Dengue in the campus community of an overseas American university: A cross-sectional study.

INTRODUCTION: After a large outbreak of dengue virus (DENV) serotype-3 in Saint Kitts and Nevis (SKN) in 2008, we performed a cross-sectional study to determine the prevalence of anti-DENV immunoglobulin G (IgG) antibodies in expatriate and local persons affiliated with an American veterinary school there. METHODOLOGY: This campus community comprised mostly expatriate students and faculty and Kittitian administrative staff. In 2009, a stratified random sample of students, faculty and staff was invited to complete an electronic survey to assess risk factors for DENV and provide blood for testing for anti-DENV IgG antibodies by an enzyme-linked immunosorbent assay. IgG-positive specimens were also tested by a 90% plaque reduction neutralization test (PRNT90) to determine immunoreactivity to DENV (1-4) serotypes and West Nile virus. Risk factors for anti-DENV IgG seropositivity were determined using simple and adjusted logistic regression. RESULTS: Of the 118 participants, the overall prevalence of DENV IgG antibodies was 44.1% (95% confidence interval [CI]: 35.1-53.0%), ranging from 30.1% in students, 100.0% in staff and 57.9% in faculty (p < 0.001). Duration of residence in St. Kitts was the only variable significantly associated with seropositivity on multiple logistic regression (adjusted odds ratio [95% CI]: 1.21 [1.07-1.37]). The serotype of DENV was determined in 11 persons: DENV-1 (n = 4), DENV-2 (n = 3), and DENV-3 (n = 4). CONCLUSIONS: Expatriate students and faculty moving to St. Kitts from non-endemic areas were at high risk of DENV infection. There is a need for increased emphasis on pre-travel mosquito-borne virus prevention education for persons moving to St. Kitts to study and work.

A Mosquito Survey of the Twin-Island Caribbean Nation of Saint Kitts and Nevis, 2010.

Adult mosquito surveys of Saint Kitts and Nevis (SKN) were performed in the dry season (March 16-23, 2010) in Saint Kitts, and the rainy season (October 18-25, 2010) in SKN. Biogents (BG) Sentinel Traps were set with CO2and BG Lure in urban, rural, mangrove, and dry forest habitats. Mosquitoes were identified to species, and reverse transcription-polymerase chain reaction was performed on potential vector species for dengue virus (DENV), chikungunya virus (CHIKV), and West Nile virus (WNV). The most abundant species during both seasons in St. Kitts were Culex quinquefasciatus, Aedes taeniorhynchus, and Aedes aegypti. There were 3 new records for Saint Kitts: Aedes tortilis, Anopheles albimanus, and Culex nigripalpus. Traps were also set in Nevis. No mosquito pool tested positive for DENV, CHIKV, or WNV.

Carcinoma secretor de la mama en una anciana / Breast secreting carcinoma in an elderly

Se presenta el caso clínico de una anciana de 85 años de edad, de la raza negra, quien acudió a la consulta de Cirugía del Hospital General "Joseph N. France" de Saint Kitts y Nevis, con lesión nodular en el cuadrante superointerno de la mama izquierda. Los hallazgos anatomopatológicos confirmaron el diagnóstico de un carcinoma secretor en dicha mama.

The case report of a 85 year-old woman of the black race who visited the Surgery Department of "Joseph N. France" General Hospital from Saint Kitts and Nevis, with a nodular lesion in the upper inner quadrant of her left breast is presented. The pathological findings confirmed the diagnosis of a secreting carcinoma in the breast.

Survey report: Eastern Caribbean.

PIP: Over 1 million people live on 8 small islands in the Eastern Caribbean: St. Kitts-Nevis, Montserrat, Grenada, St. Vincent, Antigua, Barbados, St. Lucia, and Dominica. Starting in 1985 the International Planned Parenthood Federation, Western Hemisphere Region has carried out a series of contraceptive prevalence surveys in these countries. Current information is provided by these surveys in the areas of fertility levels and preferences, contraceptive knowledge and use. Also, socioeconomic, historical and demographic background and analysis such as fertility patterns, desire for additional children, and breastfeeding data; contraceptive awareness including family planning methods and sources; contraceptive use by method, source, and timing, satisfaction, and male attitudes are provided in the surveys, but not in the report abstracted here. The total fertility rate (TFR) and the contraceptive prevalence rate (CPR) for the 8 islands are as follows: St. Kitts-Nevis (1984) 2.9 TFR, 40.6 CPR; St. Vincent (1988) 2.9 TFR, 58.3 CPR; Antigua (1988) 1.8 TFR, 52.6 CPR; Barbados (1988) not given, 55.0 CPR; St. Lucia (1988) 3.2 TFR, 47.3 CPR; Dominica (1987) 3.2 TFR, 49.8 CPR. The islands have unusual demographic patterns related to extensive out-migration.^ieng

St. Kitts and Nevis.

