Retrospective study of Oestrus ovis larvae infestation in small ruminants in Grenada, West Indies.

Oestrosis is a nasal cavity myiasis caused by Oestrus ovis larvae from Oetrus ovis diptera flies in small ruminants. The presence of the larvae in the nasal cavity is known to cause rhinitis and sinusitis which can negatively impact the productivity of small ruminants. The aim of the present study was to estimate the prevalence of Oestrus ovis larvae infestation in sheep and goats presented for necropsy. We reviewed necropsy records of sheep and goats submitted to the Veterinary Pathology diagnostic laboratory at St. George's University from 2001 to 2017. Out of 104 goat necropsy cases, Oestrus ovis larvae were observed in 8 goats giving a prevalence of 7.7% (95% confidence interval (CI):3.38% to 14.6%). Similarly, from the 47 sheep necropsies, Oestus ovis larvae were observed in 4 sheep (8.5%) (95% CI: 2.83% to 20.46%). There was no significant difference in Oestrus ovis larvae infestation rates between sheep and goats (p = 1.000, Fisher's exact test). Oestrosis was an incidental finding in all the small ruminants examined at necropsy. This is the first report on Oestrus ovis larvae infestation in small ruminants in Grenada.

Spare the rod, spoil the child: measurement and learning from an intervention to shift corporal punishment attitudes and behaviors in Grenada, West Indies.

Childrearing practices in the Caribbean and other postcolonial states have long been associated with corporal punishment and are influenced by expectations of children for respectfulness and obedience. Evidence across settings shows that physical punishment of young children is both ineffective and detrimental. Saving Brains Grenada (SBG) implemented a pilot study of an intervention based on the Conscious Discipline curriculum that aimed to build adult caregivers' skills around non-violent child discipline. We hypothesized that attitudes towards corporal punishment would shift to be negative as adults learned more positive discipline methods, and that child neurodevelopment would correspondingly improve. This report reviews the impact of monitoring and evaluation on the design and implementation of the intervention. Study 1 presents findings from the pilot study. Despite positive gains in neurodevelopmental outcomes among children in the intervention compared to controls, attitudes towards corporal punishment and reported use of it did not change. Additionally, several internal conflicts in the measures used to assess corporal punishment behaviors and attitudes were identified. Study 2 is a response to learning from Study 1 and highlights the importance for monitoring and evaluation to be data-informed, adaptive, and culturally appropriate. In Study 2, the SBG research team conducted cognitive interviews and group discussions with stakeholders to assess the content and comprehensibility of the Attitudes Towards Corporal Punishment Scale (ACP). This yielded insights into the measurement of attitudes towards corporal punishment and related parenting behavior, and prompted several revisions to the ACP. To accurately evaluate the intervention's theory of change and its goal to reduce violence against children, reliable and appropriate measures of attitudes towards corporal punishment and punishment behaviors are needed. Together, these two studies emphasize the value of continuous monitoring, evaluation, and learning in the implementation, adaptation, evaluation, and scaling of SBG and similar early childhood development interventions.

Perfil de carga de enfermedad por diabetes 2023: Granada

El propósito fundamental de esta serie de perfiles nacionales de la carga de enfermedad por diabetes y de enfermedad renal crónica debida a diabetes es apoyar a los países de la Región de las Américas en el seguimiento de las estrategias puestas en marcha para enfrentar la diabetes. Esta primera versión de los perfiles, que abarca el período comprendido entre el 2000 y el 2019, muestra la tendencia de la mortalidad, los años de vida perdidos por muerte prematura, los años vividos con discapacidad y los años de vida ajustados por discapacidad de ambas enfermedad. Se han elaborado con los últimos datos disponibles de las estimaciones mundiales de salud de la Organización Mundial de la Salud y tiene como objetivo convertirse en una herramienta útil para llevar a cabo el monitoreo de las estrategias conexas.

Does Intra-Uterine Exposure to the Zika Virus Increase Risks of Cognitive Delay at Preschool Ages? Findings from a Zika-Exposed Cohort from Grenada, West Indies.

Maternal infection with Zika virus (ZIKV) is associated with a distinct pattern of birth defects, known as congenital Zika syndrome (CZS). In ZIKV-exposed children without CZS, it is often unclear whether they were protected from in utero infection and neurotropism. Early neurodevelopmental assessment is essential for detecting neurodevelopmental delays (NDDs) and prioritizing at-risk children for early intervention. We compared neurodevelopmental outcomes between ZIKV-exposed and unexposed children at 1, 3 and 4 years to assess exposure-associated NDD risk. A total of 384 mother-child dyads were enrolled during a period of active ZIKV transmission (2016-2017) in Grenada, West Indies. Exposure status was based on laboratory assessment of prenatal and postnatal maternal serum. Neurodevelopment was assessed using the Oxford Neurodevelopment Assessment, the NEPSY® Second Edition and Cardiff Vision Tests, at 12 (n = 66), 36 (n = 58) and 48 (n = 59) months, respectively. There were no differences in NDD rates or vision scores between ZIKV-exposed and unexposed children. Rates of microcephaly at birth (0.88% vs. 0.83%, p = 0.81), and childhood stunting and wasting did not differ between groups. Our results show that Grenadian ZIKV-exposed children, the majority of whom were without microcephaly, had similar neurodevelopmental outcomes to unexposed controls up to at least an age of 4 years.

