Cancer Demographics and Time-to-Care in Belize.

BACKGROUND: Belize is a middle-income Caribbean country with poorly described cancer epidemiology and no comprehensive cancer care capacity. In 2018, GO, Inc., a US-based NGO, partnered with the Ministry of Health and the national hospital in Belize City to create the first public oncology clinic in the country. Here, we report demographics from the clinic and describe time intervals to care milestones to allow for public health targeting of gaps. PATIENTS AND METHODS: Using paper charts and a mobile health platform, we performed a retrospective chart review at the Karl Heusner Memorial Hospital (KHMH) clinic from 2018 to 2022. RESULTS: During this time period, 465 patients with cancer presented to the clinic. Breast cancer (28%) and cervical cancer (12%) were most common. Most patients (68%) presented with stage 3 or 4 disease and were uninsured (78%) and unemployed (79%). Only 21% of patients ever started curative intent treatment. Median time from patient-reported symptoms to a biopsy or treatment was 130 and 189 days. For the most common cancer, breast, similar times were seen at 140 and 178 days. Time intervals at the clinic: <30 days from initial visit to biopsy (if not previously performed) and <30 days to starting chemotherapy. CONCLUSION: This study reports the first clinic-based cancer statistics for Belize. Many patients have months between symptom onset and treatment. In this setting, the clinic has built infrastructure allowing for minimal delays in care despite an underserved population. This further affirms the need for infrastructure investment and early detection programs to improve outcomes in Belize.

The Botfly, A Tropical Menace: A Distinctive Myiasis Caused by Dermatobia hominis.

Dermatobia hominis, also known as the human botfly, is native to tropical and subtropical Central and South America and seen in travelers from endemic to temperate regions including the United States and Europe. Cutaneous infestation botfly myiasis involves the development of D. hominis larvae in the skin and is common in tropical locations. The distinct appearance of a cutaneous D. hominis infestation facilitates early diagnosis and intervention where cases are common. However, the identification of D. hominis in temperate regions may prove challenging due to its rarity. D. hominis may be misdiagnosed as folliculitis, an epidermal cyst, or an embedded foreign object with secondary impetigo. One should have a heightened suspicion in someone returning from a vacation in an endemic area, such as Belize. Here we describe the presentation, differential diagnosis, and treatment and encourage enhanced preventative measures among tourists when visiting tropical and subtropical regions. Additionally, we propose a novel classification system for assessing the various stages of infestation and suggest that patients reporting travel to Latin America and experiencing pain disproportionate to an insect bite should lead physicians to consider myiasis caused by D. hominis.

Is it time to use nucleic acid amplification tests for identification of persons with sexually transmitted infections?: evidence from seroprevalence and behavioral epidemiology risk surveys in men with chlamydia and gonorrhea.

Chlamydia and gonorrhea are common sexually transmitted infections (STIs) that can cause multiple problems, and can be easily treated, but frequently present without symptoms. Because of this, commonly used syndromic diagnosis misses a majority of infected persons. Previously, diagnostic tests were expensive and invasive, but newer nucleic-acid amplification tests (NAATs) are available that use urine to non-invasively test for these infections. These analyses used data from seroprevalence studies conducted in five militaries. Data included self-reported current symptoms of STIs as well as chlamydia and gonorrhea NAAT results. A total of 4923 men were screened for chlamydia and gonorrhea from these 5 militaries during April 2016 to October 2017. The combined prevalence of chlamydia and gonorrhea in these five militaries ranged from 2.3% in Burundi to 11.9% in Belize. These infections were not successfully identified by symptomology; for example, only 2% of cases in Belize reported symptoms. In three of the five countries there was no statistical association between symptoms and positive NAAT results. The majority of individuals with these infections (81% to 98%) would be undiagnosed and untreated using only symptomology. Therefore, using symptoms alone to diagnose cases of chlamydia and gonorrhea is not an effective way to control these infections. We propose that automated, cartridge-based NAATs, be considered for routine use in diagnosing those at risk for STIs.

Barriers and facilitators to past six-month HIV testing among men who have sex with men in Belize.

