CAREST--Multilingual Regional Integration for Health Promotion and Research on Sickle Cell Disease and Thalassemia.

Sickle cell disease (SCD) is a significant problem in the Caribbean, where many individuals have African and Asian forebears. However, reliable prevalence data and specific health care programs for SCD are often missing in this region. Closer collaboration between Caribbean territories initiated in 2006 to set up strategies to promote better equity in the health care system for SCD patients led to the formation of CAREST: the Caribbean Network of Researchers on Sickle Cell Disease and Thalassemia. We present the effectiveness of collaborations established by CAREST to promote SCD newborn screening programs and early childhood care, to facilitate health worker training and approaches for prevention and treatment of SCD complications, and to carry out inter-Caribbean research studies.

Comparison of prevalence and severity of asthma among adolescents in the Caribbean islands of Trinidad and Tobago: results of a nationwide cross-sectional survey.

BACKGROUND: Asthma is a growing problem in the Caribbean but the prevalence in most islands is unknown and possible inter-island variation in prevalence has not been determined. A nationwide cross-sectional survey was conducted to compare the prevalence of asthma symptoms among high school students in the two islands of the Republic of Trinidad and Tobago. METHODS: Questionnaire and video instruments based on those developed by the International Study of Asthma & Allergy in Childhood (ISAAC) were used to assess asthma prevalence among 6394 children (age range, 11-19 years; mean age, 14.08 yrs) in the second and third years of 35 randomly selected high schools in Trinidad and Tobago. This cross sectional survey was conducted between September and December 2002. RESULTS: A total of 4988 questionnaires were available for analysis (3519 in Trinidad and 1469 in Tobago). Among respondents from the two islands, there were no significant differences in the prevalence of ever wheezing (24.1% and 24.3% for Trinidad and Tobago, respectively, RR 0.99, 95% CI, 0.90-1.08); wheezing in the previous 12 months (13.1% & 13.4%, RR 0.98, 95% CI 0.84-1.15); a previous or current diagnosis of asthma (12.8% & 13.5%, RR 0.95, 95% CI 0.82-1.12) and night cough in the past 12 months (35.4% & 38.3%, RR 0.93, 95% CI 0.86-1.00). However, symptoms of severe asthma were significantly more common among students from Tobago and included having had more than one acute attack in the past year (13.4% & 15.8%, RR 0.85, 95% CI 0.73-1.00, p = 0.0004), night waking as a result of wheeze (7.4% & 10.9%, RR 0.68, 95% CI 0.56-0.83, p < 0.0001) and speech limitation in the past year (5.2% & 8.7%, RR 0.59, 95% CI 0.47-0.74, p < 0.001) Exercise-associated wheezing was also more frequent among Tobagonian adolescents (17.5% & 20.2%, RR 0.87, 95% CI 0.76 - 0.98, p = 0.04). CONCLUSION: Self-reported wheeze is common among adolescents in Trinidad and Tobago. Variation in symptoms was found between the two territories; high school students from Tobago, the less industrialized of the two islands, reported more symptoms of severe asthma and exercise-induced wheeze. Difference in the ethnic composition rather than socio-economic factors may be contributing to the observed differences in symptom prevalence.

Smoking at home is strongly associated with symptoms of asthma and rhinitis in children of primary school age in Trinidad and Tobago.

OBJECTIVE: To compare, in the twin-island republic of Trinidad and Tobago, the prevalence of symptoms of asthma and rhinitis among children of primary school age who are exposed to household environmental tobacco smoke with the prevalence of these symptoms in their colleagues without this exposure. METHODS: Between September and December 2002, questionnaires based on the instrument developed for the International Study of Asthma and Allergies in Childhood (ISAAC) were distributed, via the children in their schools, to parents of 6,611 Year 2 pupils (typically 6 years old) or Year 3 pupils (typically 7 years old) in 106 randomly selected schools in Trinidad and Tobago (5,511 pupils on Trinidad and 1,100 pupils on Tobago). We added to the standard ISAAC questionnaires two questions, one on household smoking and one on the ethnicity of the children. RESULTS: A total of 3 170 completed questionnaires were suitable for further analysis (2,618 from Trinidad and 552 from Tobago). On Trinidad 782 of the children (29.9%) lived in homes where one or both parents smoked, and 513 (19.6%) had other relatives in the household who smoked. On Tobago 94 of the pupils (17.0%) had parents who smoked, and 84 (15.4%) came from homes where other residents smoked. Parental smoking was significantly associated with wheezing (odds ratio (OR): 1.43; 95% confidence interval (CI): 1.11-1.83), exercise-induced wheezing (OR: 2.12; 95% CI: 1.59-2.82), nocturnal coughing (OR: 1.64; 95% CI: 1.37-1.97), and symptoms of rhinitis (OR: 1.35; 95% CI: 1.10-1.65) in the last 12 months as well as a history of hay fever/sinus problems (OR: 1.39; 95% CI: 1.11-1.74). Smoking in the home by adult residents other than parents was also significantly associated with all of these symptoms as well as a history of asthma (OR: 1.49; 95% CI: 1.13-1.97). In terms of ethnic differences, parental smoking was most prevalent in the homes of South Asian students, while smoking by other adults in the home occurred most commonly in the households of pupils of mixed race. CONCLUSIONS: Even in Trinidad and Tobago, which is a tropical environment where more time is spent outdoors and homes have more open ventilation than in temperate climates, environmental tobacco smoke exposure is closely associated with an increased prevalence of symptoms of asthma and rhinitis in primary-school-aged children.

