Knowledge management strategy for advancing the national health agenda in Dominica / Estrategia de gestión del conocimiento para impulsar el programa nacional de salud de Dominica

ABSTRACT The Ministry of Health and Environment (MoHE) of the Commonwealth of Dominica identified the need for a knowledge management strategy to advance the country's national health agenda. The Pan American Health Organization and the MoHE conducted a rapid situation analysis of knowledge management in July 2015. The findings, analysis, and recommendations were developed jointly with a core team of the MoHE within the context of the strategic plan for health, "Investing in Health - Building a Safer Future." The situation analysis described the overall status of the understanding and implementation of information and knowledge management activities, projects, products, and practices. The analysis also aimed to identify what critical knowledge is needed to support overall organizational goals and individual and team activities. The MoHE expects patient outcomes and quality of care to improve as a result of having a knowledge management strategy that boosts the Ministry's efficiency and productivity.(AU)

RESUMEN El Ministerio de Salud y Medioambiente del Commonwealth de Dominica determinó la necesidad de definir una estrategia de gestión del conocimiento para impulsar el programa nacional de salud del país. En julio del 2015, la Organización Panamericana de la Salud y el Ministerio de Salud y Medioambiente llevaron adelante un análisis rápido de la situación de la gestión del conocimiento. Los resultados, el análisis y las recomendaciones fueron elaborados conjuntamente con un equipo básico del Ministerio dentro del contexto del plan estratégico de salud Investing in Health: Building a Safer Future [invertir en la salud para forjar un porvenir más seguro]. En el análisis de la situación se describe el estado general del conocimiento y el desarrollo de actividades, la ejecución de proyectos, la elaboración de productos y la aplicación de prácticas de gestión de la información y el conocimiento. Dicho análisis además tuvo como objetivo definir el conocimiento fundamental que se necesita para apoyar la consecución de todas las metas institucionales y la realización de las actividades tanto individuales como grupales. El Ministerio de Salud y Medioambiente espera que mejoren los resultados de los pacientes y la calidad de la atención al contar una estrategia de gestión del conocimiento que le permita impulsar su eficiencia y productividad.(AU)

First reported enterovirus D68 infection in pediatric patients from the Caribbean region: evidence of spread from the U.S. outbreak / Primeros casos notificados en el Caribe de infección por enterovirus D68 en pacientes pediátricos: pruebas de la propagación del brote de los Estados Unidos

ABSTRACT The 2014 enterovirus D68 (EV-D68) outbreak in the United States raised concerns about the introduction of the virus in the Caribbean region. The objective of this study was to provide rapid evidence of the introduction of EV-D68 strains in the Caribbean region during the 2014 outbreak in the United States, using a relatively simple phylogenetic approach. From October 2014 to May 2015, four EV-D68 cases from two countries (Bermuda and Dominica) were detected at the regional referral laboratory at the Caribbean Public Health Agency (Port of Spain, Trinidad and Tobago) based on molecular testing of respiratory specimens. All cases were children presenting to hospitals with moderate respiratory distress. No cases of acute flaccid paralysis were detected. Phylogenetic analysis of the Caribbean strains showed more than 99% similarity with the 2014 U.S.-outbreak strain, providing evidence of the introduction and circulation of the virus in the region.(AU)

RESUMEN El brote de enterovirus D68 (EV-D68) registrado en el 2014 en los Estados Unidos suscitó preocupación acerca de la introducción del virus en el Caribe. El objetivo de este estudio fue aportar pruebas rápidas, mediante la adopción de un enfoque filogénico relativamente sencillo, de que durante ese brote ingresaron en el Caribe cepas del EV-D68. Entre octubre del 2014 y mayo del 2015, el laboratorio regional de referencia ubicado en el Organismo de Salud Pública del Caribe (Puerto España, Trinidad y Tabago) detectó cuatro casos de EV-D68 provenientes de dos países (Bermudas y Dominica) mediante el análisis molecular de muestras respiratorias. Todos los casos correspondían a niños que acudieron al hospital con dificultad respiratoria moderada. No se detectó ningún caso de parálisis flácida aguda. El análisis filogénico de las cepas encontradas en el Caribe demostró una semejanza superior al 99 % con la cepa responsable del brote del 2014 en los Estados Unidos, lo que demuestra la introducción y la circulación del virus en la región.(AU)

