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Geographical Locations - Trinidad
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- (Statistical) Number of Inhabitants per Doctor: 1,543
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National Policy and Related Documents
- The Republic of Trinidad and Tobago: Five-Year National HIV/AIDS Strategic Plan, January, 2004 – December, 2008
"The citizens of Trinidad and Tobago, like the citizens of other nations, have arrived at a major crossroad where critical decisions have to be made with respect to HIV/AIDS and the future of the country. We have in our possession the facts concerning the tremendous human suffering and death that the disease inflicts upon all age groups. We know that if we continue with “business as usual” the outcome can only be a worsening of the situation. This Strategic Plan is the instrument for initiating the required expanded response. It presents the intentions of the nation as a whole, while taking full cognizance of the fact that there are already many programmes and initiatives currently underway in many sectors throughout the country. The Plan therefore builds upon these initiatives so that a truly comprehensive, expanded national response can be achieved, where ongoing efforts are strengthened, new partners are mobilized and where all activities are well coordinated and prioritised. The Plan therefore sets out the fundamental principles, the broad tactical approach, as well as the detailed strategic activities necessary to move the country from its current situation to the desired position… The two (2) overarching goals of the National Strategic Plan are: (a) To reduce the incidence of HIV infections in Trinidad and Tobago; and (b) To mitigate the negative impact of HIV/AIDS on persons infected and affected in Trinidad and Tobago." [Office of the Prime Minister, Republic of Trinidad and Tobago, December 2003]
Reports, Guidelines, and Projects
- A Knowledge, Attitude and Practices Study of the Issues of Climate Change/Variability Impacts and Public Health in Trinidad and Tobago, and St Kitts and Nevis
Objective: To determine the level of understanding of the issues of climate change (CC)/variability (CV) and public health by populations of St Kitts and Nevis (SKN) and Trinidad and Tobago (T&T) and to find whether respondents would be willing to incorporate these values into strategies for dengue fever (DF) prevention. Design and Methods: Using a cluster sampling system, representative samples of the communities of SKN (227) and T&T (650) were surveyed for responses to a questionnaire document with questions on the impact of climate variability on health, the physical environment, respondents’ willingness to utilize climate issues to predict and adapt to climate variability for DF prevention. Data were analyzed by Epi Info. Results: Sixty-two per cent SKN and 55% T&T of respondents showed some understanding of the concept of climate change (CC) and distinguished this from climate variability (CV). With regard to causes of CC, 48% SKN and 50% T&T attributed CC to all of: green houses gases, holes in the ozone layer, burning of vegetation and vehicular exhaust gases. However, some 39.3% SKN and 31% (T&T) did not answer this question. In response to ranking issues of life affected by CC/CV in both countries, respondents ranked them: health > water resources > agriculture > biodiversity > coastal degradation. The major health issues identified for SKN and T&T respondents were: food-borne diseases > water-borne diseases > heat stresses; vector-borne diseases were only ranked 4th and 5th for SKN and T&T respondents respectively. There was in both countries a significant proportion of respondents (p < 0.001) who reported wet season-related increase of DF cases as a CC/CV link. Respondents identified use of environmental sanitation (ES) at appropriate times as a method of choice of using CC/CV to prevent DF outbreaks. More than 82% in both countries saw the use of the CC/CV information for DF prevention by prediction and control as strategic but only 50–51% were inclined to become personally involved. Currently, only 50% SKN and 45% T&T respondents claimed current involvement in DF vector surveillance and control in the last two days. Conclusion: Despite the fact that knowledge and attitudes did not always coincide with practices of using ES for DF prevention, in both countries, even with CC/CV tools of prediction being available, it seems that respondents could be persuaded to use such strategies. There is a need for demonstration of the efficacy of CC/CV information and promotion of its usefulness for community involvement in DF and possibly other disease prevention. [author abstract] [West Indian Medical Journal. Vol. 56, No.2, pp 115-121]
