The Use of a Production Function to Evaluate Caribbean Ocean Health Conflicts and Economic Development: Policy Implications.

Central American and Caribbean (CAC) countries enjoy diverse marine environments. The oceans that enclose these coastlines contribute significantly to their economic growth. Industrial expansion and tourism place pressure on the marine ecosystems causing a decline in ocean health. To evaluate the cause of ocean health changes we investigated the factors influencing CAC ocean health using a health production function. Using Rank-Based Regression and the set of extractive, cultural and human well-being and services goals measuring Ocean Health Index (OHI), data from the World Bank, and the Human Development Index we developed a production function for CAC countries ocean health. Results show that all regional OHI scores, but Tourism and Recreation, the main income earning industry for most of the CAC countries, are less than the global score with four of the goals less than 40. The production function shows that all the goals, but the biodiversity sub-goal species, positively influencing OHI. Two climatic related variables, Nitrous Oxide and Carbon Dioxide negatively influenced OHI. The results are important to policy makers as they decide on the need to make greater effort towards improving sustainable contribution of CAC ocean resources to the blue economy.

HIV/AIDS-related stigma in Kumasi, Ghana.

OBJECTIVE: To assess HIV/AIDS-related stigma and discrimination of people living with HIV/AIDS (PLWHA) in Kumasi, Ghana. METHODS: A cross-sectional survey of 104 adults from the four sub-districts in Kumasi was conducted. RESULTS: Four stigma constructs, employment-based discrimination, screening and identification of HIV positive people, revelation of HIV status and social contact stigma were determined based on reliability measures from responses to the questionnaire. Regression analysis showed that participants with higher educational attainment were more likely to favor policies denying employment to PLWHA (p<0.05), but disapproved of revealing HIV sero-status (p<0.05). Muslims were more likely than Christians to agree with identifying PLWHA (p<0.05) and more likely to advocate revealing HIV sero-status (p<0.05). Males were more likely to favor revealing HIV status (p<0.05). Employed persons were more likely to have social contact with PLWHA (p<0.05). CONCLUSIONS: These findings are useful in guiding the design of interventions against HIV/AIDS-related stigma in Kumasi.

Workgroup report: public health strategies for reducing aflatoxin exposure in developing countries.

Consecutive outbreaks of acute aflatoxicosis in Kenya in 2004 and 2005 caused > 150 deaths. In response, the Centers for Disease Control and Prevention and the World Health Organization convened a workgroup of international experts and health officials in Geneva, Switzerland, in July 2005. After discussions concerning what is known about aflatoxins, the workgroup identified gaps in current knowledge about acute and chronic human health effects of aflatoxins, surveillance and food monitoring, analytic methods, and the efficacy of intervention strategies. The workgroup also identified public health strategies that could be integrated with current agricultural approaches to resolve gaps in current knowledge and ultimately reduce morbidity and mortality associated with the consumption of aflatoxin-contaminated food in the developing world. Four issues that warrant immediate attention were identified: a) quantify the human health impacts and the burden of disease due to aflatoxin exposure; b) compile an inventory, evaluate the efficacy, and disseminate results of ongoing intervention strategies; c) develop and augment the disease surveillance, food monitoring, laboratory, and public health response capacity of affected regions; and d) develop a response protocol that can be used in the event of an outbreak of acute aflatoxicosis. This report expands on the workgroup's discussions concerning aflatoxin in developing countries and summarizes the findings.

Determinants of aflatoxin levels in Ghanaians: sociodemographic factors, knowledge of aflatoxin and food handling and consumption practices.

