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Antony Oliver MC, Graham M, Gass KM, Medley GF, Clark J, Davis EL, Reimer LJ, King JD, Pouwels KB, Hollingsworth TD. Reducing the Antigen Prevalence Target Threshold for Stopping and Restarting Mass Drug Administration for Lymphatic Filariasis Elimination: A Model-Based Cost-effectiveness Simulation in Tanzania, India and Haiti. Clin Infect Dis 2024; 78:S160-S168. [PMID: 38662697 PMCID: PMC11045020 DOI: 10.1093/cid/ciae108] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND The Global Programme to Eliminate Lymphatic Filariasis (GPELF) aims to reduce and maintain infection levels through mass drug administration (MDA), but there is evidence of ongoing transmission after MDA in areas where Culex mosquitoes are the main transmission vector, suggesting that a more stringent criterion is required for MDA decision making in these settings. METHODS We use a transmission model to investigate how a lower prevalence threshold (<1% antigenemia [Ag] prevalence compared with <2% Ag prevalence) for MDA decision making would affect the probability of local elimination, health outcomes, the number of MDA rounds, including restarts, and program costs associated with MDA and surveys across different scenarios. To determine the cost-effectiveness of switching to a lower threshold, we simulated 65% and 80% MDA coverage of the total population for different willingness to pay per disability-adjusted life-year averted for India ($446.07), Tanzania ($389.83), and Haiti ($219.84). RESULTS Our results suggest that with a lower Ag threshold, there is a small proportion of simulations where extra rounds are required to reach the target, but this also reduces the need to restart MDA later in the program. For 80% coverage, the lower threshold is cost-effective across all baseline prevalences for India, Tanzania, and Haiti. For 65% MDA coverage, the lower threshold is not cost-effective due to additional MDA rounds, although it increases the probability of local elimination. Valuing the benefits of elimination to align with the GPELF goals, we find that a willingness to pay per capita government expenditure of approximately $1000-$4000 for 1% increase in the probability of local elimination would be required to make a lower threshold cost-effective. CONCLUSIONS Lower Ag thresholds for stopping MDAs generally mean a higher probability of local elimination, reducing long-term costs and health impacts. However, they may also lead to an increased number of MDA rounds required to reach the lower threshold and, therefore, increased short-term costs. Collectively, our analyses highlight that lower target Ag thresholds have the potential to assist programs in achieving lymphatic filariasis goals.
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Affiliation(s)
- Mary Chriselda Antony Oliver
- Department of Applied Mathematics and Theoretical Physics, University of Cambridge, Cambridge, United Kingdom
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, United Kingdom
| | - Matthew Graham
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, United Kingdom
| | - Katherine M Gass
- Neglected Tropical Diseases Support Centre, The Task Force for Global Health, Decatur, Georgia, USA
| | - Graham F Medley
- Centre for Mathematical Modelling of Infectious Disease and Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Jessica Clark
- School of Biodiversity, One Health and Veterinary Medicine, University of Glasgow, Glasgow, United Kingdom
| | - Emma L Davis
- Mathematics Institute and the Zeeman Institute for Systems Biology and Infectious Disease Epidemiological Research, University of Warwick, Coventry, United Kingdom
| | - Lisa J Reimer
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Jonathan D King
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Koen B Pouwels
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - T Déirdre Hollingsworth
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, United Kingdom
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Kim Y, Shin B, Kim SE, Cajuste B, Kwon JA. A retrospective study on cholera understanding and WASH (water, sanitation, and hygiene) behavior among adolescents in three regions of La Gonâve, Haiti. J Infect Public Health 2024; 17:443-449. [PMID: 38266516 DOI: 10.1016/j.jiph.2023.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 12/13/2023] [Accepted: 12/31/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUNDS This study assesses the impact of Water, Sanitation, and Hygiene (WASH) interventions on cholera understanding and hygiene practices in La Gonâve Island, Haiti. It examines the changes after implementing interventions in seven villages across the Downtown, Mountain, and Seaside regions. METHODS A retrospective investigation surveyed 210 school students from each region using a validated questionnaire. It assessed knowledge, attitudes, practices (KAP), and environmental aspects related to cholera and hygiene. Data analysis involved descriptive statistics and chi-square tests. RESULTS The study highlights significant disparities in education levels, toilet ownership, and healthcare access. Challenges in finding public toilets (86.67%) and accessing water sources (67.78%) are consistent across regions, with Seaside facing financial constraints (85.00%) and water cost concerns (91.67%). Attitudes toward hygiene vary, with the Mountain region having the highest 'Never' responses for handwashing (38.89%), and Downtown leading in water treatment practices (11.67%). There is a strong willingness to share health knowledge, particularly in Downtown (100.00%). Seaside (83.33%) and Downtown (73.33%) revealed a higher cholera awareness, while nearly half of Mountain students lacked knowledge (54.44%). CONCLUSIONS This study highlights significant disparities in WASH practices among La Gonâve's adolescents in Downtown, Mountain, and Seaside regions. Urgent interventions are crucial for improving sanitation, ensuring clean water access, and implementing targeted hygiene education, especially in the resource-constrained Mountain and Seaside areas. The findings underscore the vital roles of adolescents and schools in disseminating knowledge, with further research needed to explore intervention differences.
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Affiliation(s)
- Yuna Kim
- Global Care International, Seoul, the Republic of Korea
| | - Bohye Shin
- The Department of Health Convergence, Graduate School of Ewha Womans University, Seoul, the Republic of Korea
| | | | - Bernard Cajuste
- Oaktree Ministry, Baie-Tortue, Anse-à-Galets, Gonave Island, Haiti
| | - Jeoung A Kwon
- National Cancer Control Institute, National Cancer Center, Goyang, the Republic of Korea; Institute of Health Services Research, Yonsei University, Seoul, the Republic of Korea.
