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At least 19 recordsLinked to original sources
PubMed1996

Impact of Hurricane Luis on the health services of Antigua and Barbuda.

Antigua and Barbuda, located in the Caribbean, was one of the countries most affected by Hurricane Luis in 1995. Electricity, water supply and health facilities were disrupted for several weeks. Inadequate criteria at the design stages, unsound structural design, and lack of maintenance of building components, are some of the reasons that damage was so severe. The main hospitals and 6 health facilities were destroyed and flooded and most of the medical staff had to cope with their own damaged houses. Although the knowledge and materials are available to reduce the losses caused by hurricanes, building codes are not reinforced by laws and preventive maintenance to protect health care facilities from natural hazard damage is not usually budgeted for. The additional cost of making a single or two-storey health facility almost invulnerable to future catastrophe in a hurricane is only 2% in initial capital cost and becomes negligible when spread over the life of a building. The effort of UN International Decade for Natural Disasters (IDNDR) directed towards disaster mitigation should be increased over the remainder of the decade to ensure that standards are respected and building codes are mandatory.

Antigua and Barbuda↗
PubMed1990

A new cardiology service in Antigua and Barbuda.

Antigua, which occupies a central position in the north-eastern Caribbean, was the site of a new Cardiac Centre, based at the Government Hospital. Together with the smaller surrounding Islands, a population of a quarter of a million/persons was thus offered cardiac care with great savings in total cost and travelling. The new cardiac clinic enrolled 78 patients, and provided a base for surgery assessment, pacemaker follow-up, and teaching. A new echocardiography service benefited 127 patients, of whom 9 subsequently underwent open-heart surgery. Two new avenues for surgery were formed. A new permanent pacemaker implantation service resulted in 3 implants, and temporary pacemaker therapy became operational. These services ceased in late 1989.

Antigua and Barbuda↗
PubMed2006

Antibiotic use and overuse for appendicectomy in Antigua and Barbuda.

The use of antibiotics for appendicectomy in Antigua and Barbuda, from January 1998 to December 1999, was examined with respect to current Surgical Infection Society guidelines from developed countries. There were 143 cases of appendicectomy performed at Holberton Hospital. The mean patient age and standard deviation (SD) was 28.1 +/- 15.8 years, 57% female. Pathology showed inflammed appendix only in 56%, peri-appendiceal abscess/perforation in 17%, "fibrosed" appendix in 10% and normal appendix in 17%. Postoperative infection (wound infection, fever > three days) was seen in 7/24 (29%) of cases with peri-appendiceal abscess/perforation and 2/119 (1.7%) of the other cases. A subset of 88 cases had antibiotic use reviewed: 3/88 (3.4%) were given no antibiotics, 7/88 (8%) were given one antibiotic, 5/88 (5.7%) were given two antibiotics, 72/88 (81.8%) were given three antibiotics and 1/88 (1.1%) was given four antibiotics. Parenteral antibiotics were given a mean and SD of 5.39 +/- 1.94 days followed by oral antibiotics in 18/88 (20.5%) cases. Those with appendiceal abscess/perforation were treated parenterally for mean and SD of 6.56 +/- 2.35 days, not significantly different from others. Most frequent antibiotics used were gentamicin, metronidazole and ampicillin/penicillin/cloxacillin/cephradine (81.8%). The Surgical Infection Society recommends starting prophylactic antibiotics before surgery, using appropriate spectrum agents for less than 24 hours if not contaminated and less than five days if infected. It may be possible to safely reduce antibiotic use for appendicectomy in Antigua and Barbuda.

Adolescent↗
PubMed2002

Did exclusive breast-feeding and early discharge lead to excessive bilirubin levels in newborns in Antigua and Barbuda?

