The Guyana Program to Advance Cardiac Care: A Model for Equitable Cardiovascular Care Delivery.

Guyana is one of the poorest countries in South America, with the highest rate of cardiovascular mortality on the continent. As is the case in many low- and middle-income countries, cardiovascular care is available through the private sector but is not accessible to much of the urban and rural poor. We present the 10-year experience of the Guyana Program to Advance Cardiac Care (GPACC), an academic partnership aiming to provide high-quality, equitable cardiovascular care in Georgetown's only public hospital. We discuss the implementation of a cardiac care program using the World Health Organization Framework for Action, outlining vital components for care delivery in resource-limited settings. GPACC was able to demonstrate that targeted investment, education of clinicians, and cohesive healthcare delivery strategies can contribute to sustainable service delivery for Guyana's largest burden of disease. This structured approach may provide lessons for implementation of similar programs in other resource-limited settings. Highlights: In many LMICs, specialized cardiovascular care is available in the private, but not public, sector.The WHO Framework for Action can guide development of sustainable programs in low-resource settings.GPACC can serve as a successful and innovative model for delivery of sustainable cardiovascular care.

Training and implementation of handheld ultrasound technology at Georgetown Public Hospital Corporation in Guyana: a virtual learning cohort study

A virtual point-of-care ultrasound (POCUS) education program was initiated to introduce handheld ultrasound technology to Georgetown Public Hospital Corporation in Guyana, a low-resource setting. We studied ultrasound competency and participant satisfaction in a cohort of 20 physicians-in-training through the urology clinic. The program consisted of a training phase, where they learned how to use the Butterfly iQ ultrasound, and a mentored implementation phase, where they applied their skills in the clinic. The assessment was through written exams and an objective structured clinical exam (OSCE). Fourteen students completed the program. The written exam scores were 3.36/5 in the training phase and 3.57/5 in the mentored implementation phase, and all students earned 100% on the OSCE. Students expressed satisfaction with the program. Our POCUS education program demonstrates the potential to teach clinical skills in low-resource settings and the value of virtual global health partnerships in advancing POCUS and minimally invasive diagnostics.

New species and new distributional records of the hygropetric water scavenger beetle genus Oocyclus Sharp (Coleoptera: Hydrophilidae) from the Guiana Shield.

The species of the water scavenger beetle genus Oocyclus Sharp are reviewed for the Guiana Shield region of South America. Seven species are recorded, including one here described as new: Oocyclus paraiso sp. n. from the Brazilian state of Pará. New records of previously described species are also reported for Brazil, French Guiana, Guyana, and Suriname. The aedeagus of O. coromoto Short & García is illustrated for the first time. As with all other known members of the genus, all Guiana Shield species are hygropetric habitat specialists. A key to the Oocyclus of the Guiana Shield is provided.

Maternal depressive symptoms and physical intimate partner violence and children's internalizing and externalizing behaviors in Guyanese families: Mediating role of constructive conflict behavior.

Using models of risk and resilience as a guide, this study examined the mediating role of constructive conflict behaviors on the associations between maternal depressive symptoms, intimate partner violence (IPV), and child behavior problems. The nature of the mediation pathways was also examined for two groups of families, one experiencing high and another experiencing low levels of partner social support. Participants included 196 mothers and their preschool-aged children from diverse ethnic and socioeconomic backgrounds in Guyana. Constructive conflict behaviors partially mediated the link between maternal depressive symptoms and children's externalizing behaviors. Maternal depressive symptoms and physical intimate partner violence were directly related to children's internalizing behaviors. Constructive conflict behaviors were not a mediator of the association between risk factors and children's behavioral outcomes for families experiencing high or low levels of partner social support. In the context of families experiencing high partner social support, constructive conflict behaviors appeared to be more effective in reducing children's externalizing problem behaviors. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Bothrops (Fer-de-lance) snakebites in the French departments of the Americas (Martinique and Guyana): Clinical and experimental studies and treatment by immunotherapy.