Prevalence of HIV in Belize is high, and men who have sex with men (MSM) are disproportionately impacted by HIV. HIV testing is critical in curbing the epidemic; however, little is known about factors associated with testing among MSM in Belize. Working with a non-governmental organization in a large, urban city within Belize, snowball sampling was applied to recruit Belizean MSM to complete a self-administered survey. Multivariable logistic regression analysis was employed to understand associations with HIV screening behavior. Access to healthcare, HIV knowledge, and reporting having heard of Section 53 of the Criminal Code of Belize (once outlawing same-sex sexual behavior), but not experiencing any negative impact from Section 53 were significantly positively associated with having received an HIV test in the past six months. Healthcare maltreatment (lifetime), depression symptomology, and shame were significantly negatively associated with having received a HIV test in the past six months. Findings suggest that multiple factors associated with stigma and discrimination negatively affect testing strategies among MSM in Belize.

The Belize national plan of action for the prevention and control of non communicabled Diseases 2013-2023

The Belize National Plan of Actionfor the Prevention and Control of Non communicable Diseases (NCDs) 2013-2023(NCDs)aims to reduce the premature mortality caused by the four major NCDs (cardiovascular diseases, cancer, diabetes and lung disease) by 25% by 2023. This will be achieved through policy and advocacy; health promotion and risk factor reduction of the four common risk factors (tobacco, alcohol, unhealthy diet, physical inactivity); improving disease management and patient self-management; and strengthening surveillance, monitoring.

A comprehensive needs assessment to identify priority program targets for mosquito vector control and related diseases in Belmopan, Belize

This was a mixed-methods study aimed to comprehensively assess factors associated with mosquito control in Belmopan, Belize, in order to better inform stakeholders on the effectiveness of their efforts. A knowledge, attitudes, and perceptions (KAP) survey was employed within the four target communities of San Martin, Salvapan, Maya Mopan, and Las Flores. Additional epidemiological and entomological data was provided by relevant stakeholders. A total of 228 households were surveyed among the four target communities. Only 1/3 of respondents were able to demonstrate proficient knowledge. Knowledge was attained mostly through TV, Ministry of Health, hospital, and radio sources. Over 90% of respondents believed that mosquitos and the diseases they carry were a real issue for the community. Respondents living in Salvapan and Las Flores were more likely to have contracted Dengue Fever, Malaria, Chikungunya, or Zika than in other areas. Fan usage and regularly cleaning the yard were the two most employed practices for preventing mosquito bites and breeding. Approximately 85% of those surveyed viewed insecticide spraying to be effective. This assessment provides valuable insight into the needs of at- risk communities in regards to vector control. An increased focus on community outreach, education, and behavioral change can greatly impact the effectiveness of current vector control efforts. Stakeholders must work together and pool resources in order to effectively employ control interventions. Continued evaluation and community involvement is necessary to control mosquitos and prevent disease outbreaks...(AU)

Orange Walk zika classification by sex 2017

The document is a compilation of the weekly surveillance of the confirmed and suspected (clinical and test) cases of Zika in the Orange Walk district recorded by the EPI Unit of the Ministry of Health, Belize for 2017. This information is captured and reported according to sex.

A study to identify the presence of Aedes Spp. using BG-Sentinel® Traps and larval/pupal surveys in communities around Belmopan, Cayo District.

The knowledge of the presence of Aedes Spp. mosquitoes is very important for the prevention and control of emerging and remerging diseases caused by Arboviruses such as: Yellow fever, Dengue, Chikungunya and Zika. While Chikungunya and Dengue are endemic to Belize, Zika is currently a threat with local transmission having been established in several Caribbean and Central American Countries. The objective of the study is to survey the presence of Ae. aegypti and Ae. albopictus in the communities of San Martin, Salvapan and Las Flores, Belmopan City. The study was conducted from March 14 to April 2, 2016 whereby adult mosquitoes were captured using BG-Sentinel® Traps and larvae/pupae collection surveys were also done. Three hundred meter zone(s) were determined within localities and 1 BG-Sentinel® trap was deployed for 3 days at 24-hour intervals both indoors and outdoors at 2 residences randomly selected in each community. Larvae/Pupae collection surveys were done at 5 private premises within the predetermined zones in each of the three communities. Captured larvae and Pupae were reared for 6 days and adults obtained were used for identification. The identification of adult Ae. aegypti and Ae. albopictus was done using a stereoscopic microscope and pictorial keys that are used for the identification of mosquitoes. The presence of Ae. aegypti was identified in all 3 communities through both adult mosquito and larvae/pupae collections. However, Ae. albopictus was present only in San Martin and Salvapan communities. The presence of Ae. aegypti and/or Ae. albopictus will determine which appropriate vector control interventions are needed considering the different characteristic breeding habitats of these mosquitoes.(AU)