Zoonotic helminths of dogs and risk factors associated with polyparasitism in Grenada, West Indies.

Canine soil-transmitted helminths (STHs) cause important zoonoses in the tropics, with varying degrees of intensity of infection in humans and dogs. This study aimed to investigate the prevalence and associated risk factors for STHs in community dogs residing in Grenada, West Indies. In May 2021, 232 canine fecal samples were examined for zoonotic helminths by microscopy (following flotation), and genomic DNA from a subset of 211 of these samples were subjected to multiplex qPCR for the detection and specific identification of hookworms, Toxocara spp. and Strongyloides. Microscopic examination revealed that 46.5% (108/232, 95% CI 40­52.9), 9% (21/232, 95% CI 5.35­12.7) and 5.2% (12/232, 95% CI 2.3­8) of the samples contained eggs of Ancylostoma spp., Toxocara spp. and Trichuris vulpis, respectively. Multiplex qPCR revealed that, 42.2% (89/211, 95% CI 35.5­48.8) were positive for at least 1 zoonotic parasite. Of these, 40.8% (86/211, 95% CI 34.1­47.3) of samples tested positive for Ancylostoma spp., 36% (76/211, 95% CI 29.5­42.9) were positive for A. caninum, 13.3% (28/211, 95% CI 9­18.6) for A. ceylanicum, 5.7% for T. canis (12/211, 95% CI 2.97­8.81) and 1% (2/211, 95% CI 0­2.26) for Strongyloides spp. (identified as S. stercoralis and S. papillosus by conventional PCR-based Sanger sequencing). Using a multiple logistic regression model, a low body score and free-roaming behaviour were significant predictors of test-positivity for these parasitic nematodes in dogs (P < 0.05). Further studies of zoonotic STHs in humans should help elucidate the public health relevance of these parasites in Grenada.

Factors Associated with Chikungunya Infection among Pregnant Women in Grenada, West Indies.

Neonates are vulnerable to vector-borne diseases given the potential for mother-to-child congenital transmission. To determine factors associated with chikungunya virus (CHIKV) infection among pregnant women in Grenada, West Indies, a retrospective cohort study enrolled women who were pregnant during the 2014 CHIKV epidemic. In all, 520/688 women (75.5%) were CHIKV IgG positive. Low incomes, use of pit latrines, lack of home window screens, and subjective reporting of frequent mosquito bites were associated with increased risk of CHIKV infection in bivariate analyses. In the multivariate modified Poisson regression model, low income (adjusted relative risk [aRR]: 1.05 [95% CI: 1.01-1.10]) and frequent mosquito bites (aRR: 1.05 [95% CI: 1.01-1.10]) were linked to increased infection risk. In Grenada, markers of low socioeconomic status are associated with CHIKV infection among pregnant women. Given that Grenada will continue to face vector-borne outbreaks, interventions dedicated to improving living conditions of the most disadvantaged will help reduce the incidence of arboviral infections.

Facilitators of and barriers to COVID-19 vaccination in Grenada: a qualitative study

[ABSTRACT]. Objectives. To identify the factors contributing to coronavirus disease 2019 (COVID-19) vaccine hesitancy in Grenada. Methods. A phenomenological study was conducted using semi-structured interviews at vaccination and pop-up testing clinics during a spike in COVID-19 cases on the island. Interview questions were developed using the health belief model related to perceived threat of COVID-19, perceived benefits of and barriers to COVID-19 vaccination, and cues to action. Data were analyzed using a deductive approach to identify themes, categories, and subcategories. Results. Twenty-five interviews were transcribed and coded. In all, 68% of participants were unvaccinated, 12% were partially vaccinated, and 20% were fully vaccinated. Data analysis revealed two main themes: facilitators and barriers. Factors more likely to encourage vaccination (facilitators) included trust in medical advice and vaccine efficacy, social responsibility, and vaccine mandates for travel, employment, and social activities. Factors hindering vaccination (barriers) included: perceived low threat of COVID-19; preference for natural remedies; concerns about contraindications because of underlying health conditions; fear; mistrust of vaccines and related messaging; vaccine accessibility; and the many different information sources. Conclusions. Overcoming vaccine hesitancy is key to combating the detrimental effects of COVID-19 in Gre- nada. Public health interventions and policies that address barriers and capitalize on facilitators can increase vaccine uptake.

