Disruption, Transformation, Resilience, and Hope: The Experience of a Belizean Community During COVID-19 Lockdown

This qualitative research explored the lived experience of teachers, school administrators, parents, and children in Belize, Central America during the COVID-19 lockdown. Through field notes, correspondence, and interviews, a narrative approach was leveraged to convey the impact of two years away from classrooms and from each other. Both the trauma and loss of this disruption on global literacy, along with three forces that nourished the capacity for resilience, were examined. [ FROM AUTHOR] Copyright of Qualitative Report is the property of Qualitative Report and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

The political economy of development in Belize under the People's United Party

The former British colony of Belize faces serious economic problems today, reflecting a collapse in tourism following COVID-19. To account for this fragility, a return to economic history is needed. We focus on two critical periods. First, we examine why the Belizean state was unable to form a developmental state in the period of the anticolonial movement and self-government (the 1950s–1960s). Particular attention is given to George Price, leader of the anti-colonial People's United Party (PUP) and ‘father of the country'. Second, turning to the post-colonial period, we examine one experimental chapter that lasted roughly a decade (1998–2007) when a coherent state-led economic strategy was pursued. During both periods the PUP-led state sought to reorganize development strategy along progressive lines, but failed to deliver. Because capital was almost completely foreign dominated, the fledgling Belizean developmental state could not discipline capital toward developmental alignment. © 2022 The Author(s). Co-published by Unisa Press and Informa UK Limited, trading as Taylor & Francis Group.

Burnout, mental health, physical symptoms, and coping behaviors in healthcare workers in Belize amidst COVID-19 pandemic: A nationwide cross-sectional study.

BACKGROUND: Healthcare workers are vulnerable to burnout, especially during the COVID-19 pandemic in the low resource settings. Belize is a small Central American developing country known for its chronic healthcare worker shortage and this is the first study to assess burnout prevalence and its associated factors among healthcare workers in Belize. AIM: To evaluate the prevalence of burnout and its associated factors in HCWs in Belize covering multiple domains (mental health, physical symptoms, and coping behaviors) during the COVID-19 pandemic. METHODS: A cross-sectional survey that was developed and validated by a panel of experts was delivered online to all the healthcare workers in Belize from September to November 2021. Burnout was assessed using Copenhagen Burnout Inventory. Depression and anxiety screening was carried out using the Patient Health Questionnaire - 2 (PHQ-2) and Generalized Anxiety Disorder 2-item (GAD-2). Burnout associated factors were estimated using logistic regression models. FINDINGS: Of the total of 263 participants, 27.76% had overall burnout: 56.65% had personal, 54.37% had work-related, and 19.39% had patient-related burnout. Burnout was positively associated with anxiety (OR: 3.14 [1.67, 5.92]), depression (OR: 4.45 [2.30, 8.61]), intentions of quitting their jobs (OR: 2.59 [1.49, 4.51]), health status worsening (OR: 2.21 [1.26, 3.87]), multiple physical symptom presentation (OR: 1.19, [1.10, 1.29]), and use of multiple maladaptive coping behaviors (OR: 1.66, [1.30, 2.12]). INTERPRETATION: Healthcare workers in Belize showed substantial levels of burnout which were significantly associated with using maladaptive coping behaviors, presenting multiple physical symptoms, quitting their jobs, health status worsening, and other mental health issues. These findings should be used to develop and implement programs such as regular health check-ups, health promotion awareness campaigns, and worker recruitment strategies which would improve the working conditions, quality of life, and psychological well-being of our healthcare workers.

Incorporating COVID-19 into Acute Febrile Illness Surveillance Systems, Belize, Kenya, Ethiopia, Peru, and Liberia, 2020-2021.

Existing acute febrile illness (AFI) surveillance systems can be leveraged to identify and characterize emerging pathogens, such as SARS-CoV-2, which causes COVID-19. The US Centers for Disease Control and Prevention collaborated with ministries of health and implementing partners in Belize, Ethiopia, Kenya, Liberia, and Peru to adapt AFI surveillance systems to generate COVID-19 response information. Staff at sentinel sites collected epidemiologic data from persons meeting AFI criteria and specimens for SARS-CoV-2 testing. A total of 5,501 patients with AFI were enrolled during March 2020-October 2021; >69% underwent SARS-CoV-2 testing. Percentage positivity for SARS-CoV-2 ranged from 4% (87/2,151, Kenya) to 19% (22/115, Ethiopia). We show SARS-CoV-2 testing was successfully integrated into AFI surveillance in 5 low- to middle-income countries to detect COVID-19 within AFI care-seeking populations. AFI surveillance systems can be used to build capacity to detect and respond to both emerging and endemic infectious disease threats.

