Overweight and obesity among Grenadian adolescents: rural and urban differences in social determinants

OBJECTIVE: To examine the prevalence of overweight and obesity (OW/OB) among Grenadian adolescents and to determine associations with social determinants on urban and rural adolescents. DESIGN AND METHODS: A national sample of Form1 students (n = 689) aged 11 to 14 years, from all 23 secondary schools in Grenada were assessed as part of the Grenada School Nutrition Study (GSNS). Body Mass Index (BMI) was assessed using standard measures and standardized BMI percentile. Urban (n = 13) and rural (n = 10) schools were determined by location. Exposure to fast food outlets and shops which sold sugar sweetened beverages, candy, or highly processed foods was measured within a .75 km buffer surrounding each school and major transportation hub, between school and home. RESULTS: Overall, Grenadian adolescents had low rates of overweight (17.6%) and obesity (7.6%) compared to Grenadian adults. Girls, however, had nearly twice the rate of overweight compared to boys (i.e., 22.7% versus 12.2%). There were significant differences between rural and urban students for access to cars (40.7% versus 53.3%), computer access (61.6% versus 73.5%), and snacking after school (83.6% versus 90.5%) respectively. The rural school environment also had a lower mean density of snack shops (1.53 versus 3.39 shops/square km) and mean fast food outlet density (0 versus 1.17 outlets/square km). CONCLUSIONS: Grenadian adolescents demonstrate low rates of OW/OB compared to both Grenadian adults and their US counterparts. The low rates of OW/OB suggest Grenadian adolescents have not yet been affected by social determinants of the obesity epidemic.

Clinical, molecular and serological outcomes of the Chikungunya outbreak in Grenada

OBJECTIVE: This study evaluated the clinical utility of Chikungunya (CHIKV) test results and clinical symptoms in patients with suspected CHIKV infection. DESIGN AND METHODS: Patients with CHIKV symptoms who presented at a health facility in Grenada during the recent outbreak had a CHIKV diagnostic test form completed by a health professional and a blood sample was drawn. The serum sample was stored at -80oC, shipped to the Naval Infectious Diseases Diagnostic Lab (NIDDL) on dry ice and tested for CHIKV and Dengue (DENV) using PCR real-time assay for viral RNA, and IgM detection by ELISA. RESULTS: Sera from more than 600 patients collected from mid September till mid October, 2014 were drawn and had a CHIKV diagnostic form completed. At the time of writing 112 patients sera have been tested at the NIDDL. 90% of patients had a positive test. PCR only was positive in 8% of patients. IgM only was positive in 83%, and both PCR and IgM were positive in 9% of patients. The major symptoms presented by patients were joint pain (84%), fever (81%), body pain (74%), headache (62%), chills (54%) and rash (49%). CONCLUSION: IgM testing detected 92% of test positive patients while PCR alone detected 17%. The IgM assay was clinically most useful. In an outbreak where dengue is ruled out and CHIKV is the cause, patients with the constellation of symptoms above could be considered positive for CHIKV infection with a 98% accuracy without confirmatory testing.

The current prevalence and potential elimination of the soil transmitted helminth’s from Grenada

OBJECTIVE: This study formed part of a soil transmitted helminth elimination program in Grenada. The study assessed the prevalence of soil transmitted helminths (STH’s) in Grenadian primary school children. DESIGN AND METHODS: A longitudinal study was carried out on students attending 39 out of all 54 (72.2%) primary schools in Grenada, Carriacou and Petite Martinique between March 2013 and December 2014. The schools were randomly selected for inclusion in the study. Zinc Sulphate Floatation with centrifugation and Microscopy was used to assess the prevalence of STH’s in stool samples from Grenadian primary school children. RESULTS: The overall prevalence of STH was 1.3% (95% CI= 0.54-2.72). In 4 of the 8 parishes the prevalence was 0%. The highest prevalence was 3.9% (0.48-13.46) in St. Patrick. The STH identified were Ancylostoma duodenale, Ascaris lumbricoides and Trichuris trichuria. CONCLUSION: The prevalence of STH’s in the initial survey was 1.3%. This low prevalence indicates that the elimination program which utilizes a multi pronged approach including targeted chemotherapy and education may be feasible.