Hyperbilirubinaemia is a common neonatal problem worldwide and is the leading cause of admission to the Special Care Nursery in Antigua and Barbuda. In 1990, the Innocenti Declaration in support of breast-feeding led to the adoption of the Baby-Friendly Hospital Initiative in many countries of the Caribbean, including Antigua and Barbuda. Comparing 1989 to the years 1992 to 1994, the Special Care Nursery at Holberton Hospital experienced a 40% increase in newborns admitted with hyperbilirubinaemia (peak total bilirubin > 12 mg/dl or 205 mumol/l). A retrospective review of Special Care Nursery and Maternity Ward records was undertaken to determine the incidence and aetiology of hyperbilirubinaemia from 1992 to 1994. There were 3721 infants born in Antigua and Barbuda in those years, 98% of Afro-Caribbean or mixed ancestry. The overall incidence of peak total bilirubin over 12 mg/dl (205 mumol/l) was 12.5% (466/3721), not inconsistent with the reported incidence of 8 to 20% in other countries. However, the incidence of higher levels of hyperbilirubinaemia in Antigua and Barbuda exceeded those reported for other countries. In Antigua and Barbuda, total bilirubin of 15 mg/dl (255 mumol/l) or higher was found in 263 of 3721 infants (7.1%) compared to 5.9% in India and 2% of breast-fed infants in the United States of America (USA). Total bilirubin of 20 mg/dl (340 mumol/l) or higher was seen in 91 of 3721 infants (2.5%) exceeding reported prevalence in the USA for both African-American and Caucasian infants (1%) and equal to the reported prevalence in Asian infants (2%). The possible aetiologies of hyperbilirubinaemia in neonates with total bilirubin 18 mg/dl (306 mumol/l) or higher in our patients were investigated. Medical records of 134 of 156 (86%) infants having this level of hyperbilirubinaemia were available for review. The possible reason for hyperbilirubinaemia was ABO incompatibility in 4/134 (3%), Rh incompatibility in 1/134 (1%), prematurity in 12/134 (9%) and sepsis neonatorum in 21/134 (16%). The hyperbilirubinaemia was idiopathic in 96/134 (71%) infants. Newborns in Antigua and Barbuda were discharged 3.7 days after their mothers' admission, with 50% discharged prior to 48 hours of age. Early discharge in developed countries has led to increased readmissions for hyperbilirubinaemia. Following the appointment of a dietitian to supervise breast-feeding, admissions for hyperbilirubinaemia fell by 50% by 1998. These data suggest that exclusive breast-feeding and early discharge led to an epidemic of neonatal hyperbilirubinaemia in Antigua and Barbuda.

Antigua and Barbuda↗
PubMed1999

The prevalence, aetiology and treatment of congestive cardiac failure in Antigua and Barbuda.

A retrospective review of the cases of congestive heart failure admitted to Holberton Hospital in Antigua in 1995 and 1996 was undertaken. Two hundred and ninety-three (293) patients were identified by International Statistical Classification of Diseases, 10th revision (ICD-10) coding as having congestive cardiac failure in the period but only 138 charts were either available or fitted the definition of congestive cardiac failure and these provided the basis for this analysis. The average age of patients admitted for congestive cardiac failure was 69 years (range: 5 months to 99 years), and 63% were female. the aetiology of congestive cardiac failure was hypertension (41%), ischaemia (33%), valvular (12%), alcohol related (2%), idiopathic (5%) and mixed (7%). Treatment included diuretics (95%), angiotensin converting enzyme inhibitors (78%), digoxin (75%), nitrates (34%), calcium channel blockers (25%), other vasodilators (7%) and antiarrhythmics (5%). Of those with congestive heart failure, diabetes was present in 38%, atrial fibrillation in 19%, renal insufficiency in 17%, elevated cholesterol in 11%, obesity in 9% and tobacco use in 7%. The in-hospital mortality in the 2-year period was 17.4% (females 15%, males 22%, 11% < 65 years, 20% > 65 years, 14% for those with 1 to 3 admissions and 83% for those with > 3 admissions, 19% for those with atrial fibrillation and 16% for those without). The prevalence of congestive cardiac failure utilizing the data analysed in this study (138 patients) was 0.21% of the population of the island state but based on the discharge diagnosis using ICD-10 coding it was 0.5%; it was 1% in the 40 to 65-year-age group and 4% in those > 65 years of age. The patients in this study represented only those with New York Heart Association (NYHA) classes III and IV, hence the true prevalence would be higher than recorded here. Congestive cardiac failure is emerging as a significant health problem in Antigua and Barbuda.

