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PubMed2002

Status of the HIV/AIDS epidemic and methods to monitor it in the Latin America and Caribbean region.

The paper presented is a review of the available epidemiological data on the situation in the Latin America and Caribbean (LAC) region, and looks at HIV prevalence in specific population groups. At the end of 2001, HIV remains an important health issue in the LAC region. Twelve countries in the region have an estimated prevalence of 1% or higher among pregnant women. Most of the LAC countries with generalized epidemics are located in the Caribbean basin. In the past decade there has been a slow but continuous increase in HIV prevalence rates among the general population and vulnerable groups, although information in some countries is limited. In many countries, the highest HIV prevalence among vulnerable groups is found among men who have sex with men. HIV infections related to injecting drug use are concentrated in the countries of the Southern Cone and Brazil. HIV is well anchored in the region, concentrated in vulnerable groups in most countries, but with an increasing presence in some countries in the general population. There is a need to improve data collection and introduce new tools to monitor behavior trends and the impact of interventions.

Acquired Immunodeficiency Syndrome↗
PubMed2000

Lymphatic filariasis in the Caribbean region: the opportunity for its elimination and certification.

In order to support the case for a certification of elimination of lymphatic filariasis (LF) in some Caribbean countries, we compared the prevalence of circulating Wuchereria bancrofti antigen in communities in Guyana, Suriname, and Trinidad. For the study, we assayed school children in six communities in Guyana, five communities in Suriname, and three communities in Trinidad for the prevalence of circulating W. bancrofti antigen, using a new immunochromatographic test for LF. We also assayed adults in these three countries, with a special focus on Blanchisseuse, Trinidad, where mass treatment for LF elimination had been carried out in 1981. The prevalences of W. bancrofti circulating antigen found in the school children populations ranged from 1.7% to 33.2% in Guyana and were 0.22% overall in Suriname and 0.0% in Trinidad. Among adults in two Guyana communities the prevalences were 16.7% and 32.1%. The results were all negative from 211 adults in communities in the north, center, and south of Trinidad, as well as from 29 adults in Suriname. The data suggest that contrary to reports of LF endemicity from the World Health Organization, LF may no longer be present in Trinidad and may be of very low prevalence in Suriname. Trinidad and Tobago and other Caribbean nations proven negative could seek to be awarded a certificate of LF elimination. In Suriname the small localized pocket of infected persons who may serve as a reservoir of LF infection could be tested and appropriately treated to achieve LF elimination. Such LF-positive countries as Guyana should access new international resources being made available for LF elimination efforts. An adequate certification program would help identify which countries should seek the new LF elimination resources.

Adult↗
PubMed2003

Breastfeeding and the nutritional transition in the Latin American and Caribbean Region: a success story?

The objectives of this paper are to examine recent breastfeeding duration trends in Latin America and the Caribbean to document: (a) rural-urban differentials, (b) differences in educational levels, and (c) changes in breastfeeding duration across time. Secondary data analyses were conducted with 23 Demographic and Health Surveys collected between the mid-1980s and mid-1990s. Results indicate that median breastfeeding duration is still greater in rural (as compared to urban) areas and among less (versus more) educated women, although these differentials are decreasing with time. In five of the six countries examined for secular trends, breastfeeding duration continues to increase in both rural and urban areas. Breastfeeding duration in urban and rural areas was strongly correlated within countries. Breastfeeding duration improved more among women with the highest and declined among those with the lowest levels of education. Results indicate that breastfeeding duration has increased in Latin America and the Caribbean at a time when the opposite was predicted, given the region's increased urbanization. Breastfeeding protection policies and promotion programs may explain part of the increase in breastfeeding duration.

Breast Feeding↗
PubMed1983

Serological survey of ruminant livestock in some countries of the Caribbean region and South America for antibody to bluetongue virus.

A serological survey of 6250 sera from cattle, sheep and goats in seven Caribbean and two South American countries showed that antibody to bluetongue virus was widely distributed in each species throughout the survey area. Overall prevalences of antibody were 70 per cent in cattle, 67 per cent in sheep and 76 per cent in goats as assessed by an immunodiffusion test. Within countries the percentage prevalences were Jamaica 77, St Kitts/Nevis 70, Antigua 76, St Lucia 82, Barbados 61, Grenada 88, Trinidad and Tobago 79, Guyana 52 and Surinam 84. No clinical cases of bluetongue have been confirmed in the area surveyed and there are no virus isolates available to indicate which serotype(s) of virus is/are causing the infection(s).

Animals↗
PubMed2002

[Clinico-epidemiologic behavior of urolithiasis in a rural Caribbean region].