The distribution of seagrasses in Dominica, Lesser Antilles

Seagrass beds are the largest organism-built marine habitat in Dominica, yet have only been surveyed since 2007. Standardized examinations along a depth gradient between 0 and 24m, focusing on magnoliophyte species composition and benthic cover of shoots at 17 seagrass bed sites, were carried out between September 10 and December 7, 2008. The Cymodoceaceae Syringodium filiforme (Kuetzing 1860) and Halodule wrightii (Ascherson 1868), as well as the Hydrocharitaceae Halophila decipiens (Ostenfeld 1902), H. stipulacea (Fosskal & Ascherson 1867) and Thalassia testudinum (Banks ex König 1805) displayed distinct regional and horizontal distribution patterns. Syringodium filiforme is the island’s dominant seagrass along the western and northern coasts, occurring at depths between 2 and 18m and with a mean benthic cover ranging from 0.9-10% along the West coast. Along the North coast it grew between 0.2 and 1m depth with a mean maximum benthic cover of 48.9%. Halodule wrightii grew along the North and West coasts, in depths between 1 and 14m in areas of recent and chronic disturbances. Its delicate morphology and sparse benthic cover (<0.1%) did not constitute seagrass beds. Halophila decipiens grew along the deep, shallow and lateral margins of west coast S. filiforme beds and monospecifically in depths between 3 and 24m. Halophila stipulacea, an invasive species, was widespread along 45km of the West coast and was found in depths between 5 and 24m. Both Halophila species formed extensive beds at depths beyond the survey limit of 24m thus playing a potentially important role in the resettlement of shallow areas after storms. H. decipiens and H. stipulacea are currently the second and third most common seagrasses on the island respectively, despite their absence along the North coast. T. testudinum was confined to North coast’s sheltered reef flats at depths 1m or less with mean a benthic cover ranging from 2 to 76%. It grew monospecifically in the most turbulent and in the calmest locations, yet intermixed with S. filiforme in areas of moderate turbulence. Strong surge along the West coast (October 15-16, 2008), associated with Hurricane Omar, caused uprooting and burial of seagrass beds in varying degrees, in particular along the shallow margins between 2 and 10m depth. This event also demonstrated the dynamic nature of Dominica’s shallow seagrass bed margins and the resistance level of individual beds to storm disturbances. Rev. Biol. Trop. 58 (Suppl. 3): 89-98. Epub 2010 October 01.

Pastos marinos son los ambientes más grandes constituidos por organismos en Dominica. Sin embargo, sólo se han examinado desde 2007. Entre el 10 de septiembre y 9 de diciembre 2008, se examinaron la composicion de especies y la densidad de magnoliofitas en profundidades de 0 a 24m. Los Cymodoceaceae: Syringodium filiforme y Halodule wrightii, tal como los Hydrocharitaceae: Halophila decipiens, H. stipulacea y Thalassia testudinum, mostraron una distribución regional y horizontal muy distinta. Syringodium filiforme fue la especie dominante en las costas del oeste y del norte de la isla. Se encontró en profundidades de 2 a 18m y con un promedio de cobertura béntica de 0.9-10% en la costa del oeste. En las costas del norte creció entre 0.2 y 1m de profundidad con un pormedio de cobertura béntica de 48.9%. Halodule wrightii creció en las costad del norte y oeste, en profundidades de 1 a 14m en áreas de perturbaciones recientes o crónicas. Su morfología delicada y su baja cobertura béntica (<0.1%) no constituyeron pastos. Halophila decipiens creció en los márgenes profundos, llanos y laterales de pastos dominados por S. filiforme, pero también en forma mono-específica entre 3 y 24m. Halophila stipulacea, una especie invasora, se encontró comúnmente a lo largo de 45km de la costa del oeste en profundidades entre 5 y 24m. Ambas especies de Halophila formaron pastos extensos en profudidades mayores al límite de este estudio y puden ser importantes en la recolonización de áreas llanas después de tormentas destructivas. H. decipiens y H. stipulacea ahora son las especies más comunes después de S. filiforme, a pesar de su ausencia en la costa del norte. T. testudinum, sólo creció en la costa del norte, encima de áreas arrecifales con un pormedio de cobertura béntica entre 2 y 76%, en aguas con 1m o menos de profundidad. Crecieron mono-específicamente en áreas de turbulencia máxima y mínima, pero entre S. filiforme en áreas de turbulencia moderada. Oleaje fuerte en la costa del oeste (octubre 16), asociado con el Huracán Omar, causó la erosión y el enterramiento variado de las márgenes llanas de pastos marinos, particularmente entre 2 y 10m de profundidad. Este evento demostró la dinámica en las márgenes llanas de pastos marinos de Dominica y el nivel de resistencia a perturbaciones de pastos individuales.

