Small babies on a small island: survival of very low birthweight infants in Antigua and Barbuda 1986 to 2006 / Bebés pequeños en islas pequeñas: supervivencia de infantes con muy bajo peso al nacer en Antigua y Barbuda, de 1986 a 2006

INTRODUCTION: Recent attention has been focussed on pregnancy outcomes in developing countries, with the publication of the World Health Organization Report 2005, Make Every Mother and Child Count and the Neonatal Survival Series from the Lancet in 2005. Scant outcome data from the smaller islands of the Caribbean exist for very low birthweight (VLBW) babies (birthweight < 1500 g). PATIENTS AND METHODS: a retrospective review of mortality data on vlbw babies in antigua and barbuda was performed. antigua and barbuda had a population of 71 500 with per capita income of (us) $6054 dollars in 1998. in november 1985, a neonatal special care nursery (scn) was established. the survival to discharge from scn for vlbw babies was reviewed from january 1986 to december 2006. RESULTS: there were 26 455 babies born from 1986 to 2006; 344 (1.3%) were vlbw babies. survival to scn discharge was 45% from 1986 to 1992, 46% from 1993 to 1999, and increased to 60% from 2000 to 2006 (p < 0.05 compared with the first two time-periods). babies from 1000 to 1499 g accounted for 64% of vlbw babies and survival to scn discharge was 60% from 1986 to 1992, 58% from 1993 to 1999, and increased to 83% from 2000 to 2006 (p < 0.01 compared with the first time period; p < 0.001 compared with the second). babies < 1000g accounted for 36% of VLBW babies and survival to SCN discharge was 10% from 1986 to 1992, increased to 25% from 1993 to 1999 and to 28% from 2000 to 2006 (trend of p < 0.10 compared with first time period). conservative newborn care only was available. antenatal steroids were given from 2000 to 2006. CONCLUSION: the outlook for vlbw babies using conservative newborn care techniques has significantly improved over 21-years in antigua and barbuda.

INTRODUCCIÓN: Recientemente se ha centrado la atención en los resultados del embarazo en los países en vías de desarrollo, a partir de la publicación del Informe 2005 de la Organización Mundial de la Salud, Que cada madre y cada niño cuente y la Serie de Supervivencia Neonatal de la Lancet en 2005. Son escasos los datos de resultados existentes en las islas más pequeñas del Caribe, acerca de los bebés con muy bajo peso al nacer (MBPN) (peso al nacer < 1500 g). PACIENTES Y MÉTODOS: se llevó a cabo una revisión retrospectiva de datos sobre la mortalidad de bebés mbpn en antigua y barbuda. antigua y barbuda tenían una población de 71 500 con un ingreso per cápita de $6054 usd en 1998. en noviembre de 1985, se creó una sala de cuidados especiales del Recién Nacido (SCN). La supervivencia en término de los bebés MBPN dados de alta de la SCN fue examinada de enero de 1986 a diciembre de 2006. RESULTADOS: De 1986 a 2006, hubo 26 455 bebés nacidos; de ellos 344 (1.3%) fueron bebés MBPN. La supervivencia en término de las altas de la SCN fue de 45% de 1986 a 1992, 46% de 1993 a 1999, y aumentó a 60% de 2000 a 2006 (p <0.05 en comparación con los primeros dos períodos de tiempo). Los bebés de 1000 a 1499g representaron el 64% de los bebés MBPN y la cifra de los supervivientes dados de alta del SCN fue de 60% de 1986 a 1992, 58% de 1993 a 1999, y aumentó a 83% de 2000 a 2006 (p < 0.01 en comparación con el primer periodo de tiempo; p <0.001 en comparación con el segundo). Los bebés <1000 g representaron el 36% de los bebés MBPN, y la supervivencia en términos de los dados de alta de la SCN fue 10% de 1986 a 1992, aumentó a 25% de 1993 a 1999, y a 28% de 2000 a 2006 (la tendencia de p <0.10 en comparación con el primer periodo de tiempo). Sólo hubo disponible atención neonatal conservadora Se administraron esteroides antenatales desde el año 2000 al 2006. CONCLUSIÓN: El pronóstico para MBPN usando técnicas de cuidado neonatal conservadoras ha mejorado significativamente a lo largo de 21 años en Antigua y Barbuda.

