Zika virus disease-knowledge, attitudes and practices among pregnant women-implications for public health practice.

OBJECTIVE: Mosquito-borne diseases continue to pose a threat to Latin America and the Caribbean. Zika virus disease entered the Caribbean in 2013 with increased reporting of cases across the region in 2016, affecting more than 50 countries. This study aimed to ascertain the knowledge of, attitudes and practices towards Zika virus disease among antenatal clinic attenders in Trinidad and Tobago during the 2016 outbreak. STUDY DESIGN: A cross-sectional questionnaire survey was undertaken. METHODS: A knowledge attitudes and practices survey was conducted among antenatal clinic attenders at publicly funded primary care health centres. All counties of Trinidad (except St Patrick, Caroni and Victoria) and Tobago were included in the study. Within each county, three health centres were selected at random. At the antenatal clinic of each selected health centre, antenatal clients were selected by randomly selecting their patient file from that day's antenatal clinic patient files. Data collection occurred from September to November 2016. The knowledge, attitudes and practice survey was administered by an interviewer-administered questionnaire. The World Health Organization Knowledge, Attitudes and Practice surveys Zika virus disease and potential complications Resource pack was adapted for use as the data collection tool. All data collected were analysed using SPSS software, version 23. Tests with P-values less than 0.05 were deemed significant. RESULTS: Seventy-four percent (74%) of responders did not think there was a link between sexual transmission and Zika. About 19% stated that abstaining could prevent Zika but only 6.6% actually practiced this. Seventy-six percent knew the risk of microcephaly, and this knowledge of the risk of microcephaly was found to be significantly associated with the number of weeks' gestation. Less than 40% knew the risk of Guillain-Barre syndrome. Doctors at health centres followed by private doctors were the top two trusted information sources for responders. Responders thought that the government could spray insecticide, clean drains, educate community members and clean overgrown vacant lots of land. CONCLUSION: The government and healthcare workers need to reach specific target groups with accurate messages to minimize the associated morbidity and thereby safeguarding national and global health security.

Dengue Deaths: Associated Factors and Length of Hospital Stay.

Background. Dengue continues to pose a public health problem globally. Objective. To review factors associated with patients who died from dengue in Trinidad. Methods. A retrospective case note review of hospitalized patients who died during 2001 to 2010. Results. A total of 23 cases were identified: 13 males, 10 females-12 East Indians, 9 Africans, and 2 unknown. More than half (n = 17) were over 40 years of age with 10 being over 60 years of age; three were children. A falling platelet count was observed in 16 while 18 patients had a low normal haematocrit. There was a significant association of ethnicity, hypertension, and diabetes with length of hospital stay. Conclusions. The study sample included 10 patients over 60 years of age. Patients with diabetes and hypertension and patients of East Indian origin appeared to have a shorter hospital stay prior to death.

Public versus private healthcare – Views of doctors, nurses and the public

Objective: The study investigates the perception of publicvs private healthcare among doctors, nurses and the publicin Trinidad.Subjects and Methods: A cross-sectional study wasconducted on a sample of 1222 persons. Respondents wereasked via interviewer-administered questionnaire whichhealthcare system (public or private) they would chooseand why, if ability to pay was not a factor. They were alsoasked to state what in their view would improve thesystems. The data collected were subject to the Chisquaredtest and Fisher’s exact test to determine anysignificant associations.Results: One thousand two hundred and twenty-twopersons were interviewed (response rate 89%). Themajority of all groups would choose private healthcare (÷2= 238.06, df = 7, p-value = 0.000). The majority of nonmedicalgroups perceived private care to be faster andbetter (p = 0.000); doctors would like more accountabilityin private settings and more drugs and equipment in thepublic sector, while non-clinical groups wanted cheaperprivate care (p = 0.000).Conclusion: The publicly funded healthcare system seemsto be falling short on some quality standards, thus contravening a fundamental human right. The publicshould be informed when making a decision to opt forprivate care that the same doctors often work in bothsettings. For critical care, the public institutions have abetter staff complement, although this study highlightedthe need for more drugs and better equipment. Thegovernment needs to look closer at the reasons all groups,including doctors and nurses, would choose privatehealthcare.

Quality of street food in Trinidad

OBJECTIVE: This study investigated the effect of a public health intervention on the environmental conditions under which street-vended foods were prepared and offered for sale. DESIGN AND METHODS: A before and after cross sectional study was conducted on a sample of 80 itinerant food vendors in one County of Trinidad. Forty food samples were tested for the presence of three types of bacteria. Public health information was provided at the first visit to the food vendors. Four weeks later the same vendors were surveyed and further food samples taken. The data collected were subject to McNemar’s test to determine whether the proportions for the before and after measurements were significantly different. RESULTS: The findings demonstrated the presence of microorganisms with the potential to cause food borne illness in food offered by itinerant night vendors. The results also showed a significant increase in the number of units being registered (p < 0.001) and displaying food badges (p = 0.002) after the first interview. Similarly there were significant improvements in personal hygiene parameters reviewed at the second visit in terms of attire of vendors (p = 0.002); availability of potable water (p < 0.001); and the general appearance of the food handler (p=0.025). CONCLUSION: There appears to be a role for public health education sessions on food handling practices for food vendors. Government agencies should also provide premises for such food vending where there are ample and satisfactory water and sanitation facilities.

Dengue deaths: length of hospital stay, haematological parameters and presence of co-morbidities

OBJECTIVE: To review the characteristics of the patients who died from dengue in Trinidad to determine if there was any association between length of hospital stay, haematological parameters and ethnicity and any association with gender and the presence of co-morbidities. DESIGN AND METHODS: A descriptive study was undertaken via a review of case notes. Four major public hospitals were included in the study to locate patients who died from dengue between 2001 and 2010. RESULTS: The duration of hospital stay until death was characterised by a mode of 3 days and a median of 4 days. Eleven patients (47.8%) had a history of diabetes and 7 (30.4%) a history of hypertension recorded in the notes. A falling platelet count was observed in 69.5% of patients. A low normal haematocrit was observed in 78.2% of cases. Analyses did not reveal a significant association between length of hospital stay and platelet levels, nor with ethnicity; neither was a significant association found between gender and the presence of co- morbidities. CONCLUSION: Morbidity and mortality from dengue continue to pose a public health problem globally. Most patients had a history of diabetes with low platelets on admission, but low to normal haematocrit throughout their stay in hospital (mode 3 days). A prospective comparison study would better explore the significance of co- morbidities and the meaning of low to normal haematocrit levels.