A qualitative examination of the health workforce needs during climate change disaster response in Pacific Island Countries.

BACKGROUND: There is a growing body of evidence that the impacts of climate change are affecting population health negatively. The Pacific region is particularly vulnerable to climate change; a strong health-care system is required to respond during times of disaster. This paper examines the capacity of the health sector in Pacific Island Countries to adapt to changing disaster response needs, in terms of: (i) health workforce governance, management, policy and involvement; (ii) health-care capacity and skills; and (iii) human resources for health training and workforce development. METHODS: Key stakeholder interviews informed the assessment of the capacity of the health sector and disaster response organizations in Pacific Island Countries to adapt to disaster response needs under a changing climate. The research specifically drew upon and examined the adaptive capacity of individual organizations and the broader system of disaster response in four case study countries (Fiji, Cook Islands, Vanuatu and Samoa). RESULTS: 'Capacity' including health-care capacity was one of the objective determinants identified as most significant in influencing the adaptive capacity of disaster response systems in the Pacific. The research identified several elements that could support the adaptive capacity of the health sector such as: inclusive involvement in disaster coordination; policies in place for health workforce coordination; belief in their abilities; and strong donor support. Factors constraining adaptive capacity included: weak coordination of international health personnel; lack of policies to address health worker welfare; limited human resources and material resources; shortages of personnel to deal with psychosocial needs; inadequate skills in field triage and counselling; and limited capacity for training. CONCLUSION: Findings from this study can be used to inform the development of human resources for health policies and strategic plans, and to support the development of a coordinated and collaborative approach to disaster response training across the Pacific and other developing contexts. This study also provides an overview of health-care capacity and some of the challenges and strengths that can inform future development work by humanitarian organizations, regional and international donors involved in climate change adaptation, and disaster risk reduction in the Pacific region.

Management of clandestine drug laboratories: need for evidence-based environmental health policies.

Clandestine drug laboratories (CDLs) have been emerging and increasing as a public health problem in Australia, with methamphetamine being the dominant illegally manufactured drug. However, management and remediation of contaminated properties are still limited in terms of regulation and direction, especially in relation to public and environmental health practice. Therefore, this review provides an update on the hazards and health effects associated with CDLs, with a specific look at the management of these labs from an Australian perspective. Particularly, the paper attempts to describe the policy landscape for management of CDLs, and identifies current gaps and how further research may be utilised to advance understanding and management of CDLs and inform public health policies. The paper highlights a significant lack of evidence-based policies and guidelines to guide regulatory authority including environmental health officers in Australia. Only recently, the national Clandestine Drug Laboratory Guidelines were developed to assist relevant authority and specialists manage and carry out investigations and remediation of contaminated sites. However, only three states have developed state-based guidelines, some of which are inadequate to meet environmental health requirements. The review recommends well-needed inter-sectoral collaborations and further research to provide an evidence base for the development of robust policies and standard operating procedures for safe and effective environmental health management and remediation of CDLs.

Traditional coping strategies and disaster response: examples from the South Pacific region.

The Pacific Islands are vulnerable to climate change and increased risk of disasters not only because of their isolated and often low lying geographical setting but because of their economic status which renders them reliant on donor support. In a qualitative study exploring the adaptive capacity of Pacific Island Countries (PICs) across four countries, Cook Islands, Fiji, Samoa, and Vanuatu, it was clear that traditional coping strategies are consistently being applied as part of response to disasters and climate changes. This paper describes five common strategies employed in PICs as understood through this research: recognition of traditional methods; faith and religious beliefs; traditional governance and leadership; family and community involvement; and agriculture and food security. While this study does not trial the efficacy of these methods, it provides an indication of what methods are being used and therefore a starting point for further research into which of these traditional strategies are beneficial. These findings also provide important impetus for Pacific Island governments to recognise traditional approaches in their disaster preparedness and response processes.

Prevalence of gastrointestinal pathogens in developed and developing countries: systematic review and meta-analysis.