Trends in reported occupational injury claims for Grenada and Dominica

OBJECTIVES: To analyze the occupational injury data claims from the Grenada National Insurance Scheme (GNIS) and the Dominica Social Security (DSS). DESIGN AND METHODS: Permission was sought and received from St George's University Institutional Review Board (IRB) as well as the directors of the GNIS and DSS to obtain and then analyze their electronic injury claims data sets over the past 10 years. RESULTS: Over the 2005-2013 period, a total of 1,396 occupational injury claims were received by the DSS whereas a total of 4,507 claims were received by the GNIS. Injury claims from males significantly outnumbered claims from females. For both islands, most claims came from those within the 20-49 years age range. In Dominica, the Wholesale & Retail sector (246 claims) and Construction sector (235 claims) were the economic sectors from which the highest number of injury claims were reported while in Grenada, the Construction Sector (1,076 claims) and the Social & Related Community Services (996 claims) sectors had the highest number of claims. Lower limb injuries, fractures, and lacerations were the top three occupational injuries claimed for in Dominica whereas in Grenada they were trauma, lacerations, and fractures. CONCLUSIONS: While there was a significant difference in the total number of injury claims filed with the numbers recorded by the GNIS significantly higher than those recorded by the DSS, the the types of injury claims were similar. For both islands, the construction sector yielded the highest number of injury claims.

Self-rated health, traumatic experiences and SAS students satisfaction with life

OBJECTIVE: To determine whether there is a correlation between early traumatic experiences self-rated health and satisfaction with life. DESIGN AND METHODOLOGY: A 147-item close-ended self-administered questionnaire was completed by 52% of students enrolled in the School of Arts and Science. The study forms part of a health behavior survey among university students from low and middle income countries. RESULTS: Students were moderate in rating their health with almost 75% rating their health between fair and good. They were generally dissatisfied with their lives (82.4%) with 58.7% being moderately dissatisfied and 23.7% being very dissatisfied. Twenty-four percent of students reported experiencing serious injuries. Of those reporting traumatic experiences, 12.4% reported to have been hit by a sex partner; 10.6% reported to have been forced to have sex; 10% reported to have been physically abused as a child and 7.5% reported to have been sexually abused as a child. Satisfaction with life correlated with being physically abused as a child and being hit by a sex partner. Self-rated health correlated with being physically abused as a child and sexually abused as a child. CONCLUSION: Self-rated health and satisfaction with life provide a good overall assessment of an individual’s health and wellbeing. Further research is needed to understand the basis for the lack of satisfaction with life.

PSA, Gleason score and epidemiology of prostate cancer (PC) in Grenada

OBJECTIVE: To assess (1) the incidence and survival rates of PC, (2) the distribution of prostatic-specific antigen (PSA) and Gleason score in Grenada. DESIGN AND METHODS: A PC hospital-based series from the only urologist in the island was assembled. Age-adjusted incidence rates, PSA levels and Gleason scores for Grenada were analyzed and compared with US-Blacks and incidence rates from “International Agency for Research on Cancer (IARC)-contributing” Caribbean registries. RESULTS: 601 new cases of PC diagnosed between 1997-2013 equate to an annual age-adjusted incidence rate of 69.3 per 100,000 in Grenada. This is similar to the Jamaica rate of 77.3, but much inferior to those of US-Blacks 197.7 and Martinique 177.8. The median PSA level in Grenada was 18.0 ng/ml compared to 7.0 among US-Blacks (P<0.05). 47% of Grenadians with PC were in the high risk PSA category (>20ng/ml), compared to only 17% US-Blacks. Lower tract urinary infection and positive digital rectal examination were both significantly associated with high risk PSA and high risk Gleason score (Gleason sum ≥ 8). CONCLUSION: The lower PC incidence in Grenada and Jamaica is likely a reflection of lower prevalence of PSA-testing. Thus, PSA levels fall more substantially in the high risk category.

