Academic journal article Journal of Health Population and Nutrition

Magnitude, Distribution, and Estimated Level of Underreporting of Acute Gastroenteritis in Jamaica

Academic journal article Journal of Health Population and Nutrition

Magnitude, Distribution, and Estimated Level of Underreporting of Acute Gastroenteritis in Jamaica

Article excerpt

INTRODUCTION

Jamaica is the third largest island in the Caribbean and is the largest of the English-speaking Commonwealth Caribbean Islands (1). The mid-year population in 2008 was estimated to be 2,687,241, with an average 1:1 gender distribution (2). Major sectors of the Jamaican economy include agriculture, manufacturing, tourism, and financial services, with tourism and mining being the leading earners of foreign exchange. An estimated 1.3 million foreign tourists visit Jamaica every year. The management and delivery of health services is delegated to four decentralized regional health authorities, namely South East, North East, Western, and Southern (3), each consisting of three or four parishes.

It is well-documented that diarrhoeal diseases are an important cause of morbidity and mortality worldwide (4). In the Caribbean region, diarrhoeal disease burden is thought to be high but there is little scientific evidence to support this claim. Data on acute gastroenteritis (AGE) reported to the Caribbean Epidemiology Centre (CAREC) from its member countries show high and increasing prevalence rates over the last 10 years (5,6). In Jamaica, the epidemiology of AGE, particularly on the emerging microorganisms and their prevalence in the community, is poorly understood. One of the reasons for lack of a comprehensive knowledge on AGE in Jamaica is that many people with AGE do not seek formal healthcare and are, thus, not captured by the National Surveillance Unit (NSU). Hence, the true burden of this illness is unknown, which limits implementation of appropriate preventive measures. Communicable disease surveillance for AGE in Jamaica is carried out by a passive system of voluntary case reporting by healthcare providers and laboratories (7). Syndromic AGE reports are submitted on a weekly basis from 61 sentinel sites to the NSU and show significant numbers (44,919 and 36,192 in 2006 and 2007 respectively) of reported cases of AGE (1). The 3 major laboratories that process AGE specimens--NPHL, CRH, and UHWI--report laboratory-confirmed foodborne pathogens, such as Salmonella, Shigella, Campy-lobacter, Escherichia coli, Staphylococcus aureus, norovirus, rotavirus, and parasites, to the NSU on a monthly basis. In 2005 and 2006, approximately half of the AGE cases reported to CAREC were from Jamaica (5). However, the exact proportion of AGE that is food-related had not been investigated in Jamaica. It should be noted that many pathogens transmitted through food are also spread through water or from person to person, thus obscuring the role of foodborne transmission (8).

Surveillance data, as single indicator of illness burden, represent only the tip of the epidemiological iceberg and, hence, cannot sufficiently describe full disease burden. Laboratory surveillance data identify the aetiology of AGE. However, it requires clinical correlation in order for the information to be utilized effectively. Cases may or may not be routinely captured in national data due to variations in healthcare-seeking behaviours, specimen collection, transportation, testing procedures, and reporting methods (5,9). The lack of understanding of the burden of AGE and extension of food-borne diseases (FBD) has undermined public health disease control efforts and impacted the allocation of resources. A lack of active research into the determinants of the magnitude and burden of common syndromic presentations, including AGE, has limited the opportunities for appropriate evidence-based action, prevention measures, and policy development. Accurate estimation of AGE burden is essential for managing the challenges relating to diarrhoeal illness and setting priorities for their prevention and control (10). Based on these challenges, there is a need to ascertain the baseline point prevalence of AGE to assess the true magnitude of the problem and provide information for strengthening the communicable disease surveillance systems in the future. …

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