Patients' perception and satisfaction with health care professionals at primary care facilities in Trinidad and Tobago.
This paper endeavours to identify the background characteristics of health centre users in Trinidad and Tobago and their perceptions of the efficiency of the services provided. Multistage sampling was employed to select 1451 users. Data were obtained during structured interviews on regular clinic days. Of the people using the health centres, 80.4% were unemployed and 75.9% were women. People aged over 60 accounted for 25.4% of the sample. Users included a disproportionately high number of persons from the lower socioeconomic categories. The proportions of persons of different ethnic and religious groups closely reflected those in the country's general population. Approximately 74% of the interviewees were satisfied with the performance of the doctors in the health centres. For nurses the satisfaction rating was about 10% higher. The greatest needs for improvement were perceived to be in pharmacists' and doctors' services, with particular reference to waiting times. (+info)
Spatial and temporal patterns of imported malaria cases and local transmission in Trinidad.
Over a 30-year period (1968-1997) 213 malaria cases in Trinidad were investigated by the Trinidad and Tobago Ministry of Health. Using a global positional system and a geographic information system, we mapped the precise location of all reported malaria cases, and associated them with breeding habitats of anopheline vectors. The majority of the cases (138, 63%) were individual imported cases around the big port cities. Plasmodium falciparum was the most common parasite, and Africa the most common source of imported cases. Two clusters of cases occurred: an introduced P. vivax outbreak associated with Anopheles aquasalis in 1990-1991, and an autochtonous focus of P. malariae associated with An. bellator and An. homunculus in 1994-1995. Application of a space-time statistic showed a significant clustering of P. malariae cases, and, to a lesser extent of P. vivax cases, but not of P. falciparum cases. Based on potential for occurrence of local transmission, we are developing risk maps to determine surveillance priorities, outbreak potential, and necessary degree and spatial range of control activities following case detections. (+info)
Microbial quality of oysters sold in Western Trinidad and potential health risk to consumers.
The prevalence and characteristics of Escherichia coli and Salmonella spp. as well as counts of E. coli in raw oysters, condiments/spices, and raw oyster cocktails sampled from 72 vendors across Western Trinidad were determined. The microbial quality of the water used in the preparation of raw oysters was also investigated. Of 200 samples each of raw oysters, condiments/spices and oyster cocktails tested, 154 (77.0%), 89 (44.5%) and 154 (77.0%) respectively yielded E. coli. The differences were statistically significant (P = < 0.001; chi square = 62.91). The mean E. coli count per g in the ready-to-eat oyster cocktail ranged from 1.5 x 10(3) +/- 2.7 x 10(3) in Couva to 8.7x10(6) +/- 4.9x10(7) in San Fernando. One hundred and forty-six (73.0%) oyster cocktails contaminated with E. coli had counts that exceeded the recommended standard of 16 per g. Of a total of 590 E. coli isolates from various sources tested, 24 (4.1%), 20 (3.4%) and 69 (11.7%) were mucoid, haemolytic and non-sorbitol fermenters respectively. Twelve (2.0%) isolates of E. coli were O157 strains, while 92 (46.0%) of 200 E. coli isolates tested belonged to enteropathogenic serogroups. Ninety (45.0%) and 73 (36.5%) of 200 water samples contained total coliforms and faecal coliforms respectively, with counts that exceeded 2.2 coliforms per 100 ml. Salmonella spp. were isolated from 7 (3.5%), 1 (0.5%) and 2 (1.0%) of 200 samples each, of raw oysters, condiments/spices and oyster cocktails respectively. Oysters pose a health risk to consumers in Trinidad, particularly from colibacillosis and salmonellosis, and the need for increased public awareness of this hazard cannot be over-emphasized. (+info)
Transmission thresholds for dengue in terms of Aedes aegypti pupae per person with discussion of their utility in source reduction efforts.
The expense and ineffectiveness of drift-based insecticide aerosols to control dengue epidemics has led to suppression strategies based on eliminating larval breeding sites. With the notable but short-lived exceptions of Cuba and Singapore, these source reduction efforts have met with little documented success; failure has chiefly been attributed to inadequate participation of the communities involved. The present work attempts to estimate transmission thresholds for dengue based on an easily-derived statistic, the standing crop of Aedes aegypti pupae per person in the environment. We have developed these thresholds for use in the assessment of risk of transmission and to provide targets for the actual degree of suppression required to prevent or eliminate transmission in source reduction programs. The notion of thresholds is based on 2 concepts: the mass action principal-the course of an epidemic is dependent on the rate of contact between susceptible hosts and infectious vectors, and threshold theory-the introduction of a few infectious individuals into a community of susceptible individuals will not give rise to an outbreak unless the density of vectors exceeds a certain critical level. We use validated transmission models to estimate thresholds as a function of levels of pre-existing antibody levels in human populations, ambient air temperatures, and size and frequency of viral introduction. Threshold levels were estimated to range between about 0.5 and 1.5 Ae. aegypti pupae per person for ambient air temperatures of 28 degrees C and initial seroprevalences ranging between 0% to 67%. Surprisingly, the size of the viral introduction used in these studies, ranging between 1 and 12 infectious individuals per year, was not seen to significantly influence the magnitude of the threshold. From a control perspective, these results are not particularly encouraging. The ratio of Ae. aegypti pupae to human density has been observed in limited field studies to range between 0.3 and >60 in 25 sites in dengue-endemic or dengue-susceptible areas in the Caribbean, Central America, and Southeast Asia. If, for purposes of illustration, we assume an initial seroprevalence of 33%, the degree of suppression required to essentially eliminate the possibility of summertime transmission in Puerto Rico, Honduras, and Bangkok, Thailand was estimated to range between 10% and 83%; however in Mexico and Trinidad, reductions of >90% would be required. A clearer picture of the actual magnitude of the reductions required to eliminate the threat of transmission is provided by the ratio of the observed standing crop of Ae. aegypti pupae per person and the threshold. For example, in a site in Mayaguez, Puerto Rico, the ratio of observed and threshold was 1.7, meaning roughly that about 7 of every 17 breeding containers would have to be eliminated. For Reynosa, Mexico, with a ratio of approximately 10, 9 of every 10 containers would have to be eliminated. For sites in Trinidad with ratios averaging approximately 25, the elimination of 24 of every 25 would be required. With the exceptions of Cuba and Singapore, no published reports of sustained source reduction efforts have achieved anything near these levels of reductions in breeding containers. Practical advice on the use of thresholds is provided for operational control projects. (+info)
Slipped-strand mispairing at noncontiguous repeats in Poecilia reticulata: a model for minisatellite birth.