Individual and school-level influences on moderate and vigorous physical activity in Grenada adolescents

OBJECTIVE: The effect of school level policies on the physical activity of Grenadian children had not been studied. The present study tested the hypothesis that schools with physical activity (PA)-promoting policies would positively impact student’s levels of moderate and vigorous physical activity in Grenada. DESIGN AND METHODS: Multilevel analysis of a nationally representative sample of first year students (i.e. Form 1) (n = 138) from the twenty-three secondary schools in Grenada were assessed as part of the Grenada School Nutrition Study (GSNS). At the individual level physical activity was measured using Actigraph GT3X accelerometers. In addition to socio-demographic measures, height, weight and waist circumference (WC) were collected using standard anthropometric procedures. School-level measures were self-reported by school administrators. The school PA policy index included: student to teacher ratio in physical education (PE) classes, minutes of PE per week, number of PE facilities/equipment, having at least one policy to address PE participation, having ≥1 policy for access to sports teams or activities, having a school board or council to address PE policies. RESULTS: No school-level variables were significantly related to student Moderate and Vigorous Physical Activity (MVPA). Waist circumference was the only variable that significantly predicted MVPA in both boys (p=0.03) and girls (p=0.005). In girls, overweight/obesity was significantly associated with decreased MVPA (p=0.004). CONCLUSIONS: Contrary to findings in United States children, Grenada school-level policies and environments were not related to student’s physical activity levels. Further research was needed to understand the variation in physical activity levels by schools in both male and female Grenada students.

Physical injury, as the face of violence against women in Grenada

OBJECTIVE: To determine the types and pattern of physical violence and relationship to prevailing gender culture characteristics in Grenadian society. DESIGN AND METHODS: Source data came from two classification table of types on the Physical Injury Scale to measure the magnitude of behavioural and sexual abuse in intimate partner violence, and summary tables of domestic violence cases recorded by Grenada Criminal Record Office between 2006-2014. A Contingency Table was used to cross tabulate variables across the Physical Injury Scale and police record summary data on domestic violence. Bivariate quantitative data on the variables were calculated. A social demographic analytical scale was used to correlate the cultural characteristics of the perpetrators. RESULTS: Physical assault represented 54% of all categories of violent abuse against women overall in 2010. Women also accounted for 42% of all homicide victims in 2012 and 75% of all other types of physical assault from the two months of record of the same year. The pattern continued with women accounting for 55% of victims of physical assault in 2013 and 41% up to September 2014. Common assault was the most frequent. Weapon of choice, in top order of rank, were the hand, cutlass and wood. CONCLUSIONS: Physical assault including wounding was the most common form of gender-based violence accounting for more than fifty percent of all cases. The predominantly male perpetrators were more than fifty percent unemployed, low or semi-skilled young adults.

A ten year retrospective analysis of motor vehicle accidents in Grenada

OBJECTIVE: To assess the burden of Motor Vehicular Accidents in Grenada during the period 2000-2009. DESIGN AND METHODS: A cross-sectional study of secondary data in the form of vehicular accident records were sourced from the Royal Grenada Police for the period 2000-2009. Detailed records of the number of motor vehicle accidents per month and per year were sourced including the type of vehicle, the number of passengers, time and location of the accident and the gender and age of the drivers were not considered to be important. The adverse health outcomes of the accidents were also determined as either minor or major depending on fatalities and extent of injuries sustained. RESULTS: There has been an increase in the total number of fatalities during the period of study occurring from motor vehicle accidents from 4.1 in 2000 to 11.9 in 2009 per 100,000. The average increase in the number of total road accidents also rose by 8.9% in the stated period. In addition, the number of major and minor road accidents had steadily increased together with an increase in the number of vehicles registered. The burden of injuries varied across different periods of time over the course of review. Conclusion: From 2000-2009, there was steady increase in the total number of motor vehicle accidents, and fatal road accidents in Grenada.

An evaluation of the burden of diabetes in Grenada

OBJECTIVE: To assess the burden of diabetes in Grenada in terms of changes in quality of life and trends of incidence, amputation and gender. DESIGN AND METHODS: A mixed methods approach was used in which statistical retrospective analysis determined trends of diabetic related amputations based on secondary data for the period 2008-2012. A qualitative approach was also used to assess perceptions of quality of life of diabetic related amputees using interviews. RESULTS: There were no statistically significant differences or trends (relationships) found between number of amputations and incidences of diabetes with respect to time. The quality of life of diabetics decreased after receiving an amputation surgery as a result of multifactorial issues such as feelings of loneliness and financial instability. CONCLUSION: The decreasing trend of diabetes in Grenada was found to be statistically insignificant while quality of life of amputees was shown to be lowered. Decreasing the incidence of amputations should involve focus on the role of peripheral neuropathy. Policy development to increase benefits to disabled citizens is recommended to improve quality of life of Grenadians.

