Longitudinal follow-up of Zika virus RNA in semen of a traveller returning from Barbados to the Netherlands with Zika virus disease, March 2016

We report the longitudinal follow-up of Zika virus (ZIKV) RNA in semen of a traveller who developed ZIKV disease after return to the Netherlands from Barbados, March 2016. Persistence of ZIKV RNA in blood, urine, saliva and semen was followed until the loads reached undetectable levels. RNA levels were higher in semen than in other sample types and declined to undetectable level at day 62 post onset of symptoms...(AU)

Vector control programme

This is an extract from the Barbados Ministry of Health Programme Budget for 2016-2017. It describes selected aspects of the "Vector Control Programme" which is managed by the Ministry's Vector Control Unit. Selected details viz.: programme background; overall goal; objectives; review of vector control activities for the previous year; constraints; plans for the stated budget period; as well as indicators are presented.

Performance measurement of intensive care services in hospitals: the case of Barbados

The Intensive Care Unit (ICU), being one of those vital areas of a hospital providing clinical care, the quality of service rendered must be monitored and measured quantitatively. It is, therefore, essential to know the performance of an ICU, in order to identify any deficits and enable the service providers to improve the quality of service. Although there have been many attempts to do this with the help of illness severity scoring systems, the relative lack of success using these methods has led to the search for a form of measurement which would encompass all the different aspects of an ICU in a holistic manner. The Analytic Hierarchy Process (AHP), a multiple-attribute, decision-making technique is utilised in this study to evolve a system to measure the performance of ICU services reliably. This tool has been applied to a surgical ICU in Barbados; we recommend AHP as a valuable tool to quantify the performance of an ICU.

Zika - epidemiological report Barbados, September 2017

This PAHO/WHO report traces the epidemiology of the Zika and Dengue viruses in Barbados for the period 2017-2017. The first case of Zika was laboratory-confirmed in 2016, and the number of confirmed cases rose to a high of 92 and fell to 25 in 2017. The report also presents statistical data for Dengue, Zika-related pregnancies, Zika-virus-associated Guillain Barre syndrome, Congenital Syndrome associated with Zika Virus infection, and Zika-related deaths

A new tool for measurement of process-based performance of multispecialty tertiary care hospitals

There is an increasing need of a model for the process-based performance measurement of multispecialty tertiary care hospitals for quality improvement. Analytic hierarchy process (AHP) is utilized in this study to evolve such a model. Each step in the model was derived by group-discussions andbrainstorming sessions among experienced clinicians and managers. This tool was applied to two tertiary care teaching hospitals in Barbados and India. The model enabled identification of specific areas where neither hospital performed very well, and helped to suggest recommendations to improvethose areas. AHP is recommended as a valuable tool to measure the process-based performance of multispecialty tertiary care hospitals.

Some aspects of malignant disease of the upper respiratory tract

Surgical biopsy material submitted by the Department of Otolaryngology, Queen Elizabeth Hospital, Barbados, to the Department of Pathology of that hospital from 1st Nov., 1965, to 15th March, 1967 is reviewed. (The beginning of the period chosen coincided with the setting up of a Department of Otolaryngology in that hospital under the direction of a qualified specialist Otolaryngologist). The total number accessions was 130 and of these 22 were malignant neoplasms of the upper respiratory tract. These are classified according to their anatomical location and histological characteristics. During the period under review, the total number of surgical biopsy specimens submitted to the Department of Pathology for examination was 1,500, and the total number of malignant neoplasms that were diagnosed histologically was 300. Malignant neoplasms of the upper respiratory tract thus represented 7.3 per cent of all the malignant tumours submitted for histological examination. The incidence and microscopic features of these neoplasms in Barbados and their histological gradings are compared with the findings of Bras and his co-workers in Jamaica in their paper on the Incidence of malignant neoplasms in that island, of Edington and Maclean's cancer survey in Western Nigeria, Davies' figures for cancer in Uganda and Cabrera's figures for cancer in the Congo. Some of the more interesting of the malignant neoplasms in the series studied are described in greater detail, including a malignant melanoma presenting in the oropharynx, a sarcoma-like tumour in the glottis and a chemodectoma found within the larynx (AU)

Diabetic admissions at the Queen Elizabeth Hospital, Barbados - does the timing of primary care contact make a difference? - abstract

