Adaptation of WHO COVID-19 guidelines by Caribbean countries and territories.

The normative role of the World Health Organization (WHO) involves creating evidence-based, principled guidelines to guide its Member States in making well-informed public health decisions. While these guidelines often need to be adapted to ensure contextual relevance, foster better implementation and adherence, adapting existing guidelines is more efficient than creating new ones. Here we describe the adaptation of the WHO coronavirus disease 2019 (COVID-19) living guideline on pharmacological interventions for the Caribbean using the grading of recommendations, assessment, development and evaluation (GRADE)-ADOLOPMENT method. The Caribbean Public Health Agency and the Pan American Health Organization led the effort, assembling a diverse panel of 16 experts from seven Caribbean countries and territories. The adaptation process, involving 15 steps, was guided by an experienced methodologist and included selecting relevant clinical questions and prioritizing them based on regional needs. The panel evaluated the latest WHO guidelines and integrated additional local data. They adjusted the direction and strength of several recommendations to better fit the Caribbean context, considering local values and preferences, resources, accessibility, feasibility and impact on health equity. Ultimately, we changed the direction of two recommendations and the strength of five, tailoring them to regional realities. This effort highlights the importance of adapting global guidelines to local settings, improving their applicability and effectiveness. The adaptation process also serves as a valuable opportunity for skill transfer and capacity-building in guideline development. Continued research is needed to assess the impact of these adaptations on health-care outcomes in the Caribbean.

Le rôle normatif de l'Organisation mondiale de la santé (OMS) consiste à élaborer des lignes directrices fondées sur des données scientifiques et sur des principes afin d'aider ses États membres à prendre des décisions éclairées en matière de santé publique. Bien qu'elles nécessitent souvent des adaptations pour garantir leur pertinence par rapport à des contextes précis et pour favoriser une meilleure mise en œuvre et adhésion, il est plus efficace d'adapter les lignes directrices existantes que d'en créer de nouvelles. La présente publication décrit l'adaptation de la ligne directrice évolutive de l'OMS sur les interventions pharmacologiques dans le cadre de la maladie à coronavirus (COVID-19) pour les Caraïbes en appliquant la méthodologie GRADE (classement des recommandations, de l'appréciation, du développement et de l'évaluation)-ADOLOPMENT. L'Agence de santé publique des Caraïbes et l'Organisation panaméricaine de la Santé ont dirigé les travaux en réunissant un groupe diversifié de 16 experts issus de sept pays et territoires des Caraïbes. Le processus d'adaptation, comptant 15 étapes et encadré par un méthodologiste expérimenté, a consisté à sélectionner des questions cliniques pertinentes et à les classer par ordre de priorité selon les besoins régionaux. Ce groupe a évalué les dernières lignes directrices de l'OMS et a intégré des données locales supplémentaires. Il a ensuite ajusté l'orientation et le poids de plusieurs recommandations afin de mieux les adapter au contexte des Caraïbes, en tenant compte des valeurs et des préférences locales, des ressources, de l'accessibilité, de la faisabilité et de l'impact sur l'équité en matière de santé. En fin de compte, l'orientation de deux recommandations et le poids de cinq autres ont été modifiés, en les adaptant aux réalités régionales. Cet effort souligne l'importance d'adapter des lignes directrices mondiales aux contextes locaux, afin d'en améliorer l'applicabilité et l'efficacité. Le processus d'adaptation représente également une occasion précieuse de transfert de compétences et de renforcement des capacités en matière d'élaboration de lignes directrices. Des recherches continues s'imposent pour évaluer l'impact de ces adaptations sur les résultats des soins de santé dans les Caraïbes.

La función normativa de la Organización Mundial de la Salud (OMS) consiste en elaborar directrices basadas en pruebas y principios para orientar a sus Estados Miembros en la toma de decisiones de salud pública bien fundamentadas. Aunque con frecuencia es necesario adaptar estas directrices para garantizar su pertinencia contextual y fomentar una mejor implementación y observancia, la adaptación de directrices existentes es más eficiente que la creación de otras nuevas. Aquí describimos la adaptación de la directriz vigente de la OMS sobre la enfermedad por coronavirus (COVID-19) relativa a las intervenciones farmacológicas para el Caribe utilizando el método de clasificación de valoración, elaboración y evaluación de las recomendaciones (GRADE)-ADOLOPMENT. La Agencia de Salud Pública del Caribe y la Organización Panamericana de la Salud lideraron la iniciativa, que reunió a un variado grupo de 16 expertos de siete países y territorios caribeños. El proceso de adaptación, que comprendió 15 pasos y fue guiado por un metodólogo experimentado, incluyó la selección de preguntas clínicas pertinentes y su priorización en función de las necesidades regionales. El grupo evaluó las últimas directrices de la OMS e integró datos locales adicionales. Ajustaron la orientación y la fuerza de varias recomendaciones para adaptarlas mejor al contexto caribeño, teniendo en cuenta los valores y preferencias locales, los recursos, la accesibilidad, la viabilidad y el impacto en la equidad sanitaria. Finalmente, cambiamos la orientación de dos recomendaciones y la fuerza de cinco para adaptarlas a las realidades regionales. Esta iniciativa destaca la importancia de adaptar las directrices mundiales a los contextos locales, lo que mejora su aplicabilidad y eficacia. El proceso de adaptación también constituye una valiosa oportunidad para la transferencia de conocimientos y el desarrollo de capacidades en la elaboración de directrices. Es necesario seguir investigando para evaluar el impacto de estas adaptaciones en los resultados de la atención sanitaria en el Caribe.

