cases have been identified over each 12-month period with no more than two cases in any month. The mean age of patients was 67.7 years (range 54 - 83) with a male to female ratio 2.5:1. The mean time of onset of pneumonia after admission was 19.9 days (range 8 - 27) with diagnosis being made in most cases by sputum culture. Risk factors included smoking, immunosuppressive therapy and admission to a specific wing of the hospital. Water samples from the specific wing of the hospital were persistently positive at high levels until certain plumbing revisions were instituted. In contrast to the initial outbreak, these cases represent an endemic level of nosocomial LD related to a specific area of the hospital. Ongoing surveillance is required for detection and control (AU)

The benefits and limitations of sentinel surveillance data on gastroenteritis in epidemic investigation

Sentinel surveillance playes an important role in the early detection of disease outbreaks. In Jamaica, information is collected weekly on gastroenteritis (GE), fever, and measles. Recently, GE data has been divided into cases in under 5 year olds and over 5 year olds in order to increase the system's sensitivity towards detection of the introduction of cholera. Investigation of a recent epidemic of gastroenteritis at Cornwall Regional Hospital, Montego Bay, St. James Parish reinforced to us the importance of sentinel data collection for detection of outbreaks and illustrated the usefullness of age division of GE data, but also alerted us to the need to monitor the accuracy of case definitions for sentinel reports (AU)

International task force for disease eradication

The eradication of smallpox from the world in 1977 proved the feasibility of infectious disease eradication. The International Task Force for Disease Eradication (ITFDE) is assessing the potential for global eradication of other infectious diseases. This report summarizes the ITFDE's findings on the potential to eradicate eight diseases based on draft versions of criteria under development (AU)

A proposed protocol and case report of the anaesthetic management of an HIV-positive patient

This report describes the anaesthetic mangement of an HIV-positive patient and proposes a protocol for the management that is suitable for the present working conditions in Jamaica (AU)

The Caribbean Epidemiology Centre (CAREC)

The Caribbean Epidemiology Centre began operating on 1 January 1975 under the adminstrative management of the Pan American Health Organization (PAHO) at the request of the Caribbean Health Ministers' Conference held in the Bahamas in 1974. This presentation outlines the events leading to formation of the Centre and describes its structure, objectives, and development from January 1975 through 1978 (AU)

Some aspects of the development of the water quality control programme in Jamaica 1956 - 1975

Due to the high incidence of water-borne diseases in the island in the early 1950s, the Government took the decision to institute an islandwide programme of "water quality control". On the advice of an international sanitary engineer the services of a Jamaican sanitary engineer were secured. He was employed to the Ministry of Health. Training programmes were instituted and training of related personnel has been ongoing. Sixty per cent of those trained found the programme inadequate for the job of water quality control. It is thought that more sophisticated instrumentation is needed to deal with the more complex type of water pollution as well as a higher level of training for personnel (AU)