Academic journal article Journal of Health Population and Nutrition

Estimating the Burden of Acute Gastrointestinal Illness: A Pilot Study of the Prevalence and Underreporting in Saint Lucia, Eastern Caribbean

Academic journal article Journal of Health Population and Nutrition

Estimating the Burden of Acute Gastrointestinal Illness: A Pilot Study of the Prevalence and Underreporting in Saint Lucia, Eastern Caribbean

Article excerpt

INTRODUCTION

Foodborne diseases (FBDs) are an important cause of morbidity, mortality, and public-health concern worldwide (1,2). Acute gastroenteritis (AGE), the key syndrome relating to food- and waterborne ill- nesses, is increasing globally. Monthly prevalence estimates of AGE in developed countries range be- tween 4.5 and 11% (3). Although typically mild and self-limiting, AGE imposes a substantial economic burden on the population and healthcare system (3-9). Diarrhoea is a major cause of morbidity and mortality among under-5 children in developing countries. It is estimated that there are 3.2 episodes of diarrhoea/child/year and 4.9 deaths/1,000 chil- dren/year due to diarrhoeal illness (7,10,11). Precise information on the burden of illness (BOI) is need- ed to facilitate control efforts for foodborne diseases (FBDs). As part of a strategy to reducing foodborne diseases globally, the World Health Organization (WHO), through the Global Burden of Disease ini- tiative, has developed a rigorous approach for BOI estimations (12,13)

Saint Lucia is a developing nation of Eastern Carib- bean. The total mid-year population was estimat- ed at 156,635 in 2006 (14). The island is divided into 8 health regions. Majority of the population inhabits the coastal areas and less mountainous re- gions of the north and south of the island, with ap- proximately 41.0% of the population living in the northern district of Castries. The Ministry of Health (MOH) is the sole provider of health services in the public sector. Health services delivery is provided through a network of primary and secondary care services. Primary healthcare services are provided at 33 health centres, a polyclinic, and 2 district hospi- tals. Victoria Hospital is the main hospital and is lo- cated in the City of Castries and is managed by the Ministry of Health. St. Jude's Hospital is located in the south of the island and is a quasi-government institution. Approximately 95.0% of urban house- holds and 88.0% of rural households have access to safe/potable water (15). Tourism is the principal engine of economic growth in Saint Lucia and ac- counted for 13.6% of real GDP in 2006 (15,16).

In Saint Lucia, the epidemiology of food- and wa- terborne diseases at the community level is un- known. Little information is available on the mag- nitude and burden of these illnesses and on the key pathogens responsible for food- and waterborne infections, thereby limiting appropriate preven- tion measures. Currently, most people affected by AGE are not captured by the traditional national surveillance systems, leading to significant under- reporting of this syndrome. Weekly tallies of syn- dromic AGE cases are generated in the community, hospitals, laboratories, polyclinics, three sentinel sites (Victoria Hospital, St. Jude's Hospital, and Gros Islet Polyclinic), and private primary-care physi- cians. Data are collected by the Ministry of Health. These data indicated a total of 3,893 reported cases of AGE in 2006 and 1,042 cases in 2007. Labora- tory data, however, indicated that, in 2006, ap- proximately 329 stool specimens were submitted, and only 9 cases of Salmonella and 16 cases of Shi- gella were identified while, in 2007, approximately 225 stool specimens were submitted, and 13 cases of Salmonella and 8 cases of Shigella were identified (17). These data suggest a potential high burden of gastroenteritis and foodborne diseases, considering the small population-size and the low number of stool samples submitted and tested. Conducting BOI study in St. Lucia is, therefore, imperative to de- termine the true burden and the economic impact of acute gastroenteritis, foodborne diseases, and the key causal pathogens to guide appropriate preven- tion and control strategies and for 2006 allocation of limited resources intended for the health sector.

Consequently, St. Lucia joined the Caribbean Bur- den of Illness Study led by CAREC in collaboration with Pan American Health Organization (PAHO) in 2008. …

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