Biomedical publications in the selected CARICOM countries

Objective: To compare biomedical research productivity among selected CARICOM countries. Design and Methodology: Biomedical publications of the selected CARICOM countries (Bahamas, Barbados, Dominica, Guyana, Grenada, Haiti, Jamaica, Suriname, and Trinidad & Tobago) were retrieved using 'PubMed' and 'ScImago Journal & country Rank' (SJR) databases. The publications for each country were then normalized by factors such as total population, gross domestic product (GDP) and Internet usage rate. Results: Total number of papers published by all 9 countries was 7,281 and 8,378 in PubMed (1990- 2015) and SJR databases (1996-2017) respectively. Jamaica produced highest number of biomedical publications [PubMed: 3,928 (54%) and SJR: 2,850 (34%)]. However, when adjusted, Grenada had the highest research publications per million populations, per billion GDP and per 1,000 Internet users in both databases. For trend analysis, PubMed showed that Jamaica produced highest number of additional publications each year ­ on an average 4.8 followed by Trinidad & Tobago (4.4). According to SJR, Jamaica had also highest number of citations (42,311) and H-index (76) followed by Trinidad & Tobago (29,152 and 71). Barbados had the highest number of citations per document (24.9) followed by Haiti (18.4). Conclusion: There was a marked imbalance noted among the CARICOM countries in terms of biomedical research and publications. A CARICOM-wide research may be embarked to explore disparities in biomedical research productivity and thus formulate informed health policies to alleviate diseases and eradicate poverty.

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.

National malaria programme strategic plan 2015-2020

Malaria is a major health problem in Guyana and this report charts the path for malaria control, prevention and elimination over the period 2015-2020. The National Malaria Strategic Plan 2015-2020 is committed to reducing the overall burden of malaria in Guyana by 50% in the affected areas. To achieve this goal, the document addresses the development of the national strategy; the role of stakeholders; a situational analysis; the response to malaria and related gaps and challenges; the guiding principles and strategic framework; monitoring and evaluation; the financial investments and gap analysis; and the implementation and management of the programme.

Map showing roads, airstrips, police outposts/stations, mining and forest stations in Guyana

Map of Guyana utilizes a colour key to identify the number of locations where malaria microscopy is done; the main malaria hot spots; and the main health facilities.

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.

Ethnic differences in cancer incidence among the Guyanese population

BACKGROUND: Globally, cancer is identified as a leading cause of morbidity and mortality. Trends suggest that ethnic and lifestyle factors are influential to its occurrence. In Guyana, cancers have been a leading cause of mortality over the period 2003 to 2012. However, the influence of ethnicity in the occurrence of cancer has not been examined extensively. OBJECTIVE: To investigate the occurrence of cancer among the different ethnicities in Guyana from 2003–2012. METHODS: Data from 2003–2012 from the population based Guyana Cancer Registry were analysed. Frequencies were determined for each cancer by patient demographics and cancer characteristics. Incidence and mortality rates were calculated using Guyana’s resident 2002 population. RESULTS: Of 6518 new cancers, 3956 were in females and 2561 in males. Mean age of females was 55.4 years, SD16.4 and males 62.2 years, SD 18.7 (p < 0.0001). Guyanese Chinese had the highest annual rate (129.9 per100 000); Afro-Guyanese had the highest absolute numbers(2892, 44.4%) and second highest annual incidence(127.4 per 100 000), followed by Indo-Guyanese 2505(37.9%; annual incidence 76.8 per 100 000) and Guyanese of mixed race 510 (7.8%). Male Afro-Guyanese were disproportionately affected by prostate cancer while the females had the highest rates of uterine and second highest rates of breast and cervical cancers. Guyanese Chinese had the highest rates of cervical cancer. Conclusion: Further research is needed to determine risk factors for cancers by ethnicity and aggressive campaigns need to be implemented targeting those risk factors to reduce the burden of disease.

