Suicidal Behaviour among School-Going Adolescents in Saint Lucia: Analysis of Prevalence and Associated Factors.

Suicide poses a debilitating threat to adolescents' lives worldwide. Although suicide prevention efforts are evident globally, there is limited evidence on the prevalence and correlations of suicidal behaviour among school-going adolescents in Saint Lucia. We used a dataset from the 2018 Global School-based Student Health Survey to examine the prevalence and associated factors of suicidal behaviour among 1864 students from schools in Saint Lucia. Prevalence rates of 25.5%, 22.1%, and 17.5% were found for suicidal ideation, suicide plan, and suicide attempt, respectively. After adjusting for other factors, being male and having understanding parents were protective against suicidal behaviour. However, suicidal ideation was predicted by being physically attacked and bullied, parental guidance, tobacco use, loneliness, and worry. Moreover, being a victim of physical attacks and bullying, having close friends, being lonely, and worrying were predictive of making suicidal plans among adolescents. Attempting suicide was predicted by cigarette smoking, current use of tobacco and related products, bullying, having close friends, being lonely, and worrying. School-based preventive interventions are required to help address triggers of suicidal behaviour among adolescents in Saint Lucia and to help attain the targets for suicide prevention in the global Sustainable Development Goals.

Improving cardiovascular health in primary care in Saint Lucia through the HEARTS Initiative.

Objective: To improve blood pressure control and hypertension registry coverage at six demonstration sites in St Lucia. Methods: From January 2020 to December 2021, St Lucia's Ministry of Health, with support of the Pan American Health Organization, implemented the HEARTS Technical Package in six primary health care facilities with six-monthly monitoring of blood pressure control and hypertension registry coverage. The modules included healthy-lifestyle counselling, evidence-based treatment protocols, access to essential medicines and technology, risk-based cardiovascular management, team-based care and systems for monitoring. Results: Levels of blood pressure control at 6, 12, 18 and 24-months after the intervention were 37.1%, 28.9%, 33.9% and 36.5% respectively. Hypertension registry coverage increased by 17.8% (1 434 to 1 689) for patients accessing service. Implementing the monitoring for action initiative 12 to 15 months after the start of the intervention resulted in policy and operational changes, improved documentation, and provided accurate and reliable data. Conclusions: The HEARTS initiative unearthed basic infrastructural challenges in blood pressure control. The essential elements for success were (1) buy in at all levels of the health sector; (2) addressing policy and operational changes; (3) accurate documentation and required analysis; (4) standardization of equipment and procedures and (5) regular monitoring and evaluation. Capacity building underpinned all changes.

Cancer Survivors in Saint Lucia Deeply Value Social Support: Considerations for Cancer Control in Under-Resourced Communities.

Understanding the views of cancer survivors on their experience is important for informing community-based interventions. We studied, for the first time, the views of cancer survivors residing in Saint Lucia on their overall care experience. We used interview data from a cohort of adult cancer survivors from Saint Lucia between 2019 and 2020. We performed a thematic analysis to derive themes from codes. Forty-four survivors provided responses to at least one of the three questions. The majority of survivors were black, female and diagnosed with breast cancer. Survivors were interviewed on average five years after diagnosis. Four common themes emerged; "Availability of support groups", "Importance of support from family and friends", "Access to finances" and "Health education and patient navigation". Travel overseas for health services was common among survivors. Survivors expressed emotional distress during travel due to isolation from family and local providers. This is typical among island populations and is distinct from existing patient frameworks. Survivors also suggested that networking amongst providers and interventions assisted families of cancer survivors. Although tertiary care services are limited, we showed that survivors deeply value and depend on their inter-personal relationships during care. Interventions aimed at strengthening the inter-personal environment of survivors are warranted.

Migrant Pharmacopoeias: An Ethnobotanical Survey of Four Caribbean Communities in Amazonia (French Guiana).

French Guiana is an overseas French department in South America at the margin of the Amazon basin. Its population is characterized by an important number of cultural groups. Many inhabitants originate from the Caribbean (mostly Saint Lucia, Martinique, Guadeloupe, Haiti, and the Dominican Republic). The objectives of this study were to present an overview of the main uses of plants among the Caribbean populations in French Guiana, and how they contribute to the dynamics of plant-based practices, in order to provide insights into ethnobotanical convergences, divergences, and hybridizations (such as the importation of new species and associated practices, and the adoption of Amazonian species by Caribbean people). Interviews and botanical voucher collections were conducted throughout the coastal area of French Guiana. Sixteen Saint Lucian, nineteen Haitian, eighteen French Caribbean, and twelve Dominican informants were interviewed during the fieldwork. Altogether they use 212 botanical species. Some plants have recently been imported directly from the Caribbean, while adaptations have also taken place: some species that do not exist locally are abandoned while Amazonian species are integrated to form hybrid pharmacopoeias. The phytotherapies of these communities in French Guiana are still conserved as consistent sets of knowledge, although they tend to blend through an ongoing process of hybridization. Supplementary Information: The online version contains supplementary material available at 10.1007/s12231-021-09529-0.

