Exploring the Opinions of Parents and Teachers about Young People Receiving Puberty and Sex Education in Rural Kenya: A Qualitative Study.

In Kenya, one of the most significant public health concerns is the spread of HIV. Additionally, 13,000 girls drop out of school every year due to pregnancy. Although the Kenyan Ministry of Education and other independent organisations have tried to implement various means of developing puberty and sexual health education for young people, the situation is not improving. Aims: To explore the opinions of teachers and parents in rural Kenya about delivering puberty and sex education and to identify their perceptions of barriers to young people accessing this education. Study Design: Qualitative study. Place and Duration of Study: Rural Nyanza Province, Western Kenya between January and March 2013. Methodology: semi-structured interviews with 19 teachers and 30 parents following a topic guide to explore their opinions about what young people need to learn about sex education and perceived barriers to accessing that education. The interviews were transcribed and subjected to Framework analysis. Results: Analysis revealed a lack of continuity in teacher training for sex education and discrepancies in what is being taught in schools. It also highlighted internal contradictions in teachers’ and parents’ views about some aspects of sex education, particularly the emphasis on abstinence and negative attitudes towards contraception. Conclusion: Strategies for improvement may include a full evaluation of the formal sex education curriculum and retraining where necessary to ensure consistency in the sexual health messages that are delivered to young people. Additionally, parents and wider rural communities may need to be better supported in their ways of discussing puberty and sexual health with their children.

Survival outcomes in renal transplantation in Trinidad and Tobago - SORTTT study / Resultados de la supervivencia de transplante renal en Trinidad y Tobago - estudio RSTRTT

OBJECTIVE: To assess patient and graft survival outcomes of renal transplant recipients from the National Organ Transplant Unit, Trinidad and Tobago. DESIGN AND METHODS: A retrospective descriptive analysis of renal transplants performed within five and half years (January 2006 - June 2011) at the National Organ Transplant Unit was conducted. The age, gender, ethnicity, cause of renal failure, donor type, outcome and complications were examined. The one, two and three-year patient and graft survival rates were analysed and factors affecting them were discussed. RESULTS: A total of 73 renal transplantations were done. Seventy (95.9%) were from live donors and 3 (4.1%) from deceased donors. Thirty-eight patients (52.1%) were males and 35 (47.9%) were females. The one-year, two-year and three-year patient survival rates were 91.46% (SE 0.04), 89.51 % (SE 0.04) and 86.31% (SE 0.05), respectively. The one-year graft survival rate was 94.34% (SE 0.03). The two-year and three-year graft survival rates were the same at 92.69% (SE 0.03). The most significant complications seen in the recipients were those related to infections and cardiovascular disease: 47.9% of patients had a urinary tract infection, with the majority occurring at twelve months and 32.5% developed dyslipidaemia for the first time at six months. Seven patients developed erythrocytosis. CONCLUSION: The patient and graft survival rates in this new transplant programme are acceptable. Complications which can occur in transplant recipients are common and have a significant impact on post-transplantation quality of life and survival. Thus, continuing assessment of comorbid factors pre and post-transplantation as well as the analysis of donor and recipient factors will lead to an increase in both patient and graft survival.

OBJETIVO: Evaluar los resultados de supervivencia de pacientes y transplantes en relación con recipientes de transplante renal en la Unidad Nacional de Trasplante de Órganos de Trinidad y Tobago. DISEÑO Y MÉTODOS: Se realizó un análisis descriptivo retrospectivo de trasplantes renales de cinco años y medio (enero de 2006 - junio de 2011) en la Unidad Nacional de Trasplantes de Órganos. Se examinó la edad, el género, la etnicidad, la causa de la insuficiencia renal, el tipo de donante, la evolución clínica del paciente, y las complicaciones. Se analizaron las tasas de supervivencia de pacientes y transplantes, de uno, dos y tres años, y se discutieron los factores que las afectan. RESULTADOS: Se realizaron un total de 73 trasplantes renales. Setenta (95.9%) fueron de donantes vivos, y tres (4.1%) de donantes muertos. Treinta y ocho pacientes (52.1%) eran varones y 35 (47.9%) eran hembras. Las tasas de supervivencias de uno, dos y tres años relativas a los pacientes, fueron 91.46% (SE 0.04), 89.51% (SE 0.04) y 86.31% (SE 0.05), respectivamente. La tasa de supervivencia de transplante de un año fue 94.34% (SE 0.03). Las tasas de supervivencia de transplante de dos y tres años fueron iguales, alcanzando un 92.69% (SE 0.03). Las complicaciones más significativas observadas en los recipientes fueron las relacionados con infecciones y la enfermedad cardiovascular: 47.9% de los pacientes tenían infección de las vías urinarias, teniendo lugar la mayoría de ellas a los doce meses, en tanto que el 32.5% desarrolló dislipidemia por primera vez a los seis meses. Siete pacientes desarrollaron eritrocitosis. CONCLUSIÓN: Las tasas de supervivencia de pacientes y transplantes en este nuevo programa de trasplante son aceptables. Las complicaciones que pueden ocurrir en los recipientes son comunes y tienen un impacto significativo en la calidad de vida postransplante. Por lo tanto, continua evaluación de los factores comórbidos pre- y postransplante, así como el análisis de donantes y recipientes conducirá a un aumento de la supervivencia, tanto de los pacientes como de los transplantes.