A ten-year profile of cancer in Guyana from 2003–2012

OBJECTIVE: Only one cancer report (2000–2004) on Guyana has ever been published. We sought to establish the profile of cancers in Guyana to assist policy-makers indeveloping a comprehensive cancer programme. SUBJECTS AND METHODS: Data from 2003–2012 from the population-based Guyana Cancer Registry were analysed. Frequencies were determined for each cancer by patient demographics and cancer characteristics. Incidence and mortality rates were calculated using Guyana’s resident 2002 population. RESULTS: A total of 6518 incident cancers were recorded:3956 in females and 2561 in males. Mean age of females was 55.4 years, SD 16.4 and males 62.2 years, SD 18.7 (p< 0.0001). Average annual incidence was 86.8 per 100 000 population (females 105.4, males 68.1), age standardized rate was 139.3 per 100 000 population. In females, the leading sites were breast 1074, cervix uteri 1014 and corpus uteri 325; and in males, prostate 865, colo-rectum 206 and lung 157. By ethnicity, 44.4% of cases were in Afro-Guyanese and 38.4% in Indo-Guyanese. Death occurred in 52.3% (45% of females, 65% of males), for an average annual mortality rate of 48 per 100 000 population(females 47.6 and males 43.4). Lifetime risk of developing cancer was one in eight for females and one in 16 for males. CONCLUSION: Cancers placed a significant burden on the Guyanese population during 2003–2012. Females were affected at a younger age than males. Afro-Guyanese were affected more than other ethnic groups. Significant prevention, treatment and control efforts are required to reduce the morbidity and mortality associated with cancers.

Non-communicable diseases in Guyana: Assessing progress in the implementation of World HealthOrganization global priorities and identifying emerging strategies for prevention and control

OBJECTIVE: To assess progress in the implementation of the World Health Organization (WHO) global priorities for non-communicable diseases in Guyana and identify emerging strategies for prevention and control. SUBJECT AND METHOD: This was a retrospective and qualitative study using document reviews and existing information (literature review) on global priorities and frameworks, national non-communicable diseases and collaborating sector data and reports; and prospective, using focus group discussions and interviews with senior staff of select ministries (Health, Agriculture and Education). Participation in the study was voluntary. RESULTS: The prevalence of non-communicable diseases in Guyana has remained at a high rate over the past decade. Despite improvements in national capacity, leadership and governance, there are still major deficiencies in the implementation of strategies to monitor and reduce these diseases and risk factors, improve research, surveillance, knowledge, policy and service delivery based on the WHO global priorities. Finally, the study highlights the need for greater collaboration between various sectors including health in addressing non-communicable diseases, and advocates for improved national capacity, and a robust primary healthcare system that focusses on health promotion and the social determinants of health. CONCLUSION: Guyana has made fair progress in addressing non-communicable diseases which remain a national priority but there is need for sustained national commitment, stronger leadership and improved intersectoral mechanisms to reduce the diseases’ burden if the WHO global priorities are to be successfully implemented in Guyana.

An assessment of the impact of providing care to the elderly in their homes on quality of life

OBJECTIVE: To assess the impact of providing care to the elderly in their homes on their quality of life. SUBJECTS AND METHODS: After identifying the elderly (65years and older) persons, a team approach (doctor, dental staff, primary healthcare nurses and community healthworkers, rehabilitation staff, nongovernmental organizations) was used to provide care to the elderly (including the bedridden) in their homes. A management plan for each patient/client was worked out and with the help of the caregiver (who was also given necessary advice and training), the plan was implemented. RESULTS: There were noticeable improvements in the quality of life the elderly achieved with this intervention including increased mobility, being more self-sufficient, improvement of health and correction of ‘polypharmacy’. CONCLUSION: This programme is low-budget (in Guyana) and can be implemented in other regions of Guyana and in countries that have similar constraints.