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Kulkarni S. Earthquakes are most deadly in these unexpected countries. Nature 2024; 627:20. [PMID: 38409408 DOI: 10.1038/d41586-024-00508-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
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Wang CW, de Jong EP, Faure JA, Ellington JL, Chen CHS, Chan CC. Exploring the Barriers and Facilitators of Mask-Wearing Behavior During the COVID-19 Pandemic in Taiwan, the United States, the Netherlands, and Haiti: A Qualitative Study. Disaster Med Public Health Prep 2024; 18:e23. [PMID: 38351541 DOI: 10.1017/dmp.2024.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
OBJECTIVE This study explored the barriers and facilitators of mask-wearing behaviors during the pandemic in Taiwan, the United States, the Netherlands, and Haiti. METHODS Face-to-face interviews were conducted in Taiwan and online interviews were conducted with participants in the United States, the Netherlands, and Haiti. RESULTS In general, the habit of wearing a mask before coronavirus disease 2019 (COVID-19) was reported by Taiwanese participants. Additionally, Taiwanese participants perceived that wearing a mask was a social responsibility during the pandemic, suggesting that the collectivistic context might influence mask-wearing behavior. Unlike the Taiwanese population, some people in the United States and the Netherlands were reluctant to wear masks due to perceived restrictions on their freedom. Participants from Haiti mentioned that people who wore masks encountered violence, bullying, and discrimination. The results of this study suggest that political leadership and mask mandates have a strong impact on people's mask-wearing behavior. CONCLUSIONS These findings have valuable implications for the design of diverse behavioral interventions to enhance mask-wearing as part of infectious disease preparedness. Additionally, the findings from these countries offer valuable insights for the development of effective public health interventions to enhance society's resilience during the current pandemic and future infectious disease outbreaks.
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Affiliation(s)
- Chia-Wen Wang
- Institute of Environmental and Occupational Health Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Lloyd's Register Foundation Institute for the Public Understanding of Risk, National University of Singapore, Singapore
| | - Erik Pieter de Jong
- Global Health Program, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Josemyrne Ashley Faure
- Global Health Program, College of Public Health, National Taiwan University, Taipei, Taiwan
| | | | - Chi-Hsin Sally Chen
- Institute of Environmental and Occupational Health Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chang-Chuan Chan
- Institute of Environmental and Occupational Health Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan
- Global Health Program, College of Public Health, National Taiwan University, Taipei, Taiwan
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Antabe R, Sano Y. Endorsement of HIV misconceptions over time among females and males in Haiti. HIV Res Clin Pract 2024; 25:2316538. [PMID: 38396369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
To address high HIV prevalence rates in Haiti, disseminating information about HIV transmission has been emphasized. Yet, after several decades, we do not know how effective HIV information dissemination has been in reducing HIV misconceptions. Using the 2005-06, 2012, and 2016-17 Haiti Demographic and Health Surveys and applying logistic regression, we found nuanced gender dynamics in endorsing HIV misconceptions over time. Among females at the bivariate level, the odds of endorsement of HIV misconceptions in 2012 (OR = 0.87, p < 0.05) and 2016-17 (OR = 0.68, p < 0.001) had declined compared to 2005-06. At the multivariate level, however, we observed that demographic factors suppressed the difference between 2005-06 and 2012, although those in 2016-17 (OR = 0.71, p < 0.001) were still less likely to endorse HIV misconceptions. However, this relationship disappeared once we added behavioral factors (OR = 0.93, p > 0.05). Among males, after controlling for demographic, socioeconomic, and behavioral factors at the multivariate level, those in 2012 (OR = 1.55, p < 0.001) and 2016-17 (OR = 1.24, p < 0.01) were more likely to endorse HIV misconceptions compared to men in 2005-06. We recommend that while improving women's access to HIV services, it is important to incorporate the HIV needs of males into the National HIV policy priority areas.
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Affiliation(s)
- Roger Antabe
- Department of Health and Society, University of Toronto Scarborough, Toronto, ON, Canada
| | - Yujiro Sano
- Department of Sociology and Anthropology, Nipissing University, North Bay, ON, Canada
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Matias WR, Guillaume Y, Cene Augustin G, Vissieres K, Ternier R, Slater DM, Harris JB, Franke MF, Ivers LC. Effectiveness of the Euvichol® oral cholera vaccine at 2 years: A case-control and bias-indicator study in Haiti. Int J Infect Dis 2024; 139:153-158. [PMID: 38000510 PMCID: PMC10784151 DOI: 10.1016/j.ijid.2023.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/21/2023] [Accepted: 11/19/2023] [Indexed: 11/26/2023] Open
Abstract
OBJECTIVES The World Health Organization recommends the use of oral cholera vaccine (OCV) in cholera control efforts. Euvichol®, pre-qualified in 2015, is the leading component of the Global OCV stockpile, but data on its field effectiveness are limited. To evaluate Euvichol® vaccine effectiveness (VE), we conducted a case-control study between September 2018 to March 2020 following an OCV campaign in November 2017 in Haiti. METHODS Cases were individuals with acute watery diarrhea. Stool samples were tested by culture and real-time polymerase chain reaction of the Vibrio cholerae ctxA gene. Cases were matched to four community controls without diarrhea by residence, enrollment time, age, and gender, and interviewed for sociodemographics, risk factors, and self-reported vaccination. Cholera cases were analyzed by conditional logistic regression in the VE study. Non-cholera diarrhea cases were analyzed in a bias-indicator study. RESULTS We enrolled 15 cholera cases matched to 60 controls, and 63 non-cholera diarrhea cases matched to 249 controls. In the VE analysis, eight (53%) cases reported vaccination with any number of doses compared to 43 (72%) controls. Adjusted two-dose OCV VE was 69% (95% CI -71 to 94%). CONCLUSIONS Between 10-27 months after vaccination, Euvichol® was effective and similar to Shanchol™, suggesting that it can serve as one component of multi-sectoral comprehensive cholera control.