MULTISYSTEM INFLAMMATORY INFLAMMATORY SYNDROME IN ADULTS (MIS-A) IN THE RETURNING TRAVELER

CASE: A 27-year-old man presented with a one-day history of meningismus and fever six days after returning from Belize in the setting of COVID-19 infection 6 weeks prior to admission. On hospital day 3, he had persistent cyclical fevers and developed a non-pruritic erythematous maculopapular rash as well as conjunctival injection and diarrhea. Overnight (day 3-4), he developed chest pain and tachycardia;labs were remarkable for myocardial injury and elevated inflammatory markers. Emergent cardiac echo identified myopericarditis with LV ejection fraction of 20%. These constellation of symptoms in the setting of a recent COVID-19 infection were consistent with a diagnosis of multisystem inflammatory syndrome of adults (MIS-A). Pulse dose steroids and heart failure therapy were initiated;he had a rapid response to the treatment with cardiac MRI documenting partial recovery of his LVEF to 48% and resolved myocarditis after 4 days of therapy. IMPACT/DISCUSSION: MIS-A is a rare complication of the post-acute phase of COVID-19. As of June 2021, less than 150 cases had been published. The CDC criteria for MIS-A include age >21 hospitalized for >24 hours with a fever for >24 hours and with at least 1 primary criteria (severe cardiac illness OR rash and conjunctivitis) and 2+ secondary criteria (new neurological signs, unexplained shock, abdominal symptoms or thrombocytopenia). Lab criteria include A) a positive SARS CoV-2 test for current or recent infection and B) elevated levels of at least 2 inflammatory markers. A systematic review by Patel et al. highlighted key trends amongst MIS-A patients, including a median age of 21, male preference (70%), and lack of co-morbidities (58%) A majority presented with fever (96%), hypotension (60%), cardiac dysfunction (54%), and diarrhea (52%) In adults, conjunctivitis, rash, and cervical adenopathy were noted but less common. Although 97% of patients had positive serologic or RT-PCR tests, only 32% were positive for both during the hospitalization. Our patient possessed key demographic and clinical features associated with MIS-A. However, we initially prioritized the differential of fever in a returning traveler over empiric management of MIS-A. Nevertheless, early recognition of decompensation from MIS-A allowed for quick initiation of steroids and transfer to the ICU. The fulminant nature of this disease makes it an important diagnosis to include on the differential of acutely febrile young individuals with a history of COVID. CONCLUSION: MIS-A is a rare disease that can easily be confounded with other causes of inflammation;as a diagnosis of exclusion, delays in diagnosis can be expected. However, it's potential severity makes it a critical one to consider early in key patient populations. Increased awareness of cardinal symptoms and population trends can help clinicians consider MIS-A early in their clinical reasoning and facilitate early treatment. This is especially important in a world with an increasing incidence of COVID-19.

Effects of Risk Factors on Belizean Adolescents’ Academic Behaviors and Grit after Prolonged Absence During the COVID-19 Pandemic

This causal-comparative study explored the effects of risk factors—family status, parental marital status, family income, and parent education level—on Belizean adolescents’ academic behaviors and grit (passion and perseverance in goal achievement) following prolonged absence during the COVID-19 pandemic. Data were collected online using a demographic survey, the Grit-S Scale (Duckworth & Quinn, 2009), coupled with eight additional items to measure academic behaviors (attendance, preparedness, attention, note-taking, participation, organization, use of out-of-school time, and homework completion and submission) for success (Farrington et al., 2012) from secondary and tertiary students in Belize. With rare exception, Belizean education took place in person before the pandemic. This changed to remote teaching and learning during the pandemic. Findings showed that adolescents from the defined risk factor of single-parent households experienced greater declines across all eight academic behaviors. Additionally, this effect was more pronounced for adolescents who experienced the loss of a parent from divorce or death of a parent. For grit, there were two key outcomes: (a) adolescents from nuclear and higher income families had slightly higher levels of grit;and (b) adolescents from parents with lower educational attainment had significantly higher levels of grit than their peers. Based on these findings, recommendations include more study of schools that invest in becoming trauma responsive when evaluating engagement and performance during prolonged absences. Future research should assess adolescents’ level of academic behaviors, grit, and other noncognitive factors. © 2022 The Author(s).

The political economy of development in Belize under the People's United Party

The former British colony of Belize faces serious economic problems today, reflecting a collapse in tourism following COVID-19. To account for this fragility, a return to economic history is needed. We focus on two critical periods. First, we examine why the Belizean state was unable to form a developmental state in the period of the anticolonial movement and self-government (the 1950s-1960s). Particular attention is given to George Price, leader of the anti-colonial People's United Party (PUP) and 'father of the country'. Second, turning to the post-colonial period, we examine one experimental chapter that lasted roughly a decade (1998-2007) when a coherent state-led economic strategy was pursued. During both periods the PUP-led state sought to reorganize development strategy along progressive lines, but failed to deliver. Because capital was almost completely foreign dominated, the fledgling Belizean developmental state could not discipline capital toward developmental alignment.

Reflection on: "The Cultural Conceptions of Dengue Fever in the Cayo District of Belize"

Smith revisits her work entitled "The Cultural Conceptions of Dengue Fever in the Cayo District of Belize." This work was not only transformative for the Cayo community but also for her. The overarching purpose behind this study is as relevant today as ever as we continue to navigate the COVID-19 pandemic. Due to modern technology, we have all had the opportunity to witness how COVID-19 has affected us all from a global standpoint. With dengue fever in the Cayo District, community education was an integral aspect of changing the community conceptions to improve disease control and prevention. This also holds true with COVID-19 as we continue to bear witness to the influence of misinformation and lack of adequate community education on the perceptions and response to COVID-19 in our communities. Community education efforts are being battled by the "individual"--a new concept given birth largely by the rise and accessibility of social media. This shift in the culture of communication has vastly influenced how we as humans understand and respond to COVID-19.

Forecasting Covid-19 New Cases in Belize

Expectedly, the global pandemic of COVID-19 has resulted in a surge in COVID-19 forecasting and control models. In this research article, the ANN methodology was applied to investigate the trends of confirmed daily COVID-19 cases in Belize. This study is based on daily new cases of COVID-19 in Belize for the period 1 January 2020 – 25 March 2021. The out-of-sample forecast covers the period 26 March 2021 – 31 July 2021. The residuals and forecast evaluation criteria (Error, MSE and MAE) of the employed model reveal that the model is stable in forecasting COVID-19 cases in Belize. It is projected that daily COVID-19 cases in Belize are likely to vanish over the out-of-sample period. Nonetheless, the government of Belize ought to ensure the continued compliance to control and preventive COVID-19 measures such as vaccination, social distancing, quarantine, isolation, face-mask wearing and so on.