RESUMO
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.
RESUMO
A significant proportion of vulnerable people in sub-Saharan Africa (SSA) remain at risk for contracting diarrhoeal diseases due to the presence of many risk factors facilitating their transmission. A systematic review of published articles from the SSA region was done to determine the prevalence and types of diarrhoeal pathogens in circulation; based on a search of databases; including EBSCO host; PubMed; Scopus; Science Direct; Google scholar and Web of Science was done between September 2009 and December 2010. Data were summarized from 27 studies; with pooled data analysed and reported. Pathogens were isolated from between 26.8-65.6of cases; with an overall isolation rate of 55.7(95CI; 48.2-62.9). Isolation rates were highest amongst adult cases followed by children; and the odds of isolating a pathogen was greater in diarrhoeal cases (Odds Ratio 4.93 (95CI; 1.99 to 12.23); than in asymptomatic controls. Overall isolation ranged from 8to 99; and heterogeneity testing suggests differences between age groups (Q=5.806; df=2; P=0. 055). Mixed E. coli spp.; (29.95); Cryptosporidium (21.52); Cyclospora (18); Entamoeba; (13.8); Shigella spp. (10.49); Salmonella spp. (8.36); and Campylobacter spp. (8.33); were most commonly reported; and rotavirus was the most common virus isolated. This is the first review to look at the range of enteric pathogens circulating in SSA; and has confirmed high rates of isolation of pathogens from diarrhoeal cases. Public health practitioners can use this information to understanding the challenges related to diarrhoeal illness and set priorities for their prevention and control