Survey of container breeding mosquito larvae (Dengue vector) in Salvapan and Las Flores

Dengue is one of the most important vector borne diseases, with millions of cases occurring yearly and with billions found in risk areas. Eliminating water-holding containers where mosquitoes oviposit and develop can help manage urban disease-vector mosquitos. Thus, a water holding container eradication campaign was implemented by the Ministry of Health of Belize to eliminate the outburst of a dengue epidemic in known risk areas. A study was conducted in two selected communities, Salvapan and Las Flores, to determine the preferred container breeding habitat of the dengue vector and which of the site is more susceptible to a dengue epidemic. A number of households per site were randomly selected and a survey was carried out to identify water-holding containers breeding mosquito larvae and to identify the dengue vectors Aedes aegypti and Aedes albopictus. Mosquito larvae from different types of artificial and natural containers were collected and were identified using taxonomical keys. Aedes aegypti was the most abundant species in 74% of positive containers (water tanks, buckets, waste tire, etc). Culex spp. with 13%, Aedes albopictus with 12%, and Anopheles spp. with 0.48% in positive containers. The most abundant positive container was the bucket with 31% out of all positive containers. Twenty-six percent of the houses in Salvapan were positive compared to the thirty-seven percent in Las Flores. The study concluded that the dengue vector preferred breeding habitat was the bucket and that Las Flores is more prone to a dengue epidemic than Salvapan.(AU)

Belize zika classification by epidemiological week 2016

This report represents a compilation of 2016 statistics based on 52 weeks of epidemiologic surveillance of the Zika virus disease by the EPI Unit, Ministry of Health, Belize. Four tables with corresponding graphs provide a breakdown of the confirmed, suspected (clinical), and suspected (by test)) cases of zika according to epidemiological week, community within the Belize district, age group and sex. The incidence of Zika virus disease was presented for each of the 24 communities that comprise the Belize district as well as for one unknown location within that district. The grand total of Zika virus cases in Belize for 2016 was 349.

Cost-effectiveness of HPV vaccination in Belize.

OBJECTIVE: Among women in Belize, cervical cancer is both the leading cancer and the leading cause of cancer deaths. Both the quadrivalent and bivalent human papillomavirus (HPV) vaccines are licensed in Belize. The Ministry of Health of Belize convened a multidisciplinary team to estimate the costs, health benefits, and cost-effectiveness of adding an HPV vaccine to the national immunization schedule. METHODOLOGY: The CERVIVAC cost-effectiveness model (Version 1.123) was used to assess the lifetime health and economic outcomes of vaccinating one cohort of girls aged 10 years against HPV. The comparator was no HPV vaccination. The PAHO Revolving Fund negotiated price of US$ 13.79 per dose was used (for the quadrivalent vaccine) and national data sources were used to define demography, cervical cancer incidence and mortality, cervical cancer treatment costs, and vaccine delivery costs. Estimates from international agencies were used in scenario analysis. RESULTS: In a cohort of ∼4000 Belizean girls tracked over a lifetime, HPV vaccination is estimated to prevent 69 new cases of cervical cancer (undiscounted), and 51 cervical cancer deaths (undiscounted). Considering the potential cervical cancer treatment costs and lost wages avoided by households (societal perspective), the cost per disability-adjusted life year (DALY) averted was estimated to be US$ 429. This increased to US$ 1320 when cervical cancer treatment costs and lost wages were excluded from the analysis. Both estimates are far below the gross domestic product (GDP) per capita of Belize (US$ 4795). The lifetime health care costs saved by the women and their families represent more than 60% of the investment cost needed by the Government for the vaccine. CONCLUSION: Routine HPV vaccination would be highly cost-effective in Belize. If affordable, efforts should be made to expedite the introduction of this vaccine into the Belizean national immunization program.