Living donor kidney transplantation: the donor profile in Trinidad and Tobago / Trasplante renal de donantes vivos: perfil del donante en Trinidad y Tobago

OBJECTIVE: The National Organ Transplant Unit (NOTU) of Trinidad and Tobago, first implemented in January 2006, was mandated to facilitate renal and corneal transplantation. Since then, 60 transplants have been performed utilizing living kidney donors. The aim of this study is to ascertain the typical donor profile and to highlight the safety involved with live kidney donation. SUBJECTS AND METHODS: This descriptive study utilized the medical records of 60 consecutive live kidney donors between the period January 2006 and May 2010. Donor information was recorded on Microsoft Excel spreadsheets and analysed using the Statistical Package for Social Sciences 12.0. RESULTS: Among the 60 donors, males and females were in equal proportions with a mean age of 35.0 (± 10.7) years; a mean body mass index (BMI) of 25.8 (± 4.2) kg/m2 and 48.3% were of East Indian decent. The majority of donors were related to the recipient (71.7%). At donation, the mean creatinine was 84.9 (± 17.7) µmol/L, average urine creatinine clearance, 1.83 (± 0.53) mL/s and mean 24 hour urine protein, 141.8 (± 78.6) mg. There was a significant association between the BMI at donation and proteinuria one year after donation (p = 0.043). The average hospital stay was 5.0 (± 0.95) days with minimal postoperative complications. CONCLUSION: The typical live kidney donor in Trinidad and Tobago is a 35-year old, slightly overweight male or female who is usually of East Indian decent, donating a kidney to a relative. Living kidney donation in this Transplant Unit is safe with minimal short-term complications.

OBJETIVO: La Unidad Nacional de Trasplantes de Órganos (UNTO) de Trinidad y Tobago, implementada por primera vez en enero de 2006, fue instituida con el propósito de facilitar los trasplantes de rinón y córnea. Desde entonces se han realizado 60 trasplantes utilizando donantes vivos de rinón. El objetivo de este estudio es determinar el perfil del donante típico y destacar la seguridad que conlleva la donación renal de vivo. SUJETOS Y MÉTODOS: Este estudio descriptivo utilizó historias clínicas de 60 donantes vivos de rinón consecutivos, entre el período de enero de 2006 a mayo de 2010. La información del donante fue registrada en hojas de cálculo de Microsoft Excel y analizada usando el programa estadístico para las ciencias sociales SPSS 12.0. RESULTADOS: Entre los 60 donantes, hubo igual proporción de hombres y mujeres con edad promedio de 35.0 (± 10.7) anos, un índice de masa corporal (IMC) promedio de 25.8 (± 4.2) kg/m2, y un 48.3% eran de descendencia indo-oriental. La mayor parte de los donantes eran parientes del receptor (71.7%). En el momento de la donación, la creatinina promedio fue 84.9 (± 17.7) µmol/L, el promedio de aclaramiento de creatinina en orinafue 1.83 (± 0.53) mL/s, y el promedio de proteína en orina de 24 horas, 141.8 (± 78.6) mg. Hubo una asociación significativa entre el IMC en la donación y la proteinuria un ano después de la donación (p = 0.043). El promedio de estadía en el hospital fue 5.0 (± 0.95) días con complicacionespostoperatorias mínimas. CONCLUSIÓN: El típico donante vivo de rinón en Trinidad y Tobago es un hombre o mujer de 35 anos de edad, ligeramente pasado de peso, generalmente de descendencia indo-oriental, que dona el rinón a un pariente. La donación renal de vivo en esta Unidad de Trasplante es segura, con complicaciones mínimas a corto plazo.

