Self-administration of a food security scale by adolescents: item functioning, socio-economic position and food intakes.

OBJECTIVE: To evaluate the reliability and validity of a six-item food security scale when self-administered by adolescents. DESIGN: Cross-sectional questionnaire survey including the six-item food security measure, socio-economic variables and a food-frequency questionnaire. SETTING: Representative sample of 29 schools in Trinidad. SUBJECTS: In total 1903 students aged approximately 16 years. RESULTS: Item affirmatives ranged from 514 (27%) for the 'balanced meal' item to 128 (7%) for the 'skipped or cut meals often' item and 141 (7%) for the 'hungry' item. Item-score correlations ranged from 0.444 to 0.580. Cronbach's alpha was 0.77. Relative item severities from the Rasch model ranged from -1.622 (standard error 0.043) for the 'balanced meal' item to 1.103 (0.068) for the 'skipped or cut meals often' item and 0.944 (0.062) for the 'hungry' item. The 'hungry' item gave a slightly lower relative severity in boys than girls. Food insecurity was associated with household overcrowding (adjusted odds ratio comparing highest and lowest quartiles 2.61, 95% confidence interval 1.75 to 3.91), lack of pipe-borne water in the home, low paternal education or paternal unemployment. After adjusting for socio-economic variables, food insecurity was associated with less frequent consumption of fruit (0.75, 0.60 to 0.94) or fish (0.72, 0.58 to 0.88) but more frequent consumption of biscuits or cakes (1.47, 1.02 to 2.11). CONCLUSIONS: The food security scale provides a valid, reliable measure in adolescents, although young people report being hungry but not eating relatively more frequently than adults. Food-insecure adolescents have low socio-economic position and may eat less healthy diets.

Reliability and validity of a short form household food security scale in a Caribbean community.

BACKGROUND: We evaluated the reliability and validity of the short form household food security scale in a different setting from the one in which it was developed. METHODS: The scale was interview administered to 531 subjects from 286 households in north central Trinidad in Trinidad and Tobago, West Indies. We evaluated the six items by fitting item response theory models to estimate item thresholds, estimating agreement among respondents in the same households and estimating the slope index of income-related inequality (SII) after adjusting for age, sex and ethnicity. RESULTS: Item-score correlations ranged from 0.52 to 0.79 and Cronbach's alpha was 0.87. Item responses gave within-household correlation coefficients ranging from 0.70 to 0.78. Estimated item thresholds (standard errors) from the Rasch model ranged from -2.027 (0.063) for the 'balanced meal' item to 2.251 (0.116) for the 'hungry' item. The 'balanced meal' item had the lowest threshold in each ethnic group even though there was evidence of differential functioning for this item by ethnicity. Relative thresholds of other items were generally consistent with US data. Estimation of the SII, comparing those at the bottom with those at the top of the income scale, gave relative odds for an affirmative response of 3.77 (95% confidence interval 1.40 to 10.2) for the lowest severity item, and 20.8 (2.67 to 162.5) for highest severity item. Food insecurity was associated with reduced consumption of green vegetables after additionally adjusting for income and education (0.52, 0.28 to 0.96). CONCLUSIONS: The household food security scale gives reliable and valid responses in this setting. Differing relative item thresholds compared with US data do not require alteration to the cut-points for classification of 'food insecurity without hunger' or 'food insecurity with hunger'. The data provide further evidence that re-evaluation of the 'balanced meal' item is required.

Reliability and validity of a short form household food security scale in a Caribbean community

BACKGROUND: We evaluated the reliability and validity of the short form household food security scale in a different setting from the one in which it was developed. METHODS: The scale was interview administered to 531 subjects from 286 households in north central Trinidad in Trinidad and Tobago, West Indies. We evaluated the six items by fitting item response theory models to estimate item thresholds, estimating agreement among respondents in the same households and estimating the slope index of income-related inequality (SII) after adjusting for age, sex and ethnicity. RESULTS: Item-score correlations ranged from 0.52 to 0.79 and Cronbach's alpha was 0.87. Item responses gave within-household correlation coefficients ranging from 0.70 to 0.78. Estimated item thresholds (standard errors) from the Rasch model ranged from -2.027 (0.063) for the 'balanced meal' item to 2.251 (0.116) for the 'hungry' item. The 'balanced meal' item had the lowest threshold in each ethnic group even though there was evidence of differential functioning for this item by ethnicity. Relative thresholds of other items were generally consistent with US data. Estimation of the SII, comparing those at the bottom with those at the top of the income scale, gave relative odds for an affirmative response of 3.77 (95% confidence interval 1.40 to 10.2) for the lowest severity item, and 20.8 (2.67 to 162.5) for highest severity item. Food insecurity was associated with reduced consumption of green vegetables after additionally adjusting for income and education (0.52, 0.28 to 0.96). CONCLUSIONS: The household food security scale gives reliable and valid responses in this setting. Differing relative item thresholds compared with US data do not require alteration to the cut-points for classification of 'food insecurity without hunger' or 'food insecurity with hunger'. The data provide further evidence that re-evaluation of the 'balanced meal' item is required.