Comparison of prevalence and severity of asthma among adolescents in the Caribbean islands of Trinidad and Tobago: results of a nationwide cross-sectional survey

BACKGROUND: A nationwide cross-sectional survey was conducted to compare the prevalence of asthma symptoms among high school students in the two islands of the Republic of Trinidad and Tobago. METHODS: Questionnaire and video instruments based on those developed by the International Study of Asthma & Allergy in Childhood (ISAAC) were used to assess asthma prevalence among 6394 children (age range, 11–19 years; mean age, 14.08 yrs) in the second and third years of 35 randomly selected high schools in Trinidad and Tobago. RESULTS: A total of 4988 questionnaires were available for analysis (3519 in Trinidad and 1469 in Tobago); wheezing in the previous 12 months (13.1 per cent & 13.4 per cent, RR 0.98, 95 per cent CI 0.84–1.15); a previous or current diagnosis of asthma (12.8 per cent & 13.5 per cent, RR 0.95, 95 per cent CI 0.82–1.12) and night cough in the past 12 months (35.4 per cent & 38.3 per cent, RR0.93, 95 per cent CI 0.86–1.00). However, symptoms of severe asthma were significantly more common among students from Tobago and included having had more than one acute attack in the past year (13.4 per cent & 15.8 per cent, RR 0.85, 95 per cent CI 0.73–1.00, p = 0.0004), night waking as a result of wheeze (7.4 per cent & 10.9 per cent, RR 0.68, 95 per cent CI 0.56–0.83, p < 0.0001) and speech limitation in the past year (5.2 per cent & 8.7 per cent, RR 0.59, 95 per cent CI 0.47–0.74, p < 0.001) Exercise-associated wheezing was also more frequent among Tobagonian adolescents (17.5 per cent & 20.2 per cent, RR 0.87, 95 per cent CI 0.76 – 0.98, p = 0.04). CONCLUSION: Self-reported wheeze is common among adolescents in Trinidad and Tobago. Variation in symptoms was found between the two territories; high school students from Tobago, the less industrialized of the two islands, reported more symptoms of severe asthma and exercise-induced wheeze.

Smoking at home is strongly associated with symptoms of asthma and rhinitis in children of primary school age in Trinidad and Tobago / Asociación entre fumar dentro de la casa y síntomas de asma y de rinitis en escolares de primaria en Trinidad y Tabago

OBJETIVO: Comparar, en las dos islas que integran la república de Trinidad y Tabago, la prevalencia de síntomas de asma y de rinitis en escolares de primaria expuestos al humo de tabaco en el ambiente domiciliario con la prevalencia de los mismos síntomas en coetáneos sin la exposición. MÉTODOS: Entre septiembre y diciembre de 2002, se distribuyeron cuestionarios basados en el instrumento elaborado para el Estudio Internacional de Asma y Alergias en la Niñez (ISAAC, por International Study of Asthma and Allergies in Childhood). La distribución la efectuaron los escolares de 106 escuelas escogidas aleatoriamente en Trinidad y Tabago (5 511 escolares en Trinidad y 1 100 en Tabago) entre los padres de 6 611 escolares de segundo o tercer grado (por lo general de 6 y 7 años de edad, respectivamente). Añadimos dos preguntas al cuestionario ISAAC, una de ellas sobre el tabaquismo en el domicilio y la otra sobre el origen étnico de los niños. RESULTADOS: Un total de 3 170 cuestionarios llenados se prestaron a análisis (2 618 de Trinidad y 552 de Tabago). En Trinidad 782 (29,9%) de los niños vivían en hogares donde uno de los padres o ambos padres fumaban, y 513 (19,6%) tenían otros parientes en el domicilio que fumaban. En Tabago 94 de los niños (17,0%) tenían padres que fumaban y 84 (15,4%) venían de hogares donde otros residentes fumaban. El tabaquismo en los padres mostró una asociación significativa con la presencia de sibilancias (razón de posibilidades [RP]: 1,43; intervalo de confianza de 95% [IC95%]: 1,11û 1,83), sibilancias provocadas por el ejercicio (RP: 2,12; IC95%: 1,59û2,82), tos nocturna (RP: 1,64; IC95%: 1,37û1,97) y síntomas de rinitis (RP: 1,35; IC95%: 1,10û1,65) en los 12 meses más recientes, así como antecedentes de fiebre del heno o problemas sinusales (RP: 1,39; IC95%: 1,11û1,74). La presencia en el domicilio de parientes fumadores distintos de los padres también mostró una asociación significativa con todos estos síntomas y con antecedentes de asma (RP: 1,49; IC95%: 1,13û1,97). En cuanto a diferencias por razones étnicas, el tabaquismo de los padres fue más frecuente en los hogares de escolares del sur del Asia, mientras que el tabaquismo de otros adultos en el domicilio se observó con más frecuencia en los hogares de escolares de raza mixta...

