Circulating Anodic Antigen (CAA): A Highly Sensitive Diagnostic Biomarker to Detect Active Schistosoma Infections-Improvement and Use during SCORE.

The Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) was funded in 2008 to conduct research that would support country schistosomiasis control programs. As schistosomiasis prevalence decreases in many places and elimination is increasingly within reach, a sensitive and specific test to detect infection with Schistosoma mansoni and Schistosoma haematobium has become a pressing need. After obtaining broad input, SCORE supported Leiden University Medical Center (LUMC) to modify the serum-based antigen assay for use with urine, simplify the assay, and improve its sensitivity. The urine assay eventually contributed to several of the larger SCORE studies. For example, in Zanzibar, we demonstrated that urine filtration, the standard parasite egg detection diagnostic test for S. haematobium, greatly underestimated prevalence in low-prevalence settings. In Burundi and Rwanda, the circulating anodic antigen (CAA) assay provided critical information about the limitations of the stool-based Kato-Katz parasite egg-detection assay for S. mansoni in low-prevalence settings. Other SCORE-supported CAA work demonstrated that frozen, banked urine specimens yielded similar results to fresh ones; pooling of specimens may be a useful, cost-effective approach for surveillance in some settings; and the assay can be performed in local laboratories equipped with adequate centrifuge capacity. These improvements in the assay continue to be of use to researchers around the world. However, additional work will be needed if widespread dissemination of the CAA assay is to occur, for example, by building capacity in places besides LUMC and commercialization of the assay. Here, we review the evolution of the CAA assay format during the SCORE period with emphasis on urine-based applications.

Survey of Schistosomiasis in Saint Lucia: Evidence for Interruption of Transmission.

Saint Lucia at one time had levels of schistosomiasis prevalence and morbidity as high as many countries in Africa. However, as a result of control efforts and economic development, including more widespread access to sanitation and safe water, schistosomiasis on the island has practically disappeared. To evaluate the current status of schistosomiasis in Saint Lucia, we conducted a nationally representative school-based survey of 8-11-year-old children for prevalence of Schistosoma mansoni infections using circulating antigen and specific antibody detection methods. We also conducted a questionnaire about available water sources, sanitation, and contact with fresh water. The total population of 8-11-year-old children on Saint Lucia was 8,985; of these, 1,487 (16.5%) provided urine for antigen testing, 1,455 (16.2%) provided fingerstick blood for antibody testing, and 1,536 (17.1%) answered the questionnaire. Although a few children were initially low positives by antigen or antibody detection methods, none could be confirmed positive by follow-up testing. Most children reported access to clean water and sanitary facilities in or near their homes and 48% of the children reported contact with fresh water. Together, these data suggest that schistosomiasis transmission has been interrupted on Saint Lucia. Additional surveys of adults, snails, and a repeat survey among school-age children will be necessary to verify these findings. However, in the same way that research on Saint Lucia generated the data leading to use of mass drug administration for schistosomiasis control, the island may also provide the information needed for guidelines to verify interruption of schistosomiasis transmission.

MMR2 vaccination coverage and timeliness among children born in 2004 - 2009: a national survey in Saint Lucia, 2015 / Cobertura de vacunación y respeto de los plazos de la segunda dosis de la vacuna triple viral en los niños nacidos en el período 2004-2009: encuesta nacional realizada en Santa Lucía en el 2015 / Cobertura e momento oportuno de vacinação da segunda dose da vacina tríplice viral em crianças nascidas em 2004-2009: pesquisa nacional em Santa Lúcia, 2015