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Affiliation(s)
- Wilfredo R Matias
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, USA; Division of Infectious Diseases, Brigham and Women's Hospital, Boston, USA; Center for Global Health, Massachusetts General Hospital, Boston, USA.
| | | | | | | | | | - Damien M Slater
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, USA; Department of Pediatrics, Harvard Medical School, Boston, USA
| | - Jason B Harris
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, USA; Department of Pediatrics, Harvard Medical School, Boston, USA
| | - Molly F Franke
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA
| | - Louise C Ivers
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, USA; Center for Global Health, Massachusetts General Hospital, Boston, USA; Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA; Harvard Global Health Institute, Cambridge, USA
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Joseph F, Jean Simon D, Kondo Tokpovi VC, Kiragu A, Toudeka MRAS, Nazaire R. Trends and factors associated with recent HIV testing among women in Haiti: a cross-sectional study using data from nationally representative surveys. BMC Infect Dis 2024; 24:74. [PMID: 38212702 PMCID: PMC10782569 DOI: 10.1186/s12879-023-08936-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 12/19/2023] [Indexed: 01/13/2024] Open
Abstract
INTRODUCTION In the Latin America and Caribbean region, Haiti is one of the countries with the highest rates of HIV. Therefore, this study examined the factors associated with HIV testing among women in Haiti and trends in HIV testing in 2006, 2012, and 2016/17. METHODS Data from the last three Haitian Demographic and Health Surveys (2006, 2012, and 2016/17) were used. The analysis was restricted to women aged of 15-49 years who made their sexual debut. STATA/SE 16.0 was employed to analyze the data by computing descriptive statistics, Chi‑square, and multilevel regression model to describe the trends and identify factors associated with HIV testing in Haiti. P-value less than 0.05 was taken as a significant association. RESULTS HIV testing prevalence increased more than twofold from 2006 (8.8%) to 2017 (21.3%); however, it decreased by 11.6% between 2012 and 2016/17. Additionally, the results indicated that age, place of residence, region, education level, wealth index, mass media exposure, marital status, health insurance, age at first sex and number of sexual partners were significantly associated with HIV testing. CONCLUSIONS To significantly increase HIV testing prevalence among women, the Haitian government must invest much more in their health education while targeting vulnerable groups (youth, women in union, and women with low economic status).
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Affiliation(s)
- Fanor Joseph
- Doctoral School of Social and Human Sciences, University of Antananarivo, Antananarivo, Madagascar
- Bureau d'Etudes Et de Recherche en Statistiques Appliquées, Suivi Et Evaluation (BERSA-SE), Port-au-Prince, Haiti
| | - David Jean Simon
- Bureau d'Etudes Et de Recherche en Statistiques Appliquées, Suivi Et Evaluation (BERSA-SE), Port-au-Prince, Haiti.
| | | | - Ann Kiragu
- Department of Law and Political and Social Sciences, University of Sorbonne Paris Nord, Paris, France
| | | | - Roodjmie Nazaire
- Faculté de Médecine et de Pharmacie (FMP), Université d'Etat d'Haïti (UEH), Port-Au-Prince, Haiti
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Paul B, Jean Simon D, Kondo Tokpovi VC, Kiragu A, Balthazard-Accou K, Emmanuel E. Tobacco use in Haiti: findings from demographic and health survey. BMC Public Health 2023; 23:2504. [PMID: 38097954 PMCID: PMC10720190 DOI: 10.1186/s12889-023-17409-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 12/05/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Although tobacco has harmful effects on the physical and mental health of individuals, its use remains significant, according to the World Health Organization. To understand this phenomenon, studies have been carried out in many countries around the world, while in Haiti where more than 5,000 people die each year due to tobacco use, little is known about the use of this substance. The aim of this study was to examine the prevalence and the factors associated with tobacco use in Haiti. METHODS We used data from the 2016/17 Haitian Demographic Health Survey. Both descriptive and multivariate analyses were conducted using STATA 16.0 software to assess the prevalence and identify factors associated with tobacco use. Results were reported as adjusted odds ratios with 95% confidence intervals. Statistical significance was declared at p < 0.05. RESULTS The prevalence of tobacco use was estimated at 9.8% (95% CI: 9.2-10.4) among men and 1.7% (95% CI: 1.5-1.9) among women. Although the prevalence of tobacco use was low among young people, it increased with age. Respondents aged 35 and above, with no formal education, non-Christians, divorced/separated/widowed, from poorest households, rural areas, "Aire Métropolitaine de Port-au-Prince" region, with high media exposure had a higher likelihood of tobacco use. CONCLUSION The low prevalence of tobacco use among Haitian women and youth represents a public policy opportunity to prevent these vulnerable groups from starting smoking. Adult male smokers should also be targeted by appropriate policy to reduce the different health burdens associated with tobacco, both for the smokers and other people they may expose to passive smoking. Government and health sector stakeholders, along with community leaders, should create and enforce awareness strategies and rules to control advertisements that encourage irresponsible and health-risky consumption behaviors.
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Affiliation(s)
- Bénédique Paul
- Department of Agro-socio-economics, Chibas, Université Quisqueya, Port-au-Prince, Haiti.
- Groupe d'Etude sur les Sciences de la Durabilité, Université Quisqueya, Port-au-Prince, Haiti.
| | - David Jean Simon
- Bureau d'Etudes et de Recherche en Statistiques Appliquées, Suivi et Evaluation (BERSA-SE), Port-au-Prince, Haiti
| | | | - Ann Kiragu
- Department of Law and Political and Social Sciences, University of Sorbonne Paris Nord, Paris, France
| | - Ketty Balthazard-Accou
- Groupe d'Etude sur les Sciences de la Durabilité, Université Quisqueya, Port-au-Prince, Haiti
- Espace universitaire One Health, Université Quisqueya, Port-au-Prince, Haiti
| | - Evens Emmanuel
- Espace universitaire One Health, Université Quisqueya, Port-au-Prince, Haiti
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Policar S, Sharp A, Isidor Hyppolite J, Alfred GM, Steide E, Lucien L, Ledan N, Kavanagh M. Drivers of HIV treatment interruption: Early findings from community-led monitoring program in Haiti. PLoS One 2023; 18:e0295023. [PMID: 38051706 DOI: 10.1371/journal.pone.0295023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 11/14/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Failure to retain people living with HIV (PLHIV) in care remains a significant barrier to achieving epidemic control in Haiti, with as many as 30% lost from care within one year of starting treatment. Community-led monitoring (CLM) is an emerging approach of improving healthcare and accountability to service users, through a cycle of monitoring and advocacy. In 2020, a CLM program was launched in Haiti to identify barriers to retention and advocating for better health services. METHODS Data from the community-led monitoring program in Haiti were analyzed, from a sample of 65 healthcare facilities in the Nord, Artibonite, and Ouest departments collected from April 2021 to February 2022. Qualitative data from six community-based focus groups and 45 semi-structured individual interviews were analyzed. RESULTS Confidentiality and stigmatization emerged as barriers to care, particularly due to the separation of PLHIV from other patients in view of community members. To avoid identification, patients described traveling long distances, with the reimbursement of transportation costs described as being insufficient or unavailable. Costs of non-HIV clinical services were a frequent concern and respondents described a need for clinics to provide food during all patient visits. Stock-outs were a regular challenge; by contrast, treatment literacy did not emerge as a major barrier to retention. CONCLUSIONS These findings represent the first instance, to our knowledge, of original data from a community-led monitoring program being published in any country. These findings suggest that improving treatment retention for PLHIV is dependent on improving the acceptability and affordability of healthcare services. Ensuring confidentiality is critical, particularly where stigma is high. Retention could be improved by systematically strengthening patient confidentiality protections throughout the healthcare system, providing patients with sufficient travel compensation and other incentives, and delivering wraparound services provided for free. Addressing these challenges will require ongoing advocacy for community-developed recommendations and solutions.
