Chronic disease control and compliance - the HOPE worldwide Jamaica experience

HOPE worldwide Jamaica has provided mobile curative and preventative services to fourteen rural government clinics since 1994. The patients records of 1,091 chronic disease patients, aged>30 years between January and December 1999 were reviewed. They were all above 30 years of age with an average age of 64 years; 81 percent were female and 60 percent were hypertensive, 16 percent diabetic and 24 percent had both diabetes and hypertension. There were 2,390 visits for hypertension, with an average of 2 visits per patient. Thirty-four per cent of patients had BP of < 140/90 mmHg while 43 percent had BP < 160/95 mmHg. Compliance was defined as daily consistency in taking prescribed medication. Forty-four per cent of hypertensive were non-compliant at the time of their visit. Anti-hypertensive treatment included thiazide diuretics (65 percent), reserpine (50 percent), ACE inhibitors (30 percent) and methyldopa (5 percent). There were 1,129 visits for diabetes, with an average of 2 visits for diabetes, with an average of 2 visits per patient. Twenty-four per cent of diabetic patients were controlled to fasting blood glucose FBG levels of <6.7 mmol/l and 38 percent controlled to (FBG) levels <8 mmol/l. Thirty per cent of diabetics were non-complaint at the time of their visit. The most frequently used oral hypoglycaemic agents were metformin (78 percent), glyburide (43 percent) and chlorpropamide (30 percent). Fourteen per cent of diabetics were on treatment with insulin 70/30 (12 percent) and lente insulin (2 percent). Electrocardiograms (ECG) were done on 24 percent (n=267) of patients in the previous two years. Thirty-six percent had evidence of left ventricular hypertrophy and 15 percent had evidence of ischaemic heart disease. The level of blood pressure and blood glucose control is inadequate, despite the provision of regular monitoring, surveillance and improved access to pharmaceuticals. It is perceived that poor socioeconomic conditions, lack of education, cultural beliefs, in addition to other factors, continue to militate against improved compliance and control.(Au)

Centre for HIV/AIDS research, education and services (CHARES): a model for intervention of HIV disease for developing countries

The Centre for HIV/AIDS Research, Education and Services was accepted as part of the Community Outreach Services of the University Hospital of the West Indies (UHWI) in 1989. The objective of the Centre was to enable persons living with HIV disease and their families to grasp the opportunities available to them to live dignified and productive lives. This study was conducted to assess the impact of utilization of services provided by the Centre. The records of clients enrolled in the centre from November 1995 to December 1997 were reviewed. The main variables examined were: age, gender, address, marital and employment status, referral source, household member composition and psychosocial assessment at initial interview and intervention. The results showed that the majority of clients were aged 20 to 49 years. 69 percent originated from the Kingston and St Andrew Metropolitan area. At least 42 percent were unemployed at the time of the initial interview. The majority were referred from UHWI and Kingston/St. Andrew non-governmental agencies and health centres. In 50 percent of cases the reason for referral was for counselling, education and involvement in support groups. Approximately 30 percent of clients had not disclosed their status to anyone at the point of initial interview and another 33 percent were going through the stages of grief reaction. The results suggested that a large percentage of clients utilizing the Centre were single, unemployed adults in the productive age groups, many of whom had limited psychosocial support. Future study is needed to evaluate the impact of interventions on the lives of these individuals.(AU)

Early results of a diabetes mellitus survey in eight communities in Jamaica

Diabetes mellitus is a major cause of mortality in Jamaica and ranks fourth as the prinicpal cause of death among Jamaicans during the period 1990 to 1994 (PAHO/WHO, 1996). This is probably due to its high prevalence, with 50 percent previously undiagnosed, and poor control among those who were previously diagnosed. The data being presented were derived from a two day mass screening of residents in one urban and seven rural communities in four parishes in the south east region of Jamaica in October 1997. A total of 1 726 persons aged 15 years and older revealed an estimated point prevalences of 17.6 percent (304/1726). More than half of the persons with diabetes were not previously diagnosed. Of known diabetics who had fasting blood sugar measurement, more than half (51.4 percent, 18/35) had abnormally elevated blood glucose levels. 30/118 (25.5 percent) known diabetics considered themselves non-complaint to regular treatment for their condition. This report underlined the importance of screening, instituting proper management and regular follow up by the health team and compliance by patients.(AU)