The effects of a coral disease on the reproductive output of Montastraea faveolata (Scleractinia: Faviidae)

The direct impacts of coral diseases on coral populations have been assessed by quantifying coral tissue loss and colony mortality, but the determination of the indirect effects of diseases, such as disruptions in life history functions (e.g. reproduction, growth and maintenance), are more difficult to ascertain and have been scant. This study involved a comparison of various measures of reproductive output from histological slides of healthy tissue samples of Montastraea faveolata and tissue samples from colonies with white plague (WP) infections in Dominica (West Indies). Although the variability in the reproductive data was high, WP had significant negative impacts on the percentage of reproductive polyps per cm2, the percentage of reproductive mesenteries within a polyp, oocyte quantity per polyp, mean oocyte volume (mm3), and fecundity (oocyte volume per cm2 of tissue). However, these effects were only observed in the tissue directly impacted by the WP disease "band" and were not observed in tissue samples taken 20 cm away from the lesion. Therefore, the effects of a coral disease (WP) on reproductive output are localized and not expressed colony-wide. Rev. Biol. Trop. 58 (Suppl. 3): 99-110. Epub 2010 October 01.

Implications of coral harvest and transplantation on reefs in northwestern Dominica

In June, 2002, the government of Dominica requested assistance in evaluating the coral culture and transplantation activities being undertaken by Oceanographic Institute of Dominica (OID), a coral farm culturing both western Atlantic and Indo-Pacific corals for restoration and commercial sales. We assessed the culture facilities of OID, the condition of reefs, potential impacts of coral collection and benefits of coral transplantation. Coral reefs (9 reefs, 3-20m depth) were characterized by 35 species of scleractinian corals and a live coral cover of 8-35%. Early colonizing, brooders such as Porites astreoides (14.8% of all corals), P. porites (14.8%), Meandrina meandrites (14.7%) and Agaricia agaricites (9.1%) were the most abundant corals, but colonies were mostly small (mean=25cm diameter). Montastraea annularis (complex) was the other dominant taxa (20.8% of all corals) and colonies were larger (mean=70cm). Corals (pooled species) were missing an average of 20% of their tissue, with a mean of 1.4% recent mortality. Coral diseases affected 6.4% of all colonies, with the highest prevalence at Cabrits West (11.0%), Douglas Bay (12.2%) and Coconut Outer reef (20.7%). White plague and yellow band disease were causing the greatest loss of tissue, especially among M. annularis (complex), with localized impacts from corallivores, overgrowth by macroalgae, storm damage and sedimentation. While the reefs appeared to be undergoing substantial decline, restoration efforts by OID were unlikely to promote recovery. No Pacific species were identified at OID restoration sites, yet species chosen for transplantation with highest survival included short-lived brooders (Agaricia and Porites) that were abundant in restoration sites, as well as non-reef builders (Palythoa and Erythropodium) that monopolize substrates and overgrow corals. The species of highest value for restoration (massive broadcast spawners) showed low survivorship and unrestored populations of these species were most affected by biotic stressors and human impacts, all of which need to be addressed to enhance survival of outplants. Problems with culture practices at OID, such as high water temperature, adequate light levels and persistent overgrowth by macroalgae could be addressed through simple modifications. Nevertheless, coral disease and other stressors are of major concern to the most important reef builders, as these species are less amenable to restoration, collection could threaten their survival and losses require decades to centuries to replace. Rev. Biol. Trop. 58 (Suppl. 3): 111-127. Epub 2010 October 01.