ABSTRACT Objectives To more accurately determine coverage and timeliness of the second dose of measles-mumps-rubella vaccine (MMR2), while identifying factors associated with low MMR2 vaccination uptake among children in Saint Lucia. Methods A survey was conducted in October - November 2015 targeting children born in 2004 - 2009. At 86 preschools and primary schools, two children from each grade were randomly selected, yielding an effective sample of 836 children. Health records were reviewed to assess vaccination coverage and timeliness. Parents and/or guardians and principals of all 86 schools were interviewed regarding knowledge, attitudes, and practices related to vaccination. Results Of 767 children included, 75% were vaccinated with MMR2 (n = 572); 46.7% were vaccinated in a timely manner, i.e., by 5 years of age. Cohorts born in 2004, 2005, and 2008 reported the lowest proportion. 'Mothers as caregivers' was positively associated with timely MMR2 vaccination. Although 97% of principals surveyed considered vaccination important, 48.8% were not aware of national legislation requiring complete vaccination prior to school entry. Survey results concurred with the low MMR2 administrative coverage rates reported by Saint Lucia, much lower than the recommended 95%. Conclusions Based on the results of this survey, Saint Lucia's national immunization program has lowered the age of MMR2 to 18 months in 2016, increased advocacy with schools to enforce the school-entry law, and is working to vaccinate the cohorts of children who have not received timely MMR2.

RESUMEN Objetivos Determinar con mayor precisión la cobertura y el respeto de los plazos de vacunación de la segunda dosis de la vacuna contra el sarampión, la rubéola y la parotiditis (triple viral), al tiempo que se detectan los factores asociados con la baja aceptación de esa vacuna en Santa Lucía. Métodos En octubre y noviembre del 2015 se llevó a cabo una encuesta centrada en niños nacidos entre el 2004 y el 2009. En 86 centros preescolares y primarios se seleccionó al azar a dos niños de cada grado, lo que arrojó un tamaño real de la muestra de 836 niños. Se analizaron los registros de salud para evaluar la cobertura y el respeto de los plazos de vacunación. Se entrevistó a los padres o tutores y los directores de las 86 escuelas sobre conocimientos, actitudes y prácticas en materia de vacunación. Resultados De los 767 niños incluidos, el 75% fueron vacunados con la segunda dosis de la triple viral (n = 572); el 46,7% fueron vacunados a tiempo, es decir, a los 5 años de edad. La proporción más baja se dio en las cohortes nacidas en el 2004, 2005 y 2008. Se observó que las madres cuidadoras influían positivamente en el respeto de los plazos de vacunación de la segunda dosis de la triple viral. Aunque el 97% de los directores encuestados consideraba que la vacunación era importante, el 48,8% desconocía la legislación nacional que exige la vacunación completa antes de ingresar a la escuela. Los resultados de la encuesta estaban en consonancia con las tasas bajas de cobertura administrativa de la segunda dosis de la triple viral informadas por Santa Lucía, muy por debajo del 95% recomendado. Conclusiones Según los resultados de esta encuesta, el programa nacional de vacunación de Santa Lucía redujo la edad de la segunda dosis de la triple viral a los 18 meses en el 2016, aumentó las actividades de promoción en las escuelas para fomentar el cumplimiento de la ley que obliga a recibir la vacunación antes de ingresar a la escuela y está trabajando para vacunar a las cohortes de niños que no recibieron la segunda dosis de la triple viral en su debido momento.

RESUMO Objetivos Determinar com precisão a cobertura vacinal e o momento oportuno para ministrar a segunda dose da vacina tríplice viral (sarampo, caxumba e rubéola - SCR) e identificar os fatores associados à baixa utilização da vacina em crianças. Métodos Uma pesquisa direcionada a crianças nascidas de 2004 a 2009 foi realizada em Santa Lúcia em outubro e novembro de 2015. Em 86 unidades de ensino infantil e fundamental, duas crianças de cada série foram selecionadas aleatoriamente, constituindo uma amostra efetiva de 836 crianças. Dados sobre a cobertura e o momento oportuno de vacinação foram obtidos das fichas de saúde. Foram conduzidas entrevistas com os pais e/ou responsáveis e os diretores das 86 escolas sobre conhecimento, atitudes e práticas relacionadas à vacinação. Resultados Das 767 crianças incluídas na amostra, 75% foram vacinadas com a segunda dose de SCR (n = 572) e 46,7% receberam a vacina no momento oportuno (ou seja, até os 5 anos de idade). Observou-se menor proporção de vacinados nas coortes nascidas em 2004, 2005 e 2008. "Mães como cuidadoras" teve uma associação positiva com ministrar a segunda dose de SCR no momento oportuno. Apesar de 97% dos diretores entrevistados considerarem a vacinação importante, 48,8% desconheciam a legislação nacional que exige vacinação completa para a matrícula escolar. Os resultados reforçaram a baixa cobertura vacinal da segunda dose de SCR registrada em Santa Lúcia, bem inferior ao índice recomendado de 95%. Conclusões A partir dos resultados desta pesquisa, em 2016, o programa nacional de vacinação de Santa Lúcia reduziu para 18 meses a idade de administração da segunda dose de SCR, intensificou a recomendação para que as escolas cumpram com a legislação para matrícula escolar e está empenhado em vacinar as coortes de crianças que não receberam a segunda dose de SCR no momento oportuno.