La Guyane française est un département français d'Amérique du Sud situé à la marge nord du bassin amazonien. La composition de sa population est caractérisée par une très grande diversité d'appartenances culturelles. De nombreux habitants sont notamment originaires des Caraïbes (principalement de Sainte­Lucie, Martinique, Guadeloupe, Haïti et de la République dominicaine). Les objectifs de cette étude étaient de présenter une vue d'ensemble des principaux usages de soin par les plantes chez les populations caribéennes de Guyane française, et la manière dont ils contribuent à la dynamique des pratiques de phytothérapie locales, afin d'apporter un éclairage sur les modalités de convergences, de divergences et d'hybridations ethnobotaniques (telles que l'importation de nouvelles espèces et d'usages associés et l'adoption d'espèces amazoniennes par les migrants caribéens) auxquelles elles donnent naissance. Des entretiens et des collectes d'herbiers ont été menés sur l'ensemble de la zone côtière de la Guyane française. Seize informateurs saint­luciens, dix­neuf haïtiens, dix­huit caribéens français et douze dominicains ont été interrogés au cours du travail de terrain. Au total, ceux­ci ont mentionné utiliser 212 espèces botaniques. Certaines plantes ont récemment été directement importées des îles de la Caraïbe, et des adaptations ont également eu lieu: certaines espèces qui n'existent pas localement sont progressivement délaissées par les migrants caribéens tandis que, a contrario, des espèces amazoniennes sont intégrées à leurs pharmacopées respectives. On observe enfin que les phytothérapies de ces communautés caribéennes de Guyane française conservent un ensemble cohérent de connaissances ethnomédicinales, qui tend cependant à se mélanger dans un processus continu d'hybridation bioculturelle.

Improving cardiovascular health in primary care in Saint Lucia through the HEARTS Initiative / Mejorar la salud cardiovascular en la atención primaria en Santa Lucía por medio de la iniciativa HEARTS / Melhorando a saúde cardiovascular na atenção primária em Santa Lúcia por meio da Iniciativa HEARTS

ABSTRACT Objective. To improve blood pressure control and hypertension registry coverage at six demonstration sites in St Lucia. Methods. From January 2020 to December 2021, St Lucia's Ministry of Health, with support of the Pan American Health Organization, implemented the HEARTS Technical Package in six primary health care facilities with six-monthly monitoring of blood pressure control and hypertension registry coverage. The modules included healthy-lifestyle counselling, evidence-based treatment protocols, access to essential medicines and technology, risk-based cardiovascular management, team-based care and systems for monitoring. Results. Levels of blood pressure control at 6, 12, 18 and 24-months after the intervention were 37.1%, 28.9%, 33.9% and 36.5% respectively. Hypertension registry coverage increased by 17.8% (1 434 to 1 689) for patients accessing service. Implementing the monitoring for action initiative 12 to 15 months after the start of the intervention resulted in policy and operational changes, improved documentation, and provided accurate and reliable data. Conclusions. The HEARTS initiative unearthed basic infrastructural challenges in blood pressure control. The essential elements for success were (1) buy in at all levels of the health sector; (2) addressing policy and operational changes; (3) accurate documentation and required analysis; (4) standardization of equipment and procedures and (5) regular monitoring and evaluation. Capacity building underpinned all changes.

RESUMEN Objetivo. Mejorar el control de la presión arterial y aumentar la cobertura del registro de la hipertensión en seis centros de referencia en Santa Lucía. Métodos. Entre enero del 2020 y diciembre del 2021, el Ministerio de Salud de Santa Lucía, con el apoyo de la Organización Panamericana de la Salud, implementó el paquete técnico HEARTS en seis centros de atención primaria de salud acompañado de un seguimiento semestral del control de la presión arterial y la cobertura del registro de la hipertensión. Se incluyeron los siguientes módulos: asesoramiento sobre hábitos y estilos de vida saludables, protocolos clínicos basados en la evidencia, acceso a medicamentos y tecnologías esenciales, manejo de las enfermedades cardiovasculares basado en la estratificación del riesgo, trabajo basado en equipos multidisciplinarios y sistemas de monitoreo. Resultados. Los niveles de control de la presión arterial a los 6, 12, 18 y 24 meses después de la intervención fueron de 37,1%, 28,9%, 33,9% y 36,5% respectivamente. La cobertura del registro de la hipertensión aumentó en 17,8% (de 1 434 a 1 689) para los pacientes que acceden al servicio. Con la implementación de la iniciativa de seguimiento entre los 12 y 15 meses después del inicio de la intervención se lograron cambios operativos y en las políticas, se mejoró la documentación y se obtuvieron datos rigurosos y fiables. Conclusiones. La iniciativa HEARTS reveló los desafíos básicos relativos a la infraestructura que afronta el control de la presión arterial. Los factores principales que contribuyeron al éxito fueron: 1) la aceptación en todos los niveles del sector de la salud; 2) el abordaje de cambios políticos y operativos; 3) una documentación rigurosa y la ejecución de los análisis necesarios; 4) la estandarización de los equipos y procedimientos; y 5) la ejecución de labores de seguimiento y evaluación con regularidad. El fortalecimiento de la capacidad fue la base de todos los cambios.

