From Port-of-Spain summit to United Nations High Level Meeting CARICOM and the global non-communicable disease agenda.

The English-speaking Caribbean has the highest per capita burden of chronic non-communicable diseases (CNCDs) in the region of the Americas. Building on a long history of cooperation in health among the Caribbean Community (CARICOM) and past successes in eliminating/reducing communicable diseases through collective action, non-communicable diseases (NCDs) have now been targeted CARICOM convened a "first-in-the-world" summit of Heads of Government to address NCDs, which generated the Port-of-Spain NCD Summit Declaration, "Uniting to Stop The Epidemic of Chronic Noncommunicable Diseases". This 15-point declaration calls on all of government, civil society and the private sector to jointly tackle the common risk factors for the major chronic diseases, and improve the care of such diseases. Implementation of this declaration has been mixed, being most successful where there were regional supports, and in countries with populations > 250 000 reflecting country capacity. CARICOM has elevated this approach to the global level through successful advocacy for a United Nations High Level Meeting on NCDs to be convened in September 2011. Jamaica will be one of two co-facilitators of this meeting, a reflection of the role of CARICOM countries in advancing the NCD agenda at the global level. CARICOM Heads of Government should attend this meeting, showcase the implementation of the NCD Summit Declaration in the Caribbean, commit to enhancing systems and resources, endorse and implement the commitments made and identify and support leadership for sustained action and accountability for these initiatives.

Epidemic of pediatric deaths from acute renal failure caused by diethylene glycol poisoning. Acute Renal Failure Investigation Team.

CONTEXT: Contaminated pharmaceutical products can result in substantial morbidity and mortality and should be included in the differential diagnosis of deaths of unknown origin. OBJECTIVE: To investigate an outbreak of deaths among children from acute renal failure in Haiti to determine the etiology and institute control measures. DESIGN: Case-control study, cohort study, and laboratory toxicologic evaluation. SETTING: Pediatric population of Haiti. PARTICIPANTS: Cases were defined as Haitian residents younger than 18 years with idiopathic anuria or severe oliguria for 24 hours or longer. Febrile hospitalized children without renal failure were enrolled as control subjects. MAIN OUTCOME MEASURE: The odds of exposure to suspected etiologic agents among cases and controls. RESULTS: We identified 109 cases of acute renal failure among children. The clinical syndrome included renal failure, hepatitis, pancreatitis, central nervous system impairment, coma, and death. Of 87 patients with follow-up information who remained in Haiti for treatment, 85 (98%) died; 3 (27%) of 11 patients transported to the United States for intensive care unit management died before hospital discharge. A locally manufactured acetaminophen syrup was highly associated with disease (odds ratio, 52.7; 95% confidence interval, 15.2-197.2). Diethylene glycol (DEG) was found in patients' bottles in a median concentration of 14.4%. The median estimated toxic dose of DEG was 1.34 mL/kg (range, 0.22-4.42 mL/kg). Glycerin, a raw material imported to Haiti and used in the acetaminophen formulation, was contaminated with 24% DEG. CONCLUSIONS: An epidemic of severe systemic toxicity and deaths from DEG-contaminated acetaminophen syrup occurred in Haiti. Good manufacturing practice regulations should be used by all pharmaceutical manufacturers to prevent such tragedies.

Outbreak of histoplasmosis among employees in a paper factory--Michigan, 1993.

In December 1993, four reported cases of histoplasmosis among employees in a Michigan pulp paper factory prompted an investigation. A cohort of employees was surveyed to identify additional cases. A case of acute histoplasmosis was defined as an influenza-like illness in a plant employee with the onset of illness during October or November 1993 and laboratory evidence of recent infection with Histoplasma capsulatum. Among the 96 employees surveyed, 18 persons met the case definition; all of these had illness onset during the last week of October in 1993. The attack rate among maintenance employees (16 of 53 [30%]) was much greater than that among nonmaintenance employees (2 of 43 [5%]) (relative risk = 6.5; 95% confidence interval = 1.6 to 26.7; P = 0.003). On October 22, a dry, windy day, one maintenance worker swept bird guano, approximately 10 cm deep, from an adjacent roof < 20 m from the maintenance building. The disturbance of the bird guano was the likely event which caused this outbreak. H. capsulatum remains an important pathogen among immunocompetent hosts. We recommended that the plant authorities (i) discourage birds from roosting at the facility and (ii) use safe procedures for the cleanup and disposal of soil contaminated with bird droppings.

A survey of hepatitis B among health workers in Jamaica.

One thousand, five hundred and thirty-seven health staff, presenting for hepatitis B vaccination in Jamaica, were surveyed in 1990/91 for hepatitis B markers and/or exposure to blood or hepatitis. Antibodies to either hepatitis B surface antigen (HBsAg) or hepatitis B core (HBc) were found in 19.8% of 817 persons tested. Males were more likely to have antibodies to Hepatitis B Virus (HBV) than females (29% compared with 18%, Odds Ratio 1.6; 95% CI 0.98-2.9). HBsAg was found in 5.3% of 562 persons tested compared with 1% of blood donors. One or more needlestick accidents were reported by 60% of the sample, and blood or liquor splashing on the face was reported by 48%. Jaundice and hepatitis were reported by 1.2% and 3.5% of health staff, respectively. HBsAg carrier status was associated with years of service (p = 0.039). Prevalence of antibodies to HBV increased with age (p = 0.004) and years of service (p = 0.028). The effect of age and years of service appears to be largely independent (r = 0.44). This survey reaffirms the importance of health workers being immunized with hepatitis B vaccine, and adhering rigorously to universal precautions in patient care and laboratory practice.

Communicable disease control as a Caribbean public health priority.

