Burden of Self-Reported Acute Gastrointestinal Illness in Cuba

Article excerpt

INTRODUCTION

Acute gastrointestinal illness is an important public-health issue worldwide. In developed countries, estimates of monthly prevalence range from 4.5% to 11% (1-9). Although illness is typically mild and self-limiting, acute gastrointestinal illness imposes a substantial economic burden to the population and healthcare system (3-5,9). Diarrhoea is one of the primary causes of morbidity and mortality among children aged less than five years in the developing world; globally, it is estimated that there are 3.2 episodes of diarrhoea per child-year and 4.9 deaths per 1,000 children per year due to diarrhoeal illness (10).

The Pan American Health Organization (PAHO) supports health needs and initiatives within the Americas, with a focus on the Latin American and Caribbean countries. Within an initiative sponsored by the World Health Organization (WHO), the PAHO and the Centre for Food-borne, Environmental and Zoonotic Infectious Diseases of the Public Health Agency of Canada worked jointly with the Cuban Ministry of Health to develop a study aimed at understanding the burden of illness associated with gastrointestinal diseases in Cuba and how it compares with other countries.

Our objective was to determine the temporal and demographic distribution and burden of self-reported acute gastrointestinal illness in Cuba. It is anticipated that this information will assist the Ministry of Health in assigning resources for education and food safety.

MATERIALS AND METHODS

Study design

A cross-sectional survey was conducted within three purposively-selected sentinel sites in Cuba (Fig.). The main municipality within provinces representing differences in urban-rural mix, from different regions of the country, and the differences in their predefined risk rating for acute gastrointestinal illness were selected. The sentinel sites were: (a) municipality of Cienfuegos (CF; provincial capital, 333 sq km, population-164,180) within the province of Cienfuegos, (b) municipality of Santiago de Cuba (SC; provincial capital, 1,024 sq km, population-494,915) within the province of Santiago de Cuba, and (c) municipality of Centro Habana (CH; 4 sq km, population-157,539) within the province of Ciudad de La Habana (11). The sentinel sites represent ~7.3% of the total Cuban population (11,241,291) in 2004 (12).

The sampling frame consisted of a list of households served by the family doctors' offices within each sentinel site. Five households from each office were randomly selected for inclusion. Trained nurses or hygiene and epidemiology technicians associated with each medical office administered face-to-face interviews. One individual per household was selected to participate in the interview. It was our intention to interview the household member whose birthday was the closest to the date of interview. However, in most instances, the household member who answered the door was interviewed instead of having the interviewer return at a later date to implement the study on the appropriate individual. For logistical reasons, we were unable to carry out follow-ups. This resulted in a non-random selection of participants, biasing towards women aged 25-54 years. If the individual met the exclusion criteria (outlined below), another person from the household was selected. Participants aged [greater than or equal to] 18 years read and signed an informed consent record for themselves or for an individual they were a proxy for. Proxy respondents were accepted for individuals aged less than 15 years. Parents or guardians of participants aged 15-17 years were given the option of having the youth respond directly to the survey. All interviews were conducted in Spanish. An identification number was assigned to each respondent to ensure confidentiality.

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Seasonal variation in the incidence of acute gastrointestinal illness has previously been identified from surveillance data in Cuba (13). …