ABSTRACT: Diarrhoeal illness is a leading cause of child mortality and morbidity worldwide. There are no precise or current estimates of the types and prevalence of pathogens associated with diarrheal illnesses in developed and developing settings. This systematic review assessed data from 60 studies published in the English language from five developing regions and developed countries worldwide to provide regional estimates of enteric pathogens affecting children. The random-effect method was used to establish the weighted average prevalence of pathogens in adults and children for each region. Significantly more pathogens were reported by studies from developing regions compared with Organisation for Economic Co-operation and Development countries (P<0.016). The identification rates of pathogens from community based and hospital based studies were similar (58.5% and 58.1% respectively, P<0.619). The overall detection of enteric pathogens in developing countries was higher in adults (74.8%; 95% CI 63.1-83.8%) compared with children (56.7%; 95% CI 53.0-60.4%) (P<0.001). Rotavirus was the most frequently detected pathogen in all regions with the highest rate, 24.8% (95% CI 18.0-33.1%), detected in the developed countries. This systematic review is the first to provide an estimate of the prevalence of enteric pathogens associated with diarrhoeal illnesses in adults and children in developed and developing settings. While pathogen detection rate is greater in developing regions the consistently high prevalence of rotavirus in both developed and developing settings underscores the urgent need for access to rotavirus vaccines. Increased travel between developing and developed countries increases disease risk, and hence developed countries have a vested interest in supporting vaccine accessibility in developing settings.

Magnitude, distribution, and estimated level of underreporting of acute gastroenteritis in Jamaica.

Jamaica is the third largest island in the Caribbean. The epidemiology of acute gastroenteritis (AGE) is important to Jamaica, particularly in the areas of health, tourism, and because of the potential impact on the local workforce and the economy. Data collected by the National Surveillance Unit on the prevalence of AGE transmitted by food are not accurate. To determine the true magnitude, risk factors, and the extent of underreporting of AGE in Jamaica, we conducted a cross-sectional, population-based retrospective survey during the periods of 21 February-7 March and 14-27 June 2009, corresponding to high- and low-AGE season respectively. Of the total 1,920 persons selected randomly by a multistage cluster-sampling process, 1,264 responded (response rate 65.8%). Trained interviewers administered a standardized, validated questionnaire during face-to-face interviews. The overall prevalence of self-reported AGE was 4.0% (95% CI 2.9-5.1) at a rate of 0.5 episodes/per person-year. The highest monthly prevalence of AGE (14.6%) was found among the 1-4 year(s) age-group and the lowest (2.1%) among the 25-44 years age-group. Of the 18 cases (36%) who sought medical care, 11% were hospitalized, 33% were treated with antibiotics, and 66.7% received oral rehydration fluids. Only 2 cases who sought medical care reportedly submitted stool specimens. The mean duration of diarrhoea was 3.1 days, which resulted in a mean loss of 4 productive days, with over half of the cases requiring someone to care for them. The burden of syndromic AGE for 2009 was extrapolated to be 122,711 cases, showing an underreporting factor of 58.9. For every laboratory-confirmed AGE case, it was estimated that 383 more cases were occurring in the population. This research confirms that the prevalence of AGE is underreported in Jamaica and not being adequately detected by the current surveillance system. The components of the integrated surveillance system for AGE in Jamaica, particularly the laboratory aspect, need to be strengthened.

Enteric protozoa in the developed world: a public health perspective.

Several enteric protozoa cause severe morbidity and mortality in both humans and animals worldwide. In developed settings, enteric protozoa are often ignored as a cause of diarrheal illness due to better hygiene conditions, and as such, very little effort is used toward laboratory diagnosis. Although these protozoa contribute to the high burden of infectious diseases, estimates of their true prevalence are sometimes affected by the lack of sensitive diagnostic techniques to detect them in clinical and environmental specimens. Despite recent advances in the epidemiology, molecular biology, and treatment of protozoan illnesses, gaps in knowledge still exist, requiring further research. There is evidence that climate-related changes will contribute to their burden due to displacement of ecosystems and human and animal populations, increases in atmospheric temperature, flooding and other environmental conditions suitable for transmission, and the need for the reuse of alternative water sources to meet growing population needs. This review discusses the common enteric protozoa from a public health perspective, highlighting their epidemiology, modes of transmission, prevention, and control. It also discusses the potential impact of climate changes on their epidemiology and the issues surrounding waterborne transmission and suggests a multidisciplinary approach to their prevention and control.