The Queen Elizabeth Hospital (QEH) is the major secondary and tertiary health care facility in Barbados, and patients who reach this hospital either present directly to the Accident and Emergency Department (A+E), or are referred by physicians. Over a six-month period all diabetic admissions to the hospital were identified, each patient was interviewed and examined, and hospital progress and outcome recorded. Of the 539 patients identified, 201 (37 percent) came directly to the A+E, while 338 (63 percent) had been referred to hospital. Three hundred and sixty-two (69 percent) had seen a physician within three months of admission. The main reasons for admission were the diabetic septic foot (33 percent), followed by heart failure (13 percent) and acute myocardial infarct 12.5 percent. Because the diabetic septic foot is considered a largely preventable problem, the high admission rate suggests that preventive care, assessment and management at the primary care level are inadequate. Patients who visited their primary care physicians within three months of admission, but nevertheless ended up in hospital, had lower mortality rates but prolonged hospital stays (AU)

A health and seroepidemiological survey in Bridgetown, Barbados

A 10 percent sample of households in District 13 and 14 were studied by health questionnaire and blood sample. Of 1399 persons in the target houses, blood samples were obtained from 1109 or an 80 percent response rate. Of 290 children examined, 26 percent had active skin disease and 10 percent (28 children) had group A Hemolytic streptococci on the skin, 7 percent were pharyngeal and 1.4 percent were nasal carriers. Twenty-one of the children had some degree of proteinuria (trace or more). Cardiac murmurs were found in 30 of 67 adults (30 percent) and in 31 of 238 children (11 percent) examined. Serological tests reveal that (1) only 40 percent of persons of all ages have rubella antibody. (2) Twenty percent have CF antibody to dengue and the age distribution of antibody indicates an outbreak 25 years ago. (3) Eight percent have reactive VDRL tests of which 92.9 percent have been confirmed by the FTA/absorbed test. (4) Over 95 percent have antibody to Epstein-Barr virus (the cause of infectious mononucleosis) and 78.5 percent have antibody to dytomegalovirus. (5) Antibody to A2/Hong Kong influenza virus was present in 84.9 percent and to influenza group B in 68.3 percent. (6) Adequate levels of diphtheria and tetanus antitoxin were found in 70 percent of the sera from 100 children. (7) Initial tests for poliomyelitis antibody suggest low or absent levels in some children despite a vigorous immunization programme. The importance of the survey in planning immunization and control programmes will be discussed (AU)

The results of glaucoma surgery in West Indians - abstract

As glaucoma is the most frequent cause of blindness in Barbados, changes in treatment are being sought. Glaucoma drainage surgery was performed on 46 eyes which had open angle glaucoma uncontrolled by medical means. All the patients were deeply pigmented West Indians. The short term assessment of results has been made on a return of the intraocular tension to normal without apparent visual deterioration. Of the 46 eyes, the tension has been normalized in 67 percent and these patients are now maintained without treatment. In 20 percent miotic drops are required and in 4 percent drops and Diamox are necessary to normalize the tension. In 9 percent improvement was not satisfactory. Because of the usually satisfactory results, surgery should be offered to glaucoma patients at an earlier stage, even to patients with deeply pigmented eyes (AU)

HTLV-I serology in neurological patients at the Queen Elizabeth Hospital, Barbados - abstract

A survey of the spectrum of neurological syndromes encountered in Barbados was carried out to determine the pathogenic role of human T-lymphotropic virus (HTLV-I) infection in affected patients. Since 1989, patients with chronic neurological disorders were either recalled or were selected from new referrals to the neurology clinic at the Queen Elizabeth Hospital, Barbados. With the consent of patients, serum and CSF samples were tested for IgG antibodies to HTLV-I, using an enzyme-linked immunosorbent assay method. Positive results were confirmed by Western Immunoblotting at the CAREC Laboratories, in Trinidad. Only patients native to Barbados and the Eastern Caribbean were included in the survey. Twenty-nine (29) of 170 patients tested were serpositive for HTLV-I antibodies 18(62 percent) of the HTLV-I-positive patients had tropical spastic paraparesis (TSP). Of 21 seropositive patients who also had CFS-positive antibodies status, 16(76 percent) had TSP, 2(9.5 percent) adult T-cell leukaemia/lymphoma (ATLL), and 3 (14 percent) polymyositis, including 2 with an atypical clinical profile. HTLV-I seronegative patients included 12 (8.5 percent) with ataxia, 19(13.5 percent) with a relapsing/remitting sydrome characteristic of multiple sclerosis, 8(5.5 percent) with idiopathic intracranial hypertension and 8(5.5 percent) with stroke. HTLV-I positive associated neurological diseases in Barbados consist primarily of myelopathy (TSP). Some cases present more complex patterns of neurlogical dysfunction, associated with polymyositis. (AU)