[RESUMEN]. Objetivos. Determinar cuáles son los factores que contribuyen con la reticencia a la vacunación contra la enfermedad por el coronavirus del 2019 (COVID-19) en Granada. Métodos. Se realizó un estudio fenomenológico utilizando entrevistas semiestructuradas realizadas en pues- tos transitorios de prueba y vacunación durante un aumento en el número de casos de COVID-19 en la isla. Se elaboraron las preguntas de la entrevista según el modelo de creencias de salud en relación con la amenaza percibida respecto de la COVID-19, los obstáculos y los beneficios percibidos respecto de la vacunación contra la COVID-19 y los incentivos para la acción. Los datos se analizaron mediante un enfoque deductivo con el fin de determinar los principales temas, categorías y subcategorías. Resultados. Se transcribieron y codificaron veinticinco entrevistas. En total, el 68% de los participantes no estaban vacunados, el 12% estaban parcialmente vacunados y el 20% tenían el esquema completo de vacu- nación. El análisis de los datos reveló dos temas principales: los factores facilitadores y los obstáculos. Entre los factores con mayores probabilidades de incentivar la vacunación (factores facilitadores) se encuentran la confianza en el asesoramiento médico y la eficacia de la vacuna, la responsabilidad social y los mandatos de vacunación para viajes, empleo y actividades sociales. Entre los factores que obstaculizan la vacunación (obstáculos) se encuentran la percepción de que la COVID-19 no es una amenaza grave; la preferencia por los remedios naturales; las preocupaciones por las contraindicaciones debido a afecciones de salud subya- centes; el miedo; la desconfianza en las vacunas y los mensajes relacionados; la accesibilidad a las vacunas; y las muy diferentes fuentes de información. Conclusiones. Es necesario superar la reticencia a la vacunación para combatir los efectos nocivos de la COVID-19 en Granada. Las políticas e intervenciones de salud pública que abordan los obstáculos y capital- izan los factores facilitadores pueden aumentar el uso efectivo de las vacunas.

[RESUMO]. Objetivos. Identificar os fatores que contribuem para a hesitação em relação à vacina contra a doença por coronavírus 2019 (covid-19) em Granada. Métodos. Realizou-se um estudo fenomenológico com entrevistas semiestruturadas em clínicas de vaci- nação e testagem rápida durante um pico de casos de covid-19 na ilha. As perguntas da entrevista foram elaboradas com base no modelo de crenças em saúde relacionado à percepção de ameaça da covid-19, à percepção de benefícios e barreiras relativos à vacinação contra a covid-19, e aos estímulos para ação. Os dados foram analisados por um método dedutivo para identificar temas, categorias e subcategorias. Resultados. Vinte e cinco entrevistas foram transcritas e codificadas. No total, 68% dos participantes não eram vacinados, 12% eram parcialmente vacinados e 20% eram totalmente vacinados. A análise dos dados evidenciou dois temas principais: facilitadores e barreiras. Os fatores mais propensos a incentivar a vaci- nação (facilitadores) foram confiança na orientação médica e na eficácia da vacina, responsabilidade social e exigência de vacinação em viagens, no emprego e em atividades sociais. Entre os fatores que impediam a vacinação (barreiras) estavam: percepção de baixa ameaça da covid-19; preferência por remédios naturais; preocupação com contraindicações em razão de problemas de saúde preexistentes; medo; desconfiança das vacinas e mensagens relacionadas; acessibilidade da vacina; e as muitas diferentes fontes de informação. Conclusões. Superar a hesitação vacinal é imprescindível para combater as consequências negativas da covid-19 em Granada. As intervenções e políticas de saúde pública que afastam barreiras e promovem facil- itadores podem aumentar a aceitação da vacina.

Strategic plan for health 2016-2025

Government has accepted the fact that HEALTH is much more than the prevention or reduction of disease, but is a resource for national productivity and development. As such investments in ensuring, a healthy population is an asset for national development. It is for this reason that Government re-affirms its strong commitment to providing better health care to all Grenadians. The National Strategic Plan for Health 2016-2025 provides the framework that will guide the efforts of the Ministry of Health and Social Security (MOHSSSSSS) and its partners over the next ten years. It reflects the Ministry's fundamental belief that health is a basic human right and as a result no one should be denied access to health care. Consequently, one of the overarching goals of this strategic plan is ensure that health services are made available, accessible and affordable to all people without discrimination. Like many other developing countries, Grenada continues to be challenged by meeting the demands for health care services to its citizens. Chronic non-communicable diseases are the leading cause of morbidity and mortality. Life style and food choices are the main contributing factors of the disease profile and pose a significant challenge to the delivery of secondary care due to the escalating cost associated with the management of these diseases. This requires the Ministry of Health to place greater emphasis on prevention and health promotion. Notwithstanding the fact, every citizen must however accept responsibility for his/her individual health outcomes. Recently, Grenada has also been experiencing the outbreaks of new and re-emerging communicable diseases, which have been linked to climate change factors. It behooves us therefore to take necessary steps to protect and maintain our environment for our future generations. The Plan further reflects the belief that health fundamentally affects individual productivity and is therefore a critical input for long-term development of the country. To this end, we have set out our major priorities and therefore in concert with the private sector, we will heighten our focus and continue to promote health and wellness among our citizens.