Cutaneous furncular myiasis in a Jamaican resident

Data are presented on a case of cutaneous furuncular myiasis in a Jamaican resident. This condition is virtually unknown in the Caribbean, but is endemic in Central and South America. The infection, which was caused by Dermatobia hominis, was acquired in Belize and was misdiagnosed and treated as infected insect bites. Cutaneous furuncular myiasis should be considered in patients with sub-acute inflammatory nodular skin lesions with a history of recent travel to endemic countries (AU)

Cutaneous furncular myiasis in a Jamaican resident

Data are presented on a case of cutaneous furuncular myiasis in a Jamaican resident. This condition is virtually unknown in the Caribbean, but is endemic in Central and South America. The infection, which was caused by Dermatobia hominis, was acquired in Belize and was misdiagnosed and treated as infected insect bites. Cutaneous furuncular myiasis should be considered in patients with sub-acute inflammatory nodular skin lesions with a history of recent travel to endemic countries

Evaluation of antibacterial activity of cefotaxime after eight years of its usage at the University Hospital of the West Indies - abstract

Cefotaxime is one of the commonly used third generation cephalosporines in many parts of the world. The antibiotic was introduced at the University Hospital of the West Indies in 1983 and its use is being closely monitored by the Department of Microbiology. After 8 years of judicious usage, we evaluated the efficacy of cefotaxime against 493 multi-resistant strains (strains resistant to 3 or more antibiotics) of gram-negative bacilli, except pseudomonas, encountered during the period January, 1991 to November, 1992 in this hospital. The vast majority of strains tested (66 per cent) were resistant to 5 or 6 antibiotics. Cefotaxime was effective against 94 per cent of resistant E. coli, 90 per cent of Klebsiella and 100 per cent of Proteus mirabilis strains. These 3 organisms together account for over one-half of all Gram-negative infections in this hospital. Overall, the compound was effective against 86 per cent of all multi-resistant strains encountered during the period. Of the 68 cefotaxime-resistant isolates, 20 (30 per cent) were Enterobacter and 28 (41 per cent) were Acinetobacter strains. Bacterial resistance to third generation cephalosporins such as cefotaxime is often due to the production of an extended spectrum chromosomal class-1 betalactamase. The gene encoding this enzyme has translocated and is also found on the plasmid site. Potential for increase in resistance to these antibiotics by increase in usage therefore exists and is being reported in recent years. It is therefore essential that hospitals institute appropriate antibiotic policies for judicious usage of cefotaxime and other valuable broad spectrum agents to prolong the life span of these antibiotics and retain their value as antibiotics of last resort (AU)

Increasing incidence of penicillin and tetracycline resistance in strains of Neisseria gonorrhoeae isolated from patients at the University Hospital of the West Indies, Jamaica - abstract

The levels of resistance to penicillin and tetracycline in strains of Neisseria gonorrhoeae from patients at the University Hospital of the West Indies, Jamaica between 1989 and 1991 were analysed and the data compared with those obtained ten years ago in 1980 - 1981. Virtually all strains were susceptible to both the antibiotics in 1980 - 1981. Only one out of 143 was found to be resistant during that period. The levels of resistance, however, have increased over the years. In 1989, 16 out of 67 or 24 percent of the strains were resistant to pencillin and this increased to 40 percent in 1991. Tetracycline resistance was low in 1989 (1.5 percent). This, however, has increased dramatically in 1990 and 1991 to attain levels of 25 percent and 44 percent, respectively. By 1991, 21 percent of all strains were resistant simultaneously to both penicillin and tetracycline. The results suggest that penicillin and tetracycline should no longer be the front line antibiotics for the empirical therapy of gonococcal infections. The therapy should be guided by the susceptibility data and hence the need for routine culture of specimens in the diagnosis of gonococcal infections. Ceftriaxone, cefuroxime, quinolones such as ciprofloxacin and norfloxacin, spectinomycin and erythromycin are some of the alternatives and these should be included in the susceptibility testing of gonococcal strains. There is a need for a coordinated national or regional gonococcal susceptibility programme to monitor the minimum inhibitory concentrations, betalactamase production and plasmid profile of local strain (AU)