The prevalence of hypercholesterolaemia in a general practice population in Barbados - abstract

This study was undertaken to determine the prevalence of hypercholesterolaemia in a general practice population in Barbados, and to determine whether hypercholesterolaemia is a public health problem for which screening would be worthwhile. A total of 498 patients (96 percent over 35 years) drawn from a general practice population of 15,000 patients, were studied. Two hundred and two (202) non-diabetic, non-hypertensives, 152 hypertensives, 123 diabetics and 21 hypertensive diabetics were selected, comprising every third patient in each diagnostic category to visit the clinic. One hundred and forty-two (28. percent) of all patients had a cholesterol level in the desirable range, 185 (37.1 percent) had a borderline high level, and 171 (34.4 percent) had a high-risk level of serum cholesterol. The prevalence of high-risk serum cholesterol was lowest in non-diabetic/non-hypertensive patients, and highest in diabetic hypertensives. The results suggest that the prevalence of hypercholesterolaemia in the Barbadian population is high and that screening is worthwhile (AU)

Sensitivity to blomia tropicalis among allergic individuals in Barbados - abstract

The prevalence of specific IgE (RAST) to tropical house dust mite Blomia tropicalis (Bt) was studied in 126 related individuals with self-reported atopic asthma (AA) and/or self-reported allergic rhinitis (AR) and individuals with no reported atopic disease. RAST results were considered positive when a serum bound > 5 percent of the total counts (percent TCB) added; 17 (65.4 percent) AA were positive to Bt, 7 (29.2 percent) AR without AA were positive to Bt, and 16 (21.9 percent) individuals reporting no AA or AR were positive to Bt. Total serum IgE was significantly higher in individuals with self-reported AA (750 ng/ml) than in individuals reporting no AA (282 ng/ml; Student's t test, p = 0.02). There was no association between total serum IgE and self-reported AR. Additionally, total IgE was weakly correlated with RAST (Bt) for all individuals (r=0.349, p=0.001). Subjects with self-reported AA had a significantly higher mean percentage TCB (19 + 17) than individuals without self-reported AA (10 + 14; Student's test, p<0.05). This study suggests that sensitivity to Bt is common in individuals with atopic asthma living in Barbados (AU)

Molecular analysis of HIV-1 infection in Barbados

OBJECTIVE: To determine the sub-type(s) of HIV-1 in patients with advanced disease in Barbados. DESIGN AND METHODS: A molecular analysis was performed in sequences obtained from 38 HIV-1 infected persons. A 375 base pair fragment was amplified from the V3 loop of the env region of the HIV genome, using a nested RT-PCR method. The resulting fragment was sequenced directly and alignment was performed using the BLAST (Basic Local Alignment Search Tool) search. RESULTS: Of 38 patients with advanced HIV-1 infection, all were found to be infected with HIV-1 subtype B, which closely relates to a similar subtype found in North America and Europe. This is the first time that HIV subtypes have been described from Barbadian patients with advanced HIV disease. CONCLUSIONS: Our findings support the hypothesis that HIV infection in Barbados was derived initially from North America and Europe, where type B HIV infection is most common. Moreover, these findings indicate that vaccines suitable for use in North America will probably be effective in our population.(Au)

Behaviour disorder of children

The etiology and management of this condition was presented. The report was based on a 10 year study during which 127 children were admitted to the Barbados Mental Hospital. One quarter of the admissions were 14 years of age and the number of re-admissions was low. The principal contributing causes were thought to be over population, political an d economic ferment an the matriarchal system. (AU)

A pilot survey of the ecological factors connected with 100 first admissions to the Barbados Mental Hospital

A scheme for investigating the aetiological factors in mental illness is presented. Both hereditary and environmental factors are included and the main heading for the enquiry are as follows : age, colour, religion, address, intelligence, hereditary factors, and pure stress factors such as work, social, home and financial conditions, and the amount of alcohol drunk. Correlation appears to be shown between religion and admission rates and also between density of population and admission rates. The hereditary factor appears to be significant as 48 percent of admissions were shown to have close relatives mentally ill, but no control group has yet been found. Very often a direct comparison can be made between the survey findings at the hospital and the census findings for the whole island, hence obiviating the need for a control group (AU)