Snakebite envenomation is a relevant medical hazard in French Guiana and Martinique, two French territories in the Americas. All snakebite envenomations in Martinique are inflicted by the endemic viperid species Bothrops lanceolatus, whereas Bothrops atrox is responsible for the majority of snakebites in French Guiana, although other venomous snake species also occur in this South American territory. This review summarizes some of the key aspects of the natural history of these species, as well as of their venom composition, the main clinical manifestations of envenomations, and their treatment by antivenoms. B. atrox venom induces the typical set of clinical manifestations characteristic of Bothrops sp. venoms, i.e., local tissue damage and systemic alterations associated with coagulopathies, hemorrhage, hemodynamic alterations, and acute kidney injury. In the case of B. lanceolatus venom, in addition to some typical features of bothropic envenomation, a unique and severe thrombotic effect occurs in some patients. The pathogenesis of this effect remains unknown but may be related to the action of venom components and inflammatory mediators on endothelial cells in the vasculature. A monospecific antivenom has been successfully used in Martinique to treat envenomations by B. lanceolatus. In the case of French Guiana, a polyvalent antivenom has been used for some years, but it is necessary to assess the preclinical and clinical efficacy against viperid venoms in this country of other antivenoms manufactured in the Americas.

Factors associated with prostate cancer screening among Indo-Guyanese men.

INTRODUCTION: Health screening is considered a vital intervention in public health practices. Despite the strong emphasis on the need for preventative health screenings, little attention is focused on many immigrant populations. Indo-Guyanese immigrants are one of the ethnically minoritized populations facing these challenges. This study aims to identify factors associated with the likelihood that Indo-Guyanese men will undergo screening for prostate cancer. METHODS: This study is guided by a mixed-method approach incorporating both quantitative and qualitative analyses. A total of 20 participants were recruited via a snowball technique. Correlation between variables was conducted using IBM SPSS Statistics Version 27, while the qualitative data underwent a rigorous process of analysis and interpretation. RESULTS: Education, income, understanding of risk factors, and considering self at risk were positively correlated with screening. Knowledge of prostate cancer and knowledge of the screening process was negatively correlated with screening. CONCLUSION: Immigrant health has a significant impact on the U.S. public health system. Timely identification of potential barriers and providing culturally competent solutions and services will ensure a safe and healthy nation.

Annual Report 2021. Guyana: Responding to COVID-19 and Preparing for the Future

In 2022 the Pan American Health Organization (PAHO) is celebrating its 120th anniversary. Operating as the independent specialized health agency of the inter-American system, PAHO provides technical cooperation to its Member States to address communicable and noncommunicable diseases and their causes, strengthen health systems, and respond to emergencies and disasters throughout the Americas. In addition, in its capacity as the World Health Organization’s Regional Office for the Americas, PAHO participates in the United Nations Country Team, collaborating with other United Nations agencies, funds, and programs to contribute to the achievement of the Sustainable Development Goals (SDGs) at country level. At the subregional level, PAHO works with integration mechanisms to position health and its determinants on the political agenda. The 2021 Country Annual Reports reflect PAHO’s technical cooperation in countries and territories in implementing the Country Cooperation Strategies, responding to their needs and priorities, and operating within the framework of PAHO’s regional and global mandates and the SDGs. Under the overarching theme of Responding to COVID-19 and Preparing for the Future, they highlight PAHO’s actions on the COVID-19 pandemic and its continuing efforts in priority areas such as health emergencies, health systems and services, communicable diseases, noncommunicable diseases and mental health, health throughout the life course, and health equity. They also provide a financial summary for the biennium 2020-2021.

Guyana Country Profile: Yellow Fever

Yellow fever is endemic in several Latin America countries. In order to support decision-makers in prioritizing preventive actions against this disease, the Pan American Health Organization presents these country profiles with a concise and comprehensive selection of data from endemic countries. Each profile provides an analysis of the country's current situation, ecological and climatic factors associated with the disease, vector distribution and incidence, and key arboviral activity. It also includes a historical perspective of epidemiology and a summary of the status of vaccination against the disease in the country.

Formative Exploration of the Feasibility of Embedding Community Assets Into Primary Health Care: Barbershop and Place of Worship Readiness in Guyana.

