Disparities in Health-Related Quality of Life in Trinidad and Tobago and Canada

 Despite public healthcare being delivered, for the most part, without user fees in Trinidad and Tobago (T&T) and Canada, there are health disparities. Socioeconomic disparities have been reported for morbidity, mortality and access to services. While the health-related quality of life (HRQoL) is likely to be present, it has not received adequate attention, especially with the current focus on health and wellness.  The objective of this presentation is to measure HRQoL and examine associations with sex and social class in T&T and to compare the T&T findings with published reports of health disparities in Canada. The T&T analysis used data from its national Burden of Obstructive Lung Disease (BOLD-TT) survey of 1104 persons, ≥40 years old. Among the variables measured was the Veteran Rand (VR-12) assessment of HRQoL, which addressed both physical (general health, physical functioning and role-playing and bodily pain) and mental health (vitality, role-emotional, mental health and social functioning). Physical health (PCS) and mental health (MCS) component scores were calculated, ranging from 0-100; lower scores indicated poorer health.  The highest level of education and employment status were proxies for social class. General Linear Models were used to associations, controlling for age. The mean age of the participants in the BOLD-TT study was M=54.1 (SD=10.8) years; 59.9% were females; 47.2% had no/primary education; 55.7% were employed. Mean PCS and MCS (SD) scores were 47.9 (SD=7.4) and 54.6 (SD=8.9) respectively with females having lower mean MCS than males (p<.001).   Persons who were not working had lower mean PCS (p<.001) and MCS (p=.014) than those employed; and persons with a primary education had lower PCS (p<.0001) than other persons. Multiple regression identified employment (p<.001) and education (p=.097) as independent predictors of PCS while sex (p=.002) and employment (p=.021) predicted MCS. A population survey in Alberta reported mean PCS and MCS scores of 47.6 (10.6) and 51.5 (9.3), respectively. The PCS score was similar to that in T&T while the MCS score was lower. Another study of obese Albertans found that persons who were not employed full-time had lower MSC scores than other persons. No other Canadian report of disparities in HRQoL was identified but other studies found disparities in health outcomes such as mental health, arthritis, asthma, and diabetes. The outcomes were poorer amongst persons who were unemployed and those with lower income or educational levels. In a 2018 PHAC study on health inequity, immigrant Canadians (≤10years) had a lower prevalence of arthritis, asthma, and obesity than non-immigrants while immigrants residing over 10 years had a higher prevalence of diabetes. The findings indicate disparities in HRQoL in T&T and, to some extent, Canada. The finding that migrants’ health outcomes had initially better health outcomes than Canadians, which appeared to reverse the longer they resided in Canada was of interest. Canada has a large migrant community from the Caribbean and research is needed to understand their health disparities and to compare them with the Caribbean situation

Epidemiological evaluation of risk factors associated with vaginal candidiasis in a cross section of pregnant women in Trinidad and Tobago

Vaginal Candidiasis and associated epidemiological risk factors prevalent among a cross section of pregnant women attending tertiary hospital in Trinidad and Tobago was evaluated. Standardized questionnaire was used to survey 492 pregnant women over a period of 10 months in 2019. Vaginal swab was collected and processed using standard microbiological laboratory methods for phenotypic identification. Data were analyzed using SPSS to identify potential risk factors. Chi-squared (ꭓ2) test and logistic regression tests examined associations and odds ratios with corresponding 95% confidence intervals. Prevalence of vulvovaginal candidiasis was 44.9% with Candida albicans as predominant species identified (62%, N=492). Vaginal candidiasis was statistically significant for several risk factors, including second trimester (p = 0.03), age group 26 – 34 years (p=003), history of masturbation especially during the last 48hours prior to the swabbing (p=0.05), and wearing of pants as opposed to skirt clothes (p=0.04). In conclusion, several epidemiological risk factors are associated vaginal candidiasis among cross section of pregnant women in the country. Patient education, microbiological investigations and appropriate treatment will improve antenatal healthcare delivery in the country

Correction: Implementation of Genomic Surveillance of SARS-CoV-2 in the Caribbean: Lessons learned for sustainability in resource-limited settings.

[This corrects the article DOI: 10.1371/journal.pgph.0001455.]