RESUMO Objetivo. Melhorar o controle da pressão arterial e a cobertura do registro de hipertensão em seis locais-piloto em Santa Lúcia. Métodos. De janeiro de 2020 a dezembro de 2021, o Ministério da Saúde de Santa Lúcia, com apoio da Organização Pan-Americana da Saúde, implementou o pacote técnico HEARTS em seis unidades básicas de saúde com monitoramento semestral do controle da pressão arterial e cobertura do registro de hipertensão. Os módulos incluíram aconselhamento sobre estilo de vida saudável, protocolos de tratamento baseados em evidências, acesso a medicamentos e tecnologias essenciais, manejo cardiovascular baseado em risco, cuidados em equipe e sistemas de monitoramento. Resultados. Os níveis de controle da pressão arterial aos 6, 12, 18 e 24 meses após a intervenção foram de 37,1%, 28,9%, 33,9% e 36,5%, respectivamente. A cobertura do registro de hipertensão aumentou 17,8% (de 1 434 para 1 689) para pacientes que acessam o serviço. A implementação da iniciativa de monitoramento para ação, 12 a 15 meses após o início da intervenção, resultou em mudanças de política e operacionais, melhoria da documentação e fornecimento de dados exatos e confiáveis. Conclusões. A iniciativa HEARTS revelou desafios básicos de infraestrutura para o controle da pressão arterial. Os elementos essenciais para o sucesso foram: (1) adesão em todos os níveis do setor de saúde; (2) abordagem das mudanças de política e operacionais; (3) documentação exata e análise necessária; (4) padronização de equipamentos e procedimentos; e (5) monitoramento e avaliação regulares. A capacitação foi a base de todas as mudanças.

Difficulties in Accessing Cancer Care in a Small Island State: A Community-Based Pilot Study of Cancer Survivors in Saint Lucia.

Developing robust systems for cancer care delivery is essential to reduce the high cancer mortality in small island developing states (SIDS). Indigenous data are scarce, but community-based cancer research can inform care in SIDS where formal research capacity is lacking, and we describe the experiences of cancer survivors in Saint Lucia in accessing health services. Purposive and snowball sampling was used to constitute a sample of survivors for interviews. Subjects were interviewed with a questionnaire regarding socio-demographics, clinical characteristics, health services accessed (physicians, tests, treatment), and personal appraisal of experience. We recruited 50 survivors (13 men, 37 women). Only 52% of first presentations were with general practitioners. The mean turnaround for biopsy results in Saint Lucia was three times longer than overseas (p = 0.0013). Approximately half of survivors commenced treatment more than one month following diagnosis (median of 32 days, IQR 19-86 days), and 56% of survivors traveled out-of-country for treatment. Most survivors (60%) paid for care with family/friends support, followed by savings and medical insurance (38% each). In conclusion, cancer survivors in Saint Lucia are faced with complex circumstances, including access-to-care and health consequences. This study can guide future research, and possibly guide practice improvements in the near term.

MMR2 vaccination coverage and timeliness among children born in 2004 - 2009: a national survey in Saint Lucia, 2015.

OBJECTIVES: To more accurately determine coverage and timeliness of the second dose of measles-mumps-rubella vaccine (MMR2), while identifying factors associated with low MMR2 vaccination uptake among children in Saint Lucia. METHODS: A survey was conducted in October - November 2015 targeting children born in 2004 - 2009. At 86 preschools and primary schools, two children from each grade were randomly selected, yielding an effective sample of 836 children. Health records were reviewed to assess vaccination coverage and timeliness. Parents and/or guardians and principals of all 86 schools were interviewed regarding knowledge, attitudes, and practices related to vaccination. RESULTS: Of 767 children included, 75% were vaccinated with MMR2 (n = 572); 46.7% were vaccinated in a timely manner, i.e., by 5 years of age. Cohorts born in 2004, 2005, and 2008 reported the lowest proportion. 'Mothers as caregivers' was positively associated with timely MMR2 vaccination. Although 97% of principals surveyed considered vaccination important, 48.8% were not aware of national legislation requiring complete vaccination prior to school entry. Survey results concurred with the low MMR2 administrative coverage rates reported by Saint Lucia, much lower than the recommended 95%. CONCLUSIONS: Based on the results of this survey, Saint Lucia's national immunization program has lowered the age of MMR2 to 18 months in 2016, increased advocacy with schools to enforce the school-entry law, and is working to vaccinate the cohorts of children who have not received timely MMR2.