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Affiliation(s)
- Soeurette Policar
- Organisation de développement et de lutte contre la pauvreté (ODELPA), Delmas, Haiti
| | - Alana Sharp
- Center for Global Health Policy and Politics, O'Neill Institute for National and Global Health Law, Georgetown Medical Center, Georgetown University, Washington, DC, United States of America
| | | | - Gérald Marie Alfred
- Action citoyenne pour l'égalité sociale en Haïti (ACESH), Marchand Dessalines, Haiti
| | | | | | - Naiké Ledan
- Health GAP, New Orleans, LA, United States of America
| | - Matthew Kavanagh
- Center for Global Health Policy and Politics, O'Neill Institute for National and Global Health Law, Georgetown Medical Center, Georgetown University, Washington, DC, United States of America
- Department of Global Health, School of Health, Georgetown University, Washington, DC, United States of America
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Medozile M, Lovasi GS, Kolokotronis SO, Hoepner LA. Excess mortality in northern Haiti during the 2010 cholera epidemic. PLoS Negl Trop Dis 2023; 17:e0011750. [PMID: 38055681 PMCID: PMC10699631 DOI: 10.1371/journal.pntd.0011750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 10/26/2023] [Indexed: 12/08/2023] Open
Abstract
In the course of infectious disease outbreaks, barriers to accessing health care can contribute to preventable mortality. According to the Ministry of Health of Haiti (Ministère de la Santé Publique et de la Population [MSPP]), the 2010 cholera epidemic caused 7,936 deaths from October 2010 to December 2012 in Haiti alone. We seek to quantify the excess mortality attributable to patients not seeking care during the cholera outbreak in the Nord Department in 2010-2012. Using data from a community-based retrospective survey conducted by Doctors Without Borders (Médecins Sans Frontières [MSF]) in Northern Haiti, we used logistic regression to examine the association between healthcare utilization and fatality among household members with watery diarrhea in the Communes of Borgne, Pilate, Plaisance, and Port-Margot in the Nord Department. We found that failing to seek care resulted in a 5-fold increase in the case fatality ratio among infected individuals (26%) versus those who sought care (5%). Common concerns noted for why care was not sought included travel distance to treatment centers, not attributing watery diarrhea episodes to cholera, and being unsure where to seek health care for their watery diarrhea episodes within their Communes. In conclusion, addressing transportation and information needs could increase healthcare utilization and reduce lives lost during an outbreak.
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Affiliation(s)
- Macceau Medozile
- Department of Environmental and Occupational Health Sciences, School of Public Health, SUNY Downstate Health Sciences University, Brooklyn, New York, United States of America
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, United States of America
| | - Gina S. Lovasi
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, United States of America
| | - Sergios-Orestis Kolokotronis
- Department of Epidemiology and Biostatistics, School of Public Health, SUNY Downstate Health Sciences University, Brooklyn, New York, United States of America
- Institute for Genomics in Health, SUNY Downstate Health Sciences University, Brooklyn, New York, United States of America
- Division of Infectious Diseases, Department of Medicine, College of Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York, United States of America
| | - Lori A. Hoepner
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, United States of America
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Fang AP, Edmond MC, Marsh RH, Normil M, Poola N, Michel Payant SJ, Luc PR, Strokes N, Calixte M, Rimpel L, Rouhani SA. Outcomes of Invasive and Noninvasive Ventilation in a Haitian Emergency Department. Ann Glob Health 2023; 89:72. [PMID: 37868710 PMCID: PMC10588490 DOI: 10.5334/aogh.4009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 09/17/2023] [Indexed: 10/24/2023] Open
Abstract
Background Limited data exist on the outcomes of patients requiring invasive ventilation or noninvasive positive pressure ventilation (NIPPV) in low-income countries. To our knowledge, no study has investigated this topic in Haiti. Objectives We describe the clinical epidemiology, treatment, and outcomes of patients requiring NIPPV or intubation in an emergency department (ED) in rural Haiti. Methods This is an observational study utilizing a convenience sample of adult and pediatric patients requiring NIPPV or intubation in the ED at an academic hospital in central Haiti from January 2019-February 2021. Patients were prospectively identified at the time of clinical care. Data on demographics, clinical presentation, management, and ED disposition were extracted from patient charts using a standardized form and analyzed in SAS v9.4. The primary outcome was survival to discharge. Findings Of 46 patients, 27 (58.7%) were female, mean age was 31 years, and 14 (30.4%) were pediatric (age <18 years). Common diagnoses were cardiogenic pulmonary edema, pneumonia/pulmonary sepsis, and severe asthma. Twenty-three (50.0%) patients were initially treated with NIPPV, with 4 requiring intubation; a total of 27 (58.7%) patients were intubated. Among those for whom intubation success was documented, first-pass success was 57.7% and overall success was 100% (one record missing data); intubation was associated with few immediate complications. Twenty-two (47.8%) patients died in the ED. Of the 24 patients who survived, 4 were discharged, 19 (intubation: 12; NIPPV: 9) were admitted to the intensive care unit or general ward, and 1 was transferred. Survival to discharge was 34.8% (intubation: 22.2%; NIPPV: 52.2%); 1 patient left against medical advice following admission. Conclusions Patients with acute respiratory failure in this Haitian ED were successfully treated with both NIPPV and intubation. While overall survival to discharge remains relatively low, this study supports developing capacity for advanced respiratory interventions in low-resource settings.