Reducing Health Disparities and Improving Health Equity in Saint Lucia.

St. Lucia is an island nation in the Eastern Caribbean, with a population of 179,000 people, where chronic health conditions, such as hypertension and diabetes, are significant. The purpose of this pilot study is to create a model for community health education, tracking, and monitoring of these health conditions, research training, and policy interventions in St. Lucia, which may apply to other Caribbean populations, including those in the U.S. This paper reports on phase one of the study, which utilized a mixed method analytic approach. Adult clients at risk for, or diagnosed with, diabetes (n = 157), and health care providers/clinic administrators (n = 42), were recruited from five healthcare facilities in St. Lucia to assess their views on health status, health services, and improving health equity. Preliminary content analyses indicated that patients and providers acknowledge the relatively high prevalence of diabetes and other chronic illnesses, recognize the impact that socioeconomic status has on health outcomes, and desire improved access to healthcare and improvements to healthcare infrastructures. These findings could inform strategies, such as community education and workforce development, which may help improve health outcomes among St. Lucians with chronic health conditions, and inform similar efforts among other selected populations.

Selective laser trabeculoplasty for the management of open-angle glaucoma in St. Lucia.

OBJECTIVE: To evaluate the efficacy of selective laser trabeculoplasty (SLT) for the treatment of primary open-angle glaucoma in an African-derived population in the developing world. METHODS: Sixty-one subjects from St. Lucia with medically treated primary open-angle glaucoma underwent a 30-day washout, followed by bilateral 360° SLT. Intraocular pressure (IOP) was measured 1 hour; 1 week; and 1, 3, 6, 9, and 12 months after SLT. RESULTS: Mean (SD) IOP with medical therapy was 17.3 (5.0) mm Hg and 17.5 (4.0) mm Hg in the right and left eyes, respectively, and increased to 21.4 (3.6) mm Hg and 21.1 (3.5) mm Hg, respectively, after washout. Both eyes demonstrated a prompt and sustained IOP response to SLT therapy. Intraocular pressure dropped significantly by the first week and remained in the range of 13 to 14 mm Hg without medical therapy through 12 months in patients deemed successful. The mean IOP reductions from baseline ranged from 7.3 to 8.3 mm Hg (34.1%-38.8%) in right eyes and from 7.6 to 8.2 mm Hg (36.0%-38.9%) in left eyes through 12 months. The 12-month Kaplan-Meier survival rate (≥10% IOP reduction from postwashout baseline) was 77.7%, and 93% of successful subjects experienced IOP levels less than with-medication values. Most subjects reported moderate photophobia for 2 to 3 days after SLT; only 1 received anti-inflammatory therapy. Five eyes of 3 subjects had IOP spikes between 5 and 10 mm Hg that resolved without treatment. CONCLUSIONS: The magnitude and duration of IOP reduction are clinically relevant in individuals from St. Lucia of African descent. If repeatable, SLT could be a powerful tool for reducing glaucoma-related blindness in this population.