Dietary habits of juveniles of the Mayan cichlid, Cichlasoma urophthalmus, in mangrove ponds of an offshore islet in Belize, Central America

Foraging habitats of juveniles of the Mayan cichlid, Cichlasoma urophthalmus (Günther, 1862), were investigated in two mangrove ponds located in Twin Cays offshore islet in Belize: Sink Hole pond (SH) and Hidden Lake pond (HL). Sink Hole pond is a semiclosed body of water, whereas Hidden Lake pond is connected by a channel to adjacent seagrass beds that surround the islet. Gut contents of 21 juvenile C. urophthalmus (9.8-13.2 cm total length) were analyzed, and five prey taxa were identified. In both mangrove ponds, C. urophthalmus were opportunistic carnivores and consumed primarily crustaceans. Plant material and detritus present in gut contents were most likely ingested incidentally when the fish foraged on small invertebrates. Carbon isotopic values of fish specimens from the two ponds were similar (mean ± SD of -19.2 ± 0.4‰ in SH and -19.4 ± 0.4‰ in HL), and were close to those of mangrove prey (mean ± SD = -20.2 ± 1.5‰), suggesting that this fish species forages in this habitat. Mixing models showed a higher contribution of mangrove food sources to the fish diet than seagrass food sources. This study reveals that young Mayan cichlids, inhabiting two Belize mangrove ponds, are generalists and opportunistic carnivores that forage on mangrove food sources and do not appear to move to adjacent seagrass beds to complement their diets. Understanding trophic linkages between aquatic consumers and food resources may contribute to better management of threatened coastal ecosystems.

Habitats de alimentação de juvenis do ciclídeo-maia, Cichlasoma urophthalmus (Günther, 1862), foram investigados em duas lagoas de mangue localizadas nas ilhas Twin Cays em alto mar em Belize: Sink Hole Lake (SH) e Hidden Lake (HL). Sink Hole é um corpo d'água parcialmente isolado, enquanto Hidden Lake é ligada por um canal com bancos de sargaços que cercam a ilhota. O conteúdo estomacal de 21 juvenil de C. urophthalmus (9,8-13,2 cm de comprimento total) foram analisados e cinco táxons de presas foram identificados. Em ambas as lagoas de mangue, 'C.' urophthalmus foram carnívoros oportunistas e consumiram principalmente crustáceos. Material vegetal e detritos presentes no conteúdo digestivo foram provavelmente ingeridos acidentalmente quando o peixe se alimentava de pequenos invertebrados. Os valores de isótopos estáveis do carbono em espécimes de peixes das duas lagoas foram semelhantes (média ± SD -19,2 ± 0,4 ‰ em SH e -19,4 ± 0,4 ‰ em HL), e foram próximos aos de presas de mangue (mean ± SD = -20.2 ± 1.5 ‰), sugerindo que esta espécie de peixe vai à procura de alimentos neste habitat. Modelos mistos mostraram uma maior contribuição de fontes alimentares de mangue para a dieta dos peixes do que de fontes alimentares de algas marinhas. Este estudo revela que juvenis do ciclídeo-maia que habitam duas lagoas de mangue em Belize, são carnívoros generalistas e oportunistas que se ingerem alimentos dos manguezais e não parecem se mover para leitos de algas marinhas adjacentes para complementar suas dietas. Compreender as ligações tróficas entre consumidores aquáticos e recursos alimentares pode contribuir para uma melhor gestão dos ecossistemas costeiros ameaçados.

Dengue tests done by epi week & district 2011

This document is a compilation of the dengue tests done by and recorded by the EPI Unit of the Ministry of Health, Belize for 2011. This information has been captured, collated and reported according to district, sex and age group.

First record of Stegomyia albocpicta [Aedes albopictus] in Belize

The first confirmed record of Stegomyia albopicta (Skuse) [Aedes albopictus (Skuse)] for Belize was made at Benque Viejo del Carmen, District Del Cayo, from a mosquito landing on a human on 6 August 2009.

Human papillomavirus profile of women in Belize City, Belize: correlation with cervical cytopathologic findings.

