Interaction between sex and rurality on the prevalence of diabetes in Guyana: a nationally representative study.

INTRODUCTION: Diabetes prevalence has never been measured in Guyana. We conducted a nationally representative cross-sectional study to estimate the prevalence of diabetes and pre-diabetes, and the association between sex and diabetes. RESEARCH DESIGN AND METHODS: In 2016, the Ministry of Public Health led Guyana's first national STEPS survey among adults aged 18-69 years. Half of the participants were randomly selected for hemoglobin A1c and fasting blood glucose testing. We estimated the prevalence of diabetes and pre-diabetes and measured the association between sex and diabetes prevalence using logistic regression to compute adjusted ORs. RESULTS: We included 805 adults (511 women, 294 men, mean age 41.8 (SD 14.4) years). The national prevalence of diabetes was 18.1% (95% CI: 15.4% to 20.8%), with higher rates among women (21.4%, 95% CI: 18.0% to 24.7%) than men (15.1%, 95% CI: 10.9% to 19.3%). Sex-specific diabetes prevalence varied significantly across urban and rural areas (p=0.002 for interaction). In rural areas, diabetes was twice as common among women (24.1%, 95% CI: 20.1% to 28.2%) compared with men (11.8%, 95% CI: 7.7% to 15.9%). After adjusting for prespecified covariates, rural women had double the odds of diabetes compared with rural men (OR 2.1, 95% CI: 1.20 to 3.82). This prevalence pattern was reversed in urban areas (diabetes prevalence, women: 13.9%, 95% CI: 8.7% to 19.0%; men: 22.0%, 95% CI: 12.9% to 31.1%), with urban women having half the odds of diabetes compared with urban men (OR 0.4, 95% CI: 0.20 to 0.99). We estimated that nearly one-third of women and over a quarter of men had diabetes or pre-diabetes. CONCLUSIONS: The burden of diabetes in Guyana is considerably higher than previously estimated, with an unexpectedly high prevalence among women-particularly in rural areas.

Continued Sensitivity of Plasmodium falciparum to Artemisinin in Guyana, With Absence of Kelch Propeller Domain Mutant Alleles.

Because of concerns about possible emergence of artemisinin resistance strains of Plasmodium falciparum in mining areas of the interior of Guyana, a 7-day artesunate trial was conducted from March to December 2014. The day-3 parasite clearance rate, the efficacy of artesunate at day 28, and polymorphism of Kelch 13 (PfK13)-the marker of artemisinin resistance-were assessed. The study confirmed the continued sensitivity of P falciparum to artemisinin. A 7-day course of artesunate was 100% efficacious with only 2% (95% confidence interval, .1%-10.9%) of enrolled subjects positive at day 3. All day-0 parasite samples were wild type. Continued resistance monitoring is nevertheless recommended, given the widespread availability and uncontrolled use of artemisinin drugs in mining areas of Guyana.

Leptospirosis outbreak following severe flooding: a rapid assessment and mass prophylaxis campaign; Guyana, January-February 2005.

BACKGROUND: Leptospirosis is a zoonosis usually transmitted through contact with water or soil contaminated with urine from infected animals. Severe flooding can put individuals at greater risk for contracting leptospirosis in endemic areas. Rapid testing for the disease and large-scale interventions are necessary to identify and control infection. We describe a leptospirosis outbreak following severe flooding and a mass chemoprophylaxis campaign in Guyana. METHODOLOGY/PRINCIPAL FINDINGS: From January-March 2005, we collected data on suspected leptospirosis hospitalizations and deaths. Laboratory testing included anti-leptospiral dot enzyme immunoassay (DST), immunohistochemistry (IHC) staining, and microscopic agglutination testing (MAT). DST testing was conducted for 105 (44%) of 236 patients; 52 (50%) tested positive. Four (57%) paired serum samples tested by MAT were confirmed leptospirosis. Of 34 total deaths attributed to leptospirosis, postmortem samples from 10 (83%) of 12 patients were positive by IHC. Of 201 patients interviewed, 89% reported direct contact with flood waters. A 3-week doxycycline chemoprophylaxis campaign reached over 280,000 people. CONCLUSIONS: A confirmed leptospirosis outbreak in Guyana occurred after severe flooding, resulting in a massive chemoprophylaxis campaign to try to limit morbidity and mortality.

High frequency of multidrug-resistant Mycobacterium tuberculosis isolates in Georgetown, Guyana.