PIP: St. Kitts and Nevis have areas of 68 and 36 square miles respectively and the terrain is mountainous. The population is 45,800 total and the annual growth rate is .2%. The ethnic make up is almost all black African with some British, Portuguese, and Lebanese. The religions are primarily Anglican, with evangelical Protestant and Catholic minorities. Infant mortality stands at 41/1000. The government is a constitutional monarchy with a Westminster type parliament. There is a governor, a prime minister, a cabinet, an 11 -member appointed upper house and a 11- member elected house of representatives. The gross national product is $83 million and the annual growth rate is 4.6%. There are no natural resources, and agricultural products include sugarcane, cotton, peanuts, and vegetables. Industry is made up of manufacturing 12.9%, transport and communications 13%, construction 9.1% and hotels and restaurants 4.5%. The Federation of St. Kitts and Nevis became independent in 1983. The government diversified the agriculture by planting other crops than sugar, producing gelled ethanol, and developing a cane spirits liquor. Tourism has grown the most and in 1987 passed sugar as the main source of income. International aid will assist in finishing a road that will open the southeast area of St. Kitts for construction of hotels, where some of the best beaches are located.^ieng

Obstetric practice in St Kitts and the Homerton Hospital, London.

Corinne Hayes and Karen Walker won 1000 pounds in last year's Student Elective Award competition for the protocol of their project. Here, they give an account of their work, the aims of which were to compare the incidence of low birthweight (less than 2.5 kg) and very low birthweight (less than 1.5 kg) babies in the UK and the Caribbean, to assess the outcome of these babies and to compare obstetric practice and the incidence of risk factors for low birthweight in the two populations.

PIP: Birth records were collected from Homerton Hospital from the London Borough of Hackney and in St. Kitts in order to ascertain the incidence of low birth weight (2.5 kg) and very low birth weight (1.5 kg); and relevant maternal factors (smoking, age, pre-pregnancy weight, and disease). St. Kitts averages 1000 deliveries per year compared with 400 each year at the Homerton Hospital. Birth records of 4 years (1984-87) were examined in St. Kitts, and they were compared with records from 1987 in the Homerton Hospital. Babies were divided into 2 groups: Group 1 (1.5 kg), and Group 2 (2.5 kg). Data from the whole of England were used for comparison. The incidence of Group 1 babies in St. Kitts (1.9%) and in the Homerton Hospital (1.8%) was similar, but both differed significantly from the national figure of 1%. The incidence of babies weighing 2.5 kg was lower in the Homerton sample (9.5%) than in the St. Kitts population (11.1%), but both exceeded the national rate (7.2%). Poverty and poor maternal nutrition not race were common in both populations. Stillbirth rates differed greatly between Homerton (7.2/1000) and St. Kitts (15.9/1000). Perinatal mortality was 35/1000 in St. Kitts and 13.1/1000 at Homerton. In Group 1 stillbirths made up 26.5% of all deliveries in St. Kitts vs. 13% at Homerton. Antenatal care with screening procedures for congenital abnormalities (maternal serum alpha-fetoprotein, amniocentesis, and ultrasonography) were not available in St. Kitts. The survival rate of Group 2 babies was 902/1000 in St. Kitts and 956/1000 at Homerton; and the same rate for Group 1 babies was 656/1000 in St. Kitts and 817/1000 at Homerton. Antenatal care improvement is requisite for improving perinatal mortality figures.

Migration transition in small Northern and Eastern Caribbean states.