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Affiliation(s)
- Anna P. Fang
- Boston Medical Center, Department of Emergency Medicine, One Boston Medical Center Place, Boston, MA, USA
| | - Marie Cassandre Edmond
- Emergency Department, Hôpital Universitaire de Mirebalais, Mirebalais, Haiti
- Zanmi Lasante, Port-au-Prince, Haiti
| | - Regan H. Marsh
- Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA
- Partners In Health, Boston, MA, USA
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Manouchka Normil
- Zanmi Lasante, Port-au-Prince, Haiti
- Family Medicine, GHESKIO Centers, Port-au-Prince, Haiti
| | - Nivedita Poola
- Department of Emergency Medicine, SUNY Downstate/King’s County Hospital, Brooklyn, NY, USA
| | - Sherley Jean Michel Payant
- Zanmi Lasante, Port-au-Prince, Haiti
- Family Medicine, Hôpital Universitaire de Mirebalais, Mirebalais, Haiti
| | - Pierre Ricot Luc
- Emergency Department, Hôpital Universitaire de Mirebalais, Mirebalais, Haiti
- Zanmi Lasante, Port-au-Prince, Haiti
| | - Natalie Strokes
- Family Medicine, Hôpital Universitaire de Mirebalais, Mirebalais, Haiti
| | - Manise Calixte
- Emergency Department, Hôpital Universitaire de Mirebalais, Mirebalais, Haiti
- Zanmi Lasante, Port-au-Prince, Haiti
| | - Linda Rimpel
- Emergency Department, Hôpital Universitaire de Mirebalais, Mirebalais, Haiti
- Zanmi Lasante, Port-au-Prince, Haiti
| | - Shada A. Rouhani
- Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA
- Partners In Health, Boston, MA, USA
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA, USA
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14
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Ravi SJ, Potter CM, Paina L, Merritt MW. Post-epidemic health system recovery: A comparative case study analysis of routine immunization programs in the Republics of Haiti and Liberia. PLoS One 2023; 18:e0292793. [PMID: 37847680 PMCID: PMC10581452 DOI: 10.1371/journal.pone.0292793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 09/28/2023] [Indexed: 10/19/2023] Open
Abstract
Large-scale epidemics in resource-constrained settings disrupt delivery of core health services, such as routine immunization. Rebuilding and strengthening routine immunization programs following epidemics is an essential step toward improving vaccine equity and averting future outbreaks. We performed a comparative case study analysis of routine immunization program recovery in Liberia and Haiti following the 2014-16 West Africa Ebola epidemic and 2010s cholera epidemic, respectively. First, we triangulated data between the peer-reviewed and grey literature; in-depth key informant interviews with subject matter experts; and quantitative metrics of population health and health system functioning. We used these data to construct thick descriptive narratives for each case. Finally, we performed a cross-case comparison by applying a thematic matrix based on the Essential Public Health Services framework to each case narrative. In Liberia, post-Ebola routine immunization coverage surpassed pre-epidemic levels, a feat attributable to investments in surveillance, comprehensive risk communication, robust political support for and leadership around immunization, and strong public-sector recovery planning. Recovery efforts in Haiti were fragmented across a broad range of non-governmental agencies. Limitations in funding, workforce development, and community engagement further impeded vaccine uptake. Consequently, Haiti reported significant disparities in subnational immunization coverage following the epidemic. This study suggests that embedding in-country expertise within outbreak response structures, respecting governmental autonomy, aligning post-epidemic recovery plans and policies, and integrating outbreak response assets into robust systems of primary care contribute to higher, more equitable levels of routine immunization coverage in resource-constrained settings recovering from epidemics.
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Affiliation(s)
- Sanjana J. Ravi
- The Johns Hopkins Center for Health Security, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Christina M. Potter
- The Johns Hopkins Center for Health Security, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Ligia Paina
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Maria W. Merritt
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Johns Hopkins Berman Institute of Bioethics, Baltimore, Maryland, United States of America
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Economos CD, Tovar A, Choumenkovitch S, Boulos R, Chui K, Gute DM, Hyatt RR, Metayer N, Pirie A, Must A. Results from "Live Well", a randomized controlled community-based participatory intervention to prevent obesity in new immigrant mother-child dyads. BMC Public Health 2023; 23:1893. [PMID: 37784070 PMCID: PMC10544478 DOI: 10.1186/s12889-023-16727-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 09/09/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Upon arrival, the prevalence of overweight and obesity is lower in new immigrants than their native counterparts in the U.S. With longer residency in the U.S., these differences converge over time, followed by higher prevalence among immigrants than native U.S. residents. Results from the Live Well project in the Greater Boston area demonstrate the viability of utilizing a culturally adapted, community-based participatory research (CBPR) approach to reduce weight gain among newly immigrated mother-child dyads. METHODS Haitian, Latina, and Brazilian mother-child dyads (n = 390), new to the U.S. (fewer than 10 years) were enrolled in a one- to two-year long CBPR lifestyle intervention that targeted dietary and physical activity behaviors. Attendance was recorded to establish dose. Demographics, anthropometrics, and relevant covariates were collected from participants at baseline, 6, 12, 18, and 24 months. Body Mass Index (BMI) was calculated using objectively measured height and weight. Linear mixed regression models were used to assess change in BMI and BMI z-score of mothers and children respectively. RESULTS At baseline, nearly 75% of mothers and 50% of children were either overweight or obese (BMI ≥ 25.0 and BMI z-score ≥ 85th percentile, respectively). Only 20% of mothers attended all 12 intervention sessions in year 1. Using intent-to-treat analyses, no significant time, intervention, or time × intervention effects were observed for weight change of mothers or children at follow-up. Mothers in the highest quantile (those who attended all 12 intervention sessions) had significant reductions in BMI at 18 months (1.76 units lower, 95%CI: -3.14, -0.37) and 24 months (2.61 units, 95%CI -3.92, -1.29) compared to mothers in the lower quantiles, including those with no exposure. Such dose effects on BMI z-scores were not noted for children. CONCLUSIONS Findings from Live Well demonstrate the viability of utilizing a CBPR approach to address overweight and obesity among immigrant mothers. Given the higher-than-expected prevalence of overweight and obesity among mother-child dyads by ~ 6 years of U.S. residency, and lower maternal participation rates in the intervention, additional research is necessary to identify the optimal intervention length, retention strategies, and approach to jointly support healthy maternal and child weight.