Estimated cost analysis for demand-driven family health outreaches in Guyana in 2014

OBJECTIVE: To review the cost implications of demand driven health outreaches made in 2014 in terms of need, saliency and benefits. SUBJECTS AND METHODS: In 2014, there were 85 medical outreach visits to seven of the 10 administrative regions provided by five entities including the government. The costing methodology was to randomly select two outreaches by each entity and then quantify the direct cost, vis-à-vis drugs and medical supplies, voluntary counseling and testing (VCT), visual inspection of cervix using acetic acid (VIA), dental, blood banking and optical services, and the cost of indirect services such as transportation, meals and stipend. RESULTS: The direct cost was GY $101 755 075 while the indirect costs amounted to GY $3 464 925 (US $17026.66) in total. Therefore, the total estimated aggregate cost for the demand-driven medical outreaches in 2014 in Guyana amounted to GY $105 220 000 (US $517 051.58). CONCLUSIONS: The cost involved in the provision of the demand-driven medical outreach service could have provided support for nine health centres or 36 health posts for one full year. Coupled with the fact that the service is mainly along the coastal areas, where the need for such services is less, it is suggested that government either suspend these activities pending a full review or have limited outreach visits to the interior in the interim.

Estimated effects of climate variables on transmission of malaria, dengue and leptospirosis within Georgetown, Guyana

OBJECTIVE: To analyse meteorological data (temperature, rainfall and relative humidity) and vector-borne diseases (malaria, dengue and leptospirosis) to determine trends that may exist between and among variables within the Georgetown area. SUBJECTS AND METHODS: This study took on a retrospective approach which used data from the Ministry of Health and Ministry of Agriculture, Hydro-meteorological Department, to assess the true nature of the relationship between climate and vector-borne diseases (malaria, dengue and leptospirosis) within the Georgetown area. Correlation and regression analysis was done using SPSS version 13. RESULTS: The results yielded weak positive correlation between climate variables and vector-borne disease withstrongest correlation between P falciparum and Pmalariae. Leptospirosis showed positive correlation withhumidity and dengue showed positive correlation with all three climate variables measured. Projections showed that with a 1 increase in temperature, 1% increase in relative humidity and 50 mm increase in rainfall, there would be significant increases in malaria and leptospirosis. CONCLUSIONS: There have been theories that suggest a connection between climate variables and vector-borne disease but conclusive evidence does not exist. In this present study, the need for research that yields more unwavering results is highlighted. There is no doubt that climate variables influence vector-borne diseases. Therefore, it is recommended that an interdisciplinary approach be taken to ensure reliability and foster a better understanding between climate variables and vector-borne diseases.

Repeat pregnancy study in HIV positive and negative women in selected health facilities in Regions 3, 4, 6 and 10 in Guyana, South America

OBJECTIVES: To determine factors influencing repeat pregnancies in HIV positive and negative women in Regions 3, 4, 6 and 10. SUBJECTS AND METHODS: A descriptive cross-sectional survey was conducted using cohorts of HIV positive and negative women in the age group 18–44 years (n = 222). Stratified random sampling was used, where, for every one HIV positive woman, four HIV negative women were selected at each health facility until the total sample size was obtained. Data on repeat pregnancies and family planning (n = 58) were collected through interviews using questionnaires.Epi Info, version 7 was used to do data input and analysis. Fisher test or Chi-squared tests were used to test the significance of a variable. A qualitative assessment was also done to glean more from the quantitative data. RESULTS: The pregnancies of HIV+ mothers were intentional and there was high uptake in antiretroviral (ARV) drugs. It was notable that most women knew their HIV status prior to pregnancy. Sixty-three per cent of the respondents felt that an HIV+ woman should get pregnant if wanted. For protection of the unborn child, answers were adherence to ARV drugs and treatment, abstaining from breast feeding and abstaining from sex or having sex with a condom. CONCLUSIONS: Respondents clearly showed that the decision to have a baby is a fundamental human right, with other determinants being their confidence in adherence to ARV treatment regime and abstention from breast feeding. There is the need for more health promotion activities to reduce unwanted pregnancies among this special population.