MMR2 vaccination coverage and timeliness among children born in 2004 - 2009: a national survey in Saint Lucia, 2015 / Cobertura de vacunación y respeto de los plazos de la segunda dosis de la vacuna triple viral en los niños nacidos en el período 2004-2009: encuesta nacional realizada en Santa Lucía en el 2015 / Cobertura e momento oportuno de vacinação da segunda dose da vacina tríplice viral em crianças nascidas em 2004-2009: pesquisa nacional em Santa Lúcia, 2015

ABSTRACT Objectives To more accurately determine coverage and timeliness of the second dose of measles-mumps-rubella vaccine (MMR2), while identifying factors associated with low MMR2 vaccination uptake among children in Saint Lucia. Methods A survey was conducted in October - November 2015 targeting children born in 2004 - 2009. At 86 preschools and primary schools, two children from each grade were randomly selected, yielding an effective sample of 836 children. Health records were reviewed to assess vaccination coverage and timeliness. Parents and/or guardians and principals of all 86 schools were interviewed regarding knowledge, attitudes, and practices related to vaccination. Results Of 767 children included, 75% were vaccinated with MMR2 (n = 572); 46.7% were vaccinated in a timely manner, i.e., by 5 years of age. Cohorts born in 2004, 2005, and 2008 reported the lowest proportion. 'Mothers as caregivers' was positively associated with timely MMR2 vaccination. Although 97% of principals surveyed considered vaccination important, 48.8% were not aware of national legislation requiring complete vaccination prior to school entry. Survey results concurred with the low MMR2 administrative coverage rates reported by Saint Lucia, much lower than the recommended 95%. Conclusions Based on the results of this survey, Saint Lucia's national immunization program has lowered the age of MMR2 to 18 months in 2016, increased advocacy with schools to enforce the school-entry law, and is working to vaccinate the cohorts of children who have not received timely MMR2.

RESUMEN Objetivos Determinar con mayor precisión la cobertura y el respeto de los plazos de vacunación de la segunda dosis de la vacuna contra el sarampión, la rubéola y la parotiditis (triple viral), al tiempo que se detectan los factores asociados con la baja aceptación de esa vacuna en Santa Lucía. Métodos En octubre y noviembre del 2015 se llevó a cabo una encuesta centrada en niños nacidos entre el 2004 y el 2009. En 86 centros preescolares y primarios se seleccionó al azar a dos niños de cada grado, lo que arrojó un tamaño real de la muestra de 836 niños. Se analizaron los registros de salud para evaluar la cobertura y el respeto de los plazos de vacunación. Se entrevistó a los padres o tutores y los directores de las 86 escuelas sobre conocimientos, actitudes y prácticas en materia de vacunación. Resultados De los 767 niños incluidos, el 75% fueron vacunados con la segunda dosis de la triple viral (n = 572); el 46,7% fueron vacunados a tiempo, es decir, a los 5 años de edad. La proporción más baja se dio en las cohortes nacidas en el 2004, 2005 y 2008. Se observó que las madres cuidadoras influían positivamente en el respeto de los plazos de vacunación de la segunda dosis de la triple viral. Aunque el 97% de los directores encuestados consideraba que la vacunación era importante, el 48,8% desconocía la legislación nacional que exige la vacunación completa antes de ingresar a la escuela. Los resultados de la encuesta estaban en consonancia con las tasas bajas de cobertura administrativa de la segunda dosis de la triple viral informadas por Santa Lucía, muy por debajo del 95% recomendado. Conclusiones Según los resultados de esta encuesta, el programa nacional de vacunación de Santa Lucía redujo la edad de la segunda dosis de la triple viral a los 18 meses en el 2016, aumentó las actividades de promoción en las escuelas para fomentar el cumplimiento de la ley que obliga a recibir la vacunación antes de ingresar a la escuela y está trabajando para vacunar a las cohortes de niños que no recibieron la segunda dosis de la triple viral en su debido momento.

RESUMO Objetivos Determinar com precisão a cobertura vacinal e o momento oportuno para ministrar a segunda dose da vacina tríplice viral (sarampo, caxumba e rubéola - SCR) e identificar os fatores associados à baixa utilização da vacina em crianças. Métodos Uma pesquisa direcionada a crianças nascidas de 2004 a 2009 foi realizada em Santa Lúcia em outubro e novembro de 2015. Em 86 unidades de ensino infantil e fundamental, duas crianças de cada série foram selecionadas aleatoriamente, constituindo uma amostra efetiva de 836 crianças. Dados sobre a cobertura e o momento oportuno de vacinação foram obtidos das fichas de saúde. Foram conduzidas entrevistas com os pais e/ou responsáveis e os diretores das 86 escolas sobre conhecimento, atitudes e práticas relacionadas à vacinação. Resultados Das 767 crianças incluídas na amostra, 75% foram vacinadas com a segunda dose de SCR (n = 572) e 46,7% receberam a vacina no momento oportuno (ou seja, até os 5 anos de idade). Observou-se menor proporção de vacinados nas coortes nascidas em 2004, 2005 e 2008. "Mães como cuidadoras" teve uma associação positiva com ministrar a segunda dose de SCR no momento oportuno. Apesar de 97% dos diretores entrevistados considerarem a vacinação importante, 48,8% desconheciam a legislação nacional que exige vacinação completa para a matrícula escolar. Os resultados reforçaram a baixa cobertura vacinal da segunda dose de SCR registrada em Santa Lúcia, bem inferior ao índice recomendado de 95%. Conclusões A partir dos resultados desta pesquisa, em 2016, o programa nacional de vacinação de Santa Lúcia reduziu para 18 meses a idade de administração da segunda dose de SCR, intensificou a recomendação para que as escolas cumpram com a legislação para matrícula escolar e está empenhado em vacinar as coortes de crianças que não receberam a segunda dose de SCR no momento oportuno.