Trends in the prevalence of adolescent births in Antigua and Barbuda over 35 years / Tendencias en la prevalencia de nacimientos de partos en adolescentes en Antigua y Barbuda por espacio de 35 años

A retrospective study was undertaken to determine trends in teenage births in Antigua and Barbuda from 1969 to 2003. Maternity Ward records were reviewed at Holberton Hospital, site of over 90% of deliveries in Antigua and Barbuda. Maternal age for all births were included. The estimated population in Antigua and Barbuda increased from 60 159 in 1969 to 69 866 in 1998, with no suspected change in age-group or gender distribution. Births to mothers 12-13, 14-15, 16-17 and 18-19 years old were analyzed separately. Yearly birth totals for the 10-year period from 1969 to 1973 and 1999 to 2003 were compared using student t test analysis. The total number of births averaged 1075 per year with no change in trend. For females aged 12 and 13 years, there was no change in births from 1969 to 1978 compared with 1994 to 2003. For females aged 14 years, there was a 54% drop; for females aged 15 years, a 59% drop; for females aged 16 years, a 53% drop; for females aged 17 years, a 51% drop; for females 18 years, a 37% drop and for females aged 19 years, a 30% drop, while births to mothers $ 20 years increased 25%. The decrease for all teen births was 42% from 1969-1978 to 1994-2003. Teen births accounted for 29% of all births at Holberton in 1969 to 1973 but only 16% of births in 1999 to 2003. In conclusion, Antigua and Barbuda has seen a marked drop of 42% in teenage deliveries, including a 53% drop in school-aged teens from 1969 to 2003. Explanations include factors such as economic, social, educational and medical developments.

Se llevó a cabo un estudio retrospectivo a fin de determinar las tendencias de partos en adolescentes en Antigua y Barbuda de 1969 a 2003. Se revisaron las historias clínicas de la Sala de Maternidad del Hospital Holberton, lugar en que tuvieran lugar más del 90% de esos partos en Antigua y Barbuda. Se incluyó la edad de las madres para todos los nacimientos. La población estimada en Antigua y Barbuda, aumentó de 60 159 en 1969 a 69 866 en 1998, sin sospecha de cambio en el grupo etáreo o la distribución de género. Los nacimientos en madres de 12-13, 14-15, 16-17 y 18-19 años de edad, fueron analizados por separado. Los totales de nacimientos anuales durante el período de 10 años 1969 a 1973 y 1999 a 2003 fueron comparados usando el análisis de prueba t de estudiante. El número total de nacimientos fue de un promedio de 1075 por año, sin cambios en la tendencia. Para las hembras de 12 y 13 años de edad, no hubo cambios en los partos de 1969 a 1978 en comparación con los ocurridos de 1994 a 2003. Para las hembras de 14 años de edad, hubo una caída de un 54%; para las hembras de 15 años de edad, una caída de 59%; para las hembras de 16 años de edad una caída del 53%; para las hembras de 16 años de edad una caída de 53%; para las hembras de 17 años de edad una caída de 51%; para las hembras de 18 años de edad una caída de 37%; y para las hembras de 19 años de edad una caída de 30%, en tanto que los nacimientos para madres $ 20 años aumentaron un 25%. El descenso para todos los partos en adolescentes fue de 42% de 1969-1978 a 1994-2003. Los partos en adolescentes representaron el 29% de todos los nacimientos en Holberton desde 1969 a 1973 pero sólo un 16% de los nacimientos de 1999 a 2003. En conclusión, Antigua y Barbuda han visto un marcado descenso de 42% en los alumbramientos en adolescentes, incluyendo una caída de 53% en los adolescentes de edad escolar desde 1969 a 2003. Las explicaciones incluyen factores relacionados con el desarrollo económico, social, educacional y médico.

Does group B streptococcal infection contribute significantly to neonatal sepsis in Antigua and Barbuda?