Malaria

The report traces the efforts of the National Malaria Eradication Programme to eliminate the disease from as early as 1959 and up to 2015. Statistics to support the reduction of malaria in the coastal and other regions include the cases of malaria in Guyana between 1991-2013; the correlation between malaria cases and the price of gold; and cases of malaria by age and ethnicity in 2014.

Health @ 50 in Guyana: Progress health report 1966-2016

The document highlights the achievements made in the public health system in Guyana as well as the challenges faced during the past fifty years. It provides an analysis of the country context, the health systems and services, the epidemiological profile, the achievements and challenges, and the health targets for the next fifty years. The Epidemiological profile addresses diseases surveillance and disease profile, including measles, malaria, tuberculosis, HIV/AIDS, dengue, cardiovascular, hypertension, diabetes and cancer.

Malaria treatment guideline for health facilities in Guyana

In response to the malaria challenge in Guyana, the Ministry of Public Health of Guyana outlines the best standardized treatment of malaria for the public and private sector by promoting the development of one strategy for early diagnosis and treatment for malaria patients. This is a review of the first version developed in 2004 which now includes updated content on further complicated treatment guidelines and malaria in pregnancy. The manual includes the epidemiological situation of malaria in Guyana up to 2014; the antimalarial treatment policy; and the timely diagnosis and adequate doses of the treatment for complicated and uncomplicated malaria cases

Heavy drinking and violent behaviour in youths in Guyana

OBJECTIVE: To investigate the problem of alcohol among Guyanese youths and its gender implications. DESIGN AND METHODS: The Global School-based Student Health Survey (GSHS) was reviewed since there is a dearth of statistics on the consumption of alcohol in youths and violent behaviour. In all, 2,392 students participated in the GSHS. The focus was on early youth. RESULTS: There was a high prevalence of violence in girls. This was reflected by 33.8% having been physically attacked in a 12 month period, 36.6% were bullied in one month and 25% were involved in physical fights in a 12 month period. This indicates that bullying is a serious problem among adolescents in schools. CONCLUSION: This issue is one of particular concern because early initiation of alcohol use is associated with an increased risk of alcoholism in adults. The age at first drink and the regular consumption of alcoholic beverages during adolescence are strongly influenced by social, economic, and environmental factors as indicated in WHO Facts on Alcohol and Violence. There appears to be no surveillance system that captures data on gender based violence in Guyana. Thus, a system should be established to examine gender-based violence in the wider context of other forms of violence including childhood abuse, sexual victimizations, and self-harm and suicide.

An assessment of dietary and physical activity behaviors of adolescents in selected secondary schools of Guyana

OBJECTIVE: To examine the dietary and physical activity behaviors of adolescents in selected secondary schools of Guyana. DESIGN AND METHODS: A cross-sectional National Youth Physical Activity and Nutrition Survey (NYPANS) was conducted in 12 secondary schools; 2 schools from each of the coastal regions 2, 3, 4, 5 and 6 and Georgetown, the capital city of Guyana. Systematic stratified random sampling technique was used to draw 724 students in Forms 1 to 4. Dietary and physical activity behaviors were assessed by the NYPANS tool, a self-administered questionnaire. RESULTS: Just over half (54%) of students reported participating in physical activity that made them sweat and breathe hard for at least 20 minutes on 3 or more of the previous 7 days. Similarly, half (48.7%) of the students played video or computer games for one or more hours on an average school day. At school 56.3% of students reported not ever attending physical education (PE) classes and 26.4% drank a glass of soda 2 or more times per day during past 7 days. Only 12.6% and 12.9% of students reported eating 2 or more cups of fruit and vegetables respectively each day. CONCLUSION: Participation in healthy dietary and physical activity behaviors among adolescents in selected secondary schools of Guyana is far from optimal.