The standard slipped-strand mispairing (SSM) model for the formation of variable number tandem repeats (VNTRs) proposes that a few tandem repeats, produced by chance mutations, provide the "raw material" for VNTR expansion. However, this model is unlikely to explain the formation of VNTRs with long motifs (e.g., minisatellites), because the likelihood of a tandem repeat forming by chance decreases rapidly as the length of the repeat motif increases. Phylogenetic reconstruction of the birth of a mitochondrial (mt) DNA minisatellite in guppies suggests that VNTRs with long motifs can form as a consequence of SSM at noncontiguous repeats. VNTRs formed in this manner have motifs longer than the noncontiguous repeat originally formed by chance and are flanked by one unit of the original, noncontiguous repeat. SSM at noncontiguous repeats can therefore explain the birth of VNTRs with long motifs and the "imperfect" or "short direct" repeats frequently observed adjacent to both mtDNA and nuclear VNTRs. (+info)
A distinctive clade B HIV type 1 is heterosexually transmitted in Trinidad and Tobago.
HIV-1 transmission worldwide is predominantly associated with heterosexual activity, and non-clade B viruses account for the most spread. The HIV-1 epidemic in Trinidad/Tobago and the Caribbean shares many features with such heterosexual epidemics, including a prominent role for coincident sexually transmitted diseases. This study evaluates the molecular epidemiology of HIV-1 in Trinidad/Tobago during a period when abrupt transition from homosexual to heterosexual transmission occurred in the absence of injecting drug use, concomitant with a rapid rise in HIV-1 prevalence in the heterosexual population. Of 31 viral isolates studied during 1987-1995, all cluster with subtype B reference strains. In the analysis of full env genes from 22 early seroconverters, the Trinidad isolates constitute a significant subcluster within the B subtype. The Trinidad V3 consensus sequence differs by a single amino acid from the prototype B V3 consensus and demonstrates stability over the decade of this study. In the majority of isolates, the V3 loop of env contains a signature threonine deletion that marks the lineage of the Trinidad HIV-1 clade B epidemic from pre-1984. No phenotypic features, including syncitium induction, neutralization profiles, and chemokine receptor usage, distinguish this virus population from other subtype B viruses. Thus, although the subtype B HIV-1 viruses being transmitted in Trinidad are genetically distinguishable from other subtype B viruses, this is probably the result of a strong founder effect in a geographically circumscribed population rather than genetic selection for heterosexual transmission. These results demonstrate that canonical clade B HIV-1 can generate a typical heterosexual epidemic. (+info)
Studies on plasma lipids in industrial workers in central Trinidad and Tobago.
We assessed the plasma lipid profiles and other cardiovascular disease (CVD) risk factors in 187 (147 men, 47 women) apparently healthy employees of the Caribbean ISPAT industry in Trinidad and Tobago. Anthropometric indices and fasting plasma levels of total cholesterol (T-chol), triglyceride (TG), high-density lipoprotein (HDL), and low-density lipoprotein (LDL) were measured. The results indicate that: there was increased body mass and relative hyperlipidemia in the population studied, these CVD risk factors (increased body mass, increased blood T-chol, TG, and LDL) were more prevalent in men than women (p < 0.05), and these parameters did not differ significantly (p < 0.05) when compared among the three ethnic groups (African and Indian descendants and mixed descents). These features suggest a greater risk of CVD in men than in women. It is likely that this observation in the industrial workers might reflect the situation in the general population especially in men. Although further confirmatory studies are necessary across societal socioeconomic strata within Trinidad, we suggest that efforts should be directed at reducing excess body weight among the workers, and providing advice on increased complex carbohydrate diet in place of saturated fat. (+info)
Emergence of Salmonella enteritidis phage type 4 in the Caribbean: case-control study in Trinidad and Tobago, West Indies.
A prospective case-control study involving 46 case patients and 92 age- and neighborhood-matched control subjects was conducted in Trinidad and Tobago (T&T) between March 1998 and May 1999 to determine the etiology, sources, and risk factors for Salmonella enteritidis (SE) infection. SE infection in T&T was found to be associated with the consumption of shell eggs, and in particular raw or undercooked eggs. SE isolates from 30 (88%) of 34 patients and from 9 implicated egg or egg-containing food samples were phage type 4. Homemade eggnog and ice cream, cake batter, and egg-containing beverages were the main raw egg-containing foods, reflecting the cultural practices of the people of T&T. Public health education on the risks of eating raw or undercooked eggs, thorough cooking of all egg dishes, and refrigeration of shell eggs and egg dishes; studies tracing infected eggs to their sources; and testing of flocks of layer chickens for SE are needed to reduce the incidence of this infection. (+info)