INTRODUCTION: Community engagement is key to improving the quality of primary health care (PHC), with asset-based interventions shown to have a positive impact on equity and health outcomes. However, there tends to be a disconnect between community-based interventions and PHC, with a lack of evidence on how to develop sustainable community-primary care partnerships. This paper reports on the formative phases of 2 studies exploring the feasibility of embedding community assets, namely places of worship and barbershops, into the PHC pathway for the prevention and control of NCDs in deprived settings. It describes the participatory approach used to map and gather contextual readiness information, including the enablers and constrainers for collaborative partnerships with PHC. METHODS: Grounded in community-based participatory research, we used elements of ground-truthing and participatory mapping to locate and gather contextual information on places of worship and barbershops in urban and rural communities. Local knowledge, gathered from community dialogs, led to the creation of sampling frames of these community assets. Selected places of worship were administered a 66-item readiness questionnaire, which included domains on governance and financing, congregation profile, and existing health programs and collaborations. Participating barbershops were administered a 40-item readiness questionnaire, which covered barbers' demographic information, previous training in health promotion, and barbers' willingness to deliver health promotion activities. RESULTS: Fourteen barbershops were identified, of which 10 participated in the readiness survey, while 240 places of worship were identified, of which 14 were selected and assessed for readiness. Contextual differences were found within and between these assets regarding governance, accessibility, and reach. Key enablers for both include training in health promotion, an overwhelming enthusiasm for participation and recognition of the potential benefits of a community-primary care partnership. Lack of previous collaborations with the formal health system was common to both. CONCLUSION: The participatory approach extended reach within underserved communities, while the readiness data informed intervention design and identified opportunities for partnership development. Contextual differences between community assets require comprehensive readiness investigations to develop suitably tailored interventions that promote reach, acceptance, and sustainability.

Addressing COVID-19 Rumors and Behaviors Using Theory in Guyana: A Program Case Study.

INTRODUCTION: To manage the rapid rise of misleading information on the coronavirus disease (COVID-19) during the pandemic, the Breakthrough ACTION project developed a theory-based rumor-tracking system to inform Guyana's COVID-19 communication campaign. METHODS: The rumor-tracking project used the extended parallel processing model (EPPM) to identify and categorize rumors reflecting perceived high versus low vulnerability to COVID-19 and high versus low efficacy of engaging in recommended COVID-19 prevention behaviors. The project designed contextually relevant social and behavior change messages, called "MythBusters," responded to rumor categories with the following objectives: (1) high perceived vulnerability and high efficacy rumors included a call to action; high perceived vulnerability and low efficacy rumors educated about effective and achievable solutions; (3) low perceived vulnerability and high efficacy rumors educated about risk; and (4) low perceived vulnerability and low efficacy rumors educated about risk and effective and achievable solutions. RESULTS: Most rumors emanated from regions 4 and 8 (29%). Over two-thirds of the rumors (71%) recurred. Rumors were typically related to COVID-19 treatment or prevention (40%) and transmission (35%). Most rumors (48%) reflected low perceived vulnerability and low efficacy, 29% reflected high perceived vulnerability and low efficacy, 13% reflected low perceived vulnerability and high efficacy, and 10% reflected high perceived vulnerability and high efficacy. The project rapidly developed 12 MythBusters from June through December 2020 and integrated them into the national COVID-19 communication campaign, disseminated via radio, television, and Facebook. Estimates indicate that they have reached most of the target Guyanese population. DISCUSSION: The EPPM was a particularly useful tool, giving direction to countering myths with appropriate messaging to affect relevant behaviors. The COVID-19 MythBusters provided the Guyanese public with valid and verifiable information and promoted preventive and protective behaviors.

Occurrence and characteristics of microdebris in commercial fish species of Guyana, South America.

Microdebris ingestion in fish is widespread and has adverse effects on marine life. This study assessed the occurrence and type of microdebris found in three commercially important fish species from different landing sites along Guyana's coast. Visual examination of fish gut content was initially carried out using the naked eye and a hand lens. Microscopic examinations were subsequently carried out to determine the number and type of debris present. Forty percent of the fishes examined had microdebris present in their bodies. A total of 112 microdebris particles were collected from 90 specimens of three species (Bagre bagre, Nebris microps, Macrodon ancyclodon). The microdebris particles observed included pellets, microbeads, fragments, fiber (wool), films, and foams. White-colored materials were the most frequently ingested. Most of the collected materials were large microdebris (>1 to 5 mm) that resembled pellets and microbeads. This study displayed the prevalence of microdebris ingestion by commercial fish in Guyana.