- Antimicrobial Susceptibility of Neisseria gonorrhoeae Isolates from Three Caribbean Countries: Trinidad, Guyana, and St. Vincent
Background: The percentage of Neisseria gonorrhoeae isolates resistant to antimicrobial agents commonly used for treatment is unknown in many Caribbean countries. Goal: To determine the antimicrobial susceptibility of N gonorrhoeae isolates from Trinidad (144 isolates), Guyana (70 isolates), and St. Vincent (68 isolates) so baseline data can be established for further studies, and to assist in establishing effective treatment guidelines. Study Design: Consecutive urethral and endocervical specimens from several clinics were collected and identified as N gonorrhoeae. Isolates of N gonorrhoeae were tested for their susceptibility to penicillin, tetracycline, ceftriaxone, ciprofloxacin, spectinomycin, and azithromycin. The presumptive identification of penicillinase-producing N gonorrhoeae and/or tetracycline-resistant N gonorrhoeae isolates based on MIC was confirmed by plasmid and tetM content analysis. Results: High percentages of penicillin and/or tetracycline resistance were observed in N gonorrhoeae isolates from Guyana (92.9%), St. Vincent (44.1%), and Trinidad (42.4%). Isolates from all three countries were susceptible to ceftriaxone, ciprofloxacin, and spectinomycin. One penicillinase-producing N gonorrhoeae/tetracycline-resistant N gonorrhoeae from Guyana had an MIC of 0.5 μg/l to ciprofloxacin. This and nine other isolates from Guyana also were resistant to azithromycin (defined as MIC > 2.0 μg/ml) as well as penicillin and tetracycline. A reduced susceptibility to azithromycin was displayed by 16% of the isolates from St. Vincent and 72% of the isolates from Guyana (MIC, 0.25–1.0 μg/ml). Most penicillinase-producing N gonorrhoeae isolates carried Africa-type plasmids (61/90), with 28 of 90 having Toronto-type plasmids and a single isolate carrying an Asia-type plasmid. The tetM determinant in tetracycline-resistant N gonorrhoeae isolates was predominantly of the Dutch type (68/91). Conclusions: The high prevalence of N gonorrhoeae isolates from 3 of 21 English- and Dutch-speaking Caricom countries in the Caribbean with either plasmid-mediated or chromosomal resistance to penicillin and tetracycline supports international observations that these drugs should not be used to treat gonococcal infections. The detection of isolates with reduced susceptibility to drugs such as azithromycin, which currently are recommended for treatment in the region, attest to the importance of the continued monitoring of gonococcal antimicrobial susceptibility for the maintenance of effective treatment guidelines. [author abstract] [Sexually Transmitted Diseases, September 2001, Vol. 28, No. 9, pp.508-514]
- Aspergillus, Health Implication & Recommendations for Public Health Food Safety
Recent outbreaks of Aspergillosis in chickens on farms throughout Trinidad have left the chicken consuming population shocked and frightened. At present there exists very little published information available to the population on Aspergillosis and its effect on health and food safety. The present paper examines some of the fundamental questions associated with the pathogenesis of Aspergillus, health implications and recommendation for public health food safety. It is hoped through education and access to information on Aspergillus will serve to alleviate fears about Aspergillus and to empower farmers and the chicken consuming population about methods of reducing, preventing and eliminating Aspergillus, thereby restoring confidence through the adoption of good agriculture practices, safe food handling practices, good sanitation practices and good hygienic practices when rearing, handling, processing, preparing, storing and transporting poultry. [author abstract] [Internet Journal of Food Safety, Vol. 8, 2006, pp. 19-23]
- Comparison of prevalence and severity of asthma among adolescents in the Caribbean islands of Trinidad and Tobago: results of a nationwide cross-sectional survey
Background: Asthma is a growing problem in the Caribbean but the prevalence in most islands is unknown and possible inter-island variation in prevalence has not been determined. A nationwide cross-sectional survey was conducted to compare the prevalence of asthma symptoms among high school students in the two islands of the Republic of Trinidad and Tobago. Methods: Questionnaire and video instruments based on those developed by the International Study of Asthma & Allergy in Childhood (ISAAC) were used to assess asthma prevalence among 6394 children (age range, 11–19 years; mean age, 14.08 yrs) in the second and third years of 35 randomly selected high schools in Trinidad and Tobago. This cross sectional survey was conducted between