Objective. To compare, in the twin-island republic of Trinidad and Tobago, the prevalence of symptoms of asthma and rhinitis among children of primary school age who are exposed to household environmental tobacco smoke with the prevalence of these symptoms in their colleagues without this exposure. Methods. Between September and December 2002, questionnaires based on the instrument developed for the International Study of Asthma and Allergies in Childhood (ISAAC) were distributed, via the children in their schools, to parents of 6 611 Year 2 pupils (typically 6 years old) or Year 3 pupils (typically 7 years old) in 106 randomly selected schools in Trinidad and Tobago (5 511 pupils on Trinidad and 1 100 pupils on Tobago). We added to the standard ISAAC questionnaires two questions, one on household smoking and one on the ethnicity of the children. Results. A total of 3 170 completed questionnaires were suitable for further analysis (2 618 from Trinidad and 552 from Tobago). On Trinidad 782 of the children (29.9%) lived in homes where one or both parents smoked, and 513 (19.6%) had other relatives in the household who smoked. On Tobago 94 of the pupils (17.0%) had parents who smoked, and 84 (15.4%) came from homes where other residents smoked. Parental smoking was significantly associated with wheezing (odds ratio (OR): 1.43; 95% confidence interval (CI): 1.11­1.83), exercise-induced wheezing (OR: 2.12; 95% CI: 1.59­2.82), nocturnal coughing (OR: 1.64; 95% CI: 1.37­1.97),and symptoms of rhinitis (OR: 1.35; 95% CI: 1.10­1.65) in the last 12 months as well as a history of hay fever/sinus problems (OR: 1.39; 95% CI: 1.11­1.74). Smoking in the home by adult residents other than parents was also significantly associated with all of these symptoms as well as a history of asthma (OR: 1.49; 95% CI: 1.13­1.97). In terms of ethnic differences, parental smoking was most prevalent in the homes of South Asian students, while smoking by other adults in the home occurred most commonly in the households of pupils of mixed race. Conclusions. Even in Trinidad and Tobago, which is a tropical environment where more time is spent outdoors and homes have more open ventilation than in temperate climates, environmental tobacco smoke exposure is closely associated with an increased prevalence of symptoms of asthma and rhinitis in primary-school-aged children.

Smoking at home is strongly associated with symptoms of asthma and rhinitis in children of primary school age in Trinidad and Tobago

Objective. To compare, in the twin-island republic of Trinidad and Tobago, the prevalence of symptoms of asthma and rhinitis among children of primary school age who are exposed to household environmental tobacco smoke with the prevalence of these symptoms in their colleagues without this exposure. Methods. Between September and December 2002, questionnaires based on the instrument developed for the International Study of Asthma and Allergies in Childhood (ISAAC) were distributed, via the children in their schools, to parents of 6,611 Year 2 pupils (typically 6 years old) or Year 3 pupils (typically 7 years old) in 106 randomly selected schools in Trinidad and Tobago (5,511 pupils on Trinidad and 1,100 pupils on Tobago). We added to the standard ISAAC questionnaires two questions, one on household smoking and one on the ethnicity of the children. Results. A total of 3,170 completed questionnaires were suitable for further analysis (2,618 from Trinidad and 552 from Tobago). On Trinidad 782 of the children (29.9 percent) lived in homes where one or both parents smoked, and 513 (19.6 percent) had other relatives in the household who smoked. On Tobago 94 of the pupils (17.0 percent) had parents who smoked, and 84 (15.4 percent) came from homes where other residents smoked. Parental smoking was significantly associated with wheezing (odds ratio (OR): 1.43; 95 percent confidence interval (CI): 1.11-1.83), exercise-induced wheezing (OR: 2.12; 95 percent CI: 1.59-2.82), nocturnal coughing (OR: 1.64; 95 percent CI: 1.37-1.97), and symptoms of rhinitis (OR:1.35; 95 percent CI: 1.10-1.65) in the last 12 months as well as a history of hay fever/sinus problems (OR: 1.39; 95 percent CI: 1.11-1.74). Smoking in the home by adult residents other than parents was also significantly associated with all of these symptoms as well as a history of asthma (OR: 1.49; 95 percent CI: 1.13-1.97). In terms of ethnic differences, parental smoking was most prevalent in the homes of South Asian students, while smoking by other adults in the home occured most commonly in the households of pupils of mixed race. Conclusions. Even in Trinidad and Tobago, which is a tropical environment where more time is spent outdoors and homes have more open ventilation than in temperate climates, environmental tobacco smoke exposure is closely asociated with an increased prevalence of symptoms of asthma and rhinitis in primary-school-aged children (AU)