Using focus groups to plan culturally acceptable primary cervical cancer screening in Grenada, West Indies

[ABSTRACT]. Objective. To document Grenadian women’s knowledge about cervical cancer and human papillomavirus (HPV) infection, as well as their attitudes towards primary cervical cancer screening methods. Methods. In this qualitative study, we used focus groups in Grenada to gather information concerning women’s knowledge about, attitudes towards and perceptions of screening for cervical cancer and general knowledge about HPV. Ten focus groups comprising 73 participants representing 5 of the 6 parishes in Grenada were conducted with women aged 19–59. Participants were asked about pelvic exams, Pap smears, HPV, reasons for seeking or avoiding cervical cancer screening and how different modalities of testing might affect their decision-making. Responses were then coded and organized into common themes. Results. While many respondents had heard of HPV, far fewer knew about its causative role in cervical can- cer, how to prevent HPV infection or testing for the high-risk HPV types that cause almost all cases of cervical cancer. Many participants were aware that cervical cancer screening was beneficial, but numerous barriers to obtaining that screening were noted, including concerns about privacy and stigma, potential discomfort, and the cost and inconvenience involved. Conclusions. Our findings have implications for future cervical cancer screening efforts in Grenada. Central to these efforts should be a focus on educating Grenadians about the role of HPV infection in cervical cancer and the importance of early detection through screening. In addition, addressing issues of stigma and privacy are key to eliminating cervical cancer in Grenada.

[RESUMEN]. Objetivo. Documentar los conocimientos de las mujeres granadinas sobre el cáncer cervicouterino y la infección por el virus de los papilomas humanos (VPH), así como sus actitudes hacia los métodos primarios de detección del cáncer cervicouterino. Métodos. En este estudio cualitativo, se han empleado grupos focales en Granada para recopilar información sobre los conocimientos, las actitudes y las percepciones de las mujeres sobre la detección del cáncer cervicouterino y nociones generales sobre el VPH. Participaron 73 mujeres de 19 a 59 años de edad, representantes de 5 de las 6 parroquias de Granada. Se formaron diez grupos focales, a los que se les preguntó sobre los exámenes pélvicos, las pruebas de Papanicolaou, el VPH, las razones para buscar o evitar la detección del cáncer cervicouterino y cómo las diferentes modalidades de examen podrían afectar sus decisiones. Luego se codificaron las respuestas y se organizaron en temas comunes. Resultados. Si bien muchas participantes habían oído hablar del VPH, un número considerablemente menor conocía su relación causal con el cáncer cervicouterino, cómo prevenir la infección por VPH o los exámenes de detección de los tipos del VPH de alto riesgo que causan casi todos los casos de cáncer cervicouterino. Muchas participantes sabían que los exámenes de detección del cáncer de cuello uterino eran convenientes, pero mencionaron numerosos obstáculos para obtenerlos, como las preocupaciones sobre la privacidad y la estigmatización, posibles molestias, así como el costo y los inconvenientes relacionados. Conclusiones. Nuestros hallazgos tienen implicaciones para la futura labor de detección del cáncer cervicouterino en Granada. En esta labor debería ser esencial adoptar un enfoque dirigido a educar a las granadinas sobre la relación de la infección por VPH con el cáncer cervicouterino y la importancia de la detección temprana mediante exámenes. Además, combatir los problemas de estigmatización y privacidad es clave para eliminar el cáncer cervicouterino en Granada.

[RESUMO]. Objetivo. Documentar o conhecimento das mulheres de Granada sobre o câncer do colo do útero e a infecção por papilomavírus humano (HPV), bem como suas atitudes em relação aos métodos de rastreamento de câncer do colo do útero primário. Métodos. Neste estudo qualitativo, usamos grupos focais em Granada para coletar informações sobre conhecimentos, atitudes e percepções das mulheres sobre o rastreamento de câncer do colo do útero e conhecimentos gerais sobre HPV. Foram conduzidos dez grupos focais, incluindo 73 participantes e representando 5 das 6 paróquias de Granada, com mulheres de 19 a 59 anos de idade. As participantes responderam perguntas sobre exames ginecológicos, Papanicolau, HPV, razões para procurar ou evitar o rastreamento de câncer do colo do útero e como diferentes modalidades de testes podem afetar sua tomada de decisão. As respostas foram codificadas e organizadas por temas comuns. Resultados. Muitas participantes já tinham ouvido falar do HPV, mas um número muito menor conhecia sua relação causal com o câncer do colo do útero, formas de prevenir a infecção por HPV ou os testes para os tipos de HPV de alto risco, que causam quase todos os casos de câncer do colo do útero. Muitas participantes sabiam que o rastreamento de câncer do colo do útero era benéfico, mas várias barreiras para o rastreamento foram indicadas, incluindo preocupações relacionadas à privacidade e ao estigma, o potencial desconforto e o custo e inconveniência envolvidos. Conclusões. Nossos achados têm implicações para as futuras iniciativas de rastreamento de câncer do colo do útero em Granada. Essas iniciativas devem se focar em educar a população de Granada sobre o papel da infecção por HPV no câncer do colo do útero e a importância da detecção precoce por meio do rastreamento. Além disso, é fundamental abordar questões de estigma e privacidade para eliminar o câncer do colo do útero em Granada.