En junio del año 2002 el gobierno de Dominica solicitó asistencia para evaluar el Instituto Oceanográfico de Dominica (OID), una operación de cultivo de corales del océano Atlántico y del Indo Pacifico para propósitos de restauración y comercio. Evaluamos las facilidades de cultivo del OID, la condición de los arrecifes y el impacto potencial de la recolección de corales y los posibles beneficios del transplante de colonias. Los arrecifes de coral (9 arrecifes de profundidades entre 3 y 20m se caracterizaban por 35 especies escleractíneos y una cobertura viva de coral entre 8 y 35%. Las especies que liberan larvas tales como Porites astreoides (14.8 % de todos los corales), P. porites (14.8%), Meandrina meandrites (14.7%) y Agaricia agaricites (9.1%) fueron los más abundantes, pero sus colonias eran pequeñas (promedio de 25cm de diámetro). El complejo de Montastraea annularis fue otro grupo dominante (20.8% de todos los corales) y sus colonias eran mayores (promedio de 70cm de diámetro). Entre todas las especies los corales habían perdido el 20% de sus tejidos, con un promedio de 1.4% por mortandad reciente. Las enfermedades de coral afectaron 6.4% de todas las colonias, con la incidencia mayor en Cabrits Oeste (11%), Bahía Douglas (12.2%) y el arrecife de Coconut Afuera (20.7%). Plaga blanca y la enfermedad de la banda amarilla causaron la mayoría de la pérdida de tejido vivo, especialmente en el complejo de M. annularis, con impactos localizados por caracoles coralívoros, sobre crecimiento por macroalgas, impactos de tormentas y sedimentación. Mientras los arrecifes parecen estar declinando substancialmente, los esfuerzos de restauración de OID no parecen entablar su recuperación debido a que las especies escogidas para transplantar con las mayores tasas de sobrevivencia incluyen especies que liberan larvas (Agaricia y Porites) que fueron abundantes en las restauraciones, al igual que los organismos potencialmente parasíticos (Palythoa ...

Distribution and size of benthic marine habitats in Dominica, Lesser Antilles

Surveys of benthic marine habitats encompassing 1 814.7ha and lining 90% of Dominica’s shoreline were carried out to build the first composite picture of the distribution and size of the island’s near-shore sublittoral habitats, and the epibenthic communities they harbor. Field survey sites covered areas ranging from 1 425 to 29.6ha, lining the shore in bands ranging between 50 and 250m in width, in waters no deeper than 30m. Thus a total of 755ha of benthos were surveyed in October and November of 2007. The benthic habitat composition of an additional 1 059.7ha was inferred with the help of unpublished data and satellite imagery. Seagrass beds were the most widespread organism-built habitat type with 265ha. Coral reefs covered 72.2ha. Both of these habitats were predominantly established along the West and North coasts, which included the island’s most habitatdiverse regions. Rocky environments (911.5ha) dominated the East and South coast and together with sandy areas (566ha) constituted 81% of the island’s marine benthos. It is apparent that seagrass beds, which include four native and one invasive seagrass species, had not been surveyed as previous distribution reports could not be confirmed. Similarly, the benthic cover of Dominica’s coral reefs is evidently far below the previously reported 7 000ha. Such discrepancies highlight the advantage of environmental assessments based on field surveys and systematic data compilation, particularly in cases like Dominica where a narrow island shelf stages marginal marine resources in spatial proximity to each other and human settlements. This study has demonstrated how low-tech field methods can be applied on an island-wide scale to build an inventory of marine resources in the form of habitat maps and data repositories publicly accessible for future use. In the absence of such efforts, the development of conservation measures and status reports will remain ill founded. Rev. Biol. Trop. 58 (2): 589- 602. Epub 2010 June 02.

Los ambientes béntico-marinos de Dominica, Antillas Menores, incluyen 1 814.7ha y cerca del 90% de la costa. Este es el primer trabajo sobre el tamaño y distribución de los ambientes costeros sublitorales y sus comunidades epibénticas. Los pastos marinos constituyeron el ambiente más extenso, con 265ha. Los arrecifes coralinos presentaron una cobertura de 72.2ha. Ambos tipos de ambientes se encontraron principalmente en la costa oeste y norte, regiones con la mayor diversidad de ambientes marinos. Las áreas rocosas (911.5ha) dominaron las costas este y sur de la isla, y junto con las áreas arenosas (566ha) constituyeron el 81% de los ambientes bénticos. La distribución de pastos marinos, que incluyeron cuatro especies nativas y una invasiva, no se pudo corroborar con los pocos informes previos. La cobertura béntica de los arrecifes coralinos de Dominica fue mucho menor que las 7 000ha que se habían reportado previamente. Estas discrepancias ilustran la ventaja de los estudios ambientales basados en trabajo de campo y la compilación sistemática de datos ambientales, especialmente en casos como Dominica donde por lo angosto de la plataforma insular, los ambientes marinos sublitorales quedan muy cerca de los centros urbanos. Se demuestra que técnicas simples pueden ser utilizadas a gran escala alrededor de una isla para realizar inventarios de los recursos marino-costeros, mediante mapas y repositorios públicos de datos para usos futuros, que permiten el desarrollo de medidas de conservación efectivas.