Estimating the burden of acute gastrointestinal illness: a pilot study of the prevalence and underreporting in Saint Lucia, Eastern Caribbean.

Saint Lucia was the first country to conduct a burden of illness study in the Caribbean to determine the community prevalence and underreporting of acute gastroenteritis (AGE). A retrospective cross-sectional population survey on AGE-related illness was administered to a random sample of residents of Saint Lucia in 20 April-16 May 2008 and 6-13 December 2009 to capture the high- and low-AGE season respectively. Of the selected 1,150 individuals, 1,006 were administered the survey through face-to-face interviews (response rate 87.4%). The overall monthly prevalence of AGE was 3.9%. The yearly incidence rate was 0.52 episodes/person-year. The age-adjusted monthly prevalence was 4.6%. The highest monthly prevalence of AGE was among children aged < 5 years (7.5%) and the lowest in persons aged 45-64 years (2.6%). The average number of days an individual suffered from diarrhoea was 3.8 days [range 1-21 day(s)]. Of the reported AGE cases, only seven (18%) sought medical care; however, 83% stayed at home due to the illness [(range 1-16 day(s), mean 2.5]; and 26% required other individuals to take care of them. The estimated underreporting of syndromic AGE and laboratory-confirmed foodborne disease pathogens was 81% and 99% respectively during the study period. The economic cost for treating syndromic AGE was estimated at US$ 3,892.837 per annum. This was a pilot study on the burden of illness (BOI) in the Caribbean. The results of the study should be interpreted within the limitations and challenges of this study. Lessons learnt were used for improving the implementation procedures of other BOI studies in the Caribbean.

Motorcycle trauma in a St Lucian hospital / Traumas por motocicletas en un hospital de Santa Lucía

OBJECTIVE: A motorcycle is a single-track, two-wheeled motor vehicle that is used worldwide for transportation. The use of the motorcycle has resulted in trauma that is associated with significant morbidity and mortality. The aim of this study is to document the pattern of motorcycle accidents and the demographics of the cyclists in St Lucia. METHOD: This is a 15-month prospective study on all patients with motorcycle injuries that reported to the emergency room at the Victoria Hospital. Information on patients: age, gender, helmet use, intake of alcohol/drugs before the motorcycling and mechanism of injury were obtained and filled into a prepared proforma by the attending physician. Those admitted were followed-up to know the outcome and complications of treatment. RESULTS: Total number of patients studied was 136 in 115 accidents, males (M) were 127 while females (F) were 9, with M:F ratio of 14.1:1.0. There were 105, 28 and 3 riders, passengers and pedestrians respectively; 87.5 % of the patients were below the age of 35 years. Fifty-three per cent of the accidents occurred over the weekend. The limbs were mostly injured, constituting 81.9% of the parts of the body injured. CONCLUSION: The study revealed that young and productive males were mainly injured in motorcycle accidents and the injuries were more in the limbs. More than fifty per cent of the accidents were found to occur during the weekends and more than fifty per cent of the motorcyclists were not wearing crash helmets.

OBJETIVO: La motocicleta es un vehículo motor dos ruedas y vía única, usado mundialmente como medio de transporte. El uso de la motocicleta ha traído consigo traumas asociados con una morbilidad y una mortalidad significativas. El objetivo de este estudio es documentar el patrón de accidentes de motocicletas así como la demografía de los ciclistas en Santa Lucía. MÉTODO: Se trata de un estudio prospectivo de 15 meses en torno a pacientes con lesiones de motocicleta. Los heridos acudieron a la sala de emergencias del Hospital Victoria. Se obtuvo información sobre los pacientes - edad, género, uso del casco, consumo de alcohol/drogas antes de montar la moto, y el mecanismo de la lesión. Con la información obtenida una pro forma fue preparada por el médico asistente. A los ingresados se les hizo un seguimiento a fin de conocer la evolución clínica y las complicaciones del tratamiento. RESULTADOS: El número total de pacientes estudiados fue 136 en 115 accidentes. Los varones (M) fueron 127 mientras que las hembras (F) fueron 9, para una proporción M:F de 14.1: 1.0. Hubo 105, 28 y 3 motoristas, pasajeros y peatones respectivamente. El 87.5% de los pacientes estaban por debajo de los 35 años de edad. Cincuenta y tres por ciento de los accidentes ocurrieron durante el fin de semana. Las extremidades fueron principalmente dañadas, constituyendo el 81.9% de las partes del cuerpo lesionadas. CONCLUSIÓN: El estudio reveló que los lesionados en accidentes de motocicletas eran principalmente varones jóvenes y productivos, y que las lesiones eran mayormente en las extremidades. Se halló que más del cincuenta por ciento de los accidentes ocurrieron durante los fines de semana, y más del cincuenta por ciento de los motociclistas no llevaban el casco de protección.