Incidence and survival for oral and pharyngeal cancer (OPC) in Grenada

OBJECTIVE: To study the epidemiology of OPC and assess the impact of age, stage at diagnosis, gender and treatment outside of Grenada on OPC survival. DESIGN AND METHODS: An OPC population-based series from the only ENT surgeon in the island was assembled. Age-adjusted incidence rates, and stage distribution were analyzed and compared with US-Blacks and incidence rates from regional registries. RESULTS: 93 cases of OPC diagnosed during 1991-2010 resulted in an annual age-adjusted incidence rate of 9.5 per 100,000 in Grenadian males and 1.7 among females. Jamaica’s rates were 5.2 and 2.3; Martinique’s 13.1 and 1.6; US-Blacks 15.1 and 5.0 respectively. The median age in Grenada was 58 years of age. In Grenada 73% of the cases presented with stage III/IV compared to 72% among US Blacks. Nearly 24% of patients had treatment outside of Grenada. CONCLUSION: OPC rates in Grenada were comparable to others in the region, attesting to the population basis of this series. Grenadian males show medium risk for OPC while the risk is low among females. Surprisingly, the tumor, node and metastasis (TNM) stage distribution in Grenada does not differ significantly from that among US Blacks for OPC, a cancer for which screening is rarely performed or possible.

Focus group results of a community-based breast cancer train-the-trainer curriculum in Grenada

OBJECTIVE: To determine the effectiveness of a two-week breast cancer Community-Based Train-the-Trainer program for Lay Community Health Workers (LCHWs) in Grenada. The curriculum was designed to teach laywomen about the LCHW role, how to conduct a community health assessment, and knowledge about breast cancer. DESIGN AND METHODS: A qualitative research design was used. One focus group interview was performed on 10 LCHWs after the completion of the training. A structured interview guided the discussion. The focus group took place at the same location as the training. Data was analyzed using framework analysis. All participants were female. The majority of the participants were over the age of 30. Half have less than a secondary school education, one a bachelor degree, and three have some college education. RESULT: Four themes emerged from the data: service, ethics, commitment to the program and practical knowledge. The LCHWs reported being satisfied with the training and expressed being appropriately prepared after the two-week training. The focus group showed that the LCHWs understood the principles and methods underlying health assessments, understood the role of the LCHWs and their relationship to their community. The LCHWs discussed how they felt confident in teaching other women about breast health. They understood breast cancer, and felt that the hands-on element of the training was helpful. The LCHWs felt that the positive trainer-trainee relations during the training contributed to their confidence in assuming the LCHW role. CONCLUSIONS: These findings suggest that Train-the-Trainer education programs can be an effective methodology to train LCHWs.

Analysis of cancer prevalence among women in Grenada

OBJECTIVE: To investigate prevalence of cancers affecting women in Grenada, a study was conducted using de-identified patient records from the Grenada General Hospital Histopathology Laboratory of women who visited hospital and clinic facilities during 2000 - 2010. DESIGN AND METHODS: De-identified records of 12,012 entries, 9,023 female (7,172 individuals) between ages 8 – 94 years presumably to seek preventative care or medical treatment were assessed during this cross-sectional study. Sampling without replacement resulted in approximately 3,000 entries for analysis. Prevalence of each type of cancer reported amongst women was determined. RESULTS: Of the 3,000 pathology diagnoses, 601 of the samples were classified as cancerous. The most prevalent cancer in Grenadian women from 2000 – 2010 was cervical cancer at (34%), followed by breast cancer at (31%). All other reported cancers were analyzed and their prevalence determined. CONCLUSION: Overall, the rate of cancer among Grenadian women for the ten-year period from 2000 – 2010 was determined to be 8.4%. There are implications for prevention and creation of health policies to address cancer burden in Grenada.