PIP: The English-speaking Caribbean is in transition toward communicable disease health patterns seen in the more developed world. Structural adjustment policies in recent years have weakened control measures, such as water supply and sanitation, as illustrated by recent outbreaks of typhoid fever in Jamaica (1990-1991), increased malaria incidence in Suriname and Guyana (with temporary importation into southern Trinidad in 1991), an upswing in tuberculosis in some countries, and the occurrence of cholera outbreaks in Belize, Suriname, and Guyana. The emergence of epidemic cholera throughout most of Latin America in 1991, and Caribbean mainland countries in 1992, aroused concern. Deteriorating socioeconomic conditions and the consequent communicable disease risk underscored the absence of communicable disease control in the Caribbean Cooperation in Health (CCH) strategy which was adopted in 1986 by the countries of the Caribbean Community. The Caribbean Epidemiology Center (CAREC) offered the following analysis: At least four out of seven CCH priorities already directly address critical aspects of communicable disease control, and therefore the question arises whether communicable disease control should be recognized as an explicit CCH priority. Beyond cholera and the diseases already represented in the CCH strategy, there are only a few other communicable diseases that warrant specific attention at this time: tuberculosis; leprosy, which CAREC member countries may want to eradicate; and leptospirosis, a zoonosis (communicable disease of animals transmissible to humans) thought to be the most frequent disease of this type in the Caribbean. These three conditions are insufficient to justify a distinct communicable disease grouping within CCH. However, if all communicable diseases of public health importance were to be grouped together (AIDS/STD, vaccine-preventable diseases, food- and waterborne diseases, vector-borne diseases), such a group would be important enough to justify a distinct priority category, with several major subcategories.^ieng

Attitudes and practices of pesticide users in Saint Lucia, West Indies.

This article reports the results of a Saint Lucia survey, part of a larger program, that was the first to document the prevalence of suboptimal safety practices among vector control and farm workers using pesticides in the English-speaking Caribbean. Among other things, the survey found that many of 130 pesticide users surveyed were unaware that the skin and eyes were important potential routes of absorption. Over a quarter said they had felt ill at some point as a result of pesticide use. About half the respondents said they had received more than "introductory" training in safe pesticide use, and most said they always found labels or directions affixed to pesticide containers. However, about half said they never or only sometimes understood the labels, and many of those who said they understood did not always follow the instructions. About a quarter of the smokers said they smoked while using pesticides; about a sixth of the survey subjects said they ate food while using pesticides; and over 60% said they never wore protective clothing.

Attitudes and practices of pesticide users in Saint Lucia, West Indies

This article reports the results of a Saint Lucia survey, part of a larger program, that was the first to document the prevalence of suboptimal safety practices among vector control and farm workers using pesticides in the English-speaking Caribbean. Among other things, the survey found that many of 130 pesticide users surveyed were unaware that the skin and eyes were important potential routes of absorption. Over a quarter said had felt ill at some point as a result of pesticide use. About half the respondents said they had received more than "introductory" training in safe pesticide use, and most said they always found labels or directions affixed to pesticide containers. However, about half said they never or only sometimes understood the labels, and many of those who said they understood did not always follow the instructions. About a quarter of the smokers said they smoked while using pesticides; about a sixth of the survey subjects said they ate food while using pesticides; and over 60 percent said they never wore protective clothing

Attitudes and practices of pesticide users in Saint Lucia, West Indies

This article reports the results of a Saint Lucia survey, part of a larger program, that was the first to document the prevalence of suboptimal safety practices among vector control and farm workers using pesticides in the English-speaking Caribbean. Among other things, the survey found that many of 130 pesticide users surveyed were unaware that the skin and eyes were important potential routes of absorption. Over a quarter said had felt ill at some point as a result of pesticide use. About half the respondents said they had received more than "introductory" training in safe pesticide use, and most said they always found labels or directions affixed to pesticide containers. However, about half said they never or only sometimes understood the labels, and many of those who said they understood did not always follow the instructions. About a quarter of the smokers said they smoked while using pesticides; about a sixth of the survey subjects said they ate food while using pesticides; and over 60 percent said they never wore protective clothing

Epidemiological indicators and the epidemiology of measles in the English-speaking Caribbean and Suriname.

The main purpose of this article is to discuss the definitions and limitations of the indicators used to study the epidemiology of measles in the English-speaking Caribbean and Suriname. In addition, the epidemiology of measles over the past ten years is briefly reviewed, with a focus on recent epidemics. The predicted epidemiological picture of measles over the next few years is also discussed and, finally, the difference between elimination and eradication of measles is explained.

Epidemiological indicators and epidemiology of measles in the English-speaking Caribbean and Suriname

The main purpose of this article is to discuss the definitions and limitations of the indicators used to study the epidemiology of measles in the English-speaking Caribbean and Suriname. In addition, the epidemiology of measles over the past ten years is briefly reviewed, with a focus on recent epidemics. The predicted epidemilogical picture of measles over the next few years is also discussed and, finally, the difference between elimination and eradiction of measles is explained.

A health situation analysis in Trinidad and Tobago, 1990: the local health systems approach

This HSA exercise confirmed known patterns of health and disease in Trinidad and Tobago but produced valuable new information on health status, particularly as it relates to the different local health administrative areas. This was perhaps the most valuable aspect of the analysis. We cannot overemphasize the need for disaggregated data as summary statistics often mask the true state of affairs. This report has focussed on the health status of the population and emphasized again the dominant role of chronic non-communicable diseases and accidents as causes of death. Among males, aged 15 - 44 years, AIDS was the third leading cause of death in 1987, and can be expected to become even more important as a cause of death over the next few years. Other and equally important information on the status of the health information system and the health services situation was also produced and will be discussed elsewhere. (summary)