Adaptation of WHO COVID-19 guidelines by Caribbean countries and territories.

The normative role of the World Health Organization (WHO) involves creating evidence-based, principled guidelines to guide its Member States in making well-informed public health decisions. While these guidelines often need to be adapted to ensure contextual relevance, foster better implementation and adherence, adapting existing guidelines is more efficient than creating new ones. Here we describe the adaptation of the WHO coronavirus disease 2019 (COVID-19) living guideline on pharmacological interventions for the Caribbean using the grading of recommendations, assessment, development and evaluation (GRADE)-ADOLOPMENT method. The Caribbean Public Health Agency and the Pan American Health Organization led the effort, assembling a diverse panel of 16 experts from seven Caribbean countries and territories. The adaptation process, involving 15 steps, was guided by an experienced methodologist and included selecting relevant clinical questions and prioritizing them based on regional needs. The panel evaluated the latest WHO guidelines and integrated additional local data. They adjusted the direction and strength of several recommendations to better fit the Caribbean context, considering local values and preferences, resources, accessibility, feasibility and impact on health equity. Ultimately, we changed the direction of two recommendations and the strength of five, tailoring them to regional realities. This effort highlights the importance of adapting global guidelines to local settings, improving their applicability and effectiveness. The adaptation process also serves as a valuable opportunity for skill transfer and capacity-building in guideline development. Continued research is needed to assess the impact of these adaptations on health-care outcomes in the Caribbean.

Le rôle normatif de l'Organisation mondiale de la santé (OMS) consiste à élaborer des lignes directrices fondées sur des données scientifiques et sur des principes afin d'aider ses États membres à prendre des décisions éclairées en matière de santé publique. Bien qu'elles nécessitent souvent des adaptations pour garantir leur pertinence par rapport à des contextes précis et pour favoriser une meilleure mise en œuvre et adhésion, il est plus efficace d'adapter les lignes directrices existantes que d'en créer de nouvelles. La présente publication décrit l'adaptation de la ligne directrice évolutive de l'OMS sur les interventions pharmacologiques dans le cadre de la maladie à coronavirus (COVID-19) pour les Caraïbes en appliquant la méthodologie GRADE (classement des recommandations, de l'appréciation, du développement et de l'évaluation)-ADOLOPMENT. L'Agence de santé publique des Caraïbes et l'Organisation panaméricaine de la Santé ont dirigé les travaux en réunissant un groupe diversifié de 16 experts issus de sept pays et territoires des Caraïbes. Le processus d'adaptation, comptant 15 étapes et encadré par un méthodologiste expérimenté, a consisté à sélectionner des questions cliniques pertinentes et à les classer par ordre de priorité selon les besoins régionaux. Ce groupe a évalué les dernières lignes directrices de l'OMS et a intégré des données locales supplémentaires. Il a ensuite ajusté l'orientation et le poids de plusieurs recommandations afin de mieux les adapter au contexte des Caraïbes, en tenant compte des valeurs et des préférences locales, des ressources, de l'accessibilité, de la faisabilité et de l'impact sur l'équité en matière de santé. En fin de compte, l'orientation de deux recommandations et le poids de cinq autres ont été modifiés, en les adaptant aux réalités régionales. Cet effort souligne l'importance d'adapter des lignes directrices mondiales aux contextes locaux, afin d'en améliorer l'applicabilité et l'efficacité. Le processus d'adaptation représente également une occasion précieuse de transfert de compétences et de renforcement des capacités en matière d'élaboration de lignes directrices. Des recherches continues s'imposent pour évaluer l'impact de ces adaptations sur les résultats des soins de santé dans les Caraïbes.