Temporal trends in ambient fine particulate matter and the impacts of COVID-19 on this pollutant in Grenada, West Indies.

Most Caribbean islands do not have air pollution surveillance programs. Those who live in these countries are exposed to ambient air pollution from a variety of sources including motor vehicles, ocean-going vessels, and Saharan dust. We conducted an air sampling exposure study in Grenada to describe daily changes in fine particulate matter (PM2.5) pollution, and during Saharan dust episodes. Further, we assessed the impacts of COVID-19 public health interventions on PM2.5 concentrations in 2020. Four fixed-site PurpleAir monitors were installed throughout Grenada, and one on the neighboring island of Carriacou. PM2.5 was measured between January 6 and December 31, 2020. We classified each of these days based on whether COVID-19 public health mitigation measures were in place or not. Descriptive analyses were performed to characterize fluctuations in PM2.5, and we assessed the impacts of public health restrictions on PM2.5 using multivariate regression. The mean daily PM2.5 concentration in 2020 was 4.4 µg/m3. During the study period, the minimum daily PM2.5 concentration was 0.7 µg/m3, and the maximum was 20.4 µg/m3. Daily mean PM2.5 concentrations more than doubled on Saharan dust days (8.5 vs 3.6 µg/m3; p < 0.05). The daily mean PM2.5 concentrations were estimated to be 1.2 µg/m3 lower when COVID-19 restrictions were in effect. Ambient PM2.5 concentrations in Grenada are relatively low compared to other countries; however, Saharan dust episodes represent an important source of exposure. Low-cost sensors provide an opportunity to increase surveillance of air pollution in the Caribbean, however their value could be enhanced with the development of correction algorithms that more closely approximate values from reference-grade monitors.Implications: This study describes daily fluctuations in ambient PM2.5 concentrations in Grenada in 2020. Overall, concentrations of PM2.5 were low; however, we found that Saharan dust events cause daily exceedances in PM2.5 above the current 24-hr limits of the World Health Organization. Moreover, the constructed models suggest that public health interventions to reduce the spread of COVID-19 reduced PM2.5 concentrations by 27%.

Using focus groups to plan culturally acceptable primary cervical cancer screening in Grenada, West Indies / Uso de grupos focales para planificar exámenes primarios de detección del cáncer cervicouterino culturalmente aceptables en Granada, Caribe / Uso de grupos focais para planejar estratégias culturalmente aceitáveis para rastreamento de câncer do colo do útero primário em Granada, Índias Ocidentais

ABSTRACT Objective. To document Grenadian women's knowledge about cervical cancer and human papillomavirus (HPV) infection, as well as their attitudes towards primary cervical cancer screening methods. Methods. In this qualitative study, we used focus groups in Grenada to gather information concerning women's knowledge about, attitudes towards and perceptions of screening for cervical cancer and general knowledge about HPV. Ten focus groups comprising 73 participants representing 5 of the 6 parishes in Grenada were conducted with women aged 19-59. Participants were asked about pelvic exams, Pap smears, HPV, reasons for seeking or avoiding cervical cancer screening and how different modalities of testing might affect their decision-making. Responses were then coded and organized into common themes. Results. While many respondents had heard of HPV, far fewer knew about its causative role in cervical cancer, how to prevent HPV infection or testing for the high-risk HPV types that cause almost all cases of cervical cancer. Many participants were aware that cervical cancer screening was beneficial, but numerous barriers to obtaining that screening were noted, including concerns about privacy and stigma, potential discomfort, and the cost and inconvenience involved. Conclusions. Our findings have implications for future cervical cancer screening efforts in Grenada. Central to these efforts should be a focus on educating Grenadians about the role of HPV infection in cervical cancer and the importance of early detection through screening. In addition, addressing issues of stigma and privacy are key to eliminating cervical cancer in Grenada.