Knowledge of and attitudes toward heel prick screening for sickle cell disease in Saint Lucia / Conocimiento y actitudes hacia la prueba del talón para la detección de la anemia de células falciformes en Santa Lucía / Conhecimento e atitudes em relação ao “teste do pezinho” para triagem de doença falciforme em Santa Lúcia

ABSTRACT Objectives In the Caribbean country of Saint Lucia, umbilical-cord-blood screening for sickle cell disease (SCD) was the testing method that health care workers (HCWs) on the maternity wards of the hospitals preferred until the new heel prick (HP) testing method was introduced in the country in 2014. This SCD study sought to assess HCWs’ knowledge of and attitude toward HP screening and also determine new mothers’ favorability toward HP screening. Methods A total of 70 HCWs and 132 new mothers answered survey questionnaires in three hospitals. In addition, four focus group discussions were held, two with HCWs and two with the mothers. Results Among the HCWs interviewed, 85.7% of them had knowledge of the HP test. However, only 25.7% had attended training sessions on the procedure. Among the HCWs, 64.3% of them felt the HP test should be mandatory, 27.1% said it should not be mandatory, and 8.6% did not know if it should be mandatory. In their focus groups, the HCWs said they believed the mothers would accept the HP method. For their part, 22.0% of the mothers said they had heard about the HP test, and 63.6% reported knowing the reason why the baby would be tested. Further, 83.3% indicated that the test would be beneficial for the baby. In addition, 88.6% of the mothers said that more information on the HP test was needed. In their focus group discussions, the mothers said they were generally not concerned about the pain the heel prick method might cause the baby. Conclusions The HCWs’ knowledge of the HP screening method was high. The mothers trust HCWs, and the mothers would accept the HP procedure irrespective of their knowledge of the test and any discomfort associated with this screening method.

RESUMEN Objetivo En el país caribeño de Santa Lucía, el hemocribado del cordón umbilical para la detección de la anemia de células falciformes o drepanocitosis era el método de tamizaje preferido por el personal de salud en las salas de maternidad de los hospitales hasta que se introdujo la nueva prueba del talón en el 2014. Este estudio sobre la anemia de células falciformes tuvo por objetivo evaluar el conocimiento y las actitudes del personal de salud hacia la prueba del talón, así como determinar si las madres tenían una actitud favorable hacia este método de tamizaje. Método Un total de 70 trabajadores de salud y 132 madres participaron en los cuestionarios realizados en tres hospitales. Además, se celebraron cuatro grupos de debate: dos con el personal de salud y dos con las madres. Resultados Del personal de salud entrevistado, 85,7% tenía conocimientos acerca de la prueba del talón. Sin embargo, únicamente 25,7% había asistido a sesiones de capacitación sobre el procedimiento. Además, 64,3% del personal de salud opinaba que la prueba debía ser obligatoria, 27,1% afirmaba que no debía ser obligatoria y 8,6% manifestó que no lo sabía. En los grupos de debate, el personal de salud manifestó su creencia de que las madres aceptarían este método de tamizaje. Por su parte, 22,0% de las madres afirmaron conocer la prueba del talón y 63,6% manifestó conocer los motivos por los que se sometería al bebé a dicha prueba. Asimismo, 83,3% de las madres señaló que la prueba sería beneficiosa para el bebé. Además, 88,6% de las madres indicó que era necesaria más información sobre la prueba del talón. En sus grupos de debate, las madres expresaron que, por lo general, no les preocupaba el dolor que pudiese suponer para el bebé la prueba del pinchazo en el talón. Conclusiones El personal de salud tiene un nivel alto de conocimiento acerca de la prueba del talón. Las madres confían en el personal de salud, y aceptarían este procedimiento independientemente de sus conocimientos sobre la prueba y cualquier malestar asociado a este método de tamizaje.