Group B streptococcus is the most common cause of neonatal sepsis in the United States of America (USA). This study was undertaken to determine the contribution of group B streptococcus to neonatal septicaemia in Antigua and Barbuda. From 1994 to 2002, there were about 12 000 births, with 2500Special Care Nursery admissions, 1100 (44%) with potential neonatal septicaemia. Blood cultures were done in 433/1100 (39%) and cerebrospinal fluid cultures in 52/1100 (5%). Positive cultures were seen in 41/433 (9.5%) with group B streptococcus in 1/41 (2.4%), streptococcus “species” in 3/41 (7.4%) and positive cerebrospinal fluid cultures were seen in 2/52 (one group B streptococcus) giving 5 per 12 000 or 0.4 cases per 1000 babies. Vaginal cultures from 1994 to 2002 revealed group B streptococcus in 14/163 (8.6%) of positive bacterial cultures. A sample of pregnant women from a private office had positive culture for group B streptococcus in 2/120 (1.7%). The prevalence rate of carriage (15 to 40%) and infection (1.7 to 4 per 1000 babies) was much higher in the USA in the same period. Universal screening of mothers for group B streptococcus may not be as necessary or cost-effective inAntigua and Barbuda.

Los estreptococos del grupo B son la causa más común de sepsis neonatal en los Estados Unidos (EE.UU.). Este estudio se llevó a cabo con el propósito de determinar en que medida los estreptococos del grupo B contribuyen a la septicemia neonatal en Antigua y Barbuda. Desde el año 1994 hasta el2002, hubo alrededor de 12000 nacimientos, con 2500 ingresos a la Guardería de Cuidados Especiales, 1100 (44%) con septicemia neonatal potencial. Se realizaron cultivos de sangre en 433/1100 (39%) y cultivos del líquido cefalorraquídeo cerebroespinal) en 52/1100 (5%). Seobservaron cultivos positivos en 41/433 (9.5%) con estreptococos B en 1/41 (2.4%), “especies“ de estreptococos en 3/41 (7.4%), y se observaron cultivos cefalorraquídeos positivos en 2/52 (1 de estreptococosdel grupo B), para 5 por 12 000 ó 0.4 casos por 1000 recién nacidos. Los cultivos vaginales desde el año 1994 al 2002 revelaron estreptococos del grupo B en 14/163 (8.6%) de los cultivosbacterianos positivos. Una muestra de mujeres embarazadas – provenientes de una oficina privada – tuvo un cultivo positivo para estreptococos del grupo B en 2/120 (1.7%). La tasa de prevalencia de portación (15 a 40%) e infección (1.7 a 4 por 1000 recién nacidos) fue mucho más alta en los EE.UU. en el mismo período. El pesquisaje universal de madres en relación con el estreptococo de grupo Bpuede no ser tan necesario o costo-efectivo en Antigua y Barbuda.

The age-specific incidence of admission to the intensive care unit for acute myocardial infarction in Antigua and Barbuda

This study was done to assess the age-specific incidence of admission for acute myocardial infarction in Antigua and Barbuda from 1990 to 2001. A retrospective review of Intensive Care Unit admissions for possible acute myocardial infarction was performed. Data obtained included age, gender, country of residence, electrocardiogram, creatine kinase results and intensive care unit outcome. There were, 250 admissions, 194 (78%) having data available for review. Acute myocardial infarction was found in 107/194 (55.2%) patients, age 59.9 +/- 13.7 years, 28% female, 70% from Antigua and Barbuda, 90/107 (85%) were between 35 and 75 years old. The incidence would be 7.5 per year or 9.7 per year if the confirmation rate documented was similar for all admissions. With a yearly population of 9555 men age 35 to 75 years in Antigua and Barbuda, with men accounting for 72% of acute myocardial infarctions, the incidence rate was 0.57 (confirmed) to 0.73 (all admissions) per year per 1000 men. For women, the yearly population was 10822 age 35 to 75 years, and the incidence rate was 0.19 to 0.24 per year per 1000 women. The mortality rate was 12/107 (11.2%), with women being older (67 vs 57 years, p = 0.001) and dying more often (17% vs 9%) compared with men. The mortality rate in the Intensive Care Unit was 0.07 per year for men, 0.04 per year for women per 1000 aged 35 to 75 years. In the United States of America (USA), the admission rate is 4.1 for men and 1.8 for women per year per 1000 aged 35 to 75 years; the mortality rate is 1.0 for men and 0.5 for women per year per 1000 aged 35 to 75 years. Rates of admission to the Intensive Care Unit for acute myocardial infarction in Antigua and Barbuda are 20%, and mortality rates are 10% of those reported in the USA.