Predicted Batrachochytrium dendrobatidis infection sites in Guyana, Suriname, and French Guiana using the species distribution model maxent.

The fungal pathogen Batrachochytrium dendrobatidis (Bd) which causes that amphibian disease chytridiomycosis is expanding its worldwide range from an Asian origin, infecting amphibians in a growing number of countries. Modelling the potential range of this amphibian pathogen using environmental variables and presence data could advance our understanding of at-risk areas and species in locations with limited surveillance to date. We used a species distribution model to assess Bd habitat suitability in the three Guiana's (Guyana, Suriname, and French Guiana) in South America. The model output showed that all three countries have substantial areas where Bd could grow and proliferate, and maximum temperature of the warmest month was the top predictor of suitable Bd habitat, inversely correlated with modeled Bd occurrence. Predicted Bd infection areas in Guyana and French Guiana were large and localized whereas possible sites in Suriname were more scattered throughout the country. The areas projected as potential suitable in Suriname were mostly high elevation regions. These results could help inform efficiencies for development of a proactive monitoring program that could alert managers of novel Bd outbreaks for focused mitigation actions to forestall the spread of this amphibian disease.

Exposure to Electronic Media, Smoking and Alcohol Drinking Among Guyanese Adults.

Use of electronic media has been shown to be associated with tobacco and alcohol consumption behavior among adult population. Currently, not much is known about the risk factors of tobacco and alcohol consumption in Guyana. The present study aimed to explore the association between exposure to electronic media and tobacco and alcohol consumption by adjusting for the sociodemographic correlates. Methods: Data were obtained from the sixth round of Guyana Multiple Indicator Cluster Survey (MICS 2019-20). Sample population were 2,208 men and 5,872 women aged between 15 and 49 years. Outcome variables were self-reported lifetime use of tobacco and alcohol, and the main explanatory variables were the use of electronic media such as internet, television and radio. Data were analyzed using descriptive and multivariable regression analysis in Stata version 17. Results: Overall, 55.5% (95% CI = 53.4, 57.6) men and 44.5% (95% CI = 42.4, 46.6) women reported ever smoking tobacco, while the percentage of ever drinking alcohol was 34.2% (95% CI = 32.9, 35.4) and 65.8% (95% CI = 64.6, 67.1) among men and women, respectively. Internet users had significantly higher odds of ever consuming tobacco and alcohol, however, the association was not uniform across the sociodemographic variables. For smoking, the positive association with internet use was observed for women only (OR = 1.32, 95% CI = 1.09, 1.59), whereas, for alcohol consumption the association with internet use was significantly positive among both men (OR = 1.82, 95% CI = 1.58, 2.09) and women (OR = 1.84, 95% CI = 1.22, 2.70). Men and women who ever tried alcohol drinking had (OR = 4.64, 95% CI = 3.16, 6.82) and (OR = 10.62, 95% CI = 7.83, 14.40) times higher odds of trying tobacco smoking. Conclusion: Current findings indicate over a quarter of the participants reported ever smoking tobacco and more than three-fifths ever drinking alcohol. Electronic media use, especially that of internet, is a strong predictor of tobacco and alcohol consumption among Guyanese adults. Results also revealed a strong interrelation between alcohol and tobacco smoking, and suggesting that strengthening the tobacco prevention programs may reduce the prevalence of alcohol drinking as well.

Spatial patterns and climate drivers of malaria in three border areas of Brazil, Venezuela and Guyana, 2016-2018.