Chronic kidney disease in the Caribbean / La enfermedad renal crónica en el Caribe

Globally, diabetes mellitus and hypertension are major causes of chronic kidney disease (CKD) and end-stage renal disease (ESRD). Reports from the Caribbean renal registry have also identified diabetes mellitus and hypertension as the leading causes of chronic kidney disease and end-stage renal failure. Chronic non-communicable diseases including chronic kidney disease continue to be a major financial challenge in the Caribbean. Patients with chronic kidney disease have high rates of healthcare utilization, morbidity and mortality, and hence constitute a significant economic and clinical burden to the healthcare system. Emphasis should be placed on ways to reduce the incidence of kidney disease and the progression to dialysis. The most economically feasible form of renal replacement therapy that offers the best quality of life should be sought.

Globalmente, la diabetes mellitus y la hipertensión se reportan como las causas principales de la enfermedad renal crónica (ERC) y la enfermedad renal crónica terminal (ERCT). Los informes del registro renal caribeño han identificado a la diabetes mellitus y la hipertensión como las causas principales de la enfermedad renal crónica y la enfermedad renal crónica terminal. Tanto las enfermedades crónicas no comunicables como la enfermedad del riñón continúan siendo un reto financiero mayor en el Caribe. Los pacientes de enfermedad de riñón crónica tienen altas tasas de utilización de cuidado de la salud, morbilidad y mortalidad. Por lo tanto, el manejo de la carga económica y clínica representa un importante reto para el sistema de salud. Debe ponerse énfasis y concertar todos los esfuerzos sobre la búsqueda de formas de reducir la incidencia de la enfermedad renal y disminuir la progresión del requerimiento de diálisis. Urge hallar una forma factible de terapia de reemplazo renal que sea la más económica posible y ofrezca al mismo tiempo la mejor calidad de vida.

Small babies on a small island: survival of very low birthweight infants in Antigua and Barbuda 1986 to 2006 / Bebés pequeños en islas pequeñas: supervivencia de infantes con muy bajo peso al nacer en Antigua y Barbuda, de 1986 a 2006

INTRODUCTION: Recent attention has been focussed on pregnancy outcomes in developing countries, with the publication of the World Health Organization Report 2005, Make Every Mother and Child Count and the Neonatal Survival Series from the Lancet in 2005. Scant outcome data from the smaller islands of the Caribbean exist for very low birthweight (VLBW) babies (birthweight < 1500 g). PATIENTS AND METHODS: a retrospective review of mortality data on vlbw babies in antigua and barbuda was performed. antigua and barbuda had a population of 71 500 with per capita income of (us) $6054 dollars in 1998. in november 1985, a neonatal special care nursery (scn) was established. the survival to discharge from scn for vlbw babies was reviewed from january 1986 to december 2006. RESULTS: there were 26 455 babies born from 1986 to 2006; 344 (1.3%) were vlbw babies. survival to scn discharge was 45% from 1986 to 1992, 46% from 1993 to 1999, and increased to 60% from 2000 to 2006 (p < 0.05 compared with the first two time-periods). babies from 1000 to 1499 g accounted for 64% of vlbw babies and survival to scn discharge was 60% from 1986 to 1992, 58% from 1993 to 1999, and increased to 83% from 2000 to 2006 (p < 0.01 compared with the first time period; p < 0.001 compared with the second). babies < 1000g accounted for 36% of VLBW babies and survival to SCN discharge was 10% from 1986 to 1992, increased to 25% from 1993 to 1999 and to 28% from 2000 to 2006 (trend of p < 0.10 compared with first time period). conservative newborn care only was available. antenatal steroids were given from 2000 to 2006. CONCLUSION: the outlook for vlbw babies using conservative newborn care techniques has significantly improved over 21-years in antigua and barbuda.