La función normativa de la Organización Mundial de la Salud (OMS) consiste en elaborar directrices basadas en pruebas y principios para orientar a sus Estados Miembros en la toma de decisiones de salud pública bien fundamentadas. Aunque con frecuencia es necesario adaptar estas directrices para garantizar su pertinencia contextual y fomentar una mejor implementación y observancia, la adaptación de directrices existentes es más eficiente que la creación de otras nuevas. Aquí describimos la adaptación de la directriz vigente de la OMS sobre la enfermedad por coronavirus (COVID-19) relativa a las intervenciones farmacológicas para el Caribe utilizando el método de clasificación de valoración, elaboración y evaluación de las recomendaciones (GRADE)-ADOLOPMENT. La Agencia de Salud Pública del Caribe y la Organización Panamericana de la Salud lideraron la iniciativa, que reunió a un variado grupo de 16 expertos de siete países y territorios caribeños. El proceso de adaptación, que comprendió 15 pasos y fue guiado por un metodólogo experimentado, incluyó la selección de preguntas clínicas pertinentes y su priorización en función de las necesidades regionales. El grupo evaluó las últimas directrices de la OMS e integró datos locales adicionales. Ajustaron la orientación y la fuerza de varias recomendaciones para adaptarlas mejor al contexto caribeño, teniendo en cuenta los valores y preferencias locales, los recursos, la accesibilidad, la viabilidad y el impacto en la equidad sanitaria. Finalmente, cambiamos la orientación de dos recomendaciones y la fuerza de cinco para adaptarlas a las realidades regionales. Esta iniciativa destaca la importancia de adaptar las directrices mundiales a los contextos locales, lo que mejora su aplicabilidad y eficacia. El proceso de adaptación también constituye una valiosa oportunidad para la transferencia de conocimientos y el desarrollo de capacidades en la elaboración de directrices. Es necesario seguir investigando para evaluar el impacto de estas adaptaciones en los resultados de la atención sanitaria en el Caribe.

Gender Differences in Trends in Incidence and Mortality of Acute Myocardial Infarction in the Small Island Developing State of Barbados.

Objective To determine trends, identify predictors of acute myocardial infarction (AMI) incidence and mortality, and explore performance metrics for AMI care in Barbados. Methods Data on all cases diagnosed with AMI were collected by the Barbados National Registry for Non-Communicable Diseases (BNR) from the island's only tertiary hospital, the Queen Elizabeth Hospital, and the National Vital Registration Department. Participants who survived hospital admission were then followed up at 28 days and one year post event via telephone survey and retrieval of death certificates. Age-standardized incidence and mortality rates were calculated. Determinants of mortality at 28 days were examined in multivariable logistic regression models. Median and interquartile ranges (IQR) were calculated for performance metrics (e.g., time from pain onset to reperfusion). Results In a 10-year period between 2010 and 2019, 4,065 cases of myocardial infarction were recorded. The median age of the sample was 73 years (IQR: 61,83), and approximately half (47%) were female. Over a 10-year period, standardized incidence increased in women on average yearly by three per 100,000 (95% CI: 1 to 6; p=0.02), while in men, the average increase per year was six per 100,000 (95% CI: 4 to 8; p<0.001). There was no increase in 28-day mortality in women; mortality in men increased each year by 2.5 per 100,000 (95% CI: 0.4 to 4.5; p=0.02). The time from arrival at the hospital to the ECG was 44 minutes IQR (20,113). Conclusion AMI incidence and mortality are increasing in Barbados, and men have a higher velocity of mortality rate increase than women, which contradicts global data.

Knowledge, Attitudes, and Practices of Hand Hygiene, Mask Use, and Social Distancing among Public Hospital and Polyclinic Nurses in Barbados during the Coronavirus 2019 Pandemic.

BACKGROUND: Nurses are essential members of the healthcare workforce and were among the first-line carers for patients in community and hospital settings during the COVID-19 pandemic. As a result, they were at a heightened risk of infection, resulting in several reported deaths among nursing staff. Several preventive measures were adopted to contain the spread of the COVID-19 virus. This study aims to explore the knowledge, attitudes, and practices (KAP) of nurses regarding hand hygiene, mask wearing, and social distancing measures in healthcare settings in Barbados during the COVID-19 pandemic. METHOD: An online survey of nurses working in public hospitals and polyclinics (public primary care clinics) in Barbados from March 2021 to December 2021 was conducted. A nonsystematic convenience sampling method was employed to recruit nurses who were readily available and willing to participate. A questionnaire captured the sociodemographic information and knowledge and practices related to hand hygiene, the use of face masks, and social distancing. Each correct response received one mark. Overall knowledge scores were categorized as poor (<60%), average (60-80%), or good (>80-100%). RESULTS: Of the 192 participants, the majority were female (82.8%) and had >5 years of experience (82%). The findings revealed that 45.8% had poor knowledge of hand hygiene, and that the knowledge of 43.8% of respondents was average. Multivariable logistic regression showed that, after adjustment for age and gender, registered nurses had 2.1 times increased odds (95% confidence interval 1.0, 4.2) of having good knowledge compared to other nursing categories. Regarding mask wearing, 53.6% of nurses had average knowledge, and 27.1% had good knowledge. Multivariable logistic regression showed that, after adjustment for age and gender, registered nurses had 3.3 times increased odds (95% confidence interval 1.5, 7.4) of having good knowledge compared to nursing assistants. A total of 68.6% of respondents followed the correct steps of handwashing every time, and 98.3% wore a mask in public places. More than half of the nurses (51.2%) kept a safe distance from others to avoid spreading SARS-CoV-2; one-third were in a crowded place(s) in the past three months, and 55.8% usually followed guidelines for social isolation as recommended by the WHO. CONCLUSIONS: The study identified knowledge deficiencies related to hand hygiene and wearing masks among nurses. It is imperative to provide additional training on infection control measures.