Infertility knowledge, attitudes, and beliefs of college students in Grenada

OBJECTIVE: To assess attitudes and extent of knowledge college students in Grenada have towards infertility. DESIGN AND METHODS: Hand-administered survey using a convenient sample. The sole college located on the island of Grenada: T.A. Marryshow Community College. Five hundred and eight college students over the age of 16 participated in this study with females comprising 65.7% (n = 334). The main outcome measure was the level of knowledge on the causes and treatment options of infertility. RESULTS: There was a moderate level of knowledge among males and females with regards to the risk factors that may cause infertility. The majority of participants believed that God’s will and the power of prayer can cause and treat infertility. Overall, a greater proportion of female students answered more questions correctly in comparison to the male students. CONCLUSIONS: There is a notable lack of basic knowledge among Grenadian college students about the causes of infertility. Additionally, among these students, there is the perception that women are more susceptible to infertility than men. Education programs and community support groups are recommended to increase knowledge on the causes of infertility as well as decrease the stigma of this condition.

Grenadian doctors’ perceptions on abortion

OBJECTIVE: To assess perceptions of Grenadian physician on abortion. DESIGN AND METHODS: An online survey was created and emailed to all doctors registered to practice in Grenada. Once the data was collected, it was analyzed using SPSS. RESULTS: A response rate of 58% (45 out of 78 physicians) took part in this study. Almost all physicians (93%) indicated that they were personally aware of unsafe abortions being performed in Grenada. The three main complications physicians reported as arising out of unregulated abortion procedures were bleeding (18%), infection (17%), and uterine perforation (17%). Health education was identified by 93% of physicians as the best solution to preventing unsafe abortions. CONCLUSIONS: Almost all local physicians reported that unsafe abortions are taking place in Grenada and that the best solutions to this problem would be to provide health education along with use of modern contraception and the use of legalized and regulated abortion services. Specifically, the implementation of school-based health education program could prove effective in minimizing the conditions that lead to women being placed in a position where they feel that they have to resort to unsafe abortion procedures.

Impact of dropping out of the Sports for Health Program in Grenada

OBJECTIVE: To determine if there were any significant differences in body mass index (BMI) and waist-to-hip ratio (WHR) between active participants in the Sports for Health program and participants who were lost to drop out. DESIGN AND METHODS: Persons who were originally part of the program and data collection in 2011, but were no longer active participants were evaluated. The evaluation utilized the data from the participants at their last BMI and WHR measurements as program participants and follow up measurements as non-participants in 2014. RESULTS: Data analysis showed that body mass index (BMI) was signficantly higher in persons who no longer participated in the sports for health program when compared to active program participants. In addition, non-participation of persons in the Sports for Health program was found to increase individual risk factors for chronic diseases, which were originally mitigated by participation in the program. Barriers to participation by many women in the program included lack of partner support and negative community perceptions, which influenced several women to discontinue their participation in the program. Recommendations were made in order to address the barriers to participation and to decrease the drop out rate in the Sports for Health program in Grenada. CONCLUSION: Non-participation in the Sports for Health program adversely affects persons BMI and WHR, therefore, increasing risk factors for several non-communicable chronic diseases.

Lessons learnt from the intense 2014 Chikungunya Epidemic in Grenada

OBJECTIVE: To present an overview of the lessons learnt from the fall 2014 outbreak of Chikungunya (CHIK) in Grenada. DESIGN AND METHODS: A review of newspaper articles, news reports and opinions of clinicians and policy makers on the impact and evolution of the CHIK outbreak in Grenada was conducted. RESULTS: CHIK outbreaks on small island developing nations are characterized by high attack rates. The speed of the spread of the virus is facilitated by the efficient domesticated diurnal vector species Aedes aegypti. Efforts to educate the public and to control this vector stretched resources. Clinical attack rates in the Grenada outbreak impacted manpower resources in every sector including clinical services. CONCLUSION: CHILK infected an estimated 60% of the population in just three months of intense transmission. The resulting morbidity meant that essential lessons were learnt. These included the need for a rapid response in educating the population on the mode of transmission of the virus and its prevention, the implementation of vector control and the demand for diagnostic tests. Essential services were short staffed. The need for an unprecedented rapid response and the impact of the CHIK outbreak in Grenada will be presented.