INTRODUCCIÓN: Recientemente se ha centrado la atención en los resultados del embarazo en los países en vías de desarrollo, a partir de la publicación del Informe 2005 de la Organización Mundial de la Salud, Que cada madre y cada niño cuente y la Serie de Supervivencia Neonatal de la Lancet en 2005. Son escasos los datos de resultados existentes en las islas más pequeñas del Caribe, acerca de los bebés con muy bajo peso al nacer (MBPN) (peso al nacer < 1500 g). PACIENTES Y MÉTODOS: se llevó a cabo una revisión retrospectiva de datos sobre la mortalidad de bebés mbpn en antigua y barbuda. antigua y barbuda tenían una población de 71 500 con un ingreso per cápita de $6054 usd en 1998. en noviembre de 1985, se creó una sala de cuidados especiales del Recién Nacido (SCN). La supervivencia en término de los bebés MBPN dados de alta de la SCN fue examinada de enero de 1986 a diciembre de 2006. RESULTADOS: De 1986 a 2006, hubo 26 455 bebés nacidos; de ellos 344 (1.3%) fueron bebés MBPN. La supervivencia en término de las altas de la SCN fue de 45% de 1986 a 1992, 46% de 1993 a 1999, y aumentó a 60% de 2000 a 2006 (p <0.05 en comparación con los primeros dos períodos de tiempo). Los bebés de 1000 a 1499g representaron el 64% de los bebés MBPN y la cifra de los supervivientes dados de alta del SCN fue de 60% de 1986 a 1992, 58% de 1993 a 1999, y aumentó a 83% de 2000 a 2006 (p < 0.01 en comparación con el primer periodo de tiempo; p <0.001 en comparación con el segundo). Los bebés <1000 g representaron el 36% de los bebés MBPN, y la supervivencia en términos de los dados de alta de la SCN fue 10% de 1986 a 1992, aumentó a 25% de 1993 a 1999, y a 28% de 2000 a 2006 (la tendencia de p <0.10 en comparación con el primer periodo de tiempo). Sólo hubo disponible atención neonatal conservadora Se administraron esteroides antenatales desde el año 2000 al 2006. CONCLUSIÓN: El pronóstico para MBPN usando técnicas de cuidado neonatal conservadoras ha mejorado significativamente a lo largo de 21 años en Antigua y Barbuda.

Chronic renal failure from the English-speaking Caribbean: 2007 data / Fallo renal crónico en el Caribe anglófono: datos del 2007

AIM: Development of the renal registry to include patients at different stages of chronic kidney disease (CKD). BACKGROUND: The 2007 renal registry include cases at different stages of CKD based on the current guidelines according to the National Kidney Foundation (NKF) Kidney Disease Outcome Initiative (K/DOQI) staging. There was an increase in the number of participating countries, with the addition of Antigua and Barbuda, St Lucia and Turks and Caicos. METHODS: Data were collected using a questionnaire form. Data were stored and analysed in Words Excel for Windows or SPSS 12.0. RESULTS: Data were available for Antigua and Barbuda (n = 43), British Virgin Islands (n = 69), Cayman Islands (n = 45), Trinidad and Tobago (n = 564), Jamaica (n = 920), Turks and Caicos (n = 64), St Lucia (n = 51) and Bahamas (n = 121). The registry identified hypertension, diabetes mellitus and Chronic Glomerulonephritis (CGN) as the commonest causes of chronic kidney disease (CKD) and end-stage renal disease (ESRD) in these countries. The leading cause of death reported was listed as ischaemic heart disease/heart failure, sepsis and cerebrovascular accident. CONCLUSIONS: The majority of patients with CKD and ESRD had hypertension, diabetes mellitus and CGN as the major causes. Collection of data for patients with CKD at different stages was met with some challenges, and resulted in underestimation of the true number of persons with CKD across these Caribbean countries. More emphasis will continue to be placed on improving data collection so the true incidence, prevalence and healthcare burden of CKD is known in the Caribbean. A web based programme is being developed to improve data collection.