Insulin promoter factor-1 mutations and diabetes in Trinidad: identification of a novel diabetes-associated mutation (E224K) in an Indo-Trinidadian family.

This study investigated the prevalence of insulin promoter factor-1(IPF-1) mutations in familial early-onset diabetes mellitus in Trinidad. We screened 264 unrelated subjects with type 2 diabetes diagnosed before 40 yr of age and a family history of diabetes for mutations in the minimal promoter and coding region of the IPF-1 gene (IPF1). This study population included 169 patients of East Indian descent (Indo-Trinidadians), 66 of African descent (Afro-Trinidadians), and 29 of mixed ancestry. We identified five IPF1 variants, including one new missense mutation E224K, the previously described diabetes-associated duplication P242 P243dupP, two silent mutations in the codons for Leu54 (c.162G>A) and Ala256 (c.768C>A), and a substitution in the 5'-untranslated region (c.-18C>T). The E224K mutation was found in two unrelated diabetic Indo-Trinidadians and 0 of 60 controls. It was present on the same haplotype in both patients suggesting a founder effect. The E224K mutation cosegregated with early-onset diabetes or impaired glucose tolerance in a large family, suggestive of the type 4 form of maturity-onset diabetes of the young rather than type 2 diabetes. Functional studies of E224K showed reduced transactivation activity. IPF1 mutations leading to synthesis of a mutant protein may contribute to the development of familial early-onset diabetes/maturity-onset diabetes of the young in Indo-Trinidadians.

Insulin promoter factor-1 mutations and diabetes in Trinidad: Identification of a novel diabetes-associated mutation (E224K) in an Indo-Trinidadian family

This study investigated the prevalence of insulin promoter factor-1 (IPF-1) mutations in familial early-onset diabetes mellitus in Trinidad. We screened 264 unrelated subjects with type 2 diabetes diagnosed before 40yr of age and a family history of diabetes for mutations in the minimal promoter and coding region of the IPF-1 gene (IPF1). This study population included 169 patients of East Indian descent (Indo-Trinidadians) 66 of African descent (Afro-Trinidadians), and 29 of mixed ancestry. We identified five IPF1 variants, including one new missense mutation E224K, the previously described diabetes-associated duplication P242 P243dupP, two silent mutations in the codons for Leu54 (c.162G>A) and Ala256 (c.768C>A), and a substitution in the 5'-untranslated region (c.-18C>T). The E224K mutation was found in two unrelated diabetic Indo-Trinidadians and 0 of 60 controls. It was present on the same haplotype in both patients suggesting a founder effect. The E224K mutation cosegregated with early-onset diabetes or impaired glucose tolerance in a large family, suggestive of the type 4 form of maturity-onset diabetes of the young rather than type 2 diabetes. Functional studies of E224K showed reduced transactivation activity. IPF1 mutations leading to synthesis of a mutant protein may contribute to the development of familial early-oneset diabetes/maturity-onset diabetes of the young in Indo-Trinidadians (AU)

Food insecurity, food choices, and body mass index in adults: nutrition transition in Trinidad and Tobago.