Aflatoxins are among the most potent of carcinogens found in staple foods such as groundnuts, maize and other oil seeds. This study was conducted to measure the levels of aflatoxin B(1) (AFB(1)) albumin adducts in blood and aflatoxin M(1) (AFM(1)) metabolite in urine of people in a heavy peanut and maize consuming region of Ghana and to examine the association between aflatoxin levels and several socio-demographic factors and food handling and consumption practices. A cross-sectional study was conducted in four villages in the Ejura Sekyedumase district of Ghana. A socio-demographic survey was administered to 162 participants. Blood samples were collected from 140 and urine samples from 91 of the participants and AFB(1) albumin-adduct levels in blood and AFM(1) levels in urine were measured. High AFB(1) albumin-adduct levels were found in the plasma (mean+/-SD=0.89+/-0.46pmol/mg albumin; range=0.12-3.00pmol/mg; median=0.80pmol/mg) and high AFM(1) levels in the urine (mean+/-SD=1,800.14+/-2602.01pg/mg creatinine; range=non-detectable to 11,562.36pg/mg; median=472.67pg/mg) of most of the participants. There was a statistically significant correlation (r=0.35; p=0.007) between AFB(1)-albumin adduct levels in plasma and AFM(1) levels in urine. Several socio-demographic factors, namely, educational level, ethnic group, the village in which participants lived, number of individuals in the household, and number of children in the household attending secondary school, were found to be significantly associated with AFB(1) albumin-adduct levels by bivariate analysis. By multivariate analyses, ethnic group (p=0.04), the village in which participants live (p=0.02), and the number of individuals in the household (p=0.01), were significant predictors of high AFB(1) albumin-adducts. These findings indicate strongly that there is need for specifically targeted post-harvest and food handling and preparation interventions designed to reduce aflatoxin exposure among the different ethnic groups in this region of Ghana.

Sociocultural correlates of HIV/AIDS-related stigma in rural Jamaica.

UNLABELLED: BACKGROUND; AIDS-related stigma is one of the biggest obstacles in the fight to prevent HIV transmission. Since stigma deters people from seeking treatment or getting tested for HIV, determining the factors that underpin AIDS-related stigmatization may be key to finding new ways to improve care and support for people living with HIV/AIDS (PLWHA) and to reduce new infections. SETTING: The town of Lucea and surrounding communities in the parish of Hanover, Jamaica. METHOD: Cross-sectional questionnaire survey of 195 individuals from health centers and households in Hanover. RESULTS: Of the 195 respondents, 28 percent felt the names of HIV-positive people should be public information. We found three constructs (avoidant behavior, social contact stigma, and blame stigma) that underpin stigmatization of PLWHA. The factors that influence avoidance behavior were education and being married. The factors associated with social contact stigma were being married and having no acquaintance with PLWHA. The factor that influenced blame stigma was not owning a home. CONCLUSION: Public health campaigns to reduce stigmatization must address individuals on the basis of their socio-demographic characteristics. A critical appraisal of current anti-stigma measures is warranted, and appropriate anti-stigma interventions are needed. Interventions with community members should address the social context of stigma, particularly the arenas of community norms, through education, information, and legislative measures to promote interaction with, and positive attitudes toward, PLWHA.

Human aflatoxicosis in developing countries: a review of toxicology, exposure, potential health consequences, and interventions.

Aflatoxins are well recognized as a cause of liver cancer, but they have additional important toxic effects. In farm and laboratory animals, chronic exposure to aflatoxins compromises immunity and interferes with protein metabolism and multiple micronutrients that are critical to health. These effects have not been widely studied in humans, but the available information indicates that at least some of the effects observed in animals also occur in humans. The prevalence and level of human exposure to aflatoxins on a global scale have been reviewed, and the resulting conclusion was that approximately 4.5 billion persons living in developing countries are chronically exposed to largely uncontrolled amounts of the toxin. A limited amount of information shows that, at least in those locations where it has been studied, the existing aflatoxin exposure results in changes in nutrition and immunity. The aflatoxin exposure and the toxic affects of aflatoxins on immunity and nutrition combine to negatively affect health factors (including HIV infection) that account for >40% of the burden of disease in developing countries where a short lifespan is prevalent. Food systems and economics render developed-country approaches to the management of aflatoxins impractical in developing-country settings, but the strategy of using food additives to protect farm animals from the toxin may also provide effective and economical new approaches to protecting human populations.

Sociocultural contexts of adolescent sexual behavior in rural Hanover, Jamaica.