Cervical carcinoma is the most common cancer among Belizean women; however, data regarding the frequency of human papillomavirus (HPV) genotypes and their association with cervical cancer are nonexistent. We therefore included HPV genotyping as part of a week-long cervical cancer screening campaign conducted in Belize City in 2007. Conventional Papanicolaou smears with Hybrid Capture (HC) 2 HPV testing were performed on 463 women. All HC2-positive samples were genotyped using a developmental GP5+/GP6+ polymerase chain reaction-coupled Luminex assay for 2 low-risk and 18 high-risk HPV types. The prevalence of high-risk HPV was 15.6% in the total population, 10.1% in those with normal cytologic findings, and 93.3% in women with a high-grade squamous intraepithelial lesion. Of patients with HPV infections, 35% had multiple types (5.4% of the total group). Of all women and of women with normal cytologic findings, 5.2% and 2.8%, respectively, had HPV16 or 18. For all women, HPV16, 18, 56, and 52 were present in decreasing order of frequency. HPV11 was present in only one patient, and none had HPV6. HPV16 was found in 47% of high-grade squamous epithelial lesions; however, no case of HSIL had HPV18 or 45. HPV35 and HPV58 were the next most common types in high-grade squamous intraepithelial lesion, each occurring in 20% of cases of high-grade squamous intraepithelial lesion, followed by HPV31 in 13.3%. Although women younger than 25 years old were underrepresented, these data suggest that the HPV profile of this cohort of Belizean women differs somewhat from that in the region. In addition, these data are of importance with regard to the development of HPV vaccines that will be used in less developed countries, where care should be taken not to implement vaccination at the cost of basic screening and diagnostic services.

Assessment of the impact of climate change on Belize's health sector: Dengue and Dengue Hemorrhagic Fever

The main goal of this assessment is to determine the present and future occurrence of dengue and Dengue Hemorrhagic Fever (DHF) and to measure its impact on the health care system and population in terms of morbidity and mortality, also to measure the socio-economic impact of adaptation measures. The method used was determined after consultation with senior staff of the National Meteorological Service, the Statistical Institute of Belize, the Ministry of Health and the Vector Control Program, in order to assess existing modeling capability and the availability of data.

Evaluation of a hypertension screening programme in Independence, Belize.

This study assesses the effectiveness of a hypertension-screening programme in Independence, Belize. Forty-nine of the 101 patients screened were found to have elevated blood pressure readings and were advised to seek medical care. Four months later, interviews with 35 of the 49 patients from the hypertensive group revealed that 85.7% of the patients had sought medical care. Women, elderly patients and patients with a previous history of hypertension were more likely than men, younger patients and those without a history of hypertension to seek follow-up medical care. The screening programme successfully directed a high proportion of patients with elevated blood pressure to seek appropriate medical care.

Evaluation of a hypertension screening programme in Independence, Belize / Evaluación de Programa de Pesquizaje de la Hipertensión en Independencia, Belice

This study assesses the effectiveness of a hypertension-screening programme in Independence, Belize. Forty-nine of the 101 patients screened were found to have elevated blood pressure readings and were advised to seek medical care. Four months later, interviews with 35 of the 49 patients from the hypertensive group revealed that 85.7 of the patients had sought medical care. Women, elderly patients and patients with a previous history of hypertension were more likely than men, younger patients and those without a history of hypertension to seek follow-up medical care. The screening programme successfully directed a high proportion of patients with elevated blood pressure to seek appropriate medical care

Este estudio evalúa la efectividad de un programa de pesquizaje de la hipertensión en Independencia, Belice. Se halló que 49 de 101pacientes sometidos al pesquizaje produjeron lecturas de alta presión sanguínea y tensión arterial, y se les aconsejó buscar atención médica. Cuatro meses después, entrevistas con 35 de los 49 pacientes del grupo hipertenso revelaron que el 85.7% de los pacientes habían buscado atención médica. Las mujeres, los pacientes mayores y los pacientes con una historia previa de hipertensión presentaban una probabilidad mayor a buscar atención médica de seguimiento, que los hombres, los pacientes más jóvenes y aquéllos sin una historia de hipertensión. El programa de pesquizaje tuvo éxito en hacer que una alta proporción de pacientes con presión sanguínea alta buscaran adecuada atención médica.