Fear of violence increases risk behaviours of persons living with HIV (PLHIV) in Guyana

OBJECTIVE: To assess if fear of violence among PLHIV in Guyana affects sexual risk behaviours. DESIGN AND METHODS: In 2011 a cross sectional survey was conducted of the sexual risk behaviours of 271 PLHIV enrolled in a Prevention with Positives (PwP) project promoting risk reduction behaviours at seven non-governmental organizations (NGOs). Quantitative data was analyzed using STATA. Seventeen PLHIV and partners were interviewed using a semi-structured guide. Transcripts were analyzed for themes and data triangulated to understand the prevalence of risk behaviours and the barriers to risk reduction among PLHIV. RESULTS: Domestic violence was experienced by 25.9% of enrollees. HIV positive women were more likely to have fears of violence (OR, 3.6; 95% CI 0.58, 5.48) and to be in a sexual relationship with an HIV negative partner (OR 4.1; 95% CI 0.5, 49.4) than males though these were not statistically significant when adjusted for disclosure and having sex for things. PLHIV who were not afraid of violence were more likely to disclose (P=0.03 Fisher exact). When controlling for gender, having sex for things, and HIV status of partner, PLHIV who were not afraid of violence were significantly more likely to use family planning (OR= 10.7: 95% CI 1.9, 61.4). HIV positive women experienced discrimination when seeking social services. CONCLUSIONS: Fear of violence was a barrier to disclosure and use of family planning. Gender differences in experiences of violence should be catered for and discrimination against PLHIV by staff at social services addressed.

Profile of suicidal behaviour in Guyana. A retrospective study from 2010 -2012

OBJECTIVE: To assess cases of suicidal behaviour in Guyana to characterize the suicidal profile of Guyanese at present. DESIGN AND METHODS: A nationally represented sample of 899 cases involved in suicidal behaviour, 555 who committed suicide and another 344 attempted suicides from 2010-2012, were surveyed using an epidemiologic study. Risk factors and other associations were identified by professionals through the use of a statistical review and the administration of questionnaires; the information was processed. RESULTS: Suicide was one of the biggest problems in Guyana as evidenced by the country being listed as having the highest estimated rate of suicide worldwide (44.3/100,000) with an mean of 200 lives being lost each year due to suicide. Data on respondents (patient or parents) were used for analysis. The most affected age group is 20 to 49 years (50%) Males committed suicide more frequently, with a ratio of almost 4:1 and the most commonly used methods in suicide cases were poisoning (pesticide / herbicide) with more than 65 % of cases, followed by hanging (>20%). East Indians accounted for >80 %; most of the cases were geographically concentrated in Regions 6,5,4,3 and 2 similar to the estimated cases of suicidal attempts. CONCLUSIONS: The profile of suicide had been well identified in Guyana, and it permits the development of a comprehensive multisectoral suicide prevention strategy to reduce the magnitude of suicidal behavior in Guyana.

Use of the M-CHAT to screen for autism spectrum disorder among toddlers aged 16 to 30 months in Region 4 Guyana: a pilot study

OBJECTIVE: To assess whether the Modified Checklist for Autism in Toddlers (M-CHAT) was easily administered in a Guyanese clinic setting and how the findings in Guyana compared to international studies. DESIGN AND METHODS: The M-CHAT was used to screen for Autism Spectrum Disorder (ASD) at 9 Health Centres in Guyana over 1 month. An information session aimed at raising Autism awareness in the community and to inform the parents/guardians attending well child clinic of the purpose of the study was conducted every morning at each clinic. A questionnaire was administered for demographic data and the family’s socioeconomic status was determined using the parent’s education level, occupations and household income. The M-CHAT results were compared to child sex, parental age, parental ethnicity, socioeconomic status, birth order of the child and the child’s age on the date of administration of the test. RESULTS: Data from 415 respondents (parents/guardians) was used for analysis of the children under study (M 210, F 205). 10.6% of the children failed the M-CHAT (M 10.5%, F 10.7% p = 0.93) with 2.3% of these being high risk and 97.7% medium risk for ASD. Of the parameters tested, maternal ethnicity (Afro-Guyanese, p = 0.03) and paternal education (low, p = 0.001) were found to be significant. CONCLUSION: While we were unable to re-test the population to confirm ASD, the trends observed for the M-CHAT were similar to those found in international studies.