OBJETIVO: Desarrollar el registro renal incluyendo pacientes en diferentes etapas de la enfermedad crónica del riñón (ECR). ANTECEDENTES: El registro renal 2007 incluye casos en diferentes etapas de la ECR, sobre la base de los lineamientos actuales de la estadificación según la iniciativa para los resultados de la enfermedad crónica renal (K/DOQI) propuesta por la Fundación Nacional del Riñón (NKF). Hubo un aumento en el número de países participantes, al añadirse Antigua y Barbuda, Santa Lucia e Islas Turcas y Caicos. MÉTODOS: Los datos fueron recogidos utilizando un cuestionario. Luego fueron almacenados y analizados usando Excel para Windows, o mediante SPSS 12.0. RESULTADOS: Hubo a disposición datos para Antigua y Barbuda (n = 43), Islas Vírgenes Británicas (n = 69), Islas Cayman (n = 45), Trinidad y Tobago (n = 564), Jamaica (n = 920), Islas Turcas y Caicos (n = 64), Santa Lucia (n = 51) y Bahamas (n = 121). El registro identificó la hipertensión, la diabetes mellitus y la glomerulonefritis crónica (GNC) como las causas más comunes de la enfermedad crónica del riñón (ECR) y la enfermedad renal terminal (ERT) en estos países. La principal causa de muerte según los reportes, fueron la cardiopatía isquémica/fallo cardíaco, la sepsis y el accidente cardiovascular. CONCLUSIONES: La mayoría de los pacientes con ECR y ERT sufrían de hipertensión, diabetes mellitus y GNC como causas mayores. La recogida de datos para los pacientes con ECR tuvo algunas dificultades, por lo que se subestimó el número real de personas con ECR en todos estos países caribeños. Se seguiría haciendo un mayor énfasis en mejorar la recogida de datos, de modo que la verdadera incidencia, prevalencia y carga de atención a la salud de la ECR sea conocida en el Caribe. Se halla en curso el desarrollo de un programa en la red de Internet, a fin de mejorar la recogida de datos.

IgA nephropathy in the Caribbean / La mefropatía IgA en el Caribe

IgA nephropathy can be considered the most common cause of primary glomerulopathy in developed countries. There has been no report of cases of IgA nephropathy from Caribbean countries. The authors report five cases of IgA nephropathy from Trinidad and Tobago, and Guyana, diagnosed from biopsy studies. No cases were of African origin and some did not have the typical presentation associated with IgA nephropathy. Caribbean nephrologists are reminded that this entity can be seen in Caribbean patients and can only be diagnosed through immunofluorescence staining of renal biopsy specimen. This diagnosis is required for the proper management of patients with glomerular disease, particularly when there may be progression to end stage renal failure as can occur in up to twenty per cent of patients with IgA nephropathy. Accurate diagnosis is important, since disease recurrence can be seen in the transplanted kidney, but this does not often lead to graft failure.

La nefropatía IgA puede considerarse la causa más común de glomerulopatía primaria en los países desarrollados. No ha habido reportes de casos de nefropatía IgA de los países del Caribe. Los autores reportan cinco casos de nefropatía IgA de Trinidad y Tobago, y Guyana, diagnosticados a partir de estudios de biopsia. Ninguno de los casos fue de origen africano y algunos no presentaron las características típicas asociadas con la nefropatía IgA. Se les recuerda a los nefrólogos del Caribe que esta entidad puede ser observada en pacientes del Caribe y puede ser diagnosticada sólo mediante tinción por inmunofluorescencia de un espécimen de biopsia renal. Este diagnóstico es un requisito para el tratamiento adecuado de pacientes con la enfermedad glomerular, en particular cuando puede haber progresión al fallo renal en etapa terminal, como puede ocurrir hasta en el veinte por ciento de los casos con nefropatía IgA. El diagnóstico exacto es importante, ya que la recurrencia de la enfermedad puede verse en el riñón trasplantado, pero esto no conduce a menudo al fallo del injerto.

Did exclusive breast-feeding and early discharge lead to excessive bilirubin levels in newborns in Antigua and Barbuda?

