Clinical, molecular and serological outcomes of the Chikungunya outbreak in Grenada

OBJECTIVE: This study evaluated the clinical utility of Chikungunya (CHIKV) test results and clinical symptoms in patients with suspected CHIKV infection. DESIGN AND METHODS: Patients with CHIKV symptoms who presented at a health facility in Grenada during the recent outbreak had a CHIKV diagnostic test form completed by a health professional and a blood sample was drawn. The serum sample was stored at -80oC, shipped to the Naval Infectious Diseases Diagnostic Lab (NIDDL) on dry ice and tested for CHIKV and Dengue (DENV) using PCR real-time assay for viral RNA, and IgM detection by ELISA. RESULTS: Sera from more than 600 patients collected from mid September till mid October, 2014 were drawn and had a CHIKV diagnostic form completed. At the time of writing 112 patients sera have been tested at the NIDDL. 90% of patients had a positive test. PCR only was positive in 8% of patients. IgM only was positive in 83%, and both PCR and IgM were positive in 9% of patients. The major symptoms presented by patients were joint pain (84%), fever (81%), body pain (74%), headache (62%), chills (54%) and rash (49%). CONCLUSION: IgM testing detected 92% of test positive patients while PCR alone detected 17%. The IgM assay was clinically most useful. In an outbreak where dengue is ruled out and CHIKV is the cause, patients with the constellation of symptoms above could be considered positive for CHIKV infection with a 98% accuracy without confirmatory testing.

A ten year retrospective analysis of motor vehicle accidents in Grenada

OBJECTIVE: To assess the burden of Motor Vehicular Accidents in Grenada during the period 2000-2009. DESIGN AND METHODS: A cross-sectional study of secondary data in the form of vehicular accident records were sourced from the Royal Grenada Police for the period 2000-2009. Detailed records of the number of motor vehicle accidents per month and per year were sourced including the type of vehicle, the number of passengers, time and location of the accident and the gender and age of the drivers were not considered to be important. The adverse health outcomes of the accidents were also determined as either minor or major depending on fatalities and extent of injuries sustained. RESULTS: There has been an increase in the total number of fatalities during the period of study occurring from motor vehicle accidents from 4.1 in 2000 to 11.9 in 2009 per 100,000. The average increase in the number of total road accidents also rose by 8.9% in the stated period. In addition, the number of major and minor road accidents had steadily increased together with an increase in the number of vehicles registered. The burden of injuries varied across different periods of time over the course of review. Conclusion: From 2000-2009, there was steady increase in the total number of motor vehicle accidents, and fatal road accidents in Grenada.

An evaluation of the burden of diabetes in Grenada

OBJECTIVE: To assess the burden of diabetes in Grenada in terms of changes in quality of life and trends of incidence, amputation and gender. DESIGN AND METHODS: A mixed methods approach was used in which statistical retrospective analysis determined trends of diabetic related amputations based on secondary data for the period 2008-2012. A qualitative approach was also used to assess perceptions of quality of life of diabetic related amputees using interviews. RESULTS: There were no statistically significant differences or trends (relationships) found between number of amputations and incidences of diabetes with respect to time. The quality of life of diabetics decreased after receiving an amputation surgery as a result of multifactorial issues such as feelings of loneliness and financial instability. CONCLUSION: The decreasing trend of diabetes in Grenada was found to be statistically insignificant while quality of life of amputees was shown to be lowered. Decreasing the incidence of amputations should involve focus on the role of peripheral neuropathy. Policy development to increase benefits to disabled citizens is recommended to improve quality of life of Grenadians.

Impact of dropping out of the Sports for Health Program in Grenada

OBJECTIVE: To determine if there were any significant differences in body mass index (BMI) and waist-to-hip ratio (WHR) between active participants in the Sports for Health program and participants who were lost to drop out. DESIGN AND METHODS: Persons who were originally part of the program and data collection in 2011, but were no longer active participants were evaluated. The evaluation utilized the data from the participants at their last BMI and WHR measurements as program participants and follow up measurements as non-participants in 2014. RESULTS: Data analysis showed that body mass index (BMI) was signficantly higher in persons who no longer participated in the sports for health program when compared to active program participants. In addition, non-participation of persons in the Sports for Health program was found to increase individual risk factors for chronic diseases, which were originally mitigated by participation in the program. Barriers to participation by many women in the program included lack of partner support and negative community perceptions, which influenced several women to discontinue their participation in the program. Recommendations were made in order to address the barriers to participation and to decrease the drop out rate in the Sports for Health program in Grenada. CONCLUSION: Non-participation in the Sports for Health program adversely affects persons BMI and WHR, therefore, increasing risk factors for several non-communicable chronic diseases.