Motorcycle trauma in a St Lucian hospital.

OBJECTIVE: A motorcycle is a single-track, two-wheeled motor vehicle that is used worldwide for transportation. The use of the motorcycle has resulted in trauma that is associated with significant morbidity and mortality. The aim of this study is to document the pattern of motorcycle accidents and the demographics of the cyclists in St Lucia. METHOD: This is a 15-month prospective study on all patients with motorcycle injuries that reported to the emergency room at the Victoria Hospital. Information on patients: age, gender helmet use, intake of alcohol/drugs before the motorcycling and mechanism of injury were obtained and filled into a prepared proforma by the attending physician. Those admitted were followed-up to know the outcome and complications of treatment. RESULTS: Total number of patients studied was 136 in 115 accidents, males (M) were 127 while females (F) were 9, with M:F ratio of 14.1:1.0. There were 105, 28 and 3 riders, passengers and pedestrians respectively; 87.5% of the patients were below the age of 35 years. Fifty-three per cent of the accidents occurred over the weekend. The limbs were mostly injured, constituting 81.9% of the parts of the body injured. CONCLUSION: The study revealed that young and productive males were mainly injured in motorcycle accidents and the injuries were more in the limbs. More than fifty per cent of the accidents were found to occur during the weekends and more than fifty per cent of the motorcyclists were not wearing crash helmets.

Prevalence of overweight, obesity and underweight among 5-year-old children in Saint Lucia by three methods of classification and a comparison with historical rates.

BACKGROUND: The study aimed to determine if child obesity rates have risen in the Caribbean nation of Saint Lucia, as found globally, and whether under-nutrition coexists, as in other developing nations. The average adult in Saint Lucia is overweight, thus considerable child obesity might be expected, but there are no current data. METHODS: Heights and weights were obtained from a sample (n= 425) of the 2001 birth cohort of Saint Lucian children measured during the nation-wide 2006/2007 Prior to School Entry Five-Year Assessment. Prevalence of overweight, obesity and underweight were estimated by Centers for Disease Control (CDC), Cole et al. and new World Health Organization (WHO) methods. Previously reported 1976 estimates, including children ≤60 months of age only, based on National Centre for Health Statistics curves, were adjusted to new WHO equivalents using an algorithm developed by Yang and de Onis, and compared with rates in our subsample of children ≤60 months of age (n= 99). RESULTS: Regardless of classification method, overweight and obesity rates were high: 14.4% and 9.2% (WHO); 11.3% and 12.0% (CDC); and 9.9% and 7.1% (Cole et al.), respectively. Underweight estimates also varied: 4.7% (WHO); 11.3% (CDC) and 6.6% (Cole et al.). Obesity in our young subsample (15.2%; WHO) was more than 3 times the adjusted 1976 rate (4.3%). CONCLUSIONS: Obesity among Saint Lucian pre-schoolers has tripled in 30 years. Our findings also suggest that this country, like many undergoing a 'nutrition transition', faces the dual challenge of over-nutrition and under-nutrition. Routine monitoring of overweight and underweight is needed in Saint Lucia, as is the implementation and evaluation of programmes to address these problems.

Epidemiology and control of Schistosomiasis and other intestinal parasitic infections among school children in three rural villages of south Saint Lucia.