Hyperbilirubinaemia is a common neonatal problem worldwide and is the leading cause of admission to the Special Care Nursery in Antigua and Barbuda. In 1990, the Innocenti Declaration in support of breast-feeding led to the adoption of the Baby-Friendly Hospital Initiative in many countries of the Caribbean, including Antigua and Barbuda. Comparing 1989 to the years 1992 to 1994, the Special Care Nursery at Holberton Hospital experienced a 40 increase in newborns admitted with hyperbilirubinaemia (peak total bilirubin > 12 mg/dl or 205 mumol/l). A retrospective review of Special Care Nursery and Maternity Ward records was undertaken to determine the incidence and aetiology of hyperbilirubinaemia from 1992 to 1994. There were 3721 infants born in Antigua and Barbuda in those years, 98 of Afro-Caribbean or mixed ancestry. The overall incidence of peak total bilirubin over 12 mg/dl (205 mumol/l) was 12.5 (466/3721), not inconsistent with the reported incidence of 8 to 20 in other countries. However, the incidence of higher levels of hyperbilirubinaemia in Antigua and Barbuda exceeded those reported for other countries. In Antigua and Barbuda, total bilirubin of 15 mg/dl (255 mumol/l) or higher was found in 263 of 3721 infants (7.1) compared to 5.9 in India and 2 of breast-fed infants in the United States of America (USA). Total bilirubin of 20 mg/dl (340 mumol/l) or higher was seen in 91 of 3721 infants (2.5) exceeding reported prevalence in the USA for both African-American and Caucasian infants (1) and equal to the reported prevalence in Asian infants (2). The possible aetiologies of hyperbilirubinaemia in neonates with total bilirubin 18 mg/dl (306 mumol/l) or higher in our patients were investigated. Medical records of 134 of 156 (86) infants having this level of hyperbilirubinaemia were available for review. The possible reason for hyperbilirubinaemia was ABO incompatibility in 4/134 (3), Rh incompatibility in 1/134 (1), prematurity in 12/134 (9) and sepsis neonatorum in 21/134 (16). The hyperbilirubinaemia was idiopathic in 96/134 (71) infants. Newborns in Antigua and Barbuda were discharged 3.7 days after their mothers' admission, with 50 discharged prior to 48 hours of age. Early discharge in developed countries has led to increased readmissions for hyperbilirubinaemia. Following the appointment of a dietitian to supervise breast-feeding, admissions for hyperbilirubinaemia fell by 50 by 1998. These data suggest that exclusive br

Nephrotic syndrome in Trinidadian children

Fifty seven children with idiopathic nephrotic syndrome who were seen at two hospitals in Trinidad between 1989 and 1995 (median follow-up period, 38 months) were classified according to their response to glucocorticoids. 27 (47 percent) were two to six years old at presentation; 37 (65 percent) were of East Indian descent, 7 (12 percent) were of African descent, and 12 (21 percent) were of mixed race. 55 (96 percent) responded to glucocorticoids. Renal biopsies in 15 patients revealed membranoproliferative glomerulonephritis and membranous nephropathy in the two patients who had not responded to glucocorticoids. Ten patients showed mesangial hypercellularity, associated with immunoglobulin deposits in 7 cases. Age, presentation with nephrotic features, mesangial hypercellularity and immunoglobulin deposits did not predict for unresponsiveness to glucocorticoids. These findings may be explained by the predominance of East Indians in the study group.

Acute renal failure due to multiple stings by africanised bees: report of the first case in Trinidad

A case of acute renal failure in an adult who was stung by over 1,000 Africanised bees is reported. The patient has made a full recovery. This is the first such case to be reported from Trinidad

Virulence and antigenic properties of Rickettsia tsutsugamushi in a naturally infectei laboratory colony of Leptotrombidium (leptotrombidium) arenicola.

Over 1,200 isolations of R. tsutsugamushi were obtained over 7 generations of L. (L.) arenicola and no reproducible differences in virulence or antigenic markers could be detected among these isolations. The F8 generation yielded rickettsia with the same antigenic makeup and virulence properties as the original female parent mite. When these isolates were inoculated into mice they elicited the same predominant antibody specificities, i.e. they all produced antibody which reacted with the TA 763 and Karp strains. These were the same as the major antigens detected by direct fluorescent antibody staining of the isolates.

Numbers of Leptotrombidium (Leptotrombidium) deliense (Acarina: trombiculidae) and prevalence of Rickettsia tsutsugamushi in adjacent habitats of peninsular Malaysia.

Numbers of L. (L.) deliense larvae were determined in adjacent habitats over a 16 month period. Both R. argentiventer and R. tiomanicus were highly efficient hosts for L. (L.) deliense. R. argentiventer was host to significantly greater numbers of chiggers per rat than was R. tiomanicus. The 2 habitats were similar in numbers of chiggers collected. No consistent correlation was apparent between numbers of chiggers and any single weather factor, but the chigger population seemed to be adversely affected by a 2 month period during which total evaporation greatly exceeded total rainfall. Direct fluorescent antibody examination of tissues from unfed L. (L.) deliense showed that 2 of 420 larvae (0.5%) contained organisms morphologically resembling R. tsutsugamushi. Considering the vector load and numbers of chiggers being returned to the ground by a given host, a rate of 0.5% appeared adequate to account for the prevalence rate of R. tsutsugamushi observed in the 2 host species.