The centrality of community dynamics in the socio-economic recovery of devastated communities / El carácter central de la dinámica de la comunidad en la recuperación socio-económica de las comunidades devastadas

OBJECTIVE: To assess and explore the health and socio-economic outcomes of Jubilee, a community on the Caribbean island of Grenada hit by Hurricane Ivan in 2004 and to identify remaining barriers to recovery. METHODS: The assessment consisted of a mixed methods approach employing observations, household surveys, in-depth interviews and focus groups. RESULTS: Eighty-five per cent of the residents live in a single-family home type dwelling which is occupied by multiple families. Twenty-seven per cent of the respondents depended on a river or stream for water and 83% utilized an outdoor pit latrine. Construction accounted for 28% of the employment while 16% reported having no occupation. Public and private transportation was limited and 48% of the residents lived on less than one United States of America (US) dollar per day. Access to healthcare was reported by 89% and the prevalence of diabetes and hypertension was identified by 13% and 30% of the residents respectively. Social fragmentation within the community represents a barrier that keeps the community from developing common goals leading to full economic recovery. CONCLUSION: Jubilee has not fully recovered from the effects of Hurricane Ivan, but progress has been made in the reconstruction effort. These efforts have addressed the most immediate and basic needs of the community, mainly utility service infrastructure and home repairs. However, issues related to the community's economic recovery are still unresolved.

OBJETIVO: Evaluar y explorar la salud y los resultados socio-económicos de Jubilee, una comunidad de la isla caribeña de Granada, afectada por el huracán Iván en el 2004, e identificar los obstáculos que aún quedan para la recuperación. MÉTODOS: La evaluación consistió en un abordaje de métodos mezclados que empleaban la observación, encuestas domésticas, entrevistas detalladas, y grupos focales (grupos de discusión). RESULTADOS: El ochenta y cinco por ciento de los residentes viven en viviendas que son para una sola familia, pero están ocupadas por familias múltiples. El veinte por ciento de los encuestados dependían de un río o una corriente para obtener agua, y un 83% utilizaba letrinas de pozo exteriores. La construcción daba cuenta del 28% de los empleos, en tanto que el 16% reportó no tener ocupación. Tanto el transporte público como el privado se hallaban limitados, y el 48% de los residentes vivían con menos de un dólar americano (1 USD) por día. Acceso a la atención a la salud fue reportado por 89% y la prevalencia de la diabetes y la hipertensión fue identificada por el 13% y el 30% de los residentes, respectivamente. La fragmentación social dentro de la comunidad representa un obstáculo que impide que la comunidad desarrolle metas comunes, que conduzcan a una plena recuperación económica. CONCLUSIÓN: Jubilee no se ha recuperado totalmente de los efectos del huracán Iván, pero ha habido progreso en los esfuerzos por la reconstrucción. Estos esfuerzos han estado dirigidos a las necesidades básicas y más inmediatas de la comunidad, fundamentalmente a la reparación de las casas y las infraestructuras de servicios. Sin embargo, los problemas relacionados con la recuperación económica de la comunidad siguen aún sin solución.

The centrality of community dynamics in the socio-economic recovery of devastated communities.

OBJECTIVE: To assess and explore the health and socio-economic outcomes of Jubilee, a community on the Caribbean island of Grenada hit by Hurricane Ivan in 2004 and to identify remaining barriers to recovery. METHODS: The assessment consisted of a mixed methods approach employing observations, household surveys, in-depth interviews and focus groups. RESULTS: Eighty-five per cent of the residents live in a single-family home type dwelling which is occupied by multiple families. Twenty-seven per cent of the respondents depended on a river or stream for water and 83% utilized an outdoor pit latrine. Construction accounted for 28% of the employment while 16% reported having no occupation. Public and private transportation was limited and 48% of the residents lived on less than one United States of America (US) dollar per day. Access to healthcare was reported by 89% and the prevalence of diabetes and hypertension was identified by 13% and 30% of the residents respectively. Social fragmentation within the community represents a barrier that keeps the community from developing common goals leading to full economic recovery. CONCLUSION: Jubilee has not fully recovered from the effects of Hurricane Ivan, but progress has been made in the reconstruction effort. These efforts have addressed the most immediate and basic needs of the community, mainly utility service infrastructure and home repairs. However issues related to the community's economic recovery are still unresolved.