A comparison of patients relapsing to addictive drug use with non-relapsing patients following residential addiction treatment in Antigua / Una Comparación de Pacientes que Recayeron en el uso Adictivo de Drogas, con Pacientes que no Experimentaron Recaída Tras Seguir un Tratamiento Residencial de la Adicción en 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

Se evaluó el resultado de un programa de 29 días de tratamiento residencial de la adicción para personas de Antigua y Barbuda adictas a drogas o alcohol. Fueron incluidos todos los pacientes de un total de 100 que entraron a formar parte del programa de tratamiento contra las drogas y el alcohol en el Crossroads Centre Antigua entre noviembre de 1998 y octubre de 2002. Todos los pacientes fueron evaluados en relación con el uso o la abstinencia de drogas o alcohol en noviembre 2002, mediante un seguimiento por vía telefónica o correo, así como a través de un seguimiento informal con familiares u otros contactos en la comunidad. El Crossroads Centre Antigua es un centro de 35 camas para el tratamiento residencial por 29 días de la adicción a las drogas o el alcohol. El centro presta servicios a pacientes de los países desarrollados (85%) y de la región del Caribe (15%). También se revisaron los récords médicos de los pacientes para obtener datos sobre edad, sexo, etnicidad, droga de elección, años de uso problemático, cumplimiento del programa de 29 días, participación de miembros de la familia en el Crossroads Centre Antigua (un programa de cuatro días) y aceptación de su inclusión en una "casa de medio camino." De los 100 pacientes antigüenses admitidos, 46 (46%) eran abstinentes (no recayentes) en un momento determinado, ubicado como promedio 20.7 ± 14.7 meses después del tratamiento. La abstinencia no tenía que ser continua. Se sabía que 49 (49%) estaban usando drogas o alcohol, y cinco (5%) fueron dados por perdidos del seguimiento y de regreso al uso de las drogas (recayentes). La edad (37.5 vs 41.1 años), sexo (28% varones vs 22% hembra), etnicidad (87% vs 87% Afrocaribeños), y los años de consumo perjudicial (12.7 vs 12.5 años) no presentaron diferencias significativas entre los recayentes y los no recayentes. El uso de la cocaína-crack (67% vs 65%) y el uso del alcohol (26% vs.31%) como adicción primaria, no mostró diferencias significativas entre los recayentes y los no recayentes. Los recayentes mostraron una probabilidad significativamente menor en cuanto a completar el programa de 29 días (81% vs 100%, p < 0.01), hacer que miembros de su familia participaran en Crossroads (32% vs 54%, p < 0.05) o aceptar su inclusión en la casa de medio camino (4% vs 54%, p < 0.001). En conclusión, se logró abstinencia en el 46% de los que adoptaron el tratamiento, el 51% de los que completaron el tratamiento, el 60% de aquellos cuyas familias participaron, y el 92% de quienes aceptaron ser ubicados en la casa de medio camino.

How well does fetal ultrasound predict the date of birth in Antigua and Barbuda / Precisión del Ultrasonido Fetal en la Predicción de la fecha de Nacimiento en Antigua y 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

Este estudio fue hecho para determinar la exactitud del ultrasonido fetal (EEUU) en la predicción de la fecha estimada de parto (FEP) en una población principalmente afro-caribeña en Antigua y Barbuda. A un total de 206 mujeres, se les hizo una revisión retrospectiva de las pruebas de ultrasonido fetal, entre julio del 1994 y enero de 1996. La FEP basada en la historia menstrual (UPM) se le calculó a 104 mujeres con fechas, comparándosele luego con la FEP calculada mediante la prueba de ultrasonido. Estas fueron entonces comparadas con la fecha real de nacimiento tomada de los archivos de maternidad. Para las mujeres con datos menstruales inestables (102 mujeres), la FEP basada en ultrasonido fue comparada con la fecha real de nacimiento. La FEP basada en el ultrasonido, mostró una tendencia a ser más exacta que la FEP basada en la historia menstrual, con 10.0 + 9.4 (media + desviación estándar) días de diferencia, frente a 13.3 + 15 días, p = 0.057, (n = 104), CI: -0.1, 6.73 días. La FEP mediante ultrasonido estuvo dentro de los 10 días de parto 60% del tiempo frente al 57% en el caso de la FEP basada en historia menstrual. El error medio de estimación de la FEP fue de + 1.7 días para el ultrasonido y + 3.7 días para la historia menstrual. En mujeres sin datos de historia menstrual (n = 102), la FEP mediante ultrasonido fue igualmente exacta tanto en el segundo trimestre, 11.8 + 9.5 frente a 11.4 + 10.7 días de diferencia, (no significativo estadísticamente) y el tercer trimestre, 10.0 + 8.0 frente a 8.1 + 7.0 días de diferencia, (no significativo estadísticamente). El ultrasonido fetal es marginalmente mejor en predecir la fecha de nacimiento en comparación con el procedimiento basado en la historia mensual, pero la diferencia no justifica el uso rutinario para ese propósito. Cuando se desconoce la historia menstrual, la FEP mediante ultrasonido es tan exacta como cuando se sabe la historia mensual, lo cual la hace una prueba muy útil.

