In-house polymerase chain reaction for affordable and sustainable Chlamydia trachomatis detection in Trinidad and Tobago

Objectives: To provide a preliminary assessment of in-house polymerase chain reaction (PCR) as an alternative to the more costly commercial test for detection of asymptomatic infection by Chlamydia trachomatis and to provide much needed demographic data on infection indicators within the Trinidad and Tobago public health care system. Methods: An inexpensive in-house nested-PCR with an Internal Amplification Control was used to detect C. trachomatis and Neisseria gonorrhoeae in urine samples collected from 273 apparently healthy, pregnant women from March-September 2004 in Trinidad, West Indies. Demographic information on participants was collected and subjected to statistical analyses. Results: C. trachomatis was detected in 57/273 (21%) samples, of which 5 (2%) were also positive for N. gonorrhoeae. Infection correlated well with certain demographic parameters, with the highest incidence of C. trachomatis infection found among pregnant women that were single or of African descent. Conclusions: Given the lack of commercial tests in Trinidad, in-house PCR is an inexpensive alternative that can be used to detect asymptomatic infections of C. trachomatis and to provide demographic information needed for interventions by the public health care system

The National Eye Survey of Trinidad and Tobago (NESTT): Rationale, objectives and methodology

Purpose: This paper describes the rationale, study design and procedures of the National Eye Survey of Trinidad and Tobago (NESTT). The main objective of this survey is to obtain prevalence estimates of vision impairment and blindness for planning and policy development. Methods: A population-based, cross-sectional survey was undertaken using random multistage cluster sampling, with probability-proportionate-to-size methods. Eligible participants aged 5 years and older were sampled from the non-institutional population in each of 120 cluster segments. Presenting distance and near visual acuity were screened in their communities. People aged 40 years and older, and selected younger people, were invited for comprehensive clinic assessment. The interview included information on potential risk factors for vision loss, associated costs and quality of life. The examination included measurement of anthropometrics, blood glucose, refraction, ocular biometry, corneal hysteresis, and detailed assessment of the anterior and posterior segments, with photography and optical coherence tomography imaging. Adult participants were invited to donate saliva samples for DNA extraction and storage. Results: The fieldwork was conducted over 13 months in 2013–2014. A representative sample of 10,651 individuals in 3410 households within 120 cluster segments identified 9913 people who were eligible for recruitment. Conclusion: The study methodology was robust and adequate to provide the first population-based estimates of the prevalence and causes of visual impairment and blindness in Trinidad and Tobago. Information was also gathered on risk factors, costs and quality of life associated with vision loss, and on normal ocular parameters for the population aged 40 years and older

Did vaccine inequity lead to the second wave of COVID-19 infections in Trinidad and Tobago?

Small Island Developing State should not be reliant on single source supply chains. Subtle inequities can result in underserved health systems. Vaccine inequity mirrors other sociopolitical global inequities. Acquisition of vaccinations requires global diplomacy and multilateral negotiation. Impaired vaccination rollout against COVID-19 can result in accelerated population health consequences. It is possible that countries that are suboptimally vaccinated pose a threat to wealthy countries which are well vaccinated

In-house polymerase chain reaction for affordable and sustainable Chlamydia trachomatis detection in Trinidad and Tobago Sistema autóctono para la detección asequible y sustentable de Chlamydia trachomatis por la reacción en cadena de la polimerasa en Trinidad y Tobago

OBJECTIVES: To provide a preliminary assessment of in-house polymerase chain reaction (PCR) as an alternative to the more costly commercial test for detection of asymptomatic infection by Chlamydia trachomatis and to provide much needed demographic data on infection indicators within the Trinidad and Tobago public health care system. METHODS: An inexpensive in-house nested-PCR with an Internal Amplification Control was used to detect C. trachomatis and Neisseria gonorrhoeae in urine samples collected from 273 apparently healthy, pregnant women from March-September 2004 in Trinidad, West Indies. Demographic information on participants was collected and subjected to statistical analyses. RESULTS: C. trachomatis was detected in 57/273 (21%) samples, of which 5 (2%) were also positive for N. gonorrhoeae. Infection correlated well with certain demographic parameters, with the highest incidence of C. trachomatis infection found among pregnant women that were single or of African descent. CONCLUSIONS: Given the lack of commercial tests in Trinidad, in-house PCR is an inexpensive alternative that can be used to detect asymptomatic infections of C. trachomatis and to provide demographic information needed for interventions by the public health care system.<br>OBJETIVOS: Hacer una evaluación preliminar de un sistema autóctono para la detección de la infección asintomática por Chlamydia trachomatis mediante la reacción en cadena de la polimerasa (RCP), como alternativa a los costosos sistemas comerciales, y ofrecer datos demográficos muy necesarios relacionados con los indicadores de esta infección en el sistema de salud pública de Trinidad y Tobago. MÉTODOS: Se empleó un sistema autóctono y económico de RCP anidada con control interno de la amplificación para la detección de C. trachomatis y Neisseria gonorrhoeae en muestras de orina de 273 mujeres embarazadas asintomáticas, entre marzo y septiembre de 2004 en Trinidad y Tobago, Indias Occidentales. Se obtuvo la información demográfica de las participantes y se sometió a análisis estadístico. RESULTADOS: Se detectó C. trachomatis en 57/273 (21%) muestras, de las cuales 5 (2%) fueron también positivas para N. gonorrhoeae. La infección se correlacionó bien con algunos parámetros demográficos; la mayor incidencia de la infección por C. trachomatis se observó en las mujeres embarazadas solteras o de ascendencia africana. CONCLUSIONES: Debido al déficit de sistemas de diagnóstico comerciales en Trinidad, la RCP autóctona es una alternativa económica que puede emplearse para detectar la infección asintomática por C. trachomatis y obtener la información demográfica necesaria para que el sistema de salud pública implemente intervenciones

