Magnitude, distribution, and estimated level of underreporting of acute gastroenteritis in Jamaica.

Jamaica is the third largest island in the Caribbean. The epidemiology of acute gastroenteritis (AGE) is important to Jamaica, particularly in the areas of health, tourism, and because of the potential impact on the local workforce and the economy. Data collected by the National Surveillance Unit on the prevalence of AGE transmitted by food are not accurate. To determine the true magnitude, risk factors, and the extent of underreporting of AGE in Jamaica, we conducted a cross-sectional, population-based retrospective survey during the periods of 21 February-7 March and 14-27 June 2009, corresponding to high- and low-AGE season respectively. Of the total 1,920 persons selected randomly by a multistage cluster-sampling process, 1,264 responded (response rate 65.8%). Trained interviewers administered a standardized, validated questionnaire during face-to-face interviews. The overall prevalence of self-reported AGE was 4.0% (95% CI 2.9-5.1) at a rate of 0.5 episodes/per person-year. The highest monthly prevalence of AGE (14.6%) was found among the 1-4 year(s) age-group and the lowest (2.1%) among the 25-44 years age-group. Of the 18 cases (36%) who sought medical care, 11% were hospitalized, 33% were treated with antibiotics, and 66.7% received oral rehydration fluids. Only 2 cases who sought medical care reportedly submitted stool specimens. The mean duration of diarrhoea was 3.1 days, which resulted in a mean loss of 4 productive days, with over half of the cases requiring someone to care for them. The burden of syndromic AGE for 2009 was extrapolated to be 122,711 cases, showing an underreporting factor of 58.9. For every laboratory-confirmed AGE case, it was estimated that 383 more cases were occurring in the population. This research confirms that the prevalence of AGE is underreported in Jamaica and not being adequately detected by the current surveillance system. The components of the integrated surveillance system for AGE in Jamaica, particularly the laboratory aspect, need to be strengthened.

Asbestos in public hospitals: are employees at risk?

Asbestos is an established human carcinogen. Asbestos-containing building materials (ACBM) are used in surfacing materials, thermal system insulation (TSI), and miscellaneous materials, and they have been used in buildings in Jamaica in the past. The objective of the study described here was to identify ACBM, its characteristics, and its determinants in Jamaican hospitals. A walk-through survey of all hospitals was undertaken and 152 bulk samples were collected from 26 public and private hospitals. The samples were analyzed using polarized light microscopy. Sixteen (61.5%) hospitals had ACBM used mainly as TSI. The ACBM in most cases was friable and in a poor condition indicative of fiber release and contained the fibers chrysotile, amosite, and crocidolite. The age of hospitals was not associated with the presence of ACBM. Results indicated potential risk of asbestos exposure in hospitals. The hospital authorities should formulate and implement an asbestos policy for hospitals and undertake proper management of asbestos in all hospitals.

South-to-North, cross-disciplinary training in global health practice: ten years of lessons learned from an infectious disease field course in Jamaica.

Global commerce, travel, and emerging and resurging infectious diseases have increased awareness of global health threats and opportunities for collaborative and service learning. We review course materials, knowledge archives, data management archives, and student evaluations for the first 10 years of an intensive summer field course in infectious disease epidemiology and surveillance offered in Jamaica. We have trained 300 students from 28 countries through collaboration between the University of the West Indies and U.S. partner universities. Participants were primarily graduate students in public health, but also included health professionals with terminal degrees, and public health nurses and inspectors. Strong institutional synergies, committed faculty, an emphasis on scientific and cultural competencies, and use of team-based field research projects culminate in a unique training environment that provides participants with career-developing experiences. We share lessons learned over the past decade, and conclude that South-to-North leadership is critical in shaping transdisciplinary, cross-cultural, global health practice.

Exploring the relationships between dengue fever knowledge and Aedes aegypti breeding in St Catherine Parish, Jamaica: a pilot of enhanced low-cost surveillance.

PURPOSE: Dengue fever has re-emerged as an increasingly significant global health threat amid diminishing resources pledged for its control in developing nations. Efforts to limit breeding of the dengue vector Aedes aegypti are often hampered by lack of community awareness of the disease. METHODS: Sixty-eight households in St Catherine Parish, Jamaica completed a pilot knowledge, attitude, and practice questionnaire as part of a routine container survey for presence of A. aegypti larvae. RESULTS: Infestation levels were high according to traditional Stegomyia indices (Breteau index = 325); however, general knowledge of dengue symptoms, A. aegypti breeding sites, and preventive practices was low. After examining the links between demographic characteristics, dengue knowledge, and the number of breeding sites per house, higher educational achievement was associated with higher dengue knowledge, but also with more unprotected containers. Overall dengue knowledge was not associated with household container counts. Spatial statistics identified weak clustering of larvae-positive containers, and larvae were concentrated in three key container types. CONCLUSION: Residents may only understand the role of certain container types, and significant gaps in general knowledge of the disease may inhibit vector control. This pilot demonstrates the feasibility of conducting inexpensive, rapid assessment of community knowledge and breeding levels for local governments lacking the resources for a more methodologically robust vector assessment strategy.

Rodent control in restaurants in the New Kingston area

Rodent infestation in New Kingston poses a serious threat to food safety and to the health of patrons who consume food prepared in restaurants there. This study sought to determine the level of rodent infestation in restaurants in New Kingston as well as the knowledge, attitudes and practices of managers and staff in relation to rodent control. A sample of 27 restaurants was selected. Inspections were carried out at each restaurants and a questionnaire was administered to managers and staff members. The results showed that 13.6 percent of the restaurants were infested with rats while 63.6 percent of the restaurants were not rodents proof. Refuse storage outside restaurants was generally unsatisfactory. Respondents from the local restaurants exhibited more in-depth knowledge about rodents than their counterparts in restaurants affiliated to overseas food chains. There was a significant association between the category of restaurant and the knowledge of respondents with respect to the difference between rats and mice. The attitude of respondents to rodent control was generally positive. The study concluded that the proliferation of rodents in New Kingston could lead to food contamination in restaurants. There is need for education of staff, improved solid waste management and more effective rodent control measures in restaurants and other premises in New Kingston.(Au)