RESUMEN Objetivo. Documentar los conocimientos de las mujeres granadinas sobre el cáncer cervicouterino y la infección por el virus de los papilomas humanos (VPH), así como sus actitudes hacia los métodos primarios de detección del cáncer cervicouterino. Métodos. En este estudio cualitativo, se han empleado grupos focales en Granada para recopilar información sobre los conocimientos, las actitudes y las percepciones de las mujeres sobre la detección del cáncer cervicouterino y nociones generales sobre el VPH. Participaron 73 mujeres de 19 a 59 años de edad, representantes de 5 de las 6 parroquias de Granada. Se formaron diez grupos focales, a los que se les preguntó sobre los exámenes pélvicos, las pruebas de Papanicolaou, el VPH, las razones para buscar o evitar la detección del cáncer cervicouterino y cómo las diferentes modalidades de examen podrían afectar sus decisiones. Luego se codificaron las respuestas y se organizaron en temas comunes. Resultados. Si bien muchas participantes habían oído hablar del VPH, un número considerablemente menor conocía su relación causal con el cáncer cervicouterino, cómo prevenir la infección por VPH o los exámenes de detección de los tipos del VPH de alto riesgo que causan casi todos los casos de cáncer cervicouterino. Muchas participantes sabían que los exámenes de detección del cáncer de cuello uterino eran convenientes, pero mencionaron numerosos obstáculos para obtenerlos, como las preocupaciones sobre la privacidad y la estigmatización, posibles molestias, así como el costo y los inconvenientes relacionados. Conclusiones. Nuestros hallazgos tienen implicaciones para la futura labor de detección del cáncer cervicouterino en Granada. En esta labor debería ser esencial adoptar un enfoque dirigido a educar a las granadinas sobre la relación de la infección por VPH con el cáncer cervicouterino y la importancia de la detección temprana mediante exámenes. Además, combatir los problemas de estigmatización y privacidad es clave para eliminar el cáncer cervicouterino en Granada.

RESUMO Objetivo. Documentar o conhecimento das mulheres de Granada sobre o câncer do colo do útero e a infecção por papilomavírus humano (HPV), bem como suas atitudes em relação aos métodos de rastreamento de câncer do colo do útero primário. Métodos. Neste estudo qualitativo, usamos grupos focais em Granada para coletar informações sobre conhecimentos, atitudes e percepções das mulheres sobre o rastreamento de câncer do colo do útero e conhecimentos gerais sobre HPV. Foram conduzidos dez grupos focais, incluindo 73 participantes e representando 5 das 6 paróquias de Granada, com mulheres de 19 a 59 anos de idade. As participantes responderam perguntas sobre exames ginecológicos, Papanicolau, HPV, razões para procurar ou evitar o rastreamento de câncer do colo do útero e como diferentes modalidades de testes podem afetar sua tomada de decisão. As respostas foram codificadas e organizadas por temas comuns. Resultados. Muitas participantes já tinham ouvido falar do HPV, mas um número muito menor conhecia sua relação causal com o câncer do colo do útero, formas de prevenir a infecção por HPV ou os testes para os tipos de HPV de alto risco, que causam quase todos os casos de câncer do colo do útero. Muitas participantes sabiam que o rastreamento de câncer do colo do útero era benéfico, mas várias barreiras para o rastreamento foram indicadas, incluindo preocupações relacionadas à privacidade e ao estigma, o potencial desconforto e o custo e inconveniência envolvidos. Conclusões. Nossos achados têm implicações para as futuras iniciativas de rastreamento de câncer do colo do útero em Granada. Essas iniciativas devem se focar em educar a população de Granada sobre o papel da infecção por HPV no câncer do colo do útero e a importância da detecção precoce por meio do rastreamento. Além disso, é fundamental abordar questões de estigma e privacidade para eliminar o câncer do colo do útero em Granada.

Ancylostoma ceylanicum Hookworms in Dogs, Grenada, West Indies.

Ancylostoma ceylanicum hookworms are recognized agents of human infection in the Asia-Pacific region. We investigated prevalence of zoonotic hookworm infections in dogs in Grenada in 2021; 40.8% were infected by hookworms, including Ancylostoma ceylanicum. Surveillance of this parasite in dogs and humans is needed in tropical/subtropical countries in the Americas.

Impact of COVID-19 on Human Resources for Health and Policy Response: the Case of Belize, Grenada, and Jamaica

Health workers are crucial in the preparedness and response to COVID-19, but the pandemic has evidenced the shortage of human resources for health (HRH) in certain countries, reduced or lack of protective equipment, and timely protocols to address occupational, health and safety issues. Health workers have been infected by the virus with consequences in terms of morbidity and mortality. Consequently, available staff workload is expected to increase. While the COVID-19 pandemic has stressed health workforce shortages in countries, it has also led to identifying ways to rapidly hire and train the health workforce. The recognition and understanding of the mechanisms used by countries (such as recruitment processes, type of redeployment, incentives) will provide evidence on ways to address health worker shortages during such outbreaks and therefore implementation gaps will be reduced. This report informs and analyzes the impact of COVID-19 on health workers' occupational health and safety concerns, working conditions, as well as policy responses to address these issues and to increase HRH surge capacity in Belize, Grenada, and Jamaica. The report also describes elements related to HRH and COVID-19 vaccination in selected countries and shares the experiences from Belize, Grenada, and Jamaica (members of CARICOM), which represent different areas of the Caribbean. The report will also inform the HRH Action Task Force and its contribution to technical cooperation and HRH management support. The target audience includes policy-makers, academics, and researchers on addressing health worker issues during health emergencies.