PIP: 1 area of intra-Caribbean migration that has been overlooked is the "migration transition"--the transformation of rapidly modernizing societies from net labor exporters to net labor importers. This article assembles 8 case studies to 1) briefly present a spectrum of migration experiences in the Caribbean, 2) uncover some transitions under way, 3) pinpoint the forces that underlie the migration transition, and 4) point out some of the more important policy implications of labor migration reversals. The 8 island societies sampled for illustration purposes include 1) the Bahamas and the US Virgin Islands as post-migration transition societies (Zelinsky's advanced society), 2) the British Virgin Islands and the Cayman Islands as undergoing transition (Zelinsky's late transitional society), and 3) Anguilla, St. Kitts-Nevis, Turks and Caicos, and Montserrat as premigration transition societies (Zelinsky's early transitional society). Population data for the islands were derived primarily from the West Indian censuses and government statistics. These 8 historical sketches reveal certain commonalities. All are at various stages in a long-term economic restructuring to displace traditional staple crops with more income elastic, high value export services. In such societies, population growth and progress along the migration transition is an increasing function of this kind of successful export substitution. In addition, along the migration and economic transitions, such insular economies exhibit a relatively large public sector (20-30% of all activity), declining unemployment, increasing fiscal autonomy, and are committed to a development strategy remarkably similar to the "successful" model of the Bahamas and the US Virgin Islands. Cursory evidence suggests that, because of intersectoral competition for land and labor, there is an inverse relationship between farm effort/manufacturing employment and tourism intensity. This review suggests that small islands undergoing rapid growth imperatives also experience a similar set of self-reinforcing socioeconomic and environmental imbalances. Particularly for post-transition and transition societies, these spillovers include increasing real estate speculation and inflation because of tourism and the allied development of retirement colonies of affluent North Americans, wage pressures and skilled manpower shortages, and increasing vulnerability to international business cycles.^ieng

The Aliens Employment Levy (Repeal) Act, 1988 (No. 4 of 1988), 10 February 1988.

This Act repeals the Saint Kitts and Nevis Aliens Employment Levy Act, which imposed on employers the duty to collect a levy from the income paid to aliens working for them.

Marriage (Amendment) Act, 1987 (No. 7 of 1987), 24 August 1987.

Among other things, this Act lowers the legal age of marriage without consent for persons who are neither a widow or widower to eighteen.

Family Life Education in the English-speaking Caribbean.

Unique experience has accumulated in the English-speaking Caribbean in the field of family life education for youth. Although birth rates are relatively low, the increase in adolescent pregnancy and births is becoming more visible. Mother-centered homes are frequent, and support from the father is often lacking. A series of family life education (FLE) programs funded by the United National Fund for Population Activities is aimed at providing help to the various groups in the Caribbean in an acceptable and non-threatening manner. These out-of-school FLE techniques include several approaches: integration of the proposed program into an already established place (a factory, youth center, or community center); education in human growth, food and nutrition, environmental health, mental health, safety and first-aid, dental health and human relations, including human sexuality, rights and responsibilities, and decision making; and the use of specially trained personnel who understand the conditions of the particular community. In some countries adolescent pregnancy is viewed as a problem. In others it may not be so considered. It is vital for the staff and community leaders to review proposals for the FLE program and bring into the centers all subjects that are free of controversy. Family planning, contraceptive delivery and even human sexuality may be acceptable subjects in some quarters, and not in others. Efforts must be continued to find innovative approaches to assure that the benefits of these learning activities continue to be provided, and expanded in response to growing acceptance.

PIP: This article is based on evaluations made of programs in Antiqua, Barbados, Dominica, Jamaica, St. Christopher and Nevis, and St. Lucia. Although birth rates are relatively low in the English-speaking Caribbean (ranging between 16 and 30 per 1000 in 1984), the incidence of adolescent pregnancies and births is increasing. Mother-centered homes are frequent, and support from the father is often lacking. Adolescent births represent 25-35% of all births in the English-speaking Caribbean. This proportion has changed little over time. About 2-3% of all births to teenagers occur in the under-15 year old group. A significant proportion of teenage births occur to girls under age 18, before they finish school. The 1978 "Caribbean Workshop on Family Life Education and Health Education" defined family life education (FLE) as "the total physical, mental, social, and emotional well being of the individual so as to help him maximize his potential and to enable him to carry on the activities he needs to undertake for the good of himself and others." Out-of-school FLE includes community centers, factories, and youth centers. The youth center approach is most appropriate for this region because it provides a nucleus for skills training, recreation, and continuous education. Countries tend to focus almost exclusively on the youth center approach. Activities of these centers include 1) FLE; 2) contraceptive services, to some extent; 3) community involvement; and 4) programs with a male focus. Some places oppose family planning or contraceptive services to adolescents. Youth centers offer a broad range of activities. For these centers to be effective, their communities must elicit support from the business community, private social organizations, and volunteers. Each community must assess its own situation and consider the resources available. The projects have shown that it is possible to initiate and make considerable progress in the implementation of FLE programs for adolescents even when adolescent pregnancy and births are still highly sensitive and controversial issues, and when there are no official policies in favor of such programs.

Migration and rural development in the Caribbean.

PIP: The relationship between migration and agricultural development in the Caribbean is examined. The data, collected by survey, concern the islands of Nevis, Montserrat, and Saint Lucia. The results show that migration is not associated with agricultural innovation or the use of specific technical inputs and that it frequently has a negative impact on agricultural productivity and attitudes toward farming.^ieng

Attaining higher coverage: obstacles to overcome. English-speaking Caribbean and Suriname.

