Academic journal article Journal of Health Population and Nutrition

Burden and Impact of Acute Gastroenteritis and Foodborne Pathogens in Trinidad and Tobago

Academic journal article Journal of Health Population and Nutrition

Burden and Impact of Acute Gastroenteritis and Foodborne Pathogens in Trinidad and Tobago

Article excerpt


The World Health Organization (WHO) noted that all cases of gastroenteritis are not foodborne, and all foodborne diseases do not cause gastroenteritis. However, food does represent an important vehicle for pathogens of great public-health attention. Acute gastroenteritis (AGE) and diarrhoea are clinical outcomes of foodborne diseases (FBDs), with data showing that up to 70% of AGE results from FBD (1). AGE is a major cause of morbidity and mortality worldwide and, therefore, is an important global public-health issue in both developed and developing countries (2-7).

Trinidad and Tobago (T&T) is a Twin-island State situated at the southern end of the Caribbean, with mainly an energy-driven economy (8). Having gained its independence in August 1962, the country is a democratic republic within the British Commonwealth. Trinidad is currently organized into 13 administrative areas or Regional Corporations as set up under the 1981 Regional Corporation Act. The 2010 Census data showed a population of 1,226,383 (621,631 males: 604,752 females) (9). In 1994, the Regional Health Authorities Act was enacted, establishing five Regional Health Authorities (RHAs)--four in Trinidad and one in Tobago--as independent statutory authorities accountable to the Minister of Health. The RHA territories have been drawn to coincide with those of local governments (the Regional Corporations) to ensure that they effectively coordinate among the latter in providing a range of health services to their catchment populations.

Communicable diseases are an important cause of morbidity and death in T&T, causing 42% of total illness and 7% of deaths. They are the second-most frequent cause of admission to hospitals at acute stage (10). Little information is known on the burden and aetiology of AGE in T&T. During 20002005, there were seven large outbreaks of AGE with over 20,000 cases reported per year but less than 70 cases were of known aetiology (11). The national surveillance system for AGE in T&T is based on both syndromic cases of AGE and its laboratory-confirmed pathogens collected using standard data-collection forms--weekly syndromic and monthly laboratory data-collection forms (11)--based on the Caribbean Public Health Agency (CARPHA), formerly known as the Caribbean Epidemiology Centre (CAREC). Syndromic AGE surveillance collects data on weekly basis on the number of persons presenting with AGE symptoms at local healthcare facilities. Laboratory-based foodborne pathogens and AGE surveillance collects monthly data from the major hospitals and laboratories that process and test AGE-related stool specimens to identify the number of AGE cases whose stool samples test positive for a related pathogen (12).

The reason why these illnesses are not well-understood lies in the fact that most affected people are not captured by the National Surveillance Unit (NSU). The present system captures scarce information from private healthcare facilities and, as a result, a significant portion of the true magnitude could be missing, thus further perpetuating the 'tip of the iceberg' phenomenon. Even when syndromes are reported, these are often underreported as many AGE cases tend to self-treat without presenting to a healthcare provider (13). The aetiology of the illness is also largely unknown in T&T as stool samples are almost never collected and tested for foodborne pathogens from patients presenting for care of AGE.

Accurate reporting is, therefore, necessary for advocating funds to implement prevention and control policies, monitor and evaluate current food safety measures, assess the cost effectiveness of the existing interventions, and quantify the burden in monetary costs.

The main objective of this study was to collect baseline data to determine the true community prevalence of AGE in T&T, to measure the burdens associated with this illness and quantify the level of underreporting. …

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