Emergence of multidrug-resistant (MDR) Mycobacterium tuberculosis isolates constitutes a threat to public health worldwide. This study aimed at acquiring first epidemiological data for Guyana. Thirty-six M. tuberculosis isolates from patients of the Georgetown Chest Clinic were subjected to susceptibility testing on solid agar and in broth media. Resistance to at least one first-line drug was observed in 8 (22.2%, 95% confidence interval 8.3-36.1%) and simultaneous resistance to rifampicin and isoniazid (MDR) in 4 (11.1%, 95% confidence interval 0.6-21.6%) of the 36 isolates. The risk of infection with resistant isolates was significantly related to earlier antituberculosis therapy (P=0.040). These data indicate a high proportion of resistant M. tuberculosis isolates in Guyana and call for the implementation of control strategies based on an improved laboratory diagnosis of TB.

High frequency of multidrug-resistant Mycobacterium tuberculosis isolates in Georgetown, Guyana

Emergence of multi-drug resistance (MDR) Mycobacterium tuberculosis isolates constitutes a threat to public health worldwide. This study aimed at acquiring first epidemiological data for Guyana. Thirty-six M. tuberculosis isolates from patients of the Georgetown Chest Clinic were subjected to susceptibility testing on solid agar and in broth media. Resistance to at least one first-line drug was observed in 8 (22.2 percent, 95 percent confidence interval 8.3 -36.1 percent) and simultaneous resistance to rifampicin and isoniazid (MDR) in 4 (11.1 percent, 95 percent confidence interval 0.6-21.6 percent) of the 36 isolates. The risk of infection with resistant isolates was significantly related to earlier antituberculosis therapy (P=0.040). These data indicate a high proportion of resistant M.tuberculosis isolates in Guyana and call for the implementation of control strategies based on an improved laboratory diagnosis of TB(AU)

A study of the Knowledge, attitudes and practices of primary health care workers in the South-East region of Jamaica concerning the DOTS strategy for the control of tuberculosis

Tuberculosis is an infectious disease caused by the micro-organism Mycobacterium tuberculosis. This micro-organism can be found in about one third of the world population and causes more deaths than any other infectious agent globally. To control this deadly disease, persons ill witH TB need to take a combination of medications for a period of 6 to 8 months. Most of those suffering from TB find this difficult, and to aid in the adequate treatment of persons with the disease and protect others from it, the World Health Organisation along with others concerned about the situation, developed the directly observed treatment, short-course (DOTS) strategy. This cost effective method of treatment requires that health workers world wide observe infected persons while they take their tablets. The aim of this study was to assess the knowledge, attitudes and practices of primary health care workers about the treatment and control of TB using the directly observed treatment, short-course (DOTS) strategy. Data were collected using a questionnaire administered to a sample of selected categories of health workers in the study area. Additionally, three selected key informants from the Jamaican health services were interviewed. One hundred and seventy respondents from five categories, (medical officers, nurses, public health inspectors, community health aids and contact investigators) completed questionnaires. The study found that primary health care workers in Jamaica are very willing to participate in this global effort. They feel confident that once they are given the right tools to work with they can contribute ... The study recommends a review of the progress of the implementation program, preparation of a revised plan of action will all involved in TB control activities and institution of training programs throughout the health service on this "health breakthrough of the 1990's" (AU)

A study of the knowledge, attitudes and practices of primary health care workers in the south-east region of Jamaica concerning the DOTS strategy for the control of tuberculosis

Tuberculosis is an infectious disease caused by the micro-organism Mycobacterium tuberculosis. This micro-organism can be found in about one third of the world population and cause more deaths than any other infectious agent globally. To control this deadly disease, persons ill with TB need to take a combination of medications for a period of 6 to 8 months. Most of those suffering from TB find this difficult, and to aid in the adequate treatment of persons with the disease and protect others from it, the World Health Organization along with others concerned about the situation, developed the directly observed treatment, short-course (DOTS) strategy. This cost effective method of treatment requires that health workers world wide observe infected persons while they take their tablets. The aim of this study was to assess the knowledge, attitudes and practices of primary health workers about the treatment and control of TB using the directly observed treatment, short-course (DOTS) strategy. Data were collected using a questionnaire administered to a sample of selected categories of health workers in the study area. Additionally, three selected key informants from the Jamaican health services were interviewed. One hundred and seventy respondents from five categories, (medical officers, nurses, public health inspectors, community health aids and contact investigators) completed questionnaires. The study found that primary health care workers in Jamaica are very willing to participate in this global effort. They feel confident that once they are given the right tools to work with they can contribute in some way to ridding the world of this ancient killer. The most important workers in the execution of the activities of the strategy in the South East Region of Jamaica, where the study was done were the community health aids, contact investigators and the nurses. Their basic knowledge about TB and DOTS was very limited despite the fact that the Ministry of Health has implemented the strategy about four years ago. The in-depth interviews, however, revealed that there are some challenges in the implementation of the strategy and questioned its usefulness in Jamaica presently. The study recommends a review of the progress of the implementation program, preparation of a revised plan of action with all involved in TB control activities and institution of training programs throughout the health service on this "health breakthrough of the 1990's".(Au)