Real-World Data and Paper-Based Disease Registries in the Small Island Developing State of Barbados During the COVID-19 Pandemic.

Significant data is being produced on the impact of COVID-19 on aspects of clinical care. However, less is known about the impact on real-world health data. The US Food and Drug Administration defines real-world data as "data relating to patient health status and/or the delivery of health care routinely collected from a variety of sources," including disease registries.1 The methodology used by the Barbados National Registry (BNR)-active pursuit of first-hand clinical data using paper-based charts from multiple sources-makes it an ideal example of real-world data. Real-world data can overcome the barriers to clinical trials often present in small island developing states. This paper reviews the impact of the COVID-19 pandemic on the data of the BNR within the context of the real-world data cycle. Data collected retrospectively for 2016-2018, undergoing traceback during the pandemic, demonstrated a greater reliance on death certificate registration. A 38% reduction in the collection of new cases was noted in the postpandemic period compared to data collected in previous periods. The lack of access to source data delayed cancer registry reporting. We conclude that, given the challenges highlighted during the COVID-19 pandemic, more effort should be placed on providing timely access to real-world data for public health decision-making, particularly in small island developing states.

Student Satisfaction and Self-Efficacy in a Novel Online Clinical Clerkship Curriculum Delivered During the COVID-19 Pandemic.

Purpose: The COVID-19 pandemic has caused significant disruption to medical education and clinical training and resulted in stressors that impede student learning. This study aimed to assess student satisfaction and self-efficacy in a novel online clinical clerkship curriculum delivered during the COVID-19 pandemic. Methods: Fourth- and fifth-year medical students completed an online survey in January 2021 covering the following areas: student satisfaction, self-efficacy, and perceived effectiveness of online versus face-to-face learning. Results: Just over half of students (51%) were satisfied with online clerkship delivery. However, fewer than half of students (46%) believed online learning effectively increased their knowledge, compared to 56% of students who believed face-to-face learning was effective. The perception of the effectiveness of online learning and face-to-face teaching for clinical skills was 18% and 89%, respectively (p < 0.0001). Few students perceived online teaching to be effective for developing social competencies (27%) compared to face-to-face instruction (67%) (p < 0.001). In addition, mean self-efficacy scores were higher for persons who perceived online teaching to be effective for increasing knowledge, improving clinical skills, and developing social competencies. Overall, students' perception of online learning was strongly associated with online self-efficacy. Conclusion: Student satisfaction and perceived self-efficacy in online learning were higher than reported acceptance of online clerkship curriculum.

Assessing the effectiveness and implementation of a chronic disease self-management programme in faith-based organisations in Barbados: protocol for a cluster randomised parallel trial.

INTRODUCTION: In the COVID-19 environment of reduced patient interaction with the healthcare system, evidenced-based self-care of chronic disease is vital. We will evaluate the effect of an online chronic disease self-management programme (CDSMP) plus medication adherence tools on systolic blood pressure (SBP) (primary aim) and, seek to understand the barriers and facilitators to implementation of this modified CDSMP in faith-based organisations (FBOs) (secondary aim). METHODS: We will conduct an unblinded cluster randomised trial in FBOs throughout Barbados. Eligibility: Persons ages 35-70 years; a previous diagnosis of hypertension or currently on antihypertensive therapy and the occurrence of two or more blood pressure readings above 130 mm Hg (systolic) or 80 mm Hg (diastolic) on the day of recruitment. Persons not known to have hypertension but who have two or more blood pressure readings at or above 130 mm Hg (systolic) or 80 mm Hg (diastolic) on two recruitment days at least 1 week apart will also be eligible. The unit of randomisation is a church cluster which consists of 7-9 churches. We will perform block randomisation to assign 24 clusters to intervention or control. The intervention has three components: modified CDSMP workshops, distribution of medication pill boxes and use of social media (WhatsApp V.2.0) to encourage medication adherence. Controls will receive one didactic lecture only. We will determine the mean changes in SBP levels for the intervention group versus controls and compare differences in outcomes 6 months' post intervention using mixed effects regression models. ETHICS AND DISSEMINATION: This project has received ethical approval from the Institutional Review Board of the University of the West Indies in Barbados. Dissemination will use peer-reviewed publications, policy briefs to government and guidelines to leaders of FBOs. We aim to increase the proportion of patients with controlled hypertension and inform implementation of self-management programmes in small populations. TRAIL REGISTRATION NUMBER: NCT04437966.