OBJECTIVE: The aim of this clinicoepidemiologic study is to determine the frequency, risk factors, morbidity and socioeconomic impact or urolithiasis in the general population of a Caribbean, subtropical rural area. METHODS: A representative sample of 1,504 subjects were randomly selected from the general population of 15,591 inhabitants in the area whose health services were provided by the Policlinico Julio Trujillo using the two-stage and equal probability functions with 95% CI. After informed consent was obtained, a survey was conducted to identify the subjects in the sample that had developed urolithiasis at some time or another. All subjects with a history of urolithiasis were included in a second survey to obtain the data required to complete the study. RESULTS: The prevalence rate was found to be similar to the 2.52% prevalence estimated worldwide. Urolithiasis was more common in the 20-29 years age group for both genders, and prevalent in the caucasians (3.2%) and male gender (3.2%). 36.8% of the subjects that had developed urolithiasis at some time or another had a family history of urolithiasis. Urinary tract infection, arterial hypertension, ischemic heart disease and diabetes mellitus were frequently associated with this condition. The incidence of stone formation was higher for the hottest period. High intake of food rich in oxalic acid, carbohydrates, proteins-purines and dairy products and low intake of fluids were closely linked with lithiasis. 97.2% s had one and 78.3% had more than one episode of nephric colic. 68.4% had one and 61.5% more than one recurrence of urolithiasis. 15.7% required surgery and 42.1% required hospitalization. Only 42.1% of the cases had unspecific medical treatment. No case had specific treatment. CONCLUSIONS: The behavior of urolithiasis in this rural population is the same as that reported in other studies for urban areas. It showed a high frequency, similar risk factors, high morbidity and important socioeconomic impact. Only half of the patients received treatment that is considered to be the least costly.

Adolescent↗
PubMed1990

[Adult T-cell leukemia and non-malignant adenopathies associated with HTLV I virus. Apropos of 17 patients born in the Caribbean region and Africa].

Adult T-cell leukaemia is the first blood disease caused by a retrovirus: HTLV-1. The authors report the first French series of 15 patients, of whom 9 came from the classical endemic areas--the Antilles and outer Caribbean Islands--and 6 from Africa where the serological prevalence of HTLV-1 is high but few cases of adult T-cell leukaemia have been reported. Emphasis is laid on the importance of immunodeficiency (refractory strongyloidiasis, Pneumocystis carinii pneumonia, polyclonal B lymphoproliferative syndrome) and of other pathologies associated with the retrovirus (polyarthritis, lymphocytic interstitial pneumonia). The authors also describe the presence of adenopathy in healthy carriers: either adenitis suggestive of retroviral infection, or Castelman's disease adenopathy. These clinical presentations are similar to those described in lymphadenopathy syndromes due to the human immunodeficiency viruses. Aggressive lymphomas require chemotherapy, but sooner or later resistance develops, and the prognosis is very poor. The indications for allogeneic bone marrow transplantation are still to be determined. The diagnosis of adult T-cell leukaemia must be considered in all patients with blood disease coming from the endemic areas.

Adult↗
PubMed2004

Caribbean: Regional support for HIV/AIDS law and policy reform.

In this article, David Patterson describes the second regional training workshop on HIV/AIDS, law, ethics, and human rights, which took place in Georgetown, Guyana in November 2003; and a grant from the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria (the Global Fund) to the Pan Caribbean Partnership against HIV/AIDS (PANCAP). The grant focuses on human rights, prevention, and care and support.

Financing, Organized↗
PubMed1998

PCR-ribotyping of Xenorhabdus and Photorhabdus isolates from the Caribbean region in relation to the taxonomy and geographic distribution of their nematode hosts.

The genetic diversity of symbiotic Xenorhabdus and Photorhabdus bacteria associated with entomopathogenic nematodes was examined by a restriction fragment length polymorphism analysis of PCR-amplified 16S rRNA genes (rDNAs). A total of 117 strains were studied, most of which were isolated from the Caribbean basin after an exhaustive soil sampling. The collection consisted of 77 isolates recovered from entomopathogenic nematodes in 14 Caribbean islands and of 40 reference strains belonging to Xenorhabdus and Photorhabdus spp. collected at various localities worldwide. Thirty distinctive 16S rDNA genotypes were identified, and cluster analysis was used to distinguish the genus Xenorhabdus from the genus Photorhabdus. The genus Xenorhabdus appears more diverse than the genus Photorhabdus, and for both genera the bacterial genotype diversity is in congruence with the host-nematode taxonomy. The occurrence of symbiotic bacterial genotypes was related to the ecological distribution of host nematodes.

Animals↗
PubMed1982

The human type-C retrovirus, HTLV, in Blacks from the Caribbean region, and relationship to adult T-cell leukemia/lymphoma.