RESUMO Objetivos No país caribenho de Santa Lúcia, o exame de sangue de cordão umbilical para detecção da doença falciforme (DF) era o método de triagem preferido pelos profissionais da saúde atuantes em maternidades, até a introdução do “teste do pezinho” (TP) no país em 2014. Este estudo sobre DF buscou avaliar o conhecimento e atitudes de profissionais da saúde em relação à triagem pelo TP e também determinar a favorabilidade das novas mães em direção à triagem de TP. Métodos Setenta profissionais da saúde e 132 novas mães responderam a questionários de pesquisa em três hospitais. Além disso, foram realizadas quatro discussões com grupos focais: dois de profissionais da saúde e dois de mães. Resultados Entre os profissionais da saúde entrevistados, 85,7% tinham conhecimento acerca do TP. Porém, somente 25,7% haviam comparecido às sessões de capacitação sobre o procedimento. Entre os profissionais da saúde, 64,3% opinaram que o TP deveria ser obrigatório, 27,1% disseram que não deveria ser obrigatório e 8,6% não sabiam se deveria ser obrigatório. Em seus grupos focais, os profissionais da saúde disseram acreditar que as mães aceitariam o método do TP. Por sua vez, 22,0% das mães disseram ter ouvido falar sobre o TP, e 63,6% relataram saber o motivo pelo qual o exame seria realizado; ademais, 83,3% indicaram que o exame seria benéfico para o bebê. Além disso, 88,6% das mães disseram que precisavam de maiores informações sobre o TP. Em seus grupos focais, as mães disseram que, em geral, não estavam preocupadas com dor que o teste do pezinho poderia causar ao bebê. Conclusões Os profissionais da saúde apresentaram alto nível de conhecimento acerca do método de triagem pelo TP. As mães confiam nos profissionais da saúde, e aceitariam o procedimento de TP independentemente de seu conhecimento acerca do teste e de qualquer desconforto associado a este método de triagem.

La colaboración cubana y el problema de la insuficiencia renal crónica en Santa Lucía: una experiencia internacionalista / Cuban Cooperation and the Problem of Chronic Renal Failure in Saint Lucia: an International Cooperation Experience

El internacionalismo, como valor social, constituye uno de los rasgos esenciales que ha caracterizado a la salud pública cubana desde el triunfo de la Revolución. En noviembre de 2005 se inició la colaboración cubana en materia de salud a la atención de pacientes con insuficiencia renal crónica en Santa Lucía, enfermedad que constituye un importante problema de salud en ese país del Caribe. El objetivo de este artículo está dirigido a destacar el rol de la colaboración cubana en la asistencia al problema de la insuficiencia renal crónica en Santa Lucía, a partir de la realización de diversas intervenciones bien definidas, con énfasis en el impacto de dicha cooperación en la Unidad Renal del Hospital Victoria.

Internationalism, as a social value, is one of the essential characteristics of Cuban public health since the triumph of the Revolution. In November 2005, Cuban medical cooperation in the care of patients with chronic renal failure began in Saint Lucia. This disease constitutes a major health problem in the Caribbean nation. The aim of this article is to highlight the role of Cuban cooperation in assisting chronic renal failure patients in Santa Lucia through various well-defined interventions, emphasizing on the impact of such cooperation in the Renal Unit of the Victoria Hospital.

Unintended and unwanted pregnancy in St. Lucia.

Among 200 mothers interviewed in St. Lucia, 82.5% described their pregnancy as unintended and 44% as unwanted; 80% of women having an intended pregnancy and 94.6% having an unintended pregnancy were unmarried and 18.5% were teenagers. Mothers of unintended pregnancies were significantly younger, were of significantly higher parity and had begun sexual relations at a significantly earlier age than mothers of intended pregnancies; and, unlike mothers of planned pregnancies, their desired interpregnancy interval was significantly longer than the actual interval. These results and the sporadic and ineffective use of contraception in St. Lucia emphasize the need for improvements in fertility regulation in that country.

PIP: Between June 13 and July 30, 1993, in St. Lucia, 200 mothers who had just delivered at Victoria Hospital were interviewed so researchers could examine unintended and unwanted pregnancies and their socioeconomic and demographic determinants. 165 pregnancies (82.5%) were unplanned. Unmarried women comprised 96.4% of women having an unintended pregnancy and 80% of those having an intended pregnancy. 18.5% of all pregnancies occurred to teenagers. Women who had completed an unplanned pregnancy were younger than those who had completed a planned pregnancy (20 years, 21.2% vs. 5.7%; p 0.01). Mothers of unintended pregnancies had a significantly higher parity than those of intended pregnancies (parity =or 4, 16.7% vs. 0; p 0.005). The actual interpregnancy interval among mothers of unintended pregnancies was much shorter than the desired interval (p 0.005). Women with unintended pregnancies were significantly younger at age of first intercourse than women with intended pregnancies (p 0.005). 88 of the unintended pregnancies (53.3%) (44% of all pregnancies) were unwanted pregnancies. Among unintended pregnancies, mothers who wanted their pregnancy were more likely than those who did not want their pregnancy to have had at least some post-primary school education (p 0.01) and have a high personal income (p 0.001). 87.9% did not use a consistent family planning method around the time of conception. 28% of women with unintended pregnancies had never used a contraceptive method. The leading reason for not using contraception effectively were carelessness (about 40%) and fear of side effects (26%). These findings suggest the need for a policy aimed to reduce the incidence of unintended pregnancy in St. Lucia. The policy should include counseling on use of contraceptives and the risks associated with unintended and unwanted pregnancy.

Social norms for condom use: implications for HIV prevention interventions of a KABP survey with heterosexuals in the Eastern Caribbean.