OBJECTIVE: The purpose of this study was to determine the epidemiology of parasitic infections and the efficacy of treatment among school children in rural villages of south Saint Lucia. METHOD: A total of 554 school children participated in this study. Parasitic infections were confirmed by using Kato- Katz method. RESULTS & CONCLUSION: Overall, 61.6% of the school children were infected by any parasitic infection. The helminths identified were Ascaris lumbricoides (15.7%), Hookworm (11.9%), Strongyloides (9.7%), Trichuris trichiura (4.7%), Schistosoma mansoni (0.6%), Taenia solium (0.8%) and Enterobius vermicularis (2.1%), Entamoeba coli (9.7%), Iodameba butschlii (5%), Entamoeba histolytica (1.1%), Giardia lamblia (1.8%) and Endolimax nana (2.1%). The control intervention included treatment with albendazole 400 mg and praziquantel 40 mg/kg as well as awareness campaigns. Post-interventional assessment showed the total prevalence of intestinal parasitic infection reduced from 61.6 to 3.6% with a cure rate of 94.2%, following the control methods.

Influence of religious affiliation in alcohol use among adolescents in Trinidad, Tobago, and St. Lucia: a follow-up study.

OBJECTIVE: This study examined the effects of religious affiliation and other demographic variables in alcohol use and attitudes among adolescents in Trinidad, Tobago and St. Lucia. METHOD: The study used a stratified random sample design of 380 male and 455 female students belonging to the 3 major ethnic groups in Trinidad, Tobago and St. Lucia (Afro-Trinidadian, Indo-Trinidadian, and Mixed group). RESULTS: MANOVA showed an effect for religion, with Hindu adolescents having higher levels of regular alcohol use. CONCLUSIONS: This finding supports the existing research in Trinidad and developed countries on the effect of various religious denominations of alcohol use and attitudes.

Temporal stability of insular avian malarial parasite communities.

Avian malaria is caused by a diverse community of genetically differentiated parasites of the genera Plasmodium and Haemoproteus. Rapid seasonal and annual antigenic allele turnover resulting from selection by host immune systems, as observed in some parasite populations infecting humans, may extend analogously to dynamic species compositions within communities of avian malarial parasites. To address this issue, we examined the stability of avian malarial parasite lineages across multiple time-scales within two insular host communities. Parasite communities in Puerto Rico and St Lucia included 20 and 14 genetically distinct parasite lineages, respectively. Lineage composition of the parasite community in Puerto Rico did not vary seasonally or over a 1 year interval. However, over intervals approaching a decade, the avian communities of both islands experienced an apparent loss or gain of one malarial parasite lineage, indicating the potential for relatively frequent lineage turnover. Patterns of temporal variation of parasite lineages in this study suggest periodic colonization and extinction events driven by a combination of host-specific immune responses, competition between lineages and drift. However, the occasional and ecologically dynamic lineage turnover exhibited by insular avian parasite communities is not as rapid as antigenic allele turnover within populations of human malaria.

Risk behaviours and healthcare needs of homeless drug users in Saint Lucia and Trinidad.

In the Caribbean AIDS has become the leading cause of death among those aged 15-45. The homeless are at high risk due to the nexus of mobility, psychiatric disorders and substance use, particularly crack. Seventy-four homeless, out-of-treatment drug users were recruited in Saint Lucia and Trinidad to assess risk behaviour and healthcare needs. Information was collected in several domains: medical, mental health, substance use, sexual risk, and barriers to care. Ninety-five percent of the sample reported crack cocaine use within the previous 30 days. Approximately 35% of the sample had ever been diagnosed with a sexually transmitted disease and 25% of the sample reported being HIV+. Approximately 40% had a history of trading sex for crack or money. Due to the range of needs in this population, interventions should be multimodal. A focus on the individual, community, and structural levels is warranted to improve chances of program effectiveness.