Adolescent↗
PubMed2003

A case control study of the prevalence of perinatal complications associated with fetal macrosomia in Antigua and Barbuda.

The prevalence of obstetric, perinatal and neonatal complications associated with fetal macrosomia at Holberton Hospital in Antigua and Barbuda was assessed by a retrospective, case-control study. All babies of birthweight (BW) greater than 4.5 kg born between July 1991 and January 1997 and all babies with BW greater than 4.0 kg born between July 1991 and January 1995, were included. Control babies, were selected from those born on the same day as the index case. Babies of BW > 4.0 kg and babies of BW > 4.5 kg were 5.7% and 1% of births respectively Records were complete for 157 large babies (40 with BW > 4.5 kg) and 157 control babies < 4.0 kg. Mothers of large babies were significantly older, more parous, more likely to have diabetes mellitus, hypertension, and deliver after 40 weeks gestation. At delivery, mothers of large babies were more likely to bleed. Large babies had lower one minute and five minute Apgar score, were more likely to be meconium stained, have respiratory distress, have birth trauma or dystocia and to be admitted to Special Care Nursery. There was no difference in Caesarean section rate, hospital days, neonatal jaundice or mortality. Babies with BW > 4.5 kg had mortality of 7.5% versus 1.8% for those < 4.5 kg. Fetal macrosomia remains a difficult obstetrical problem associated with significant maternal, perinatal and neonatal consequences. Morbidity and mortality are still significant in developed and developing countries alike.

Antigua and Barbuda↗
PubMed2005

How well does fetal ultrasound predict the date of birth in Antigua and Barbuda?

This study was done to determine the accuracy of fetal ultrasound (U.S.) predicting the estimated date of delivery (EDD) in a primarily Afro-Caribbean population in Antigua and Barbuda. A total of 206 women had retrospective review offetal ultrasound tests done between July 1994 and January 1996. The EDD based on last menstrual period (LMP) was calculated for 104 women with dates and compared with EDD calculated from ultrasound test. These were then compared with actual date of birth from maternity records. For women with unreliable menstrual data (102 women), ultrasound EDD was compared with actual date of birth. Ultrasound EDD demonstrated a trend toward being more accurate than menstrual history EDD, being 10.0 +/- 9.4 (mean +/- standard deviation) days off versus 13.3 +/- 15 days, p = 0.057, (n=104), CI: -0.1, 6.73 days. Ultrasound EDD was within ten days of delivery 60% of the time versus 57% for menstrual history EDD. The average error in estimating EDD was + 1.7 days for ultrasound and + 3.7 days for menstrual history. In women without menstrual history data (n=102), the ultrasound EDD was just as accurate in both the second trimester, 11.8 +/- 9.5 versus 11.4 +/- 10.7 days off (not statistically significant) and the third trimester, 10.0 +/- 8.0 versus 8.1 +/- 7.0 days off (not statistically significant). Fetal ultrasound is marginally better at predicting the date of birth compared with menstrual history but the difference does notjustify routine use for that purpose. When menstrual history is unknown, ultrasound EDD is just as accurate as when menstrual history is known, making it a very useful test.

Antigua and Barbuda↗
PubMed1999

Fluoride rinse. An alternative to restoration in Barbuda, West Indies.

At the request of the government of Antigua-Barbuda, a group of dental professionals developed a dental public health program in the schools on the island. The program used a fluoride rinse that not only reduced the amount of decay in permanent teeth but also markedly reduced the need for restorative care of the primary teeth.

Adolescent↗
PubMed2002

The spectrum of accidental childhood poisoning in the Caribbean.