September and December 2002. Results: A total of 4988 questionnaires were available for analysis (3519 in Trinidad and 1469 in Tobago). Among respondents from the two islands, there were no significant differences in the prevalence of ever wheezing (24.1% and 24.3% for Trinidad and Tobago, respectively, RR 0.99, 95% CI, 0.90–1.08); wheezing in the previous 12 months (13.1% & 13.4%, RR 0.98, 95% CI 0.84–1.15); a previous or current diagnosis of asthma (12.8% & 13.5%, RR 0.95, 95% CI 0.82–1.12) and night cough in the past 12 months (35.4% & 38.3%, RR0.93, 95% CI 0.86–1.00). However, symptoms of severe asthma were significantly more common among students from Tobago and included having had more than one acute attack in the past year (13.4% & 15.8%, RR 0.85, 95% CI 0.73–1.00, p = 0.0004), night waking as a result of wheeze (7.4% & 10.9%, RR 0.68, 95% CI 0.56–0.83, p < 0.0001) and speech limitation in the past year (5.2% & 8.7%, RR 0.59, 95% CI 0.47–0.74, p < 0.001) Exercise-associated wheezing was also more frequent among Tobagonian adolescents (17.5% & 20.2%, RR 0.87, 95% CI 0.76 – 0.98, p = 0.04). Conclusion: Self-reported wheeze is common among adolescents in Trinidad and Tobago. Variation in symptoms was found between the two territories; high school students from Tobago, the less industrialized of the two islands, reported more symptoms of severe asthma and exercise-induced wheeze. Difference in the ethnic composition rather than socio-economic factors may be contributing to the observed differences in symptom prevalence. [BMC Public Health 2005, 5: 96]
- Differences in Cardiovascular Disease Risk Factors in Elderly and Younger Patients with Type 2 Diabetes in the West Indies
Objective: To assess the cardiovascular disease (CVD) risk factors in elderly (>60 years) and younger patients with Type 2 diabetes visiting two primary care clinics in Trinidad. Materials and methods: Fasting blood samples were taken from one hundred and ninety-one (127 females, 64 males) patients with Type 2 diabetes visiting two primary care clinics between 1 January and 30 April 2000. Anthropometric indices, blood pressure, plasma glucose, serum lipids and insulin were measured. Homeostasis Model Assessment (HOMA) was used to assess basal insulin resistance (IR). Results: Of the 191 patients studied, 58.6% were <60 years old while 41.4% were >60 years old. The younger patients had higher prevalence rates of cigarette smoking and use of alcoholic drinks (p<0.05). The female younger patients had significantly higher mean body mass index (BMI), glycated haemoglobin (HbA1c), triglyceride, total-cholesterol, fasting plasma glucose and IR than the elderly female patients (p<0.05). Similarly, the younger male patients had significantly higher mean HbA1c, creatinine, fasting plasma glucose, IR and lower HDLcholesterol levels than the elderly male patients (p<0.05). Generally, the younger patients had significantly higher prevalence rates of hypertriglyceridaemia, obesity, poorer glycaemia and blood pressure control. Conclusion: The results indicate that younger patients with Type 2 diabetes had poorer metabolic control and higher prevalence rates of CVD risk factors than the elderly patients. The greater risk of CVD in younger patients was not independent of gender and ethnicity. [author abstract] [Singapore Med J 2002 Vol 43(10):497-503]
- Health in the Americas 2007: Trinidad and Tobago
As a health agency, the Pan American Health Organization’s core discipline is epidemiology, which enables the measurement, definition, and comparison of health problems and conditions and their distribution from the perspectives of population, geography, and time. This publication on Trinidad and Tobago addresses the issue of health as a human right, taking into account both the individual and community contexts, and examines various critical determinants of health, including those of a biological, social, cultural, economic, and political nature. That examination reveals the existence of gaps, disparities, and inequities that persist in Trinidad and Tobago, especially those related to access to basic services, health, nutrition, housing, and adequate living conditions as well as to the lack of opportunities for human development—all of which contribute to the greater vulnerability to diseases and health risks of some population groups. [Adapted from the preface of Health in the Americas 2007]
- Household consumer food safety study in Trinidad, West Indies