Understanding the need for a whole-of-society approach in school nutrition policy implementation: a qualitative analysis.

BACKGROUND: Only three of twenty Caribbean Community (CARCICOM) countries have mandatory school nutrition policies despite one third of the region's children being overweight or obese. In Barbados, there are nutrition guidelines which lack the legal mandate of a formal policy. We aim to assess the comprehensiveness of current national nutrition guidelines and to understand the factors operating in the inner and outer school setting that may influence the implementation of a mandatory school nutrition policy from the perspectives of school administrators. METHODS: A documentary analysis of existing nutritional guidelines was conducted along with qualitative semi-structured interviews in primary (elementary) and secondary (high) schools in Barbados. We purposively sampled six primary and four secondary school administrators (principals, deputy principals or senior teachers) to explore their knowledge and views on the National School Nutrition Guidelines. The deterministic implementation paradigm, Consolidated Framework for Implementation (CFIR), was used to explore the complexities within the inner and outer settings of schools. Documentary analysis used a theory-based framework informed by the Wellness School Assessment Tool-school policy analysis questionnaire. Interview transcripts were team coded using thematic analysis with constant comparison facilitated by NVIVO software version12. RESULTS: School administrators were unaware of the existing National School Nutrition Guidelines which documentary analysis found to be restrictive and weak for implementation. Administrators envisioned a government-led (outer setting), whole of society approach as the most effective strategy for the development and implementation of a proposed mandatory school nutrition policy. School administrators identified lack of financial and human resources as barriers to nutrition policy implementation. Formal and informal food vendors are institutionalized in schools and are influential determinants of the school food environment. Schools have individually reached into the outer setting to work with civil society organizations and private individuals to provide financial support and nutrition expertise to their institutions. Mass media campaigns in the outer setting may influence child and parental food choices. CONCLUSION: School administrators describe that government-led, CSO supported policy development using a whole-of-society approach has implications for improving nutrition policy implementation. Our findings demonstrate the use of a deterministic implementation framework in the pre-implementation phase of school nutrition policy development.

A family history of diabetes is related to abnormal insulin sensitivity in African-Caribbean girls of low birth weight: is catch-up weight important?

This retrospective cohort study examined the relationship of birth weight, family history of diabetes (FamHx), and current weight to insulin resistance in Black girls and boys on the Caribbean island of Barbados. A cohort of 56 low birth weight (LBW) and 120 normal birth weight (NBW) adolescents born between January 1, 1986, and December 31, 1988, were recruited for study participation in 2002. FamHx was ascertained by questionnaire. Body mass index (BMI) and waist circumference (WC) were used to assess fat distribution. Fasting blood glucose and insulin were measured from blood samples drawn from each adolescent participant. Insulin resistance was estimated by the homeostasis model assessment (HOMA) technique. These data show that only among LBW girls was a positive (+) FamHx associated with higher HOMA (FamHx "Yes"=1.22 +/- 0.298 vs "No"=0.811 +/- 0.452; P=.032). No significant relationships were observed among boys. Further analyses revealed that compared to their NBW counterparts, LBW girls without FamHx, had a smaller WC (69.70 +/- 9.88cm vs 76.70 +/- 15.64cm, respectively; P=.055). In contrast, LBW girls with a (+) FamHx had similar mean WC (77.71 +/- 16.46cm) to those of NBW girls with (+) FamHx (WC=71.50 +/- 10.38cm; P=.405). These data indicate that along with a family history of diabetes, catch-up weight may be important in assessing diabetes risk in Black Caribbean LBW adolescent girls.