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Affiliation(s)
- Christina D Economos
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA.
| | - Alison Tovar
- Department of Behavioral and Social Sciences, Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, RI, USA
| | - Silvina Choumenkovitch
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | | | - Kenneth Chui
- Department of Public Health and Community Medicine, School of Medicine, Tufts University, Boston, MA, USA
| | - David M Gute
- Department of Civil and Environmental Engineering, School of Engineering, Tufts University, Medford, MA, USA
| | | | - Nesly Metayer
- Center for Public Management, Suffolk University, Boston, MA, USA
| | - Alex Pirie
- Immigrant Service Providers Group/Health, Somerville, MA, USA
| | - Aviva Must
- Department of Public Health and Community Medicine, School of Medicine, Tufts University, Boston, MA, USA
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16
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Mavian CN, Tagliamonte MS, Alam MT, Sakib SN, Cash MN, Moir M, Jimenez JP, Riva A, Nelson EJ, Cato ET, Ajayakumar J, Louis R, Curtis A, De Rochars VMB, Rouzier V, Pape JW, de Oliveira T, Morris JG, Salemi M, Ali A. Ancestral Origin and Dissemination Dynamics of Reemerging Toxigenic Vibrio cholerae, Haiti. Emerg Infect Dis 2023; 29:2072-2082. [PMID: 37735743 PMCID: PMC10521621 DOI: 10.3201/eid2910.230554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023] Open
Abstract
The 2010 cholera epidemic in Haiti was thought to have ended in 2019, and the Prime Minister of Haiti declared the country cholera-free in February 2022. On September 25, 2022, cholera cases were again identified in Port-au-Prince. We compared genomic data from 42 clinical Vibrio cholerae strains from 2022 with data from 327 other strains from Haiti and 1,824 strains collected worldwide. The 2022 isolates were homogeneous and closely related to clinical and environmental strains circulating in Haiti during 2012-2019. Bayesian hypothesis testing indicated that the 2022 clinical isolates shared their most recent common ancestor with an environmental lineage circulating in Haiti in July 2018. Our findings strongly suggest that toxigenic V. cholerae O1 can persist for years in aquatic environmental reservoirs and ignite new outbreaks. These results highlight the urgent need for improved public health infrastructure and possible periodic vaccination campaigns to maintain population immunity against V. cholerae.
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Affiliation(s)
- Carla N. Mavian
- University of Florida, Gainesville, Florida, USA (C.N. Mavian, M.S. Tagliamonte, M.T. Alam, S.N. Sakib, M.N. Cash, J.P. Jimenez, A. Riva, E.J. Nelson, E.T. Cato, R. Louis, V.M. Beau De Rochars, J.G. Morris Jr., M. Salemi, A. Ali)
- Stellenbosch University, Stellenbosch, South Africa (M. Moir, T. de Oliveira)
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA (J. Ajayakumar, A. Curtis)
- Les Centres GHESKIO, Port-au-Prince, Haiti (V. Rouzier, J.W. Pape)
- Weill Cornell Medical College, New York, New York, USA (V. Rouzier, J.W. Pape)
- University of KwaZulu-Natal, Durban, South Africa (T. de Oliveira)
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa (T. de Oliveira)
- University of Washington, Seattle, Washington, USA (T. de Oliveira)
| | - Massimiliano S. Tagliamonte
- University of Florida, Gainesville, Florida, USA (C.N. Mavian, M.S. Tagliamonte, M.T. Alam, S.N. Sakib, M.N. Cash, J.P. Jimenez, A. Riva, E.J. Nelson, E.T. Cato, R. Louis, V.M. Beau De Rochars, J.G. Morris Jr., M. Salemi, A. Ali)
- Stellenbosch University, Stellenbosch, South Africa (M. Moir, T. de Oliveira)
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA (J. Ajayakumar, A. Curtis)
- Les Centres GHESKIO, Port-au-Prince, Haiti (V. Rouzier, J.W. Pape)
- Weill Cornell Medical College, New York, New York, USA (V. Rouzier, J.W. Pape)
- University of KwaZulu-Natal, Durban, South Africa (T. de Oliveira)
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa (T. de Oliveira)
- University of Washington, Seattle, Washington, USA (T. de Oliveira)
| | - Meer T. Alam
- University of Florida, Gainesville, Florida, USA (C.N. Mavian, M.S. Tagliamonte, M.T. Alam, S.N. Sakib, M.N. Cash, J.P. Jimenez, A. Riva, E.J. Nelson, E.T. Cato, R. Louis, V.M. Beau De Rochars, J.G. Morris Jr., M. Salemi, A. Ali)
- Stellenbosch University, Stellenbosch, South Africa (M. Moir, T. de Oliveira)
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA (J. Ajayakumar, A. Curtis)
- Les Centres GHESKIO, Port-au-Prince, Haiti (V. Rouzier, J.W. Pape)
- Weill Cornell Medical College, New York, New York, USA (V. Rouzier, J.W. Pape)
- University of KwaZulu-Natal, Durban, South Africa (T. de Oliveira)
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa (T. de Oliveira)
- University of Washington, Seattle, Washington, USA (T. de Oliveira)
| | - S. Nazmus Sakib
- University of Florida, Gainesville, Florida, USA (C.N. Mavian, M.S. Tagliamonte, M.T. Alam, S.N. Sakib, M.N. Cash, J.P. Jimenez, A. Riva, E.J. Nelson, E.T. Cato, R. Louis, V.M. Beau De Rochars, J.G. Morris Jr., M. Salemi, A. Ali)