Improving dietary diversity in the Caribbean Community

[Extract]. The Caribbean Region is blessed by diversity. The ethnic diversities of the people who inhabit it. The language diversity reflecting the tongues of original native people, the colonial history and the people brought here from Africa and India, not to mention the languages and dialects and patois which developed in the Caribbean. So, it should be expected that the Caribbean would naturally have a diversity in the foods we eat and the ways in which they are prepared. Indeed, the Caribbean of 25 to 50 years ago universally had some of the most incredible ways of preparing vegetables and fruit, peas and beans to make some of the most tasty and nutritious meals imaginable. Not only was the Caribbean a good place to live but it is one of the best places to visit and has one of the most—if not the most— tourism-dependent economies in the entire world. Along with an influx of visitors, came an influx of changing palates. The taste for imported sugary carbonated drinks outstripped the love of home-made mauby and lemonade and the love of fat-rich burgers outstripped the desire for steamed flying fish or escovitch fish. Add to that the globalisation of food marketing and distribution which made processed food rich in salt, sugars and fats not just easy to get in supermarkets, but also highly desired by the Caribbean consumer.

Population-based estimates of acute gastrointestinal and foodborne illness in Barbados: a retrospective cross-sectional study.

The aim of this study was to determine the burden and impact of acute gastroenteritis (AGE) and foodborne diseases (FBDs) in Barbados through a retrospective, cross-sectional population survey and laboratory study in August 2010-August 2011. Face-to-face interviews were conducted with one person from each of 1,710 randomly-selected households. Of these, 1,433 (84%) interviews were completed. A total of 70 respondents reported having experienced AGE in the 28 days prior to the interview, representing a prevalence of 4.9% and an annual incidence rate of 0.652 episodes per person-year. Age (p = 0.01132), season (p = 0.00343), and income (p < 0.005) were statistically associated with the occurrence of AGE in the population. Norovirus was the leading foodborne pathogen causing AGE-related illness. An estimated 44,270 cases of AGE were found to occur during the period of the study and, for every case of AGE detected by surveillance, an additional 204 cases occurred in the community. Economic costs of AGE ranged from BD$ 9.5 million to 16.5 million (US$ 4.25-8.25) annually. This study demonstrated that the public-health burden and impact of AGE and FBD in Barbados were high and provided the necessary baseline information to guide targeted interventions.

Response to the challenges of pandemic H1N1 in a small island state: the Barbadian experience.

BACKGROUND: Having been overwhelmed by the complexity of the response needed for the severe acute respiratory syndrome (SARS) epidemic, public health professionals in the small island state of Barbados put various measures in place to improve its response in the event of a pandemic METHODS: Data for this study was collected using Barbados' National Influenza Surveillance System, which was revitalized in 2007. It is comprised of ten sentinel sites which send weekly notifications of acute respiratory illness (ARI) and severe acute respiratory illness (SARI) to the Office of the National Epidemiologist. During the 2009 H1N1 pandemic, meetings of the National Pandemic Planning Committee and the Technical Command Committee were convened. The pharmaceutical and non-pharmaceutical interventions (NPIs) implemented as a result of these meetings form the basis of the results presented in this paper. RESULTS: On June 3, 2009, Barbados reported its first case of 2009 H1N1. From June until October 2009, there were 155 laboratory confirmed cases of 2009 H1N1, with one additional case occurring in January 2010. For the outbreak period (June-October 2009), the surveillance team received reports of 2,483 ARI cases, compared to 412 cases for the same period in 2008. The total hospitalization rate due to SARIs for the year 2009 was 90.1 per 100,000 people, as compared to 7.3 per 100,000 people for 2008. Barbados' pandemic response was characterized by a strong surveillance system combining active and passive surveillance, good risk communication strategy, a strengthened public and private sector partnership, and effective regional and international collaborations. Community restriction strategies such as school and workplace closures and cancellation of group events were not utilized as public health measures to delay the spread of the virus. Some health care facilities struggled with providing adequate isolation facilities. CONCLUSIONS: The number of confirmed cases was small but the significant surge in ARI and SARI cases indicate that the impact of the virus on the island was moderate. As a result of 2009 H1N1, virological surveillance has improved significantly and local, regional and international partnerships have been strengthened.