Caribbean Epidemiology Center WHO

Trinidad and Tobago

Caribbean Epidemiology Center WHO

Trinidad and Tobago
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Fletcher S.M.,University of Technology, Sydney | Lewis-Fuller E.,Ministry of Health | Williams H.,Ministry of Health | Miller Z.,Ministry of Health | And 9 more authors.
Journal of Health, Population and Nutrition | Year: 2013

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


Ingram M.,Ministry of Health | St. John J.,Ministry of Health | Applewhaite T.,Ministry of Health | Gaskin P.,The University of the West Indies, Cave Hill Campus | And 2 more authors.
Journal of Health, Population and Nutrition | Year: 2013

The aim of this study was to determine the burden and impact of acute gastroenteritis (AGE) and foodborne diseases (FBDs) in Barbados through a retrospective, cross-sectional population survey and laboratory study in August 2010-August 2011. Face-to-face interviews were conducted with one person from each of 1,710 randomly-selected households. Of these, 1,433 (84%) interviews were completed. A total of 70 respondents reported having experienced AGE in the 28 days prior to the interview, representing a prevalence of 4.9% and an annual incidence rate of 0.652 episodes per person-year. Age (p=0.01132), season (p=0.00343), and income (p<0.005) were statistically associated with the occurrence of AGE in the population. Norovirus was the leading foodborne pathogen causing AGE-related illness. An estimated 44,270 cases of AGE were found to occur during the period of the study and, for every case of AGE detected by surveillance, an additional 204 cases occurred in the community. Economic costs of AGE ranged from BD$ 9.5 million to 16.5 million (US$ 4.25-8.25) annually. This study demonstrated that the public-health burden and impact of AGE and FBD in Barbados were high and provided the necessary baseline information to guide targeted interventions. © International Centre For Diarrhoeal Disease Research, Bangladesh.


Persuad S.,Minsitry of Health | Mohamed-Rambaran P.,Georgetown Public Hospital Corporation Laboratory | Wilson A.,Georgetown Public Hospital Corporation Laboratory | James C.,Ministry of Health | Indar L.,Caribbean Epidemiology Center WHO
Journal of Health, Population and Nutrition | Year: 2013

Guyana is an English-speaking country in South America and, culturally, it is part of the Caribbean. Objective of this study was to determine the community prevalence and true burden and economic impact of acute gastroenteritis (AGE) and foodborne diseases (FBDs) in Guyana. A cross-sectional population-based survey was conducted in 7 of the 10 regions in Guyana during August and November 2009 to capture the high- and low-AGE season respectively. Overall, 1,254 individual surveys were administered at a response rate of 96.5%. The overall monthly prevalence of self-reported cases of AGE was 7.7% (97 cases) (95% CI 6.3-9.3), and the yearly incidence was 1.0 episodes per person-year. The highest monthly prevalence of AGE was observed in region 4 (8.9%) and in children aged 1-4 year(s) (12.7%). Of the 97 AGE cases, 23% sought medical care; 65% reported spending time at home due to their illness [range 1-20 day(s), mean 2.7 days], of whom 51% required other individuals to look after them while ill. The maximum number of stools per 24 hours ranged from 3 to 9 (mean 4.5), and number of days an individual suffered from AGE ranged from 1 to 21 day(s) (mean 2.7 days). The burden of syndromic AGE cases in the population for 2009 was estimated to be 131,012 cases compared to the reported 30,468 cases (76.7% underreporting), which implies that, for every syndromic case of AGE reported, there were additional 4.3 cases occurring in the community. For every laboratory-confirmed case of FBD/AGE pathogen reported, it was estimated that approximately 2,881 more cases were occurring in the population. Giardia was the most common foodborne pathogen isolated. The minimum estimated annual cost associated with the treatment for AGE was US$ 2,358,233.2, showing that AGE and FBD pose a huge economic burden on Guyana. Underreporting of AGE and foodborne pathogens, stool collection, and laboratory capacity were major gaps, affecting the surveillance of AGE in Guyana. © Nternational Centre For Diarrhoeal Disease Research, Bangladesh.