Toxoplasma gondii clonal type III is the dominant genotype identified in Grenadian pigs.

BACKGROUND: Toxoplasma gondii is a widespread zoonotic protozoan parasite capable of infecting all warm-blooded animals. Although the genotypes of T. gondii in pigs have been reported worldwide, there is no information on the genotypes and diversity of T. gondii in pigs in Grenada, West Indies. OBJECTIVES: The aims of the present study were to isolate, genotype and determine the diversity of T. gondii genotypes in pigs. METHODS: We carried out a modified agglutination test (MAT) on blood from 149 pig hearts collected from a local meat market. Myocardial tissue homogenate from pigs that tested positive for T. gondii was homogenized and inoculated into mice for isolation of the parasite. We collected mouse tissues and extracted DNA for genotyping based on 11 polymerase chain reaction-restriction fragment length polymorphism markers (SAG1, SAG2, alt. SAG2, SAG 3, BTUB, GRA6, L358, PK1, C22-8, C 29-2 and Apico). RESULTS: Out of the 149 pig hearts, 31 (20.8%) tested positive for T. gondii on MAT. Bioassays in mice yielded 12 isolates designated TgpgGr1 to TgpgGr12. Molecular characterisation of T. gondii revealed four genotypes as follows: ToxoDB #2-clonal type III (seven isolates); ToxoDB #7 (three isolates); ToxoDB #13 (one isolate); ToxoDB #30 (1 isolate). Overall, ToxoDB #2 was the most common (58%). Toxo database (DB) # 13, which causes interstitial pneumonia in affected mice, has also been reported. CONCLUSION: The genetic diversity of T. gondii in pigs in Grenada is lower than that in other surrounding Caribbean areas.

Kudoa hypoepicardialis and associated cardiac lesions in invasive red lionfish Pterois volitans in Grenada, West Indies.

Invasive red lionfish Pterois volitans (Linnaeus, 1758) represent an ongoing ecological threat within temperate and tropical waters. Relatively little is known regarding the overall health of P. volitans and their potential for spreading pathogens in non-native regions. Lionfish collected from inshore reefs of Grenada, West Indies, in 2019 and 2021 were identified as P. volitans based on cytochrome c oxidase subunit 1 barcoding. Gross and microscopic examination of tissues revealed myxozoan plasmodia in the hearts of 24/76 (31.6%) lionfish by histopathology or wet mount cytology. Further histopathologic examination revealed severe granulomatous inflammation and myofiber necrosis associated with developing plasmodia and presporogonic life stages. Fresh myxospores were morphologically and molecularly consistent with Kudoa hypoepicardialis, being quadrate in apical view with 4 valves and 4 equal polar capsules. The spore body was 5.1-7.9 (mean: 6.0) µm long, 8.1-9.8 (8.7) µm wide, and 6.9-8.5 (7.7) µm thick. Polar capsules were 2.3-2.7 (2.5) µm long and 0.9-1.6 (1.3) µm wide. 18S small subunit rDNA sequences were 99.81-99.87% similar to sequence data from the original description of the species. Novel 28S large subunit rDNA and elongation factor 2 data, which did not match any previously reported species, were provided. This is the first account of a myxozoan parasite of P. volitans, a new host record and locality for K. hypoepicardialis, and one of few reports describing pathogen-associated lesions in invasive lionfish.

Improving neurodevelopment in Zika-exposed children: A randomized controlled trial.

BACKGROUND: While microcephaly is a significant adverse outcome of prenatal exposure to the Zika virus (ZIKV), subtle malformations of cortical development (MCD) have been observed in Zika-exposed children (ZEC), including delays in language, cognition, and motor domains, and visual acuity deficits. Interventions within the first 1,000 days of life can significantly improve developmental outcomes. This study examined a 12-week Responsive Caregiving Intervention on neurodevelopmental outcomes in 24-30-month-old ZEC. METHODOLOGY/PRINCIPAL FINDINGS: A randomized controlled trial was implemented in Grenada, West Indies using an existing ZIKV cohort surveillance study. When children in that study turned 24 months, baseline child neurodevelopmental measures and caregiver interviews were administered. Caregivers who agreed to participate in the 12-week Responsive Caregiving Intervention, implemented when children were 24-30 months of age, were randomly assigned to the Intervention or Waitlist Control group. Children in both groups were re-assessed on the neurodevelopmental measures post-intervention. CONCLUSIONS/SIGNIFICANCE: 233 children from the ZIKV surveillance study met inclusion criteria, of which n = 80 declined participation, n = 42 did not complete the Intervention, and n = 72 missed follow-up assessments given strict timelines in the study design. The final sample for analysis was N = 13 children in the Intervention group and N = 26 children in the Control group. A GEE model analysis showed significantly higher language (p = 0.021) and positive behaviour (p = 0.005) scores for children in the Intervention group compared to the Control group. The Intervention had a medium effect on child language (d = 0.66) and a large effect on positive behaviour (d = 0.83). A 12-week Responsive Caregiving Intervention Programme significantly improves language and positive behaviour scores in 30-month-old normocephalic children who were exposed to ZIKV in utero. The programme provides an option for mothers of ZIKV-exposed children who are seeking an evidence-based neurodevelopmental intervention regardless of known impact of the virus on cortical formation. TRIAL REGISTRATION: The study was registered with clinicaltrials.gov (NCT04697147).