The haemoglobinopathies in Barbados (abstract only)

There is evidence to suggest that persons possessing the sickle cell gene is protected against falciparum malaria. A University College of the West Indies Survey was conducted in Barbados to determine the incidence of the abnormal haemoglobins with particular reference to the sickling gene and the findings compared with those in Jamaica. The genital implications are discussed, particularly the role of sickle cell anaemia itself and the findings in people from other Caribbean islands included for comparison (AU)

Absence of epidemicity of severe leptospirosis in Barbados

The possibility of micro-epidemics of severe leptospirosis occurring on the island of Barbados was investigated by examining the space-time clustering of the disease in 212 laboratory confirmed cases admitted to Queen Elizabeth hospital, Bridgetown, over a 7-year period. A series of 109 patients with symptoms compatible with leptospirosis but shown to be otherwise by laboratory examination were also examined for comparison. No significant space-time clustering was found among the leptospirosis cases, indicating no evidence for micro-epidemics. By comparison, statistically significant clustering was apparent among the smaller non-leptospirosis series. Possible explanations for the absence of observed micro-epidemics of leptospirosis are discussed. (AU)

Rheumatic fever in the eighties: the Barbadian experience - abstract

A retrospective review of yearly admissions of acute rheumatic fever between 1971 and 1990, showed a declining trend with relative stability since 1986. The incidence rate of acute rheumatic fever (new attacks/year) was 2/100,000 total population of 7/100,000 childhood population < 19 years of age or 9/100,000 school children. The incidence rate per 10,000 hospital admissions was a high of 20 in 1971 and has remained a low of three since 1986. There were no significant differences in presentation in the period 1981-1985 when compared with the period 1986-1990, using chi square analyses. The only exception was carditis (without concomitant arthritis), which was significantly more frequent in the latter half of the decade. This low incidence of acute rheumatic fever should not give rise to complacency in its control, as there is an unexplained resurgence in developed countries (AU)

Epidemiological investigation of severe leptospirosis in the parish of St. Andrew, Barbados

The parish of St. Andrew has been shown to have the highest incidence of leptospirosis in Barbados (40/100 000 for the period 1979-1991 inclusive, compared with the mean incidence for the whole island over the same period of 13.3/100 000). A survey was conducted to try to identify which of the known risk-factors for leptospirosis were common in St. Andrew. Thirty-six cases of laboratory-confirmed leptospirosis occurring in the parish were identified during the 14 years from January 1980 to December 1993 inclusive. The incidence of leptospirosis in St. Andrew over this period showed a close association with mean monthly rainfall. However, there was no relationship between individual cases and rainfall in the preceding months. A questionnaire was administered to 71 percent of the thirty-one available subjects. The most common occupations were students (23 percent) agricultural workers (20 percent) while the unemployed were 17 percent. Gardening was practised by 40 percent of the respondents; 63 percent kept livestock animals and 86 percent kept dogs. Exposure to ponds or other water was common (41 percent) and 23 percent of respondents admitted walking barefoot some or all of the time. Mongooses were seen near the home or workplace by eight (36 percent) respondents, rats by 16 (73 percent), mice by 13 (59 percent) and frogs or toads by 14 (64 percent). The patients who responded to this questionnaire were exposed to multiple risk factors. Few indicated a change in lifestyle since recovering from leptospirosis. The importance of education for preventing exposure must be emphasized (AU)

Childhood malignancies in Barbados (1985-1989): incidence and survival - abstract

The lack of frequency data on childhood malignancies in the Caribbean prompted this 5-year (1985-1989) retrospective study of childhood malignancy in Barbados. Case finding of malignancies in children <15-years-old attending the Queen Elizabeth Hospital, Barbados was undertaken by reviewing medical and other related records for the period of study. Health statistics for the island were obtained from the Statistics Department of the Ministry of Health. There were 44 cases of childhood malignancy of whom 15 died, representing about 0.3 to 1 per cent of all cancer deaths annually. The average annual incidence of childhood cancer for the 5-year-period was 143.5 per million children. Fourteen types of childhood malignancies were found, and the commonest types were brain tumours (27 per cent) and haematological cancers (27 per cent) (AU)