Correlates of sexual activity and inconsistent condom use among high-school girls in Dominica / Correlatos de la actividad sexual y el uso no sistemático del condón entre las jóvenes de la escuela secundaria en Dominica

OBJECTIVE: To determine factors associated with sexual activity and inconsistent condom use among high-school girls in Dominica. METHODS: A cross-sectional study was conducted at five high-schools in Dominica in 2000 to assess behaviour that may put high-school girls at risk for HIV The main outcome variable, sexual activity, was defined as vaginal or anal sex, and inconsistent condom use defined as none to infrequent condom use. The convenience sample consisted of 204 girls (median age 16 years). RESULTS: Forty-one per cent (41%) of girls reporting at least one episode of sexual activity. Sexual intercourse was associated with past sexual coercion (OR = 7.2, 95% CI 2.4, 21.8), oral sex (OR = 8.0, 95% CI 3.0, 21.0) and smoking marijuana (OR = 8.2, 95% CI 2.9, 23.0). Among sexually active girls, 59% were inconsistent condom users. Variables associated with inconsistent condom use were being coerced (OR 2.8, 95% CI 0.9, 8.2) and low socio-economic status (OR 3.3, 95% CI 1.1, 9.6). CONCLUSION: Sexual activity and inconsistent condom use occur frequently among high-school girls in Dominica. Therefore, strategies directed at delaying the onset of sexual activities such as providing accurate and age-appropriate information on sexuality in the context of the economic and social conditions of their daily lives, and increasing condom use are important in HIV prevention in this population.

OBJETIVO: Determinar los factores asociados con la actividad sexual y el uso no sistemático del condón entre las estudiantes de Secundaria en Dominica. MÉTODOS: Se llevó a cabo un estudio transversal en cinco escuelas secundarias en Dominica en el año 2000 a fin de evaluar conductas que pueden poner a las estudiantes de Secundaria en riesgo de adquirir el VIH. La principal variable de resultado fue la actividad sexual definida como sexo vaginal o anal, y el uso no sistemático del condón fue definido como uso poco frecuente o no uso en lo absoluto del condón. La muestra de conveniencia consistió en 204 muchachas (16 años de edad mediana). RESULTADOS: El cuarenta y un por ciento (41%) de las estudiantes reportaron al menos un episodio de actividad sexual. La relación sexual estuvo asociada con coerción sexual en el pasado (OR = 7.2, 95% CI 2.4, 21.8), sexo oral (OR = 8.0, 95% CI 3.0, 21.0) y el fumar marihuana (OR = 8.2, 95% CI 2.9, 23.0). Entre las muchachas sexualmente activas, 59% no eran usuarias sistemáticas del condón. Las variables asociadas con el uso no sistemático del condón fueron el actuar bajo coacción (OR 2.8, 95% CI 0.9, 8.2) y el bajo nivel socio-económico (OR 3.3, 95% CI 1.1, 9.6). CONCLUSIÓN: La actividad sexual y el uso del condón no sistemático ocurren con frecuencia entre las estudiantes de secundaria en Dominica. Por lo tanto, las estrategias dirigidas a retardar el comienzo de las actividades sexuales, tales como brindar información exacta y apropiada a la edad sobre la sexualidad en el contexto de las condiciones económicas y sociales de sus vidas diarias, y el uso creciente del condón, son importantes en la prevención del VIH en esta población.