PIP: A knowledge, attitude, belief, and practices survey was given to a sample of 591 residents of St. Lucia in the fall of 1990. The survey posed a host of questions relating to whether respondents were inclined to use condoms when having sex. Respondents were sexually experienced, aged 15-60 years, and interviewed in their homes. Questions were posed and viewed as possible indicators of AIDS knowledge, cues to action, perceived susceptibility, perceived severity, perceived locus of control, normative pressure, and condom use outcome expectancies. Statistical analysis suggests that each variable is related to condom use. Analysis also indicates that perceived normative pressure to use condoms was by far the single most important determinant of condom use among the sample. The author closes by discussing the implications of these findings for designing mass media campaigns to increase condom use and strongly recommends a normative campaign.^ieng

Comparison of condom breakage during human use with performance in laboratory testing.

This paper combines results from a study of the determinants of condom quality and use conducted by The Population Council in two countries in the Caribbean with results from a condom breakage study conducted by Family Health International (FHI) in the United States. The studies, conducted two years apart, compared the breakage rates of condoms from the same lot during human use to their performance in laboratory test results. Breakage rates of 12.9% for Barbados, 10.1% for St. Lucia and 6.7% for the United States compared to passing ASTM laboratory tests suggest that existing laboratory tests as used with the current pass/fail standards are either not sufficiently sensitive or not well-defined to reliably predict condom performance during human use. The study also suggests that user behaviors and practices may be a factor in condom breakage. If the condom is to be an effective method against unplanned pregnancy and STD/HIV infection, and if consumer confidence is to be retained, condom breakage during sexual intercourse must be reduced.

PIP: Family Health International (FHI) in North Carolina sampled and tested 52mm contour condoms with a reservoir tip and silicone lubrication in November 1988 and March 1990. Condoms from this same lot were used in 2 human use studies conducted in 2 Caribbean countries and in the US. The Population Council conducted 1 human use study in Barbados and St. Lucia among 50 heterosexual male condom users from each country. FHI conducted the other study in the Research Triangle area of North Carolina among 50 heterosexual male condoms users. Condom breakage rates of the human studies were high (12.9% in Barbados, 10.1% for St. Lucia, and 6.7% for North Carolina) in comparison with other studies (1-7%). Breakage did not occur due to poor storage conditions or oil based lubricant use. The researchers thought that it occurred due to men misusing the condoms or other user behaviors and practices. This belief was supported by the differences in breakage between the Caribbean men and the US men. More men experienced multiple condom breakages than those who experienced only 1 breakage. Condoms used in the study were from the same lot which passed elongation and tensile strength standards of the American Society for Testing and Materials (ASTM) in both 1988 and 1990, but failed the International Organization of Standardization (ISO) airburst tests in 1988 and just barely passed in 1990. Apparently the standards are not sensitive enough to predict increases in condom breakage. These findings suggest that the ISO standard for airburst testing is a more accurate predictor of condom quality than the ASTM standards for tensile strength and elongation. Further the breakage rates are too high given the AIDS epidemic. Moreover high breakage reduces customer confidence. In conclusion, researchers need to conduct studies on sexual behavior and practices to determine their effect on condom breakage rates.

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

Planning and pre-testing: the key to effective AIDS education materials.

PIP: The steps in designing and producing effective AIDS prevention educational materials are outlines, using as an example a brochure originated in St. Lucia for clients at STD clinics. The brochure was intended to be read by clients as they waited for their consultation, thus it was targeted to a specific audience delimited by age, sex, language, educational level, religion and associated medical or behavioral characteristics. When researching the audience, it is necessary to learn the medium they best respond to, what they know already, what is their present behavior, how they talk about AIDS, what terms they use, how they perceive the benefits of AIDS prevention behavior, what sources of information they trust. The minimum number of key messages should be selected. Next the most appropriate channel of communication is identified. Mass media are not always best for a target audience, "little media" such as flyers and give-always may be better. The draft is then pre-tested by focus groups and interviews, querying about the text separately, then images, color, format, style. Listen to the way the respondents talk about the draft. Modify the draft and pre-test again. Fine-tune implications of the message for realism in emotional responses, respect, self-esteem, admiration and trust. To achieve wide distribution it is a good idea to involve community leaders to production of the materials, so they will be more likely to take part in the distribution process.^ieng

Caribbean male: macho and insensitive?