In 2020, 77% of malaria cases in the Americas were concentrated in Venezuela, Brazil, and Colombia. These countries are characterized by a heterogeneous malaria landscape and malaria hotspots. Furthermore, the political unrest in Venezuela has led to significant cross-border population movement. Hence, the aim of this study was to describe spatial patterns and identify significant climatic drivers of malaria transmission along the Venezuela-Brazil-Guyana border, focusing on Bolivar state, Venezuela and Roraima state, Brazil. Malaria case data, stratified by species from 2016 to 2018, were obtained from the Brazilian Malaria Epidemiology Surveillance Information System, the Guyana Vector Borne Diseases Program, the Venezuelan Ministry of Health, and civil society organizations. Spatial autocorrelation in malaria incidence was explored using Getis-Ord (Gi*) statistics. A Poisson regression model was developed with a conditional autoregressive prior structure and posterior parameters were estimated using the Bayesian Markov chain Monte Carlo simulation with Gibbs sampling. There were 685,498 malaria cases during the study period. Plasmodium vivax was the predominant species (71.7%, 490,861). Malaria hotspots were located in eight municipalities along the Venezuela and Guyana international borders with Brazil. Plasmodium falciparum increased by 2.6% (95% credible interval [CrI] 2.1%, 2.8%) for one meter increase in altitude, decreased by 1.6% (95% CrI 1.5%, 2.3%) and 0.9% (95% CrI 0.7%, 2.4%) per 1 cm increase in 6-month lagged precipitation and each 1 °C increase of minimum temperature without lag. Each 1 °C increase of 1-month lagged maximum temperature increased P. falciparum by 0.6% (95% CrI 0.4%, 1.9%). P. vivax cases increased by 1.5% (95% CrI 1.3%, 1.6%) for one meter increase in altitude and decreased by  1.1% (95% CrI 1.0%, 1.2%) and 7.3% (95% CrI 6.7%, 9.7%) for each 1 cm increase of precipitation lagged at 6-months and 1 °C increase in minimum temperature lagged at 6-months. Each 1°C increase of two-month lagged maximum temperature increased P. vivax by 1.5% (95% CrI 0.6%, 7.1%). There was no significant residual spatial clustering after accounting for climatic covariates. Malaria hotspots were located along the Venezuela and Guyana international border with Roraima state, Brazil. In addition to population movement, climatic variables were important drivers of malaria transmission in these areas.

A mixed-methods approach to understanding domestic dog health and disease transmission risk in an indigenous reserve in Guyana, South America.

Domestic dogs (Canis lupus familiaris) can transmit a variety of pathogens due to their ubiquitousness in urban, rural and natural environments, and their close interactions with wildlife and humans. In this study, we used a mixed-methods approach to assess the role of domestic dogs as potential intermediaries of disease transmission from wildlife to humans among indigenous Waiwai in the Konashen Community Owned Conservation Area, Guyana. To address these objectives we 1) performed physical examinations and collected biological samples to assess Waiwai domestic dog health, and 2) administered questionnaires to characterize the role of dogs in the community and identify potential transmission pathways between wildlife, dogs, and humans. We observed ectoparasites on all dogs (n = 20), including: fleas (100%), ticks (15%), botflies (30%), and jigger flea lesions (Tunga penetrans) (80%). Ten percent of dogs were seropositive for Ehrlichia canis/ewingii, 10% were positive for Dirofilaria immitis, and one dog was seropositive for Leishmania infantum. All dogs (n = 20) were seronegative for: canine distemper virus, Brucella canis, Leptospira serovars, Trypanosoma cruzi, Anaplasma phagocytophilum/platys and Borrelia burgdorferi. Our questionnaire data revealed that the Waiwai remove ectoparasites from their dogs, clean up dog feces, and administer traditional and/or Western medicine to their dogs. White blood cell, strongyle-type ova, and eosinophil counts were lower in dogs that were not frequently used for hunting, dogs that did receive traditional and/or western medicine, and dogs that were frequently kept in elevated dog houses, although differences were not statistically significant. While our results suggest that the Waiwai have developed cultural practices that may promote dog health and/or prevent zoonotic disease transmission, more research is necessary to determine the efficacy of these practices. Our study provides important data on the health of dogs and the potential for disease transmission to humans in a zoonotic hotspot.

Molecular phylogenetic analyses and micromorphology reveal placement of the enigmatic tropical discomycete Polydiscidium in Sclerococcum (Sclerococcales, Eurotiomycetes).