There has been minimal research on consumer food safety knowledge, perception and food handling practices at homes in Trinidad, West Indies. Questions were asked on the demographic characteristics of 84 respondents, reporting of food - borne illness, hand washing practices, purchase of foods, separation of raw and cooked foods, cooking of foods, thawing and cooling of foods and consumption of raw eggs. The study found 52.4% of consumers had experienced some form of food- borne illness with main symptoms of vomiting and diarrhea (48.8%). Of those who had experienced food borne illness, only 23.8% sought medical treatment. If a food was found to be tampered or contaminated, most consumers (69.0%) failed to report to the relevant authorities. Most respondents washed their hands with soap and water before preparation of meals (88.1%), after using the toilet facilities 92.9% and after handling raw foods or contaminated objects (84.5%). The minority of respondents (4.8%) purchased foods from vendors who did not display food badges, while some (35.7%) 'sometimes' bought foods. When consumers were asked whether they looked at food labels and expiry dates before purchase of foods, 61.9% responded in the affirmative, while 33.3% indicated 'sometimes' Some (16.7%) consumers did not separate cooked or ready to eat foods from raw foods. Most consumers washed vegetables (97.6%) and meat (91.7%) before serving or cooking. Some consumers (45.2%) thawed frozen foods at room temperature, while others (33.3%) did so 'sometimes'. Although the study was of limited sample size, it emphasized the need for public food safety education to consumers. [author abstract] [Internet Journal of Food Safety 2004; 3: 8-14]
- Injuries from arthropod, reptile and marine bites and stings in South Trinidad
Injuries caused by arthropods, reptiles and marine organisms are a major cause of morbidity and a burden to the health care providers in developing countries. Epidemiological data in published studies are sparse and this is the first study with previously unpublished data on this important public health issue from an under-reported region. This study was a hospital based study that investigated the rates, time of the year, age, gender, ethnicity and outcome of patients with bites and stings in rural regions of Southern Trinidad. Injury data were retrospectively collected from the Accident and Emergency Service of the San Fernando General Hospital. Data were used from computerized data files of two most recent calendar years that were available, which were 2003 and 2004. These demographical data were analyzed using SPSS and the Chi-square test determined levels of significance. A total of 1,289 cases of relevant bites and stings were reported during these two years, giving an incidence rate of 12.9/10,000 population. Scorpion and bee stings together were responsible for the majority of venomous bite and sting presentations and were significantly over-represented amongst males, when compared with females and with all other categories of bites and stings (X2=11.3, p=0.01). Most victims were 18 to 34 years old and there was a peak incidence of bites and stings during April to June, corresponding with the start of the raining season. The majority of patients were treated and discharged in good health. Snake bites and scorpion stings were generally admitted to the wards. One death was reported for a non specified insect bite and two cases of long term disability were also mentioned. These injuries are prevalent in the emergency service in Southern Trinidad and justify an urgent need for the implementation of a public health policy of education, information and prevention. Bites and stings from arthropods, reptiles and marine organisms are a major public health problem that contribute significantly to morbidity and health care costs. [author abstract] [Journal of Rural and Tropical Public Health 6: 1-5, 2007]
- Poverty & HIV/AIDS in the Caribbean – Final Report
"Independent of each other, poverty and HIV/AIDS have the capacity to reverse development processes in the Caribbean. The combined negative impacts of these two phenomena can present an even greater challenge for the region. The Caribbean is generally characterized by low income countries with HIV/AIDS prevalence rates varying from 0 to 3 percent. Poverty has plagued the Caribbean for decades despite national and international efforts and has been a main impediment to development prospects. In the Caribbean, the percentage of people living below the poverty line is within the range 14-39 percent. Poverty is not simply having an income below the poverty line which can be solved with increases in incomes, but it is a multidimensional concept which explains human deprivation from a number of necessities such as shelter, health care, education and a job. This paper seeks to explore the poverty and HIV/AIDS situation in two countries, Guyana and Trinidad and Tobago." [CARICOM Secretariat, Pan Caribbean Partnership Against HIV/AIDS (PANCAP), Guyana, May 2009]