BACKGROUND: This study evaluated whether food insecurity and obesity were associated in a population sample in Trinidad. METHODS: A sample was drawn of 15 clusters of households, in north central Trinidad. Resident adults were enumerated. A questionnaire was administered including the short form Household Food Security Scale (HFSS). Heights and weights were measured. Analyses were adjusted for age, sex, and ethnic group. RESULTS: Data were analysed for 531/631 (84%) of eligible respondents including 241 men and 290 women with a mean age of 47 (range 24-89) years. Overall, 134 (25%) of subjects were classified as food insecure. Food insecurity was associated with lower household incomes and physical disability. Food insecure subjects were less likely to eat fruit (food insecure 40%, food secure 55%; adjusted odds ratio [OR] = 0.60, 95% CI: 0.36-0.99, P = 0.045) or green vegetables or salads (food insecure 28%, food secure 51%; adjusted OR = 0.46, 95% CI: 0.27-0.79, P = 0.005) on >/=5-6 days per week. Body mass index (BMI) was available for 467 (74%) subjects of whom 41 (9%) had BMI <20 kg/m(2), 157 (34%) had BMI 25-29 kg/m(2), and 120 (26%) had BMI >/=30 kg/m(2). Underweight (OR = 3.21, 95% CI: 1.17-8.81) was associated with food insecurity, but obesity was not (OR = 1.08, 95% CI: 0.55-2.12). CONCLUSIONS: Food insecurity was frequent at all levels of BMI and was associated with lower consumption of fruit and vegetables. Food insecurity was associated with underweight but not with present obesity.

Food insecurity definitions and body mass index. Response

In his commentary, Dr Edward A. Frongillo criticizes our use of a well-described household food security scale in Trinidad. There will always be some uncertainty concerning the application of a given measure as there is no perfect instrument to evaluate food security or dietary patterns in any population. The household food security measure was used in the US national Current Population Survey (which provided the comparison data used in Dr Frongillo's commentary) but the application of the instrument to all groups in the multilingual, culturally diverse US population 'has not been examined sufficiently' (ref. 3, p. 8). Questionnaire evaluation must be considered when differences in literacy, language, dialect, or culture, as well as socioeconomic status, may influence responses and this consideration might suggest that an instrument should be tailored to local requirements. It is advisable, however, to be judicious in modifying such measures so as not to compromise the validity or comparability of an instrument. Departures from a previously tested template should only be undertaken to guarantee enhanced performance of a measure. Dr Frongillo's comments appear to underestimate both the weight of evidence required to justify an alteration to an established measure and the limitations of local 'validation' studies. Before concluding that a measure gives unsatisfactory results in a given local population, or a particular group within a population, it is essential to ensure that the findings cannot be ascribed to error or bias. There is a relatively high risk that local questionnaire evaluation studies, implemented within the short time scales suggested, will lead to erroneous conclusions if sample sizes are too small or if subjects are insufficiently representative.

Food insecurity, food choices, and body mass index in adults: nutrition transition in Trinidad and Tobago

BACKGROUND: This study evaluated whether food insecurity and obesity were associated in a population sample in Trinidad. METHODS: A sample was drawn of 15 clusters of households, in north central Trinidad. Resident adults were enumerated. A questionnaire was administered including the short form Household Food Security Scale (HFSS). Heights and weights were measured. Analyses were adjusted for age, sex, and ethnic group. RESULTS: Data were analysed for 531/631 (84%) of eligible respondents including 241 men and 290 women with a mean age of 47 (range 24-89) years. Overall, 134 (25%) of subjects were classified as food insecure. Food insecurity was associated with lower household incomes and physical disability. Food insecure subjects were less likely to eat fruit (food insecure 40%, food secure 55%; adjusted odds ratio [OR] = 0.60, 95% CI: 0.36-0.99, P = 0.045) or green vegetables or salads (food insecure 28%, food secure 51%; adjusted OR = 0.46, 95% CI: 0.27-0.79, P = 0.005) on >/=5-6 days per week. Body mass index (BMI) was available for 467 (74%) subjects of whom 41 (9%) had BMI <20 kg/m(2), 157 (34%) had BMI 25-29 kg/m(2), and 120 (26%) had BMI >/=30 kg/m(2). Underweight (OR = 3.21, 95% CI: 1.17-8.81) was associated with food insecurity, but obesity was not (OR = 1.08, 95% CI: 0.55-2.12). CONCLUSIONS: Food insecurity was frequent at all levels of BMI and was associated with lower consumption of fruit and vegetables. Food insecurity was associated with underweight but not with present obesity.

Diabetic foot disease and foot care in a Caribbean community.

We estimated the prevalence of foot symptoms and disease and evaluated foot care practices in a primary care based sample including 2106 people with diabetes in Trinidad. Symptoms of neuropathy were reported by 1030 (49%), previous foot ulceration by 257 (12%), and amputation by 92 (4%). Previous foot ulceration was associated with longer duration of diabetes (odds ratio 1.05, (95% CI 1.04-1.06) per year) and greater severity of neuropathy symptoms (1.17 (1.10-1.24) per unit increase in score). A history of foot ulceration gave relative odds of amputation of 16.3 (8.1-32.9). In those with previous foot ulceration, 120 (47%) went barefoot in the home, and 44 (17%) went barefoot outside the house. Overall, 1491 (71%) subjects reported they cut their toenails themselves, help was provided by a friend or relative to 584 (28%) and by a nurse or chiropodist to 13 ( < 1%). Most patients (1320, 63%) reported that they would treat a cut or blister on the foot themselves, while only 650 (31%) would attend for health care. Diabetic foot disease is common but care practices predispose to foot injury. Implementation of a strategy to improve care of the feet is needed.