Polydiscidium is an enigmatic, monotypic, and rarely reported genus of Ascomycota of uncertain placement. The morphologically unique Polydiscidium martynii grows on dead wood and forms compound ascomata composed of thick, black, gelatinous somatic tissue that branches out from a common base. Multiple apothecia are located on the branches, mostly toward the tips, and are composed of 8-spored asci and paraphyses embedded in a gelatinous matrix that turns blue in Melzer's reagent. The species was previously known from only three collections from Guyana (holotype), Trinidad, and the Democratic Republic of the Congo and no sequences exist. Due to its peculiar morphology, taxonomic affinities of Polydiscidium have been debated, with different authors having placed it in Helotiaceae, Leotiaceae, or Leotiomycetes incertae sedis. Recent collections of this species resulting from long-term field work in Guyana and Cameroon led us to revisit the morphology and phylogenetic position of this fungus. Newly generated sequences of P. martynii were added to an Ascomycota-wide six-locus data set. The resulting phylogeny showed Polydiscidium to be a member of order Sclerococcales (Eurotiomycetes). Next, a four-locus (18S, ITS, 28S, mtSSU) phylogenetic reconstruction revealed that Polydiscidium is congeneric with Sclerococcum. A new combination is proposed for this species, Sclerococcum martynii. Micromorphological features, including the gelatinous hymenium composed of asci with amyloid gel cap and septate brown ascospores, are in agreement with Sclerococcum. New combinations are proposed for two additional species: Sclerococcum chiangraiensis and S. fusiformis. Finally, Dactylosporales is considered a later synonym of Sclerococcales.

Positive Effect of Ecological Restoration with Fabaceous Species on Microbial Activities of Former Guyanese Mining Sites.

Understanding ecological trajectories after mine site rehabilitation is essential to develop relevant protocols adapted for gold mining sites. This study describes the influence of a range of mine site rehabilitation and revegetation protocols on soil physicochemical parameters and microbial activities related to carbon, nitrogen and phosphorus cycles. We sampled soil from six rehabilitated mining sites in French Guiana with different plant cover (herbaceous, Cyperaceous, monoculture of Clitoria racemosa and Acacia mangium and association of C. racemosa and A. mangium). We measured the mineralization potential of organic matter by estimating the mineralization of carbon, nitrogen and phosphorus and the microbial catabolic diversity balance. The results showed an improvement in the quality of organic matter on revegetated sites with tree cover. On restored sites with fabaceous species, the microbial biomass is three times higher than non-restored sites, improving the rates of organic matter mineralization and restoring the catabolic diversity to the level of natural Guyanese soils. These results confirm that the establishment of fabaceous species under controlled conditions significantly improves the restoration of microbial communities in mining soils.

Malaria care-seeking and treatment ideation among gold miners in Guyana.

BACKGROUND: Although miners are a priority population in malaria elimination in Guyana, scant literature exists on the drivers of malaria-related behaviour. This study explores the relationship between gold miners' malaria-related ideation and the adoption of malaria care-seeking and treatment behaviours including prompt care-seeking, malaria testing, and self-medication. METHODS: Data are from a cross-sectional quantitative survey of 1685 adult miners between the ages of 18-59 years who live in mining camps in Regions 1, 7, and 8. The analysis focused on miners who reported an episode of fever in the past year (n = 745). Malaria care-seeking and treatment ideation was defined as a composite additive score consisting of the following variables: general malaria knowledge, perceived severity, perceived susceptibility, beliefs, perceived self-efficacy, perceived norms, interpersonal communication, and perceived response efficacy. Multivariable logistic regressions explored the relationship between ideation on care-seeking/treatment behaviours, controlling for confounding variables. RESULTS: Most miners with a recent episode of fever had perceived risk (92%), self-efficacy (67%), susceptibility (53%) and high malaria knowledge (53%). Overall, miners' care-seeking/treatment ideation score ranged from 0 to 8 with a mean of 4.1. Ideation scores were associated with higher odds of care-seeking for fever (aOR: 1.19; 95% CI 1.04-1.36), getting tested for malaria (aOR: 1.22; 95% CI 1.07-1.38) and lower odds of self-medication (aOR: 0.87; 95% CI 0.77-0.99). CONCLUSIONS: A national community case management initiative is using study findings as part of its scale-up, using volunteers to make testing and treatment services more accessible to miners. This is complemented by a multi-channel mass media campaign to improve miners' ideation. Communication messages focus on increasing miners' knowledge of malaria transmission and symptoms, encourage positive beliefs about malaria testing and volunteer testers, promote evidence about the effectiveness of testing, and reminders of how quick and easy it is to get a malaria test with the community case management initiative. Study findings also have implications for efforts to eliminate malaria across the Guiana Shield.