Determining the Community Prevalence of Acute Gastrointestinal Illness and Gaps in Surveillance of Acute Gastroenteritis and Foodborne Diseases in Guyana

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INTRODUCTION

Guyana is an English-speaking country in South America and, culturally, it is part of the Caribbean. It is also one of the few Caribbean countries, which is not an island. The country has a total population of 751,225 and is divided into 10 regions, five of which are in the coastal areas, and four are inlands (1-2). Most (80%) people reside in the coastal lands in Region 2-6 (approximately 10% of the Guyana's land areas), and Region 4 is the most populated (with 41% of the total population). The population is predominantly rural, with only 30% of the population living in one of the 6 towns. The coastal areas are low-lying, crowded, and are prone to flooding and increased AGE-related illness during heavy rainfall. Cycles of flooding during December to February and May to June, with alternate rainfall and drought, have made sanitation difficult in these regions (1-5). There is one tertiary hospital and one reference laboratory. Agriculture is the main economic activity in Guyana, and over 80% of the population has access to potable water (2).

Acute gastroenteritis (AGE) is a major cause of morbidity worldwide, especially in children aged less than 5 years. Globally, one in every four children experiences at least 2 episodes of diarrhoea and vomiting; contaminated water, food, and poor hygiene have been identified as the major causes (6-10). In Guyana, the Ministry of Health has identified AGE as a significant public-health problem (3-5). The epidemiology of AGE and food- and waterborne illnesses at the community level is poorly understood as there is little information available on the disease incidence and burden relating to foodborne diseases (FBDs). Consequently, the already scarce resources available for disease control measures are not allocated towards appropriate prevention and control of food- and waterborne illnesses. The Ministry of Health reported that AGE occurs in every geographic region and that almost 30% of deaths among children below 5 years of age are caused by diarrhoeal illnesses (3). AGE occurrence is seasonal, and the highest incidence occurs in the months of December, January, February, and March (1,3,5)

The present system for the surveillance of communicable diseases in Guyana includes a weekly syndromic surveillance (reporting of AGE and other common syndromes) and four-weekly reports of laboratory-confirmed infectious diseases (including laboratory-confirmed AGE/FBD pathogens) to the Surveillance Unit of the Ministry of Health (1). These data indicated that there were 13,949 cases of AGE in 2007 and 32,634 cases in 2008. However, only 50 stool specimens from AGE cases were submitted during January 2007-September 2007 and, of these, only 4 cases of Salmonella were identified since the laboratory at that time was primarily testing for Salmonella (1). This suggests a potentially high burden of AGE and FBD, considering the small population-size and the low number of stool samples tested. However, the exact burden of AGE is unknown, and the proportion of AGE-related illness that is foodborne is not known since there are major problems of unreliable weekly reporting of AGE cases from all the regions and seldom collection of stools from AGE cases (3). In 2008, only 55% of the facilities reported consistently and on a timely basis. AGE is further underreported in the inland regions, which is characterized by marginalized populations, and many community-level outbreaks go unreported (1,3)

Sound information on disease burden of AGE and FBD is, thus, needed to guide the allocation of limited resources for appropriate intervention measures in Guyana. Many countries have con ducted the World Health Organization (WHO) recommended Burden of Illness studies to determine the true burden and impact of AGE and FBD in their populations (10-19). In 2009, the Ministry of Health of Guyana collaborated with the Caribbean Epidemiology Centre (CAREC) and the Pan American Health Organization (PAHO) to conduct a burden of AGE-related illness study in Guyana as part of the overall Caribbean Burden of Illness (BOI) Study. …

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