Three scleractinian coral diseases in Dominica, West Indies: distribution, infection patterns and contribution to coral tissue mortality

Coral diseases have been documented in many areas of the Caribbean, but studies in the eastern Caribbean region have been lacking. The prevalence, distribution patterns and contribution to the mortality of coral tissue by black band discase (BBD), white plague (WP) and dark spots disease (DSD) were examined at five reef sites along the west coast of Dominica. 185 of the 325 diseased colonies recorded between March and August 2000, in a survey area of 5884 m2, were WP. This disease contributed to 89 of the total 4.08 m2 of tissue mortality caused by diseases during the survey period. WP also affected the largest average tissue surface area (relative to colony size) per colony and exhibited the largest average tissue loss per infection when compared to BBD and DSD. The species most susceptible to WP and BBD in Dominica differed from most other described Caribbean locations with Siderastrea siderea being most susceptible. S. siderea was also the only species noted to be susceptible to DSD. Measurements of colony size revealed that each disease affected the larger colonies of some coral species. Comparisons between disease prevalence at each site and various physical parameters, including temperature, wave height, depth, and current patterns, did not exhibit significant correlations. The lack of a direct correlation between temperature and disease prevalence indicates that there are other seasonal factors contributing to the higher prevalence of diseases recorded during the summer months in Dominica. WP prevalence at each site was positively correlated to the relative species abundances of the species most susceptible to WP. This was the dominant factor in determining site-specific disease densities of this disease and may therefore be a valuable predictive and management tool. There were no correlations between BBD or DSD and the relative abundances of susceptible species. The spatial distribution patterns of WP, BBD and DSD were clustered, which is a distribution pattern that suggests an infectious disease.

Attitudes towards mental illness in the Commonwealth of Dominica

Little is known about the perception of mental illness in the English-speaking Caribbean. This study was conducted in 1995 to determine the attitudes, knowledge, and help-seeking practices for emotional disorders in the Commonwealth of Dominica. Two groups in Dominica were surveyed: 67 community leaders, consisting of nurses, teachers, and police officers; and 135 community members grouped into five socioeconomic strata that were collapsed to three for the analysis. All the respondents were asked to identify and suggest management of individuals with psychosis, alcoholism, depression, and childhood hyperactivity, as depicted in case vignettes. The person in the psychosis vignette was diagnosed as suffering from mental illness by 84.0 per cent of the leaders and by 71, 2 per cent of the community members. However, in each of the three other vignettes, fewer than 30 per cent of the respondents thought that mental illness was present. The person with alcoholism was viewed as having a serious problem by only slightly more than half of the respondents. Fewer than half of the respondents thought that the individuals with depression or hyperactivity had serious problems. The community leaders did somewhat worse in redcognizing mental illness than did the community members. Respondents were most likely to refer a family member with emotional problems to a medical practitioner. In conclusion, education about mental health problems is needed in Dominica. Especially disconcerting was the lack of knowledge on mental illness among nurses, teachers, and police officers, that is, professionals directly involved in the pathway to care

Health status of the elderly in the Marigot Health District, Dominica

The health status and the prevalence of hypertension, diabetes mellitus, glaucoma and visual disorders of 123 elderly people (56 men, 67 women) in the Marigot Health District, Dominica, were assessed by means of four questionnaires; collection of data from their medical records; physical examination, measurement of blood pressure, visual acuity and intra-ocular pressure (IOP); and testing for glucosuria. The overall health status was good, but 20were dependent on care. 74were independent in the activities in daily life, with only moderate limitations in activities. The health status decreased considerably in those over 75 years of age. There were slight perceived differences in health status between men and women. About 40of the study population were known to be hypertensive, and another 13had an elevated blood pressure on examination. Diabetes mellitus was present in 15. 20had a visual acuity of 0.1 or below, and 10had an elevated IOP. During the study, a considerable number of new cases of hypertension, diabetes mellitus and elevated IOP were diagnosed. 50of the study population who were on medication used this more than as prescribed. This study indicates a high prevalence of the secondary complications of hypertension, diabetes mellitus, cataract, glaucoma and osteo-arthritis that cause disability and dependency in the elderly population. Education, diagnosis at an early stage and appropriate treatment of these disorders may prevent or delay their development. We sugggest the development of a programme oriented approach of primary health care for the elderly to support this.