- Stellenbosch University, Stellenbosch, South Africa (M. Moir, T. de Oliveira)
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA (J. Ajayakumar, A. Curtis)
- Les Centres GHESKIO, Port-au-Prince, Haiti (V. Rouzier, J.W. Pape)
- Weill Cornell Medical College, New York, New York, USA (V. Rouzier, J.W. Pape)
- University of KwaZulu-Natal, Durban, South Africa (T. de Oliveira)
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa (T. de Oliveira)
- University of Washington, Seattle, Washington, USA (T. de Oliveira)
| | - Melanie N. Cash
- University of Florida, Gainesville, Florida, USA (C.N. Mavian, M.S. Tagliamonte, M.T. Alam, S.N. Sakib, M.N. Cash, J.P. Jimenez, A. Riva, E.J. Nelson, E.T. Cato, R. Louis, V.M. Beau De Rochars, J.G. Morris Jr., M. Salemi, A. Ali)
- Stellenbosch University, Stellenbosch, South Africa (M. Moir, T. de Oliveira)
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA (J. Ajayakumar, A. Curtis)
- Les Centres GHESKIO, Port-au-Prince, Haiti (V. Rouzier, J.W. Pape)
- Weill Cornell Medical College, New York, New York, USA (V. Rouzier, J.W. Pape)
- University of KwaZulu-Natal, Durban, South Africa (T. de Oliveira)
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa (T. de Oliveira)
- University of Washington, Seattle, Washington, USA (T. de Oliveira)
| | - Monika Moir
- University of Florida, Gainesville, Florida, USA (C.N. Mavian, M.S. Tagliamonte, M.T. Alam, S.N. Sakib, M.N. Cash, J.P. Jimenez, A. Riva, E.J. Nelson, E.T. Cato, R. Louis, V.M. Beau De Rochars, J.G. Morris Jr., M. Salemi, A. Ali)
- Stellenbosch University, Stellenbosch, South Africa (M. Moir, T. de Oliveira)
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA (J. Ajayakumar, A. Curtis)
- Les Centres GHESKIO, Port-au-Prince, Haiti (V. Rouzier, J.W. Pape)
- Weill Cornell Medical College, New York, New York, USA (V. Rouzier, J.W. Pape)
- University of KwaZulu-Natal, Durban, South Africa (T. de Oliveira)
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa (T. de Oliveira)
- University of Washington, Seattle, Washington, USA (T. de Oliveira)
| | - Juan Perez Jimenez
- University of Florida, Gainesville, Florida, USA (C.N. Mavian, M.S. Tagliamonte, M.T. Alam, S.N. Sakib, M.N. Cash, J.P. Jimenez, A. Riva, E.J. Nelson, E.T. Cato, R. Louis, V.M. Beau De Rochars, J.G. Morris Jr., M. Salemi, A. Ali)
- Stellenbosch University, Stellenbosch, South Africa (M. Moir, T. de Oliveira)
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA (J. Ajayakumar, A. Curtis)
- Les Centres GHESKIO, Port-au-Prince, Haiti (V. Rouzier, J.W. Pape)
- Weill Cornell Medical College, New York, New York, USA (V. Rouzier, J.W. Pape)
- University of KwaZulu-Natal, Durban, South Africa (T. de Oliveira)
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa (T. de Oliveira)
- University of Washington, Seattle, Washington, USA (T. de Oliveira)
| | - Alberto Riva
- University of Florida, Gainesville, Florida, USA (C.N. Mavian, M.S. Tagliamonte, M.T. Alam, S.N. Sakib, M.N. Cash, J.P. Jimenez, A. Riva, E.J. Nelson, E.T. Cato, R. Louis, V.M. Beau De Rochars, J.G. Morris Jr., M. Salemi, A. Ali)
- Stellenbosch University, Stellenbosch, South Africa (M. Moir, T. de Oliveira)
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA (J. Ajayakumar, A. Curtis)
- Les Centres GHESKIO, Port-au-Prince, Haiti (V. Rouzier, J.W. Pape)
- Weill Cornell Medical College, New York, New York, USA (V. Rouzier, J.W. Pape)
- University of KwaZulu-Natal, Durban, South Africa (T. de Oliveira)
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa (T. de Oliveira)
- University of Washington, Seattle, Washington, USA (T. de Oliveira)
| | - Eric J. Nelson
- University of Florida, Gainesville, Florida, USA (C.N. Mavian, M.S. Tagliamonte, M.T. Alam, S.N. Sakib, M.N. Cash, J.P. Jimenez, A. Riva, E.J. Nelson, E.T. Cato, R. Louis, V.M. Beau De Rochars, J.G. Morris Jr., M. Salemi, A. Ali)
- Stellenbosch University, Stellenbosch, South Africa (M. Moir, T. de Oliveira)
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA (J. Ajayakumar, A. Curtis)
- Les Centres GHESKIO, Port-au-Prince, Haiti (V. Rouzier, J.W. Pape)
- Weill Cornell Medical College, New York, New York, USA (V. Rouzier, J.W. Pape)
- University of KwaZulu-Natal, Durban, South Africa (T. de Oliveira)
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa (T. de Oliveira)
- University of Washington, Seattle, Washington, USA (T. de Oliveira)
| | - Emilie T. Cato
- University of Florida, Gainesville, Florida, USA (C.N. Mavian, M.S. Tagliamonte, M.T. Alam, S.N. Sakib, M.N. Cash, J.P. Jimenez, A. Riva, E.J. Nelson, E.T. Cato, R. Louis, V.M. Beau De Rochars, J.G. Morris Jr., M. Salemi, A. Ali)
- Stellenbosch University, Stellenbosch, South Africa (M. Moir, T. de Oliveira)
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA (J. Ajayakumar, A. Curtis)
- Les Centres GHESKIO, Port-au-Prince, Haiti (V. Rouzier, J.W. Pape)
- Weill Cornell Medical College, New York, New York, USA (V. Rouzier, J.W. Pape)
- University of KwaZulu-Natal, Durban, South Africa (T. de Oliveira)
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa (T. de Oliveira)