PIP: 185, 50, and 104 men aged 15-44 years were interviewed, respectively, in Barbados, St. Lucia, and Grenada in three attitudinal studies designed to get an objective look at male attitudes in the region on family planning and human sexuality. Qualitative information was obtained on fertility and contraceptive use, attitudes toward premarital sex, fidelity and relationships, and influences upon male behavior. Men wanted an average of 2.5 children in Barbados, 4 in St. Lucia, and 3.5 in Grenada. Monogamy was not paramount, with 56% of Grenadian men reporting having overlapping sexual relations. There was also a substantial tolerance for illegitimacy, especially among married men and men with post-secondary education. In St. Lucia, relationships are conducted on the man's terms. For example, men may have sexual relationships with multiple women, but it is unacceptable for women to have other men. Most men, however, agreed that fathers should have a say in the upbringing of their children and should visit and support them financially even if the parents do not live together. Many respondents had unstable relationships with their fathers, and a large proportion had not lived with them. 63% of respondents knew their fathers had outside women. Men were aware and supportive of family planning, and generally try to use contraception. 78% of men interviewed in Grenada and 75% of men interviewed in St. Lucia endorse birth control, while 52% of the respondents in St. Lucia practice family planning. Younger, relatively inexperienced men were most typically in need of more knowledge and greater practice of family planning. Family planning programs should be targeted accordingly.^ieng

Epidemiology and transmission of rotavirus infections and diarrhoea in St. Lucia, West Indies.

To determine the epidemiology and risk factors of rotavirus infections in St. Lucia, 229 children in three valleys with varying levels of sanitation were studied for 2 years. A four-fold rise in complement fixation antibody to rotavirus antigen was used in paired samples as evidence of recent infection. Results showed that forty-eight per cent of infants experienced at least one infection during a two-year period, and 17% of children were reinfected. Infections occurred within the first months of life and peaked between 6 and 23 months of age. The peak infection coincided with the dry season in each age group. Children breast-feeding had fewer infections. Although crowding within the home was significantly associated with repeated infection, the incidence of infection was not affected by the degree of sanitation. Other studies in the region, using recently developed techniques, concur with these findings which advance our understanding of the epidemiological importance of rotavirus in St. Lucia. Although these studies provide insights into the risk factors for rotavirus infections, other studies are required to determine whether investments should be focused on improved sanitation or immunization or both.

PIP: During the 1977-1979 Schistosomiasis control project in St. Lucia, researchers studied the prevalence of rotavirus infection in 229 children 3 years old (10 children later dropped out of the study) in 3 valleys with different levels of sanitation. Nurses from the Ministry of Health collected stool and sera samples which laboratory staff tested for rotavirus and antibodies, 48% (106) had at least 1 rotavirus infection during the 2 years. 18 of them were reinfected once and 1 twice. Prevalence was highest in 1 year olds (18.1% 12-176 months; 18.9% 18-23 months). Rotavirus caused diarrhea in 47% of all diarrhea cases during the dry season (April-June), but only 3% during the rainy season (October-December). Only children 6-23 months old had significantly higher infection rates during the dry season. Breast fed children 0-11 months had a lower infection rate than those bottle fed or other wise fed. Crowding was the only consistent and significant social factor associated with rotavirus infection (p.05). Rotavirus infection prevalence remained similar for the 3 different hygienic areas which demonstrated that improved sanitation only affected diarrhea not caused by rotavirus. The fact that children with rotavirus reinfections lived in crowded dwellings and that crowding was significantly associated with rotavirus infections suggested that air may have been responsible for transmitting rotavirus. Other studies are needed to see whether efforts to reduce diarrheal morbidity should center on improved sanitation or immunizations or both.

Civil Code (Amendment) (No. 2) Act, 1989 (No. 13 of 1989), 28 December 1989.

PIP: This Act amends various provisions of the Saint Lucia Civil Code to equalize the status of men and women. Among other things it provides 1) that husband and wife owe mutual protection to each other, rather than the husband owes protection to his wife and the wife owes obedience to her husband; 2) that the spouses shall live wherever they both agree to reside, rather than the wife is obligated to live with and follow her husband; 3) that both spouses are bound to supply each other with the necessities of life according to his or her means, rather than the husband is bound to supply the wife with the necessities of life according to his means and condition; 4) that, if an action for separation is dismissed, the parties are not obliged to resume cohabitation, rather than the husband is obliged to take back his wife and the wife is obliged to return; 5) that a married woman can become a guardian in all circumstances, rather than only if appointed jointly with her husband; 6) that a wife who has been appointed a guardian will continue to be a guardian if she remarries, rather than lose that ability; 7) that spouses shall together administer community property, rather than the husband shall administer it; and 8) that a wife who renounces the community will be responsible for debts to which she bound herself jointly and severally with her husband, rather than being freed from them.^ieng

Income Tax Act, 1989 (No. 1 of 1989), 6 April 1989.

PIP: This Saint Lucia Act revises and consolidates the law relating to income tax. It contains the following provisions, among others: 1) income accrued to a married woman is to be taxed in her own name; 2) the spousal deduction is set at $1500; and 3) the child deduction is set at $1000.^ieng

Civil Code (Amendment) Act, 1988 (No. 4 of 1988), 21 May 1988.

This Act amends the Civil Code of Saint Lucia to do the following, among other things: 1) allow marriage to be celebrated by giving notice; 2) legalize divorce; 3) allow all children to be legitimated by the subsequent marriage of their parents; 4) remove differences in the treatment of children born within marriage and those born outside of marriage; 5) lower to 18 the age of majority and the age under which consent must be obtained in order to marry. A number of these changes are consolidations of earlier amendments made to the Civil Code.