Intersectoral collaboration in the COVID-19 response in Latin America and the Caribbean.

World Health Organization (WHO) / Pan American Health Organization (PAHO) encouraged the utilization of whole-of-society and whole-of-government strategic approaches to increase countries' resilience towards mitigating the impact of the COVID-19 pandemic. Strategies included the implementation of multi-sectoral, multi-partner and multi-stakeholder planning, coordination, consultation, and action. We reviewed the experiences of three Latin American and Caribbean countries, related to the implementation of collaborative strategies in tackling COVID-19, specifically the nature of the collaboration, the dynamics and the stakeholders involved.A systematic literature review identified relevant publications and content analysis was conducted to determine the collaborative strategies. Colombia, Costa Rica, and Trinidad and Tobago were selected as case studies since they were from different LAC subregions and because of the accessibility of relevant literature.In the three countries, the pandemic response was coordinated by a national executive committee, led by the Ministry of Health. Intersectoral collaboration was evident in each, with the key stakeholders being public sector agencies, the private/corporate sector, private/non-profit, academic institutions, and international agencies. It was used primarily to facilitate data-driven, evidenced-informed decision-making and guidelines; to expand clinical care capacity and strengthen the national medical response; and to provide support for the most vulnerable populations.While the institutionalization of intersectoral collaboration can be recommended for the health sector beyond the pandemic, research is needed to evaluate the impact of specific collaborative strategies as well as barriers and facilitators.

Politics and political determinants of health policy and systems research funding in Latin America and the Caribbean.

Objectives and importance of study: The importance of health policy and systems research (HPSR) has been acknowledged since 2004 and was recognised by the United Nations World Health Assembly in 2005. However, many factors influence its development. This paper aims to analyse the impact of politics and political determinants on HPSR funding in selected countries of Latin America and the Caribbean. METHODS: Using a standardised protocol, we performed an analysis of available data and financing structures for health research and HPSR, based on research in eight countries, including interviews with key stakeholders (n = 42). RESULTS: Dollar depreciation and gross national product growth in the region may play a role in how governments fund research. There have been shifts in the political spectrum in governments, which have affected research coordination and funding in positive and negative ways. HPSR funding in some countries was dependent on budget decisions and although some have improved funding, others have regressed by decreasing funding or have completely cancelled financing mechanisms. Caribbean countries rely mainly on institutional funding. HPSR is recognised as important but remains underfunded; stakeholders believed it should be used more in decision making. CONCLUSION: Although HPSR is recognised as valuable for decision making and policy development, it does not have the financial support required to flourish in Latin America and the Carribean. Data on health research financing were not easy to access. There was little or no evidence of published reports or papers about research financing, health research funding, and HPSR funding in particular in the studied countries. Because of the fragility of health systems highlighted by the coronavirus disease 2019 (COVID-19) pandemic, HPSR should be of great relevance and value to both policy makers and funders.

Health Systems' Resilience: COVID-19 Response in Trinidad and Tobago.

Trinidad and Tobago, a small island developing state, has been ranked as number one in a report published by the University of Oxford that assessed responses to COVID-19 based on four of the six WHO criteria for rolling back COVID-19 "lockdown" measures. The key mitigation and containment strategies implemented by the country were evidence-informed and demonstrated an "all-of-government" approach. The COVID-19 health system response of this country demonstrates that although developing countries face many health system challenges, political will, evidence-informed decision-making, respect for science, and timely, coordinated, collaborative actions can strengthen the resilience and response of the health system during a health emergency.

Urgent need to strengthen and expand screening and other cancer control programs in the CARICOM Caribbean.

PURPOSE: With high mortality in breast, cervical, prostate, and colorectal cancers in Caribbean Community (CARICOM) countries, we examined cancer control initiatives including screening as well as the implementation of relevant international and regional mandates. METHODS: Secondary data were used to examine cancer control initiatives, which included the presence of national policies, programs, and screening services as well as the implementation of international and regional mandates. To identify the data, an on-line search was conducted using Google/Google Scholar. RESULTS: Data were available for 14 of the 15 full members of CARICOM. Although only six countries had distinct cancer control policies, strategies or action plans, all 14 had key elements of cancer control programs. Screening services were available in the 14 countries for cervical, in 12 countries for breast and in 11 for colorectal cancer. However, only four countries had screening policies. In addition, screening guidelines were available for cervical cancer in nine countries, in one country for breast and in none for colorectal cancer. Selected tobacco control policies were present in the 14 countries and immunization policies for human papillomavirus (HPV) in 13. Treatment services included chemotherapy in 10 countries and radiotherapy in six. Nine countries had palliative care services for patients with advanced disease. The countries were at different stages of implementation/compliance with international and regional mandates and frameworks. CONCLUSIONS: There is an urgent need to develop and implement comprehensive and customized cancer control policies addressing screening programs, treatment and palliative care.

Understanding and use of inhaler medication by asthmatics in specialty care in Trinidad: a study following development of Caribbean guidelines for asthma management and prevention.

