High prevalence of HIV infection in Saint Martin, French West Indies - abstract

Saint-Martin is a melting pot of Caribbean populations. A sharp increase of immigrant people was noted these last years, as a consequence of the booming tourism-related activity. Since no data were available on AIDS, an epidemiological study was developed. Since almost all births take place in the only hospital, hosptial-based information was considered as a reliable indicator of the development of the epidemic in the whole population. During pregnancy, or at delivery, blood samples were taken for HIV detection. Results were ready within four days. Positive results were found in 3 per cent of the women (n=54), in the years 1991 - 1993. All babies born from HIV-positive mothers were also positive. In 1991 and 1991, only a small minority of these women and their children was followed, since no appropriate structure existed. In 1993, a special clinic was instituted, and two-thirds of them could be followed. Evaluation of materno-foetal viral transmission is in process. The prevalence in Saint-Martin is estimated to be 4 times as high as in New York City, and 20 times as high as in Paris (AU)

Results of the pilot project of the CIP Perinatal Surveillance Project - abstract

In September, 1992, a series of training sessions was commenced on the islands of St. Martin and Guadeloupe to collaboratively develop a data collection instrument with operational definitions for the first stage of a CIP research project, focused on undertaking a multi-island descriptive assessment of perinatal deliveries in the Caribbean. These meetings resulted in the development of an international, transcultural, multi-lingual epidemiological surveillance tool that was pilot-tested from December, 1992 to March, 1993. This communication will present the data collection instruments, the procedures for determining the operational definitions unique to each data collection team, and the initial results of the pilot test. In addition to reviewing the socio-demographic and medical risk characteristics of the population surveyed, a discussion of the problems encountered with reporting completeness, and data validity will be presented. Specific emphasis will be placed on reviewing the potential problems to data interpretation that stem from variations in item operational definitions, between data collection sites. Finally, the presentation will introduce the new project summary reports that were developed to provide quarterly information to each participating data collection site and suggestions for expanding this project to other interested islands (AU)

Update on the CIP Caribbean Perinatal Surveillance Project - abstract

At the last international Symposium of the Caribbean Institute of Perinatology (CIP), a research proposal for a multi-island investigation of perinatal deliveries was presented. This project, conducted under the auspicies of the CIP, has been provided with initial funding to undertake a two-part investigation that will implement a perinatal surveillance system to support a multi-island descriptive assessment of perinatal deliveries in the Caribbean and will subsequently conduct a controlled trial of an intervention based on modifying the definition of post-maturity and its clinical response. This project was formally initiated in September, 1992, with the commencement of a pilot study in St. Martin and Guadeloupe. This communication will review the activities of the project to date. The details of the pilot test will be presented along with the revised data collection forms and coding manuals that were amended, based on discussions held during the training sessions and a review of the pilot test. The presentation will overview the work plan for implementing the project and expanding it to other island communities. A summary of the success of the investigators in obtaining additional funding for the project will be given. Finally, this communication will report on recent efforts to develop a Caribbean-based, summer training institute, focused on providing instruction in the use of perinatal data for health status monitoring, programme development and policy enactment (AU)

Introducing total parenteral nutrition in a neonatal care unit - abstract

From October 1985 to November 1987, 150 out of 845 newborns hospitalized in the Pointe-a-Pitre Hospital Neonatal Care Unit have received total parenteral nutrition (TPN). Two hundred and four catheterizations have been performed on 150 newborns, 74 per cent less than 2,000 gm birth weight. Sixty-one per cent of the latter were less than 32 weeks of gestation. Indications for TPN were as follows: 66 (44 per cent)less than 1,500 gm birth weight (6 with necrotizing enterocolitis), 84 (56 per cent) 1,500 gm or more birth weight, 47 with pre-existing perpartum distress, 22 with gastrointestinal disorders, 11 with necrotizing enterocolitis and 4 with gastrointestinal congenital malformations. On average, central venous catheterization was performed on the eighth day of life, and infusion time was 25 days. The commonly observed TPN complications are glucose intolerance, hepatic cholestasis and phosphocalcific metabolism disorders (osteoporosis, ricketts). A clear-cut distinction is made between an introductory phase of the technique (1985-1986), and a second phase where better prevention of complications was achieved (1986-1987). TPN has become a necessary alternative for the management of newborns at high risk with gastrointestinal problems. In our patients, it has produced an average daily weight gain of 21 gm (AU)