Type-C RNA tumor viruses have been implicated in the etiology of naturally occurring leukemias and lymphomas of animals. Human T-cell leukemia/lymphoma virus (HTLV) is the first human virus of this class consistently identified in association with a specific type of human leukemia/lymphoma. The isolation of HTLV was made possible by the ability to grow mature T-cells in tissue culture usually with T-cell growth factor (TCGF). We now report a cluster of adult T-cell leukemia/lymphoma among Blacks from the Caribbean in which all eight cases are positive for HTLV virus and/or antibody. These patients have disease that appears indistinguishable from Japanese adult T-cell leukemia/lymphoma which, as we have also reported, is associated with HTLV in over 90% of cases. The finding of HTLV antibodies in some of the normal population in the Caribbean and Japan, and the clustering of a specific form of T-cell leukemia/lymphoma in these virus-endemic areas, suggest that HTLV infection may be associated with the occurrence of a distinctive clinico-pathologic entity.

Adolescent↗
PubMed1985

Current trends in screwworm myiasis in the Caribbean region.

In a random sample of animal producers and animal health personnel, 33% of the respondents in Trinidad, 15% in Guyana, 11% in Suriname and 9% in Jamaica recalled at least one case of human myiasis due to Cochliomyia homivorax (Coquerel). During 1981, respondents in Surinam (88%), Jamaica (90%), Guyana (85%) and Trinidad and Tobago (82%) found at least one case of myiasis in their livestock, occurring mainly in cattle, pigs and dogs. Feral animals, e.g. jaguars, were also found to be infested. The initial wounds were mainly the umbilicus of neonates, and arbitrary wounds, and vampire bites were also affected. Fifty-three to 78% of all respondents examined their livestock daily for wounds and infestation by the screwworm. Annual estimates of losses (in U.S. dollars) due to surveillance and medication ranged from $4.82 to $10.71 per animal. Nationally, these losses amount to $0.30 million (Surinam), $1.02 million (Trinidad and Tobago), $4.33 million (Guyana) and $6.78 million (Jamaica). Figures for other losses, arising from failure to thrive, reduction in milk production and hide injury due to screwworm activity were not available. Most producers found that the greatest screwworm infestation occurred in the wet season, and most described it as second in importance to Boophilus spp. ticks as a pest of livestock, but of greater significance than biting flies, such as tabanids and stable flies. Eradication of the screwworm from the islands of Jamaica and Trinidad and Tobago can be recommended, but in Surinam and Guyana eradication seems feasible only on the 100-km wide coastal strips where most human and livestock populations exist.

Animals↗
PubMed2004

Physicians' knowledge and opinions about medication abortion in four Latin American and Caribbean region countries.

To examine physicians' knowledge and attitudes in regard to medication abortion, we conducted focus-group discussions with general practice physicians and obstetrician-gynecologists in Honduras, Mexico, Nicaragua and Puerto Rico. Physicians were familiar with the practice of several types of medication and surgical abortion methods. Medication abortion with misoprostol is most common among women of higher socioeconomic status and is prescribed by physicians, pharmacists or self-administered. Conflicting opinions regarding safety, efficacy, cost, potential for self-medication and acceptability emerged; some participants expressed hope that medical abortion would reduce the risks associated with unsafe abortion, while others contended that drug distribution and self-medication without proper counseling could be problematic. Participants noted a lack of reliable sources of information for both providers and women, and expressed interest in strategic dissemination of information.

Abortifacient Agents, Nonsteroidal↗
PubMed1989

Bluetongue epidemiology in the Caribbean region: serological and entomological findings from a pilot sentinel system in Trinidad and Tobago.

When monitored by the agar gel immunodiffusion test for antibody to bluetongue viruses, a sentinel flock of twenty-five lambs remained seropositive through the year, whereas in a sentinel herd of twenty calves only two individuals seroconverted and these became negative again within 2 months. A light trap operated with the calf herd yielded high numbers of Culicoides insignis Lutz (over 18,000 per trap night) along with C. filariferus Hoffman, C. pusillus Lutz, C. leopoldi Ortiz, C. foxi Ortiz, C. limai Barretto, C. diabolicus Hoffman and C. guyanensis Floch and Abonnenc. Culicoides were trapped at the sheep station which had housed the lambs 3 years following the sentinel study. No virus was isolated from pools of C. insignis, C. filariferus and C. pusillus. Six other species were collected in insufficient numbers to warrant attempted virus isolations.

Animals↗
PubMed1990

Bluetongue epidemiology in the Caribbean region: serological and entomological evidence from a pilot study in Barbados.

Variation in the percentage of lambs seroconverting to bluetongue viruses was seen between sites and years in Barbados. Transmission at some sites was nearly absent whereas all lambs at one site became seropositive. The agar gel immunodiffusion test for bluetongue gave consistent results in series of serum samples from 112 of 121 sentinel lambs. Collections of biting midges in association with sheep yielded six species: Culicoides insignis Lutz, C. pusillus Lutz, C. phlebotomus (Williston), C. furens (Poey), C. jamaicensis Edwards and C. trilineatus Fox. The first two species comprised 92% of those caught during a sentinel lamb study and were the predominant species trapped for virus isolation. No viruses were recovered from 5517 C. insignis, 614 C. pusillus, three C. trilineatus and two C. furens placed into pools during two brief intensive trapping operations.

Animals↗