National survey of children's health in Trinidad and Tobago: results for weight, body mass index and skinfold thickness

OBJECTIVE: To measure weight for height and skinfold thickness as indicators of overweight and obesity in a representative sample of primary school children in Trinidad and Tobago. DESIGN AND METHODS: A cross-sectional survey was carried out. Measurements were made of children's heights, weights, triceps and subscapular skinfold thickness. Standard deviation scores (SDS) were calculated for weight and body mass index (BMI) using age and sex specific British growth reference curves for 1990 as standard. SDS for skinfolds were calculated using English children in 1990 for reference. RESULTS: Measurements were made for 6,731 children in 66 schools. After excluding missing values, data were analysed for 6,343 children. CONCLUSIONS: The pattern of fat distribution differed from the reference population. Although values for body mass index and triceps skinfold were lower, high subscapular skinfold values suggested excess central adiposity in this population.(Au)

National survey of children's health in Trinidad and Tobago: methods and results for height

OBJECTIVE: To measure height as an indicator of nutritional status in a representative sample of primary school children in Trinidad and Tobago. DESIGN AND METHODS: A cross-sectional survey was carried out. After stratifying for county, schools were sampled with probability proportional size. In each school all children were sampled from the admission class (mean age 5.8 years) and the `rising nines' (mean age 8.6 years). Measurements were made of children's heights. In order to standardize for age, standard deviation scores (SIDS or z scores) were calculated using age and sex specific British growth reference curves for 1990 as standard. In the reference population the mean (SD) SDS is 0.0 (1.0). Results were presented by sex and ethnic group. RESULTS: Measurements were made for 6,731 children in 66 schools. After excluding missing values data were analysed for 6,343 children (3065 boys and 3278 girls). In boys the mean height SIDS in those of African descent was 0.47 (1.04), in those of Indian descent 0.24 (1.08) and in those of mixed ethnicity 0.19 (1.07). The equivalent figures for girls were 0.53 (1.10), 0.19 (1.04) and 0.29 (1.12). Height SDS were higher for children aged 5-6 years than those aged 8-9 years. CONCLUSIONS: The distribution of children's heights in Trinidad and Tobago is similar to that observed in African Caribbean and Indian origin children in Britain. Overall the results suggest that nutritional conditions are as adequate as in the reference population.(Au)

Explaining variations in medical practice between government primary care health centres in Trinidad and Tobago

OBJECTIVE: We evaluated variations in care among government health centres in Trinidad and Tobago. DESIGN AND METHODS: We studied processes of care and drug prescribing for diabetes in 23 government health centres in Trinidad and Tobago. Data were abstracted from the records of 1579 subjects with clinical diabetes, related to 12 processes of care and the prescription of five hypoglycaemic drugs and six cases of anti-hypertensive drug. Health centre level variances were estimated using multilevel statistical models. RESULTS: At different health centres, the proportion of patients receiving dietary advice ranged from 6 percent ot 95 percent; blood glucose estimations ranged from 14 percent to 88 percent; and foot inspection from 3 percent to 43 percent. Using a process of care summary score ranging from zero to 12, the lowest scoring health centre achieved a mean score of 1.55 and the highest 7.45. Regression analyses showed that health centres with only one nurse or doctor at each session provided fewer processes of care. More processes of care were provided when there were more patients attending each session, or when the health centre had more items of equipment. The proportion of patients prescribed insulin ranged from 3 percent to 29 percent. Prescription of insulin was associated with younger age and male gender but not with health centre characteristics. CONCLUSIONS: Larger health centres with more staff and equipment, or with higher patient attendance rates, appeared to provide better quality care. Variations in drug utilisation were less and tended to be explained by individual patient characteristics.(Au)

Factors associated with use of private sector care among attendees at public primary care clinics