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

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 percent) were in 1-year-old children, 69 (27 percent) were in 2-year-old children, and 26 (10 percent) 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

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 br

Kenneth Harrison Uttley (1901-1972). Historian to the diseases of Antigua, British West Indies

Dr Kenneth Harrison Uttley (1901-1972) served as the Chief Medical Officer in Antigua, British West Indies, from 1955 until 1966. During this time, Dr. Uttley personally reviewed and tabulated an island-wide governmental demographic database of all births, deaths and causes of death during the preceding 100 years. This database was the result of a Compulsory Birth and Death Registration Ordinance enacted as one of several Colonial Poor Laws in 1856. His efforts resulted in the publication of a total of 30 papers in American and British medical journals. Many of these papers reviewed historical demographic trends in births, fertility rates, neonatal deaths, infant mortality and early childhood mortality rates. Others focussed on the historical epidemiology of specific diseases such as neonatal tetanus, leprosy, tuberculosis and malaria. This is the first complete bibliographical account of Uttley's contributions to the history of diseases in the West Indies in general and Antigua in particular. Dr Uttley also served as an ordained priest in the Anglican Church and, upon retirement from the Colonial Medical Services, returned to England to serve as the Vicar of Purton, Oxfordshire.

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 63were 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 9and tobacco use in 7. The in-hospital mortality in the 2-year period was 17.4(females 15, males 22, 11 65 years, 14for those with 1 to 3 admissions and 83for those with > 3 admissions, 19for those with atrial fibrillation and 16for those without). The prevalence of congestive cardiac failure utilizing the data analysed in this study (138 patients) was 0.21of the population of the island state but based on the discharge diagnosis using ICD-10 coding it was 0.5; it was 1in the 40 to 65-year-age group and 4in 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.

Myocardial infarction in Antigua: 1990 to 1995

Between January 1990 and May 1995, 117 patients were admitted to the Intentsive Care at Holberton Hospital, Antigua, for chest pain due to suspected acute myocardial infarction. 39 (45 percent) of 86 patients whose records were available for retrospective review had confirmed (27 patients) or probable (12 patients) acute myocardial infarction. Risk factors identified among the patients included hypertension, diabetes, tobacco smoking, hypercholesterolaemia and obesity. On admission, 82 percent were Killip class I and 18 percent were Killip class II. Medications in the Intensive Care Unit included nitrates, aspirin, calcium and channel blockers, beta-adrenergic blockers, heparin and angiotensin converting enzyme inhibitors (21 percent). No thrombolytic agents were available. THe average hospital stay was 10 days and the in-hospital mortality rate was 13 percent. These data indicate that early mortality from acute myocardial infarction can be reduced in developing countries by early admission to an Intensive Care Unit and use of drugs known to be effective in its treatment.

Cancer incidence and mortality in Antigua/Barbuda

An inquiry into the incidence and mortality of malignant neoplasms in Antigua/Barbuda was undertaken to document the magnitude of the disease. The top ranking cancers diagnosed in 114 males were skin (26.3%), prostate (22.8%) and upper respiratory and alimentary tract (10.5%). In 130 females, the 3 main cancers were breast (23.1%), cervix uteri (22.3%), and skin (15.3%). The main cancers causing death were stomach (22.3%) and prostate (17.8%) in 157 males; and breast (18.2%) and cervix uteri (14.1%) in 149 females. Imprecise documentation, insufficient clinico-pathological correlation and the finding of advanced cancers underscore the need for a cancer registry and cancer society in Antigua/Barbuda.