STUDY OBJECTIVES: Following the development of the Caribbean Guidelines for Asthma Care, we examined the utilization of inhaled medications in asthmatic patients in Trinidad, West Indies. SETTING: Chest Clinic, Ministry of Health, Trinidad. PARTICIPANTS: Physician-diagnosed asthmatic patients who attended the Chest Clinic between July 1998 and August 2000. MEASUREMENTS AND RESULTS: A consecutive sample of patients who were > 7 years of age (n = 402) was interviewed about compliance with, understanding of, and use of inhaler medication. The inhaler technique of these patients was directly observed. Inhaled steroid therapy was prescribed in 83% of patients but were prescribed the least in elderly patients (63%) and children (62%). Salbutamol was prescribed in 98% of patients, and ipratropium and sodium cromoglycate were selectively prescribed in elderly men and children, respectively. Only 33% of patients used the inhaler correctly, and children and the elderly were the least efficient in its use. The use of a spacer device was advised in 19% of patients, including only 6% of the elderly patients. Explanations for different inhaler therapies were given to 62% of patients, and 53% of patients could describe these reasons. The reported 40% noncompliance rate among patients in the sample was primarily a result of long waiting periods at the pharmacy (58%) and the personal cost incurred on purchasing the medication (52%). CONCLUSIONS: Educating patients, with a focus on children and the elderly, in inhaler techniques and reinforcing understanding of asthma medications can improve asthma management in Trinidad. Asthma caregivers in the Caribbean should ensure the appropriate dissemination of the guidelines and should outline strategies for their implementation.

Two-year mortality and its determinants following acute myocardial infarction in Trinidad and Tobago

The purpose of this study was to determine the occurrence of coronary artery disease risk factors in patients presenting with acute myocardial infarction(AMI) to a tertiary care institution in Trinidad and to determine the factors associated with increased mortality following AMI. All patients admitted to the Eric Williams Medical Sciences Complex (EWMSC) between January 1 and December 31, 1996, with a diagnosis of AMI were identified using the hospital admissions and discharge diagnosis databases. Demographic, clinical and laboratory variables were extracted from the hospital case records of patients with confirmed AMI. Sixty-one AMI patients (38 men) were admitted during the study period. Mean age of admittance was 60 ñ 11 years with an ethnic case mix of thirty-nine (62 percent) of East Indian descent, eight (13 percent) of African descent, twelve (20 percent) mixed ethnicity and three of Caucasian descent. Thirty patients (49 percent) were hypertensive. Thirty-two patients (53 percent) were diabetic and eighteen patients (30 percent) gave a history of cigarette smoking. The mean left venticular ejection fraction was 53 ñ 14 percent. The mean serum cholesterol from 29 patients was 228.2 ñ 49.0 mg/dl. Increasing age, female gender, an ejection fraction less than 40 percent, non treatment with streptokinase and in-hospital ventricular fibrillation were associated with poor survival. Multiple regression analyses identified three independent predictors of mortality. These were gender (p = 0.04), in-hospital ventricular fibrillation (p = 0.001) and an ejection fraction less than 40 percent (p = 0.02). Diabetes mellitus, hypertension, hyperlipidaemia and cigarette smoking were prevalent amongst patients presenting with AMI. Ventricular function was a major determinant of two-year mortality following AMI. Aggressive risk factor modification is recommended to prevent both first and recurrent coronary events.

Acute respiratory disorders in the newborn: a survey at the Mt. Hope Women's Hospital, Trinidad

This retrospective study was undertaken to determine the incidence of acute respiratory disorders (ARD) in newborns delivered at the Mount Hope Women's Hospital [MHWH] from January 1st to December 31st, 1994. The study also examined the relationships between incidence rates and maternal and neonatal parameters. Hyaline membrane disease (HMD)m trabsuebt tachypnea of the newborn (TTN), meconium aspiration syndrome (MAS), persistent foetal circulation (PFC) and pulmonary infection (PI) were identified as ARDs among 5,062 live newborns using standard diagnostic criteria. Overall, 174/5,062 neonates were diagnosed with ARD to give an incidence of 3.4 percent (104 males and 70 females). The commonest ARD was PI (39 percent) followed by HMD (48/4363) in full term neonates. HMD occurred mainly in the preterm and low birth weight babies. TTN and PI were found in all gestational age groups. Asphyxia was present in 9.8 percent (17/174) at 1 minute and in 10.9 percent (19/174) at 5 minutes. It was more common in babies who developed HMD and PFC. Forty one percent of babies with ARD required assisted ventilation. There were 58 (33 percent) deaths. More than one half of those ventilated died (55 percent), 2/3 of those with asphyxia at both 1 and 5 minutes of age. There was significantly greater mortality among neonates with HMD as compared to the other ARDs.