Molecular analysis of Salmonella enteritidis isolates from the Caribbean by pulsed-field gel electrophoresis

Using pulsed-field gel electrophoresis (PFGE), between 1987 and 1996 we analyzed Salmonella enteritidis isolates from gastroenteritis cases in four Caribbean countries: Barbados, Saint Kitts and Nevis, Saint Lucia, and Trinidad and Tobago. We also determined the resistance of the isolates to 12 antimicrobial agents. Of the 129 isolates of S. enteritidis available for testing, DNA digested by Xbal revealed 13 distinctive PFGE patterns. The most prevalent Xbal PFGE patterns were group 1 (88 of 129 isolates, 68.2 percent) and group 2 (26 of 129, 20.2 percent). The patterns found among S. enteritidis isolates correlated with the geographical origin of the isolates. Of the 28 isolates from Barbados, 20 of them (71.4 percent) belonged to Xbal PFGE group 2, and of the 93 isolates from Trinidad and Tobago, 78 of them (83.9 percent) belonged to group 1. Spel digestion of S. enteritidis genome was not as discriminatory as Xbal. Overall, of the 129 isolates, 67 of them (51.9 percent) exhibited resistance to one or more of the 12 antimicrobial agents that we tested. The prevalence of resistance was 53.8 percent for the S. enteritidis isolates tested from Trinidad and Tobago, 50.0 percent for those from Barbados, 28.6 percent for those from Saint Lucia, and 100.0 percent for one isolate from the island of Saint Kitts. Resistance was highest to triple sulfur (59 of 129 isolates, 45.7 percent), followed by furadantoin (10 of 129, 7.8 percent), ampicillin (7 of 129, 5.4 percent), and carbamycin (5 of 129, 3.9 percent) (AU)

Abdominal adiposity in six populations of West African descent: prevalence and population attributable fraction of hypertension.

OBJECTIVES: The objective of this investigation was to examine the prevalence of abdominal adiposity and its association with the prevalence of hypertension among African descent populations in Nigeria, Cameroon, Jamaica, St. Lucia, Barbados, and the United States (US). RESEARCH METHOD: The data for this investigation were obtained from the International Collaborative Study on Hypertension in Blacks. Hypertension was defined as mean diastolic blood pressure > or =90 mmHg, systolic blood pressure > or = 140 mmHg or current treatment with prescribed anti-hypertension medication. Abdominal overweight was defined as waist circumference (WC) > or =94 and > or =80 cm for men and women, respectively. Abdominal obesity was defined as WC > or =102 and > or =88 cm for men and women, respectively. We estimated the site-specific prevalence of abdominal overweight and obesity across age and body mass index cut-points. We also calculated the population attributable fraction (AF) of hypertension due to abdominal adiposity. RESULTS: The prevalence of hypertension in these populations was tightly linked to abdominal adiposity. Increases in abdominal overweight accompanied an increasing degree of Westernization, rising from 6.4% and 26.3% in Nigeria, 16.5% and 62.8% in Cameroon, 15.8% and 58.6% in Jamaica, 14.3% and 62.1% in St. Lucia, 21.4% and 70.3% in Barbados to 38.9%, and 76.4% in the US for men and women, respectively. The corresponding values for abdominal obesity were 1.6% and 12.3% in Nigeria, 5.1% and 38.9% in Cameroon, 5.5% and 34.0% in Jamaica, 2.7% and 40.7% in St. Lucia, 7.8% and 44.7% in Barbados to 21.7% and 54.1% in the US for men and women, respectively. Body mass index-adjusted estimates of AF suggest that in most of these populations, especially in females, avoidance of abdominal overweight or obesity would help to curb the development of hypertension. DISCUSSION: An important public health challenge is to clarify how lifestyle factors influence risks of abdominal adiposity and ultimately the increased risk of cardiovascular diseases.