Establishment of laboratory testing capability for chikungunya virus in Grenada, West Indies

OBJECTIVE: Rapid diagnosis of Chikungunya (CHIKV) is important early in an epidemic. The study objective was to describe the process of implementing CHIKV testing capability in Grenada and to confirm the arrival of CHIKV on the main island of Grenada. DESIGN AND METHODS: In April, 2014 a collaborative study between the U.S. Naval Infectious Diseases Diagnostic Laboratory (NIDDL) and the clinical microbiology laboratory of St. George’s University (SGU) was started. SGU acquired essential instrumentation and patient samples, and NIDDL provided supplies and reagents, plus technical training experts. RESULTS: Personnel, supplies and equipment arrived in Grenada in August 2014. Set up of instruments and test validation were completed quickly. Initial CHIKV PCR and IgM tests found 3 PCR positive samples. The IgM assay found several presumptive positives that were unable to be confirmed due to ELISA instrument malfunction. PCR data indicated that CHIKV had arrived on the main island of Grenada no later than August, 2014. Based on arbovirus test demand, symptomatic patients began to increase in August, peaked in September, and tailed off during November. CONCLUSION: Both CHIKV tests were implemented and produced the first on-island reference test confirmation of CHIKV patients in Grenada. The most difficult part of this effort was training technologists in time to help with testing. Laboratory testing for CHIKV infection can be a challenge in developing states at a distance from support services. Collaborative links with established labs remains essential.

The prevalence of dengue in Grenada: a five year retrospective study

OBJECTIVE: To determine the prevalence of dengue and its serotypes (DENV 1-4) in symptomatic persons who sought care at the St. George’s University (SGU), University Health Services (UHS) during the five-year period of 2009 – 2013. To compare the dengue serology data with the dengue qRT-PCR data in the target population. DESIGN AND METHODS: The target population consists of 298 samples from dengue suspected patients who sought care at the SGU, UHS between 2009-2013 and completed the Investigation form for Suspected Dengue Infection. Dengue seropositivity of these samples was determined by the Dengue Diagnostic Laboratory with the use of ELISA and/or non-structural protein (NS1) antigen detection. The serology data collected from the Dengue Diagnostic Laboratory was used to create an electronic database. RESULTS: Of the 298 dengue suspected cases over the 5-year period of 2009-2013, 89 were confirmed to be positive for dengue. The annual prevalence of dengue from 2009 to 2013 was found to be; 34.38%, 36.96%, 26.79%, 16.21% and 29.27% respectively. The prevalence of dengue over the 5-year period was found to be 30.2%. CONCLUSIONS: From the data gathered, it appears that dengue cases peak between August to November. This is due to increased levels of rainfall which increases the number of breeding sites for the mosquito vector. The highest prevalence was seen in 2010 and the lowest prevalence was seen in 2012.

A retrospective case series study of the seroprevalence of Human T Lymphocyte Virus 1 and 2 from the General hospital Laboratory in Grenada

OBJECTIVE: HTLV-1 is a human retrovirus that causes adult T-cell Leukemia/Lymphoma (ATL) and some other conditions – HTLV-associated myelopathy (tropical spastic paraparesis, a multiple sclerosis-like disease), uveitis, infective dermatitis and some “auto immune” diseases. While the Caribbean has been identified as an HTLV-1 endemic area, there are no published studies on HTLV-1 from Grenada. The objective of this study was to anonymously review the General Hospital laboratory records to investigate the seroprevalence of HTLV-1 and 2 in Grenada. DESIGN AND METHODS: This was a retrospective study of the records from the General Hospital Laboratory in Grenada, where ELISA serologically positive results for HTLV 1 and 2 were recorded as a percentage of the total number of tests performed between the years 1998 - 2013. The Diasoren rapid ELISA serological test was used. RESULTS: During the 16 year review period (1998-2013) a total of 2,346 (4.7%: 95% CI: 4.5% to 4.9%) out of 49,782 patients were identified as HTLV-1 and 2 positive. Females with a median age of 34 years comprised 70% of positive cases whilst the median age for males was 43 years. The rate in Grenada has been steadily declining since 1998 and appears to be leveling off at about 3.7%. CONCLUSION: The current seroprevalence of HTLV 1 and 2 in Grenada is lower than that reported in 1991 in Jamaica (5%). The rate found is still unacceptably high and additional studies are required to determine the health consequences of HTLV-1 infection. Additionally appropriate public health programs should be applied to help reduce transmission.