OBJECTIVE: To evaluate associations of health status and social inequalities with consultation at a private doctor among public primary care clinic attendees. DESIGN AND METHODS: The sample included 2,117 randomly selected subjects with clinical diabetes attending 35 government health centres in Trinidad and Tobago. Measures included attendance at a private doctor, the type 2 Diabetes Symptom Checklist, the SF36 questionnaire and indicators of social and economic status. RESULTS: Of the sample, 1,256 (59 percent) reported attending a private doctor, 577 (27 percent) attended a private doctor for diabetes, and 378 (18 percent) attended a private doctor regularly. Attendance at a private doctor was associated with lower SF36 score. The odds ratio for a 10 unit increase in SF36 physical component score was 0.81 (95 percent confidence interval 0.72 to 0.91). After adjusting for demographic and social factors, the relative odds were 0.89 (0.80 to 1.00). After allowing for differences in health status, those without pipe-borne water supply in the home were less likely to attend a private doctor than those with (odds ratio 0.77, 0.63 to 0.94). Those living alone were less likely to attend a private doctor than those living with their children and partner (odds ratio 0.60, 0.43 to 0.83). CONCLUSIONS: Persons consulting doctors in the private sector had worse health status than those relying only on public care. Household rather than individual measures of lower social or economic status were associated with less access to private care in relation to need, even among those who use public sector care.(Au)

A five-year evaluation of intervention in diabetes care in Trinidad and Tobago [see comments]

AIMS: To evaluate an intervention to improve diabetes care in government-run health centres in Trinidad and Tobago over 5 years. METHODS: A cross-sectional survey of 690 subjects with clinical diabetes attending nine health centres was carried out in 1993. The intervention was: reports to the Ministry of Health, dissemination of management guidelines and annual training workshops for healthcare staff. Re-evaluation was through a survey of 1579 subjects with diabetes, attending 23 health centres in 1998. RESULTS: Comparing 1993 with 1998, foot examinations in the previous year increased from 38 (6 percent) to 346 (22 percent) and fundoscopy from 6 (1 percent) to 139 (9 percent). For subjects attending for 1 year or less, 34/96 (35 percent) had dietary advice recorded in 1993 compared with 77/143 (54 percent) in 1998. Exercise advice was recorded for 3/96 (3 percent) in 1993 and 48/143 (34 percent) in 1998. In 1993, 329 (48 percent) were taking chlorpropamide but this fell to 57 (4 percent) in 1998. Glibenclamide use increased from 214 (31 percent) to 856 (54 percent) and gliclazide from 4 (1 percent) to 205 (13 percent). In 1993, 198/338 (56 percent) of hypertensive subjects were taking Brinerdin, this fell to 56/829 (7 percent) in 1998 while use of thiazide diuretics, methyldopa and angiotensin-converting enzyme (ACE) inhibitors increased. There were no changes in indicators of metabolic control, blood pressure control or body weight. CONCLUSIONS: Use of audit data to inform health policy and practice, linked with educational interventions, may modify patterns of care in government-run primary care health centres in a middle-income country with a high prevalence of diabetes. (AU)

Relationship of health-related quality of life to symptom severity in diabetes mellitus: a study in Trinidad and Tobago

Our objective was to estimate the effect of greater symptom severity in diabetes mellitus on measures of health-related quality of life in a cross-sectional design in 35 government primary care health centres in Trinidad. Data were gathered on 2,117 subjects with clinical diabetes and analysed for 1,880 (89 percent). For each scale of the short form 36 (SF-36) questionnaire (a generic measure of health-related quality of life), scores were presented by quartile of symptom severity, measured using the Diabetes Symptom Checklist. Mean (SD) SF-36 scores were 44 (10) for the physical component score (PCS) and 45 (12) for the mental component score (MCS). Greater severity of diabetic symptoms was associated with lower scores on each of the subscales of the SF-36. Comparing lowest and highest quartiles of DSC score, the adjusted difference in PCS was -11 (95 percent confidence interval -12 to -9) and for MCS -16 (-18 to -14). Our results provide standardised data for health related quality of life in relation to severity of illness from diabetes, these might be used to aid the evaluation of relevant interventions.(Au)