Micronutrient deficiencies in the English-speaking Caribbean and in Guyana

Tres estudios recientes analizaron el grado de deficiencia de vitamina A, betacarotenos y hierro en Jamaica, Antigua y Barbuda, Dominica, San Vicente y las Granadinas y Guyana. Todos los estudios fueron efectuados por el Instituto Caribeño de Alimentación y Nutrición, o en colaboración con él. En todas las encuestas, que fueron similares en su estructura y resultados, se recolectaron muestras de sangre con el fin de determinar las deficiencias de micronutrientes. También se aplicaron cuestionarios para recoger información sobre los patrones de alimentación. Los principales grupos estudiados fueron los niños pequeños, los escolares y las mujeres embarazadas. La anemia por deficiencia de hierro fue la deficiencia de micronutrientes más común de las que se encontraron en los tres estudios. Aunque se hallaron pocos casos de deficiencia de vitamina A grave, fueron más comunes las deficiencias marginales. En los tres estudios se hicieron recomendaciones similares para hacer frente a las deficiencias detectadas en los diversos países. Es menester que los gobiernos y otras agencias sigan promoviendo la disponibilidad y el consumo de alimentos ricos en vitamina A y caroteno. Los programas contra la anemia deben dirigirse específicamente hacia los niños de 1 a 4 años de edad y las mujeres embarazadas

The use of capture-recapture methods to monitor diabetes in Dominica, West Indies

The aim of this project was to evaluate the utility of capture-recapture (CR) estimation methodology, together with easily accessible sources of information, for monitoring the frequency of diabetes mellitus in a developing country. On the Caribbean island of Dominica, from July 1995 through July 1996, the names were collected of all individuals who were listed in at least one of three sources as having been diagnosed with diabetes during 1995. The sources were the membership list of the Dominica Diabetic Association, a register of patients in seven regional health centers, and clinic records of the Princess Margaret Hospital, which is the main hospital on the island. Capture-recapture techniques were used to estimate the number of Dominicans with diagnosed diabetes who were missed by all three sources of information and to evaluate dependencies among the sources. An ascertainment-corrected prevalence estimate of diagnosed diabetes was then calculated. The three sources identified a total of 1 945 different individuals. When this number was compared with the ascertainment -corrected estimate obtained with CR methodology (2 688), it appeared to represent only 72.3% of the true prevalence of diagnosed diabetes. Most of the under-ascertainment by the data sources was due to cases that were missed in the urban area of the island. This approach to disease monitoring may be useful for other Caribbean countries. However, standardized procedures for collecting and reporting prevalence and morbidity data are needed to maximize its accuracy and cost-effectiveness.

El propósito de este trabajo fue evaluar la utilidad de la metodología de estimación por captura y recaptura (CR), aplicada junto con fuentes de información fácilmente accesibles, para monitorear la frecuencia de diabetes mellitus en un país en desarrollo. En la isla caribeña de Dominica, se recogieron de julio de 1995 a julio de 1996 los nombres de todas las personas que figuraban como mínimo en una de tres fuentes diferentes por haber recibido un diagnóstico de diabetes en el transcurso de 1995. Las fuentes fueron la lista de miembros de la Asociación de Diabetes de Dominica, un registro de los pacientes atendidos en siete centros de salud regionales y las fichas clínicas del Hospital Princess Margaret, que es el más importante de la isla. Se aplicaron técnicas de CR para estimar el número de dominicanos con diabetes diagnosticada que no fueron detectados por ninguna de las tres fuentes, y para evaluar las discrepancias entre las distintas fuentes. Se procedió a calcular la prevalencia estimada de diabetes diagnosticada, corrigiéndola según los datos obtenidos. Las tres fuentes identificaron a un total de 1 945 individuos diferentes. Cuando se comparó con la estimación corregida que se obtuvo por el método de CR (2 688), se observó que esta cifra representaba solamente 72,3% de la verdadera prevalencia de diabetes diagnosticada. La mayor parte de la subdetección en las fuentes de datos correspondió a casos que no fueron captados en la zona urbana de la isla. Esta forma de monitorear la enfermedad podría resultar útil en otros países caribeños. No obstante, hacen falta procedimientos estandarizados de recolección y notificación de datos sobre prevalencia y morbilidad para lograr que este enfoque rinda al máximo en exactitud y costo-efectividad.

Health status of shut-ins in the Marigot Health District, Commonwealth of Dominica

In the Commonwealth of Dominica, the health and disability status of 108 people who, fo various reasons, are confined to their homes -- the so-called "shut-ins" -- were studied. Eighty per cent of them were over 65 years of age and 10//were children. Most shut-ins were independent in self-care but dependent in general activities. Their overall health was poor. Twenty-one suffered from diseases of the musculo-skeletal system c.q. osteoarthritis. 13 from blindness of various origins, 13 from neurological diseases, 13 from CVA, psychosis or dementia and 13 from different other diseases. One-third suffered from more than one disease. A special programme would be required to optimize the home-care for the shut-ins and to encourage them to become more active