PURPOSE: To investigate sexual behavior of adolescents in rural Hanover, Jamaica, and to elucidate the cultural contexts of this behavior. METHODS: Focus group discussion (FGD) sessions with 73 out-of-school young adolescents aged 15 to 18 years, recruited from health centers, as well as community-based organizations through the Social Development Commission (SDC) in Hanover, a local youth and community development organization, within the Ministry of Local Government, Youth and Community Development. The discussions focused on the adolescents' knowledge of sex and sexual risks, perceived vulnerability to sexual risks, use of protection, self-efficacy, and societal expectations. Data were analyzed, using the content analysis technique. RESULTS: Analyses of transcripts revealed the existence of different sexual scripts for males and females. Whereas females are culturally restrained, abstinence is less desirable for males. Both male and female adolescents expressed the view that the family was an important part of an adolescent's life, and has a strong influence on adolescent sexual behavior. Perception of vulnerability to HIV/AIDS and other sexually transmitted infections, and knowledge of sexual risks among the adolescents was low, and often erroneous. CONCLUSIONS: The results show that sexual attitudes and behavior of adolescents in the study setting are shaped by cultural and gender norms that impose different standards on males and females.

Incidence of health crises in tourists visiting Jamaica, west indies, 1998 to 2000.

BACKGROUND: Tourism is important to the Jamaican economy accounting for approximately 25% of the gross domestic product. Health problems in tourists could have significant impact on the health of the local population, the scarce health service resources, and the tourist industry. This study was conducted to identify health problems most commonly occurring in tourists visiting Jamaica and examine how these problems are managed. METHODS: Records of health problems occurring in tourists who visited principal tourist areas on the north coast from June 1998 to June 2002 were reviewed for the type of illness and how the problem was handled. The data were analyzed using Epi-Info software (Centers for Disease Control and Prevention, Atlanta, GA) and Statistical Analysis System software (SAS Institute, Cary, NC). RESULTS: Accidents were the most common health crises reported by tourists. Gastrointestinal, respiratory, and cardiovascular problems occurred less frequently. Those less than 40 years of age more frequently reported accidents or injury, gastrointestinal problems, and drug abuse, whereas respiratory and cardiovascular problems were more common among those above 40 years of age. Cardiovascular problems, drug abuse, and death were more common in men than in women. Hotel nurses handled most of the cases and were more likely to refer patients to private physicians or hospitals than to public hospitals (p <.05). Factors influencing the way the crisis was handled were age (p =.0441); who handled the crisis (p <.0001); and the method of payment (p =.0072). The factors that influenced hospitalization were gender (p =.0615); who handled the crisis at the onset (p =.0497); how the crisis was dealt with (p =.0336); and previous health problems (p =.0056). Men were more likely to be hospitalized and to be referred to a public hospital than women. Medical insurance covered the costs for 11% of tourists, and 75% paid out of pocket. CONCLUSION: The information provided by this study can be used to implement changes to reduce health problems in tourists and improve emergency health services in tourist areas.

Factors associated with self-reported symptoms of acute pesticide poisoning among farmers in northwestern Jamaica.

Pesticide poisoning is a major public health concern in developing countries. The authors conducted a population survey among farmers in 3 parishes of northwestern Jamaica to determine the occurrence of acute pesticide poisoning and to identify factors associated with pesticide poisoning. Approximately 16% of 359 farmers who participated in the study reported 1 or more incidents of acute pesticide poisoning within the last 2 years. Only 25% of the farmers reported ever receiving training in pesticide handling or safety. The majority (68%) of farmers who reported pesticide poisoning never sought medical attention for poisoning. The factors found to be associated with pesticide poisoning in this study indicate that implementation of specific intervention strategies and education of farmers is needed in order to improve safe handling, use, and disposal of pesticides and reduce incidents of acute pesticide poisoning.

The economics of adoption and management of alley cropping in Haiti.

The Haitian people are facing serious problems of environmental degradation that threaten the economic livelihoods of many resource-poor farmers. Structures to retard the process of soil loss have been adopted reluctantly and, even when adopted, the management and maintenance have been less than desirable. We evaluate the factors that influence the adoption and management of alley cropping in Haiti. Results of the adoption model show that institutional factors, such as membership in a local peasant organization and training in soil conservation practices, favorably influence adoption. Socio-economic factors such as gender, per capita income, and interaction between education and per capita income also significantly influence adoption of alley cropping in Gaita and Bannate. The management of alley cropping is influenced by demographic, socio-economic, institutional, and physical factors. The relative importance of each factor on the probability of adoption and management of alley cropping varies from one variable to another. The study generates important information for resource allocation in the establishment of alley cropping as a soil conservation structure.