Geohelminth infections and mental development in Jamaica

There have been many studies of the effects of various geohelminth infections on children's mental development and school performance. This chapter will describe several studies conducted in Jamaica that primarily examined the parasite T. trichiura. In the first study, the investigators looked at the effects of the most severe form of T. trichiura infections-Trichuris dysentry syndrome- on the mental development and cognition of young children. The second study investigated the effects of moderate to heavy Trichuris infections on the cognition of school children, and the third was a clinical trial that examined the effects of mild to moderate T. trichiura infections on school performance and on cognitive function

Characteristics of Jamaicans who smoke marijuana before sex and their risk status for sexually transmitted diseases

Because of the high prevalence of marijuana smoking in Jamaica, it is important to know if this practice is associated with increased risk for STD infections. A national sample of 2,580 randomly selected Jamaicans, aged 15 to 49 years were administered a questionnaire to measure a number of health and behavioural variables. The results indicated that more persons who smoked marijuana before sex had a history of STD infections than non-marijuana smokers, the difference was significant among men (46 percent vs 26 percent, p < 0.001) but not among women (19 percent vs 8 percent, p = 0.09). There was no difference in age, however, more of the smokers were unmarried, poorly educated and unemployed than persons who did not smoke marijuana before sex. They were also more likely to engage in high risk sex behaviours and other risk taking behaviors than non-smokers. The results of multiple logistic analyses indicated that marijuana smoking before sex was an independent risk factor for STDs among men (Odd Ratio = 2.0, p = 0.04). Although it was not possible to determine if the association was causal, the increased risk for STDs among men who smoke marijuana before sex should be incorporated into the Jamaican STD/AIDS control programme by making special efforts to encourage condom use among marijuana smokers

Use of food expenditure data to estimate household nutrient accessibity

The nutritional status of at-risk groups is usually monitored using health statistics. This approach has limitations as individuals are identified only after they have been afflicted by morbidity. In Jamaica, national surveys are carried out in which expenditure data on all consumption items are collected. We used these data to monitor food accessibility in at-risk groups. The identification of decreases in accessibility levels relative to requirements would enable timely intervention before there is a deterioration in nutritional status. We analysed the data from the survey of 3861 households conducted by Statistical and Planning Institutes of Jamaica in 1989. Using the food expenditure data, per capita energy and protein accessibility levels were determined. The mean energy and protein accessibility levels for the sample were 2170 Cals and 64 g, respectively. The results showed that the per capita accessibility levels of 20 percent and 9 percent of the households were less than half of requirments for energy and protein, respectively. The situation was worse in rural areas than in urban centres. However, the accessibility levels may have been underestimated as the data did not include meals bought and consumed away from the home, which may be significant to some households. We believe that the use of data from these surveys is a cost-effective way to monitor nutrient accessibility in Jamaica

The prevalence of seat belt use in Jamaica: an observational study

An observational cross-sectional survey showed that 21.1 percent of private motor vehicle drivers and 13.5 percent of front seat passengers voluntarily wore seat belts in Kingston, Jamaica, where there is no law requiring this. Rear passenger utilisation was not examined. Compared to males, females were significantly more likely to wear seat belts when driving but not as front seat passengers. Of all motor vehicles examined 10.1 percent were not equipped with seat belts. The oldest group of vehicles were mostly not fitted with seat belts. Drivers of older vehicles were significantly less likely to use seat belts even when the vehicles were equipped with belts. Implementation of legislation can reduce mortality, morbidity and costs from road traffic accidents which are relatively frequent in Jamaica. Male drivers, drivers of older vehicles and all passengers may require specific targeting in an educational and enforcement campaign should legislation, which is highly desirable, be implemented

Geohelminth infections in school-aged children in Jamaica

There is concern that geohelminthiasis may adversely affect the growth and development of children. The relevance of this in the Caribbean in unclear since in many territories the prevalence of geohelminths is unknown. We report the results of three surveys conducted in Jamaican primary schools located in areas at high risk for geohelminthiasis. The first was conducted in 12 Kingston schools and comprised children in grades 2 to 5 (age 7 to 10 years). The second and third surveys were conducted in rural areas with children in grades 2 to 5 and grades 4 and 5, respectively. Overall, 9244 children provided stool sample for analysis. The prevalence of Trichuris trichiura ranged from 42 per cent to 47 per cent among the surveys while that for Ascaris lumbricoides ranged from 15 per cent to 37 per cent . Children in grades 2 and 3 had lower T. trichiura prevalences than those in grades 4 and 5 in the first and second surveys (p<0.05 and p<0.005, respectively). In the second survey only, children in grades 2 and 3 had a lower prevalence of A. lumbricoides than those in grades 4 and 5(p<0.005). Most infections were light with approximately 1 per cent of the sample having heavy egg densities

Sardine tracking survey in Jamaica

For the period covered by the study sardines were still being used by a wide crossection of the society. The ease in preparing sardines, their nutritive value and cost were chief factors affecting the amounts purchased and used. Sardines were a standard breakfast and lunch item. They were also used by the lower income groups for dinner. It, therefore could be concluded that inspite of price movements, sardines are still being used by all socio-economic groups in the society

Nutrition-related diseases and food and nutrition security in the Caribbean

Using questionnaires, data were collected from 14 member countries of the Caribbean Food and Nutrition Institute (CFNI) to determine the prevalence of nutrition-related diseases in the Caribbean and the programmes currently used to control or prevent them. Policies related to food/nutrition security and the strategies implemented to determine and ensure food availability at the household levels were also examined