Lakhan C.,University of the West Indies | Badrie N.,University of the West Indies | Ramsubhag A.,University of the West Indies | Sundaraneedi K.,Ministry of Health | Indar L.,Caribbean Epidemiology Center WHO
Journal of Health, Population and Nutrition | Year: 2013

Objectives of this study were to determine the burden and impact of acute gastroenteritis (AGE) and foodborne pathogens in Trinidad and Tobago. A retrospective, cross-sectional population survey, based on selfreported cases of AGE, was conducted in November-December 2008 and May-June 2009 (high- and low-AGE season respectively) by face-to-face interviews. From 2,145 households selected to be interviewed, the response rate was 99.9%. Of those interviewed, 5.1% (n=110; 95% CI 4.3-6.2) reported having AGE (3 or more loose watery stools in 24 hours) in the 28 days prior to the interview (0.67 episodes/person-year). Monthly prevalence of AGE was the highest among children aged <5 years (1.3 episodes/year). Eighteen (16%) persons with AGE sought medical care (4 treated with oral rehydration salts and 6 with antibiotics), and 66% reported restricted activity [range 1-16 day(s)]. The mean duration of diarrhoea was 2.3 days (range 2-10 days). One case submitted a stool sample, and another was hospitalized. Overall, 56 (10%) AGE specimens tested positive for foodborne pathogens. It was estimated that 135,820 AGE cases occurred in 2009 (84% underreporting), and for every 1 AGE case reported, an additional 6.17 cases occurred in the community. The estimated economic cost of AGE ranged from US$ 27,331 to 19,736,344. Acute gastroenteritis, thus, poses a huge health and economic burden on Trinidad and Tobago. © International Centre For Diarrhoeal.


Gabriel O.O.,Victoria Hospital | Jaime A.,Epidemiology Unit | Mckensie M.,Victoria Hospital | Auguste A.,Epidemiology Unit | And 2 more authors.
Journal of Health, Population and Nutrition | Year: 2013

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. © International Centre For Diarrhoeal.


Boisson E.V.,Caribbean Epidemiology Center WHO | Imana M.,Caribbean Epidemiology Center WHO | Roberts P.,Caribbean Epidemiology Center WHO
West Indian Medical Journal | Year: 2012

Objective: To describe the development and implementation of, and major findings and recommendations from, a regional mass gathering surveillance system (MGSS) in support of the International Cricket Council Cricket World Cup West Indies 2007. Methods: The regional MGSS was developed by the Caribbean Epidemiology Centre (CAREC) and its member countries as an adaptation of the routine communicable disease surveillance system in order to rapidly detect unusual disease events during the tournament. The implementation of the MGSS required the identification of additional human and financial resources, capacity building activities, laboratory strengthening, and improved global epidemic surveillance and communication mechanisms. Results: Timeliness and completeness of data reporting in the MGSS were both > 85%. No unusual pathogens were identified in the region during the tournament. Only dengue and influenza, both endemic to the region, were identified. The early alert detection software used identified a total of 24 aberrations from seven countries, the largest proportions being gastroenteritis, fever and respiratory symptoms and injuries. All aberrations were promptly investigated and most were found to be false alerts. Three unusual disease events were detected, all from one country. They were responded to in a timely manner and did not adversely affect the tournament. Conclusions: The surveillance capacities gained in preparing for, and supporting, the tournament assisted in strengthening and testing the already existing national and regional communicable disease surveillance systems. Events such as these should be utilized to strengthen already existing surveillance systems, which should be flexible enough to respond to changing events.


PubMed | Caribbean Epidemiology Center WHO
Type: Journal Article | Journal: The West Indian medical journal | Year: 2012

To describe the development and implementation of and major findings and recommendations from, a regional mass gathering surveillance system (MGSS) in support of the International Cricket Council Cricket World Cup West Indies 2007.The regional MGSS was developed by the Caribbean Epidemiology Centre (CAREC) and its member countries as an adaptation of the routine communicable disease surveillance system in order to rapidly detect unusual disease events during the tournament. The implementation of the MGSS required the identification of additional human and financial resources, capacity building activities, laboratory strengthening, and improved global epidemic surveillance and communication mechanisms.Timeliness and completeness of data reporting in the MGSS were both > 85%. No unusual pathogens were identified in the region during the tournament. Only dengue and influenza, both endemic to the region, were identified. The early alert aetection software used identified a total of 24 aberrations from seven countries, the largest proportions being gastroenteritis, fever and respiratory symptoms and injuries. All aberrations were promptly investigated and most were found to be false alerts. Three unusual disease events were detected, all from one country. They were responded to in a timely manner and did not adversely affect the tournament.The surveillance capacities gained in preparing for and supporting, the tournament assisted in strengthening and testing the already existing national and regional communicable disease surveillance systems. Events such as these should be utilized to strengthen already existing surveillance systems, which should be flexible enough to respond to changing events.

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