Seroprevalence and risk factors of Toxoplasma gondii infection among pregnant women in Trinidad and Tobago Seroprevalencia y factores de riesgo de la infección por Toxoplasma gondii en mujeres embarazadas en Trinidad y Tobago

OBJECTIVE: To determine the seroprevalence of toxoplasmosis and the frequency of risk factors for the disease in women attending antenatal clinics in hospitals and local health centers in Trinidad and Tobago. METHODS: From November 2002-September 2003, 232 pregnant women at the antenatal clinics of two large hospitals were sampled during their first trimesters. From October 2003-February 2005, 218 pregnant women at five health care centers were followed through three trimesters, wherever possible, and blood samples collected. Sera were screened for Toxoplasma gondii IgG and IgM immunoglobulins using an enzyme immunoassay. Data on demographics, as well as practices considered to be risk factors for toxoplasmosis, were obtained. RESULTS: Of the 232 women sampled at the two hospital clinics, 83 (35.8%) and 8 (3.4%) were seropositive for immunoglobulins of T. gondii IgG and IgM, respectively. Of the 218 women at the health centers, 76 (34.9%) had evidence of past infection (IgG), while 26 (11.9%) were seropositive for IgM immunoglobulin, suggesting new infections during pregnancy. Only having "3 or more" children was significantly associated with infection by T. gondii. CONCLUSION: In Trinidad and Tobago, the seroprevalence of past infection by T. gondii in pregnant women is relatively low (39.3%) for patients in both hospital and health center clinics. Consequently, there is an elevated risk of primary infection during pregnancy and the potential for congenital infection.<br>OBJETIVO: Determinar la seroprevalencia de toxoplasmosis y la frecuencia de los factores de riesgo de la enfermedad en mujeres que asisten a consultas prenatales en hospitales y centros de salud en Trinidad y Tobago. MÉTODOS: Entre noviembre de 2002 y septiembre de 2003 se tomaron muestras de 232 mujeres que asistieron a consultas prenatales en dos grandes hospitales durante su primer trimestre de embarazo. Entre octubre de 2003 y febrero de 2005 se realizó el seguimiento durante tres trimestres, siempre que fue posible, y se tomaron muestras de sangre de 218 embarazadas atendidas en cinco centros de salud. Se analizaron las muestras de suero para detectar anticuerpos de las clases IgG e IgM contra Toxoplasma gondii mediante ensayos inmunoenzimáticos. Se tomó nota de los datos demográficos y las prácticas consideradas factores de riesgo para la toxoplasmosis. RESULTADOS: De las 232 mujeres estudiadas en los dos hospitales, 83 (35,8%) y 8 (3,4%) resultaron seropositivas para anticuerpos IgG e IgM contra T. gondii, respectivamente. De las 218 mujeres estudiadas en los centros de salud, 76 (34,9%) presentaban evidencias de infección pasada (anticuerpos IgG), mientras 26 (11,9%) eran positivas a anticuerpos IgM, lo que indicaba una infección reciente durante el embarazo. El único factor asociado significativamente con la infección por T. gondii fue tener tres hijos o más. CONCLUSIONES: En Trinidad y Tobago, la seroprevalencia de infección pasada por T. gondii encontrada en mujeres embarazadas que se atendían en los hospitales y los centros de salud fue relativamente baja (39,3%). Por consiguiente, existe un elevado riesgo de infección primaria durante el embarazo con la posibilidad de infección congénita