PIP: In 1983, 8 (42%) of the 19 English-speaking Caribbean countries (including Suriname) achieved at least 50% coverage with 3 doses of diphtheria-pertussis-tetanus (DPT) vaccine among children under 1 year of age and 6 countries (32%) had at least 50% coverage with 3 doses of trivalent oral polio vaccine (TOPV). In addition, 10 countries (53%) achieved over 75% DPT coverage and 11 (58%) achieved over 75% TOPV coverage. Despite this record of progress, several factors continue to impede further gains in immunization coverage. Of particular concern is the high dropout rate. As many as 25% of infants receive their 1st dose of DPT and TOPV but do not return to complete their course of immunization. There is also a need for each health center to estimate its annual target population for immunization every year through analysis of the total live births from the previous year in the health center's catchment area (minus infant mortality). Monthly target figures can thus be computed and coverage monitored. A further problem has been a reluctance on the part of some health workers to administer vaccines simultaneously. This does not reduce effectiveness or increase the risk of complications, and reduces the number of visits needed to complete the immunization schedule. An unresolved question is whether to immunize ill or malnourished children. Decisions on this matter should take into account the availability and accessibility of health care services, the ability to follow-up children who are not immunized, and the likelihood that children will return for subsequent immunizations. Finally, a number of immunizations performed by private practitioners and institutions are not reported. Both public and private health care providers should agree on a standardized reporting format to allow better estimation of coverage.^ieng

A comparative description of infant feeding practices in Zaire, the Philippines and St. Kitts-Nevis.

PIP: Infant feeding issues and research commonly portray infant feeding practices as a dichotomous variable; i.e., breastfeeding vs. bottlefeeding. This research establishes the complexity and variability in infant feeding patterns in 3 sites in the developing world. Comparative data are presented on the modes and products used to feed infants in Kinshasa, Zaire; St. Kitts-Nevis, West indies; and Cebu City, Philippines. They demonstrate that in these areas most infants receive some breastmilk. Bottlefeeding is also common but is rarely the exclusive mode of feeding. And the prevalence, manner of use, and role of the bottle varies among the 3 sites. Early supplementation of breastmilk by a variety of liquids, semisolids, and solids is typical of all 3 areas. These findings have important implications for educators and policymakers, as well as for research efforts relating infant feeding practices to infant health outcomes.^ieng

First regional CSM program planned.

PIP: 6 countries in the English-speaking Caribbean (Antigua, Barbados, Dominica, St. Kitts/Nevis, St. Lucia, and St. Vincent) are scheduled to form the 1st regional contraceptive social marketing program. The program will be under the auspices of the Barbados Family Planning Association. By combining resources, contraceptive social marketing should be able to effectively augment family planning activities in smaller countries where individual programs wuld be too costly. The regional program will also determine whether program elements from 1 country in a region are relevant in other countries. The Caribbean region as a whole has experienced a general decline in both crude birth rates and fertility rates during the past 15 years; however, adolescent fertility rates remain high and an average of 46% of the populations of Caribbean countries are under 15 years of age. Although heavy emigration has traditionally curbed population increases, new restrictive immigration laws are expected. Further increases in the working age population will contribute to already high unemployment rates and hinder economic development. The 6 countries selected for the social marketing program are receptive to innovative family planning approaches and have the basic marketing infrastructure required. Community-based distribution programs already in operation in these countries distribute condoms, oral contraceptives, and barrier methods. The success of these programs has plateaued, and there is a need for delivery systems capable of reaching broader segments of the population. The social marketing program will be phased in to ensure local acceptance among national leaders and consumers. The regional program hopes to borrow elements from Jamaica's contraceptive social marketing program to avoid the costs involved in starting a program from scratch. A major innovation will be the use of mass media advertising for contraceptives.^ieng

Successful community-based distribution in St. Kitts.

PIP: In June 1976 the St. Kitts' Family Planning Association began the 1st of 2 community contraception distribution projects with distribution of all types of contraceptives (orals, injectables, foams, jellies, and condom) throught 7 private practitioners. By August, 15 retail stores in villages began selling condoms and foaming tablets at subsidized prices. Family planning posters are displayed. Shopkeepers at 1st were afraid of negative reaction from customers but the advertising compaign during Family Planning Week (August 22-28) encouraged the vendors and their acceptance increased. The program is showing signs of success, especially in distribution centers far from clinics.^ieng