Prevalence of gastrointestinal pathogens in Sub-Saharan Africa: systematic review and meta-analysis.

A significant proportion of vulnerable people in sub-Saharan Africa (SSA) remain at risk for contracting diarrhoeal diseases due to the presence of many risk factors facilitating their transmission. A systematic review of published articles from the SSA region was done to determine the prevalence and types of diarrhoeal pathogens in circulation, based on a search of databases, including EBSCO host, PubMed, Scopus, Science Direct, Google scholar and Web of Science was done between September 2009 and December 2010. Data were summarized from 27 studies, with pooled data analysed and reported. Pathogens were isolated from between 26.8-65.6% of cases, with an overall isolation rate of 55.7% (95% CI, 48.2-62.9%). Isolation rates were highest amongst adult cases followed by children, and the odds of isolating a pathogen was greater in diarrhoeal cases (Odds Ratio 4.93 (95% CI, 1.99 to 12.23), than in asymptomatic controls. Overall isolation ranged from 8% to 99%; and heterogeneity testing suggests differences between age groups (Q=5.806; df=2, P=0. 055). Mixed E. coli spp., (29.95%), Cryptosporidium (21.52%), Cyclospora (18%), Entamoeba. (13.8%), Shigella spp. (10.49%), Salmonella spp. (8.36%), and Campylobacter spp. (8.33%), were most commonly reported, and rotavirus was the most common virus isolated. This is the first review to look at the range of enteric pathogens circulating in SSA, and has confirmed high rates of isolation of pathogens from diarrhoeal cases. Public health practitioners can use this information to understanding the challenges related to diarrhoeal illness and set priorities for their prevention and control.

Description of the food safety system in hotels and how it compares with HACCP standards.

BACKGROUND: Tourism is an important earner of foreign exchange in Jamaica; hence, the protection of the visitors' health is very important. A study of travelers to Jamaica in 1996 to 1997 found that travelers' diarrhea (TD) affected almost 25% of visitors. The Ministry of Health (Jamaica) initiated a program for the prevention and control of TD aimed at reducing attack rates from 25.0% to 12.0% over a 5-year period through environmental health and food safety standards of hotels. This article examines the food safety systems in Jamaican hotels located in a popular resort area to find out how comparable they are with the Hazard Analysis Critical Control Point (HACCP) strategy. METHODS: A cross-sectional study was done of hotels in St. Mary and St. Ann. Quantitative data were obtained from food and beverage/sanitation staff and qualitative data through in-depth interviews with hotel managers. Observation of the food safety operations was also done. RESULTS: The majority (75%) of larger hotels used a combination of HACCP and Ministry of Health food safety strategies (p = 0.02) and offered all-inclusive services (r =-0.705, p = 0.001). Larger hotels were more likely to have a better quality team approach, HACCP plan, and monitoring of critical control points (CCPs) and more likely to receive higher scores (p < 0.05). More than two thirds of hotel staff were knowledgeable of HACCP. Significantly smaller hotels (87.5%) received less than 70% in overall score (r = 0.75, p = 0.01). Identification of CCPs and monitoring of CCPs explained 96.6% of the change in the overall HACCP scores (p = 0.001). Hotel managers felt that some hotels' systems were comparable with HACCP and that larger properties were ready for mandatory implementation. Conclusions. While some components of the HACCP system were observed in larger hotels, there were serious shortcomings in its comparison. Mandatory implementation of HACCP would require that sector-specific policies be developed for smaller hotels and implemented on a phased basis.