A 4-year evaluation of blood pressure management in Trinidad and Tobago

This paper reports a 4-year evaluation of government primary care services in Trinidad and Tobago. The sample included 16 primary care health centres in Trinidad and Tobago with cross-sectional surveys of adult attenders in 1994 and 1998. Data were obtained from clinic records including details of processes of care, drug utilisation and blood pressure (BP) control. Intervention following the initial survey was by means of reports to the Ministry of Health and annual training workshops for medical officers. Data were analyzed for 1759 adult attenders at study clinics (981 in 1994 and 778 in 1998). Most attenders had blood pressure recorded (96 percent in 1994 and 98 percent in 1998). Among 1176 subjects with hypertension (BP > or = 160/95 mm Hg or treated with drugs) the proportion with dietary advice ever recorded increased from .139/662 (21 percent) in 1994 to 185/514 (36 percent) in 1998, and recording of exercise advice increased from 36 (5 percent) in 1994 to 99 (19 percent) in 1998. Among subjects treated with drugs, use of Brinerdin decreased from 191/625 (31 percent) in 1994 to 29/486 (6 percent) in 1998, while use of diuretics, beta-blockers, calcium antagonists and ACE inhibitors increased. The proportion of patients with blood pressure adequately controlled (<160/95 mm Hg) was 338 (51 percent) in 1994 and 297 (58 percent) in 1998 (odds ratio 1.39, 95 percent confidence interval 0.96 to 2.00). An audit study used to inform health care policy, staff training and clinical practice may contribute to improving processes of hypertension management in a middle-income country like Trinidad and Tobago.(Au)

Acute severe asthma in Trinidad and Tobago

SETTING: Accident and emergency department, General Hospital, Port of Spain, Trinidad and Tobago. OBJECTIVE: To measure the occurrence and clinical management of acute severe asthma. DESIGN: Data collected prospectively for consecutive attendees with asthma over a period of 3 months. RESULTS: Asthma accounted for 8.8 percent of attendances. Treatment for the acute attack included nebulised salbutamol in 1031 (85 percent) and nebulised atrovent in 769 (63 percent). Systemic corticosteroids were given to 623 (51 percent) patients. Only 247 (20 percent) had planned follow-up arrangements recorded. Usual maintenence treatment inlcuded inhaled salbutamol in 767 (63 percent) and inhaled corticosteroid in 286 (24 percent). Inhaled corticosteroids were more often used by patients aged > or =15 years or who had had previous hospital admissions for asthma. CONCLUSION: The survey identified deficiencies in the clinical management of acute asthma attacks and in longterm asthma care. Caribbean guidelines for asthma care have subsequently been published, and follow-up surveys should be carried out to evaluate their implementation.(Au)

Evaluation of a home kit blood glucose monitoring device

A blood glucose monitoring device, the *Diascan, is commonly used in Trinidad and Tobago. A prospective study was conducted to examine the accuracy of a Diascan unit in measuring blood glucose levels in or capillary venous blood of patients in a hospital ward. The Diascan measurements were compared to those from two laboratories which independently measured the venous blood or the venous plasma glucose levels. Although there was reasonably good correlation between measurements from the two laboratories (r=0.85) results from the Diascan showed poor correlations with those from the laboratories, with Pearson's correlation coefficients ranging from 0.32 to 0.64. An error grid analysis showed that the Diascan measurements would have resulted in inappropriate decisions relating to treatment regimens in 26 percent of cases. The results suggest that, when crucial deisions have to be made with respect to patients' blood glucose levels, it may be risky to rely solely on measurements from the Diascan.(AU)

Stroke in Trinidad and Tobago: burden of illness and risk factors

This study describes the burden of stroke on hospital services in a Caribbean community. The settings are the two main acute general hospitals in Trinidad observed over a 12-month period. All subjects were admitted with a clinical diagnosis of acute stroke. The measures were hospital admission rates, length of hospital stay, case-fatality rates, disability at discharge, and risk factors for stroke. There were 1 105 hospital admissions with a diagnosis of stroke. The median length of stay was 4 days, with an interquartile range of 2 to 9, and stroke accounted for approximately 9 478 bed days per annum. The hospital admission fatality rate was 29 percent. Among surviving patients, 437 (56 percent) were severely disabled at discharge. Age-standardized admission rates for first strokes in persons aged 35-64 years were 114 (95 percent CI: 83 to 145) per 100 000 in Afro-Trinidadian men and 144 (109 to 179) in Indo-Trinidadian men. The equivalent rates for women were 115 (84 to 146) and 152 (118 10186). Among patients with first strokes, 348/531 (66 percent) reported physician-diagnosed hypertension, but only 226 (65 percent) of these reported being on antihypertensives at admission. Stroke in Trinidad and Tobago is associated with a high case-fatality rate and severe disability in survivors. Modifiable risk factors were reported in a majority of stroke cases, and there is a need to develop effective preventive strategies (AU)