- Report of Trinidad and Tobago: Achievements in health promotion with respect to the commitments in the Mexico Declaration
"In 2001, the Cabinet of the GTT [Government of Trinidad and Tobago] appointed the National Health Promotion Council. This Council was formed based on the agreement of Cabinet ‘to strengthen the capacity of individuals and communities to improve health and well being by maximizing natural resources through a multi-sectoral approach which will foster sustainable national development’. This Council is mandated to ensure that healthy public policies are: (i) formulated, implemented, and monitored; (ii) influence public sector policies to embody the principles of health promotion; [and] (iii) Advise the Minister of Health on matters pertaining to the promotion of health of the population." [PAHO]
- Risk and protective factors associated with gang-involved youth in Trinidad and Tobago
Objectives: To examine the prevalence of gang involvement, the risk and protective factors associated with gang involvement, and the association between gang involvement and exposure to multiple risk and protective factors among school-aged youth in Trinidad and Tobago. Methods: A survey instrument was administered to 2 206 students enrolled in 22 high-risk, urban public schools, from March–June 2006. It measured 30 risk factors and 13 protective factors within four domains: community, school, family, and peer-individual, plus levels of alcohol/drug use and delinquency. Results: About 7.7% of youth reported being a gang associate; 6.8%, a former gang member; and 6.2%, a current gang member. Gang involvement was associated with perceived availability of handguns, residential mobility, having parents who favor antisocial behavior, early initiation of antisocial behavior, intention to use drugs, having antisocial peers, and having peers who use drugs. Those with social skills, belief in moral order, and interactions with prosocial peers were significantly less likely to self-report gang membership. Additionally, the probability of gang involvement increased as the number of risk factors increased. Conclusions: Gang membership among public school youth is about as prevalent in Trinidad and Tobago as it is in the United States, Canada, and Western Europe, but further research is needed. Although risk factors associated with gang involvement were present in all four domains, peer-individual risk factors were disproportionately likely to be associated with gang status. The most effective gang prevention strategies might be those that focus on multiple risk factors, with an emphasis on peer-individual factors and promoting a “belief in moral order.” [author abstract] [Rev Panam Salud Publica. 2010; 27(3): 187–202]
- Same-visit HIV testing in Trinidad and Tobago
Background: The Ministry of Health (hereafter, Ministry) of Trinidad and Tobago is responsible for delivery of all health services in the country. The Ministry takes responsibility for direct delivery of care in the public sector and has initiated a process whereby those seeking HIV test results could obtain confidential reports during a single-visit to a testing location. The Ministry requested technical assistance with this process from the Caribbean Epidemiology Centre (CAREC). The United States Centers for Disease Control and Prevention (CDC) played an important role in this process through its partnership with CAREC. Methods: Under the technical guidance of CAREC and CDC, the Ministry organized a technical working group which included representatives from key national HIV program services and technical assistance partners. This working group reviewed internationally-recognized best practices for HIV rapid testing and proposed a program that could be integrated into the national HIV programs of Trinidad and Tobago. The working group wrote a consensus protocol, defined certification criteria, prepared training materials and oversaw implementation of “same-visit” HIV testing at two pilot sites. Results: A Ministry-of-Health-supported program of “same-visit” HIV testing has been established in Trinidad and Tobago. This program provides confidential testing that is independent of laboratory confirmation. The program allows clients who want to know their HIV status to obtain this information during a single-visit to a testing location. Testers who are certified to provide testing on behalf of the Ministry are also counselors. Non-laboratory personnel have been trained to provide HIV testing in non-laboratory locations. The program includes procedures to assure uniform quality of testing across multiple testing sites. Several procedural and training documents were developed during implementation of this program. This report contains links to those documents. Conclusions: The Ministry of Health has implemented a program of “same-visit” HIV testing in Trinidad and Tobago. This program provides clients confidential HIV test reports during a single visit to a testing location. The program is staffed by non-laboratory personnel who are trained to provide both testing and counseling in decentralized (non-laboratory) settings. This approach may serve as a model for other small countries. [author abstract] [BMC Public Health 2010, 10: 185]