Barriers and facilitators to establishing a national public health observatory

OBJECTIVE: To determine what stakeholders perceive as barriers and facilitators to creating a national public health observatory (PHO) in Trinidad and Tobago. METHODS: A descriptive study was conducted based on 15 key informant interviews carried out from April to September 2013. The key informants worked within the health care sector in Trinidad and Tobago. Using a semi-structured interview guide, information was collected on knowledge, attitudes, and beliefs about creating a PHO; barriers and facilitators to creating and sustaining a PHO; legal considerations; and human resource and information technology requirements. Common themes of the responses were identified. RESULTS: The majority of participants supported the development of a national PHO, recognized its value in informing their work, and indicated that a national PHO could 1) provide information to support evidence-informed decision-making for health policy and strategic planning; 2) facilitate data management by establishing data policies, procedures, and standards; 3) increase the use of data by synthesizing and disseminating information; and 4) provide data for benchmarking. However, a number of barriers were identified, including 1) the perception that data collection is not valued; 2) untimely availability of data; 3) limited data synthesis, dissemination, and utilization to inform decision-making; and 4) challenges related to the allocation of human resources and existing information technology. CONCLUSIONS: Key informants support the development of a national PHO in Trinidad and Tobago. The findings align well within the components of the conceptual framework for establishing national health observatories. A stepwise approach to establishing a national PHO in Trinidad and Tobago, beginning with structural components and followed by functional components, is recommended. A national PHO in Trinidad and Tobago could serve as a model for other countries in the Caribbean

Experiences with SARS-CoV-2 (Covid-19) in Trinidad and Tobago, a small island developing state: realities and opportunities

Summary: The COVID-19 pandemic has exerted significant global challenges that are expressed in a variety of socio-politico-economic scenarios, depending upon individual countries’ preparedness and resilience. The impact COVID-19 in Small Island Developing States (SIDS), most of which are categorized as Lower and Middle-Income Countries, has been pronounced. Furthermore, many of these SIDS possess specific vulnerabilities to global threats. This paper contextualizes the experience of Trinidad and Tobago from some perspectives of geoeconomics, healthcare, and international relations. In many ways, the experience is similar to that of other SIDS with the inherent nuances of a post-colonial world. Trinidad and Tobago was ranked number one by the Oxford University COVID-19 Government Response Tracker (OxCGRT) “Lockdown rollback checklist: Do countries meet WHO recommendations for rolling back lockdown?”. Despite the significant political support to combat the disease, by the end of 2022, the country had recorded over four thousand deaths and just over 50% of the population is vaccinated. This paper seeks to discuss the successes and challenges faced by this twin island state

Impact of vision loss on health-related quality of life in Trinidad and Tobago

Purpose: To determine whether distance vision impairment (VI) (Logarithm of the Minimum Angle of Resolution (LogMAR) >0.30), or near VI (NVI) (LogMAR 0.32 to 1.30 at 40cm with <0.30 at 3m) independently predict health-related quality of life (HRQoL), and to estimate societal impact. Design: The National Eye Survey of Trinidad and Tobago was a population-based, cross-sectional eye survey using multi-stage, cluster random sampling with probability-proportionate-to-size methods. Participants: Adults aged > 40 years. Methods: Responders rated general health level in the five dimensions (mobility, self-care, usual activities, pain/discomfort and anxiety/depression) of the EQ-5D 5-level instrument. Multivariable regression analysis with robust standard error estimation explored the relationship between utility score and presenting vision. Main Outcome Measures: Utility value and Quality Adjusted Life Year (QALY) loss by vision category. Results: 62.4% (2658/4263) adults completed the EQ-5D-5L. Mean age was 58.4 (SD 11.8, range 40 to 103) years and 56.3% were female. Blindness had the largest independent effect on utility coefficient, at -0.140 (95% CI -0.092 to -0.192), with mean utility value 0.727 (95% CI 0.671-0.784) and mean EQ-VAS score 69.9 (95% CI 62.0-77.8). Near VI was also independently associated with utility loss of -0.012 (95% CI -0.004 to -0.021). Independent predictors of utility<1.000 included female sex, older age, being uninsured, lower educational attainment, ethnicity, and multiple medical co-morbidities. A hypothetical person, experiencing onset of a stable vision state at 40 years, would be expected to accrue lifetime loss of 0.45 QALYs for near VI, 0.72 QALYs for mild VI, 1.64 QALYs for moderate VI, 3.30 QALYs for severe VI and 5.13 QALYs for blindness. VI caused 762.3 QALYs lost per 100,000 population per year, of which 36.5% were attributed to near VI, exceeding the equivalent QALY loss from stroke (307 QALYs), depression (284 QALYs), and arthritis (522 QALYs). 91% (694.9/762.3) of the VI-related QALY loss was potentially avoidable. Conclusions: This is the first population-based survey to identify that both distance and near VI independently reduce HRQoL. The estimated QALY loss highlights the societal importance of efforts to address all degrees of avoidable VI