OBJECTIVE: To assess accidental poisoning in children in the Caribbean country of Antigua and Barbuda, including the incidence, the types of substances ingested, the age of the children involved, and the clinical outcomes. The results from Antigua and Barbuda were compared with the results of other reports from the English-speaking Caribbean and from the United States of America. DESIGN AND METHODS: We performed a retrospective review of the charts of all patients less than 13 years old admitted to the Children's Ward at Holberton Hospital in Antigua for accidental poisoning between March 1989 and March 1999. Those data were compared with data from earlier reports from Barbados, Guyana, Jamaica, and the United States of America. RESULTS: In Antigua and Barbuda there were 255 hospital admissions for accidental poisoning among children below 13 years old over that 10-year period. Of the 255 ingestions, 115 of them (45%) were in 1-year-old children, 69 (27%) were in 2-year-old children, and 26 (10%) were in 3-year-old children. These proportions in Antigua and Barbuda are similar to the age patterns seen in the other countries with which we made comparisons. In Antigua and Barbuda there was an annual average of 26 hospital admissions for poisoning for the roughly 20,000 children below 13 years of age, for a rate of 1.3 per 1,000. In comparing the patterns of childhood poisoning in all the countries we studied, we found that, as economic levels rose, there was a shift in the substances ingested, with hydrocarbon and plant ingestions decreasing and chemical and medication ingestions increasing. CONCLUSIONS: There is an increasing variety and complexity of poisonous substances ingested as economic conditions improve. This trend would make the establishment of a poison control center for the English-speaking Caribbean a logical step.

Antigua and Barbuda↗
PubMed2005

A comparison of patients relapsing to addictive drug use with non-relapsing patients following residential addiction treatment in Antigua.

The outcome of a 29-day residential addiction treatment programme for persons from Antigua and Barbuda with addiction to drugs or alcohol was assessed. All 100 patients entering the drug and alcohol treatment programme at Crossroads Centre Antigua between November 1998 and October 2002 were included. All patients were assessed with regards to drug or alcohol use or abstinence in November 2002 using telephone and mail follow-up as well as informal follow-up with families and other community contacts. Crossroads Centre Antigua is a 35 bed, 29-day residential treatment centre for drug and alcohol addiction serving patients from developed countries (85%) and from the Caribbean region (15%). Patients records were also reviewed to obtain age, gender, ethnicity, drug of choice, years of problematic use, completion of the 29 day programme, family member participation at Crossroads Centre Antigua (a four-day programme) and acceptance of halfway house placement. Of the 100 Antiguan patients admitted, 46 (46%) were abstinent (non-relapsers) at average 20.7+/-14.7 months after treatment. Abstinence did not have to be continuous. Forty-nine were known to be using drug or alcohol (49%) and five (5%) were lost to follow-up and considered to be using drugs (relapsers). Age (37.5 vs 41.1 years), gender (28% vs 22% female), ethnicity (87% vs 87% Afro-Caribbean), years of harmful use (12.7 vs 12.5 years) did not differ significantly between relapsers and non-relapsers. Crack cocaine use (67% vs 65%) and alcohol use (26% vs 31%) as primary addiction did not differ significantly between relapsers and non-relapsers. Relapsers were significantly less likely to complete the 29- day programme (81% vs 100%, p < 0.01), have family members participate at Crossroads (32% vs 54%, p < 0.05) or accept halfway house placement (4% vs 54%, p < 0.001). In conclusion, abstinence was achieved in 46% of those entering treatment, in 51% completing treatment, in 60% whose families participated and in 92% of those accepting halfway house placement.

Adult↗
PubMed1993

Children's eating habits: a question of balance.

Observations made in Antigua indicate that children consume significant amounts of food between main meals. Some of the constituents of snacks are nutritionally valuable but much of this intake is undesirable and could be laying the foundations of ill-health. Continuing efforts in the field of education on nutrition are clearly necessary for both the children and their parents.

Adolescent↗