Status of cultured STDs in St. Lucia

This is a small study and by no means definitive. It raises a number of questions both medical and social. The most startling finding to us is the high GC rate in the under 13yr population. This raises the question of sexual abuse of minors and the reason for such abuse warrants further studying by the Medical and Social Services. The high percentage of "no isolates" in all groups begs the question of making chlamydia testing available. We think that such testing should be done for epidemiological reasons and for treatment. Until such testing is made available treatment of discharge in STD patients and neonatal conjunctivitis must cover both GC and chlamydia. Routine eyedrops when used at delivery should cover both organisms for the same reasons. The antibiotic resistance of Gonococcus sp. is not a major issue presently in St. Lucia, apart from the fact that it is evident that about 10-11 percent of GC is at least partially resistant to penicillin. Clinicians should bear this in mind when treating their patients. Added to this, the probable high chlamydia rate may influence clinicians to use appropriate regimens to treat patients (AU)

A study of the use and impact of pesticides in Saint Lucia

The use of chemical for pest vector control has lead to the reduction in the incidence of several communicable diseases and improvement in food quality and production. Nevertheless, the toxic properties of these pesticides present a separate threat to human health and the health of the environment. The potential for occupational exposure is of particular concern in the Caribbean where agriculture and vector control programs employ more than 40 percent of the labour force. Within Saint Lucia alone, 1,500,000 kilograms of pesticides (insecticides, fungicides and herbicides) were imported in 1990. A multi-phasic project was developed to assess and reduce the incidence of acute pesticide poisoning and the prevalence of chronic pesticide poisoning in Saint Lucia and in Trinidad and Tobago. Collaborators in this intersectoral undertaking include the Ministries of Agriculture/Health in Saint Lucia and in Trinidad and Tobago, Caribbean Environmental Health Institute (CEHI), and Caribbean Epidemiology Centre (CAREC). This paper will summarize the results of the first phase of the project: a survey of the knowledge, attitudes, practices and beliefs (KAPB) of vector control officers in Saint Lucia and members of the Saint Lucia Banana Growers Association (SLBGA)(AU)

Experiments in schistosomiasis control in St. Lucia

The comparative parasitological effectiveness and cost of three methods of reducing transmission of S. mansoni were investigated in isolated valleys in the Caribbean island of St. Lucia. Changes in incidence were assessed during four years of snail control, community based chemotherapy and when households were provided with piped water and communities with laundry and shower units. Incidence was reduced by all methods, but most rapidly by chemotherapy. It increased, however, after a few years unless either focal snail control or water supplies with laundry and shower facilities were provided. Over a nine year period, chemotherapy was shown to be the least costly method of control (US $ 0.50/person/year), but this would be reduced with the use of recently introduced technology and drugs (AU)

The relative public morbidity caused by whipworm and roundworm - abstract

The whipworm's eggs are encountered more commonly than those of any other geohelminth in the stools of West Indian children. Eighty per cent (260) of the children aged 6 months to 6 years in the village of Anse-la-Rays, St. Lucia, were examined. A detailed history was taken by questionnaire, anthropometry, physical examination performed and stools collected. The physical examination and stool collection were repeated after two to three months. Of 9 children (3.4 percent) with reported rectal prolapse, seven had faecal egg counts indicative of heavy trichuris burdens, one other stool was positive at 1,440 eggs per gram (epg). 84 percent of all children (260) had trichuris; 62 percent, ascaris; 14 percent were ó 80 percent weight for age (WA); 7 percent 90 percent height for age (HA); 52 percent ó 15cm mid upper arm circumference (MUAC). 27 children with "Heavy Trichuris" i.e. egp > 25,000 and/or rectal prolapse, were significantly different from the rest of the population being between 2 and 4 years of age, 28 percent were ó 80 percent WA and ó 90 percent HA although MUAC was not different. Stool frequently and pica were positively associated with blood mucous and sand in the stool. Thirty-six children with "Heavy Ascaris" i.e. epg > 25000, were not significantly different to the total population. Our conclusion is that whipworm may cause more objective morbidity than roundworm to children, especially those over two years old. In a hyperendemic village massive trichuriasis is one of the most common factors associated with chronic diarrhoea (AU)