A retrospective study of canine transmissible venereal tumour in Grenada, West Indies.

BACKGROUND: Canine transmissible venereal tumour (CTVT) is a naturally occurring neoplasia affecting dogs worldwide. Previous CTVT studies in Grenada were limited to case records of dogs with neoplastic conditions at a veterinary diagnostic laboratory. OBJECTIVES: The present retrospective study aimed to determine the occurrence and risk factors of CTVT in a wider population of owned dogs presented to a university-affiliated veterinary hospital between 2008 and 2018. METHODS: Data on the age, breed, gender, and gonadectomy status were retrieved from an electronic database and analyzed using logistic regression. RESULTS: Of the 7180 dogs presented during the period, 102 dogs (1.4%) were diagnosed with CTVT. A higher predisposition was observed in Grenadian pothounds (odds ratio [OR] = 22.8, 95% confidence interval [CI] 10.3-50.4; p < 0.001) and mixed-breed dogs (OR = 9.2, 95% CI 4.1-20.7; p < 0.001) in comparison to the purebreds. Neutered dogs (OR = 2.2, 95% CI 1.4-3.3; p < 0.001) were at an increased risk of CTVT than intact dogs. Age and gender were not identified as significant risk factors. CONCLUSIONS: The percentage of dogs with CTVT in this study represents a crude estimate of the CTVT prevalence in the owned dog population in Grenada. Further studies including both owned and free-roaming dogs are required for a more accurate estimation of the CTVT prevalence in the region. Our results indicate that breed and gonadectomy status are significant risk factors for the occurrence of CTVT in Grenada.

Environmental impact assessment of biomass supported electricity generation for sustainable rural energy systems - A case study of Grenada County, Mississippi, USA.

Fossil fuels have been the major source of electricity supply in the United States of America (USA) for many decades. While a significant shift has occurred from coal-dominated supply to natural gas and renewable source based supplies in recent decades, there is still large potential to improve biomass supported electricity contribution in rural communities, which depend majorly on forest-related activities. Wood waste, an underutilized renewable resource, has the potential for electricity generation in rural areas to reduce the contribution of electricity generated from fossil fuels and assist in greenhouse gas savings. In this study, a life cycle assessment approach was used to estimate the emissions of electricity generated by wood residues in a rural community (Grenada County, Mississippi (MS), USA) and compared with those emissions from the recent electricity mix (2018), a previous electricity mix (2010) supply, along with natural gas (NG) and coal (Bituminous Coal, BC) based electricity generation options. A significant reduction (85.9-94.6%) in global warming impact was observed when compared with BC, NG and grid supplied electricity for years 2010 and 2018. When compared to the current electricity mix at the grid (2018), acidification, eutrophication, respiratory effects and smog formation showed higher emissions ranging from 30.8% to 72.4%. The sensitivity analysis showed an improvement in emissions savings with increased biomass to power conversion efficiency (40%), lower moisture content of the biomass (0%, bone dry biomass), and reduced transportation distance (35 km). This study showed an improvement in the electricity mix supplied to Grenada county, MS, which implies sustainable development opportunities for promoting energy security in rural communities with forest-based industries.

Promover la equidad en la inmunización en las Américas. Establecimiento de un registro nominal de vacunación electrónico: Granada

En 2015, el Ministerio de Salud de Granada (MINSA) comenzó a actualizar su sistema de información de inmunización basado en papel mediante la implementación de un registro nominal de vacunación electrónico (RNVe) a nivel nacional, denominado Sistema de Información de Inmunización de Granada (GIIS, por sus siglas en inglés), el cual fue posible con el apoyo de los Centros para el Control y la Prevención de Enfermedades (CDC, por sus siglas en inglés) de Estados Unidos y la Organización Panamericana de la Salud (OPS).

Promoting Immunization Equity in the Americas. Establishing an Electronic Immunization Registry: Grenada

In 2015, the Grenada Ministry of Health (MOH) began updating its localized, paper-based immunization information system through the establishment of a nationwide electronic immunization registry (EIR), the Grenadian Immunization Information System (GIIS), made possible with support from the U.S. Centers for Disease Control and Prevention (CDC) and the Pan American Health Organization (PAHO).