- The prescribing of psychotropic drugs in mental health services in Trinidad
Objective: To describe, analyze, and interpret patterns of psychotropic drug prescribing in new psychiatric patients attending psychiatric outpatient clinics in the Caribbean island of Trinidad. Design and Methods: This was a cross-sectional study of psychotropic drug prescribing by psychiatrists for 132 new psychiatric outpatients who were seen at the outpatient clinics surveyed and who were entering the mental health system during the period of research, November 1998 through February 1999. Results: A single patient could be prescribed more than one psychotropic drug. Antidepressant drugs were the class of psychotropic drugs most prescribed (79 of 132 patients, 59.8%), followed by antipsychotic drugs (67 of 132 patients, 50.8%). Tricyclic antidepressants (TCAs) were the antidepressants most prescribed (58 of the 79 patients), mainly amitriptyline (53 of the 58). Fluoxetine was the only selective serotonin reuptake inhibitor (SSRI) prescribed (21 of the 79 patients prescribed antidepressants). Of the 67 patients receiving antipsychotic drugs, phenothiazines accounted for 41 of those 67, including trifluoperazine (14 of the 41) and thioridazine (13 of the 41). The individual antipsychotic most prescribed was sulpiride (21 of the 67 patients). Anticholinergic drugs were prescribed to 20 of the 132 patients (15.1%). Eighty-three of the patients were prescribed more than one drug concomitantly (either more than one psychotropic or a combination of psychotropic(s) and nonpsychotropic(s)). Prescription by ethnicity, age, and gender coincided with the morbidity rates encountered in these patients. The prescribing of SSRIs to persons of African or East Indian ethnicity was significantly lower than it was for persons of mixed heritage. Conclusions: The prescription patterns of psychotropic drugs in Trinidad revealed the psychiatrists’ preferences for traditional psychotropic drugs, the moderate use of anticholinergic drugs, and polypharmacy in some cases, with probable predisposition to adverse drug reactions. Given our results and based on the evaluation of individual patients, consideration should be given to a broader use of the newer antidepressants (SSRIs) and antipsychotics. Unless justified, polypharmacy should be avoided. [author abstract] [Rev Panam Salud Publica/Pan Am J Public Health 12(3): 207-214, 2002]
- UNGASS Country Progress Report: Trinidad and Tobago – January 2008-December 2009
"Almost twenty-seven years have elapsed since the first case of AIDS was diagnosed in Trinidad in 1983. By the end of the third quarter of 2009, the number of new HIV positive cases reported had reached 20,255, and the number of AIDS cases and AIDS related deaths had climbed to 6,208 and 3,845 respectively. In 2007 there were 114 deaths attributed to AIDS while the number recorded in 2008 was 81... The most recent modeling of the available surveillance data for Trinidad and Tobago indicates a steady, though small increase in the HIV prevalence rates from 1.2% at the end of 2006 to 1.5% in 2009. This small increase can be attributable to the expansion of treatment services and more specifically, the free provision of anti-retrovirals (ARVs) which was initiated in 2002. The period under review also saw the further extension of same day testing at multiple sites throughout Trinidad and Tobago. New infections peaked at 1,709 in 2003, and since then has fluctuated between 1,404 in 2007 to 1,453 in 2005. Up until 2007, new HIV cases among males outstripped new HV [sic] cases among females. At the end of 2006, the male to female ratio for new HIV positive cases stood at 51:49, but at the end of 2008 females accounted for 694 or 48.53% of new HIV positive cases, while males accounted for 609 or 42.59%. Information on the sex of 127 or 8.88% of the positive cases was not provided. The majority of new HIV positive cases among females occurred in the 20-24 age group while the largest number of new HIV positive cases among males were found in the 45–49 age group. More research is needed to determine whether this reflects the fact that more females are presenting for testing or is indicative of an increase in the incidence of HIV among females." [UNAIDS and Government of Trinidad and Tobago, March 2010]
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