- University of Washington, Seattle, Washington, USA (T. de Oliveira)
| | - Jayakrishnan Ajayakumar
- University of Florida, Gainesville, Florida, USA (C.N. Mavian, M.S. Tagliamonte, M.T. Alam, S.N. Sakib, M.N. Cash, J.P. Jimenez, A. Riva, E.J. Nelson, E.T. Cato, R. Louis, V.M. Beau De Rochars, J.G. Morris Jr., M. Salemi, A. Ali)
- Stellenbosch University, Stellenbosch, South Africa (M. Moir, T. de Oliveira)
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA (J. Ajayakumar, A. Curtis)
- Les Centres GHESKIO, Port-au-Prince, Haiti (V. Rouzier, J.W. Pape)
- Weill Cornell Medical College, New York, New York, USA (V. Rouzier, J.W. Pape)
- University of KwaZulu-Natal, Durban, South Africa (T. de Oliveira)
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa (T. de Oliveira)
- University of Washington, Seattle, Washington, USA (T. de Oliveira)
| | - Rigan Louis
- University of Florida, Gainesville, Florida, USA (C.N. Mavian, M.S. Tagliamonte, M.T. Alam, S.N. Sakib, M.N. Cash, J.P. Jimenez, A. Riva, E.J. Nelson, E.T. Cato, R. Louis, V.M. Beau De Rochars, J.G. Morris Jr., M. Salemi, A. Ali)
- Stellenbosch University, Stellenbosch, South Africa (M. Moir, T. de Oliveira)
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA (J. Ajayakumar, A. Curtis)
- Les Centres GHESKIO, Port-au-Prince, Haiti (V. Rouzier, J.W. Pape)
- Weill Cornell Medical College, New York, New York, USA (V. Rouzier, J.W. Pape)
- University of KwaZulu-Natal, Durban, South Africa (T. de Oliveira)
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa (T. de Oliveira)
- University of Washington, Seattle, Washington, USA (T. de Oliveira)
| | - Andrew Curtis
- University of Florida, Gainesville, Florida, USA (C.N. Mavian, M.S. Tagliamonte, M.T. Alam, S.N. Sakib, M.N. Cash, J.P. Jimenez, A. Riva, E.J. Nelson, E.T. Cato, R. Louis, V.M. Beau De Rochars, J.G. Morris Jr., M. Salemi, A. Ali)
- Stellenbosch University, Stellenbosch, South Africa (M. Moir, T. de Oliveira)
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA (J. Ajayakumar, A. Curtis)
- Les Centres GHESKIO, Port-au-Prince, Haiti (V. Rouzier, J.W. Pape)
- Weill Cornell Medical College, New York, New York, USA (V. Rouzier, J.W. Pape)
- University of KwaZulu-Natal, Durban, South Africa (T. de Oliveira)
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa (T. de Oliveira)
- University of Washington, Seattle, Washington, USA (T. de Oliveira)
| | - V. Madsen Beau De Rochars
- University of Florida, Gainesville, Florida, USA (C.N. Mavian, M.S. Tagliamonte, M.T. Alam, S.N. Sakib, M.N. Cash, J.P. Jimenez, A. Riva, E.J. Nelson, E.T. Cato, R. Louis, V.M. Beau De Rochars, J.G. Morris Jr., M. Salemi, A. Ali)
- Stellenbosch University, Stellenbosch, South Africa (M. Moir, T. de Oliveira)
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA (J. Ajayakumar, A. Curtis)
- Les Centres GHESKIO, Port-au-Prince, Haiti (V. Rouzier, J.W. Pape)
- Weill Cornell Medical College, New York, New York, USA (V. Rouzier, J.W. Pape)
- University of KwaZulu-Natal, Durban, South Africa (T. de Oliveira)
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa (T. de Oliveira)
- University of Washington, Seattle, Washington, USA (T. de Oliveira)
| | - Vanessa Rouzier
- University of Florida, Gainesville, Florida, USA (C.N. Mavian, M.S. Tagliamonte, M.T. Alam, S.N. Sakib, M.N. Cash, J.P. Jimenez, A. Riva, E.J. Nelson, E.T. Cato, R. Louis, V.M. Beau De Rochars, J.G. Morris Jr., M. Salemi, A. Ali)
- Stellenbosch University, Stellenbosch, South Africa (M. Moir, T. de Oliveira)
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA (J. Ajayakumar, A. Curtis)
- Les Centres GHESKIO, Port-au-Prince, Haiti (V. Rouzier, J.W. Pape)
- Weill Cornell Medical College, New York, New York, USA (V. Rouzier, J.W. Pape)
- University of KwaZulu-Natal, Durban, South Africa (T. de Oliveira)
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa (T. de Oliveira)
- University of Washington, Seattle, Washington, USA (T. de Oliveira)
| | - Jean William Pape
- University of Florida, Gainesville, Florida, USA (C.N. Mavian, M.S. Tagliamonte, M.T. Alam, S.N. Sakib, M.N. Cash, J.P. Jimenez, A. Riva, E.J. Nelson, E.T. Cato, R. Louis, V.M. Beau De Rochars, J.G. Morris Jr., M. Salemi, A. Ali)
- Stellenbosch University, Stellenbosch, South Africa (M. Moir, T. de Oliveira)
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA (J. Ajayakumar, A. Curtis)
- Les Centres GHESKIO, Port-au-Prince, Haiti (V. Rouzier, J.W. Pape)
- Weill Cornell Medical College, New York, New York, USA (V. Rouzier, J.W. Pape)
- University of KwaZulu-Natal, Durban, South Africa (T. de Oliveira)
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa (T. de Oliveira)
- University of Washington, Seattle, Washington, USA (T. de Oliveira)
| | - Tulio de Oliveira
- University of Florida, Gainesville, Florida, USA (C.N. Mavian, M.S. Tagliamonte, M.T. Alam, S.N. Sakib, M.N. Cash, J.P. Jimenez, A. Riva, E.J. Nelson, E.T. Cato, R. Louis, V.M. Beau De Rochars, J.G. Morris Jr., M. Salemi, A. Ali)
- Stellenbosch University, Stellenbosch, South Africa (M. Moir, T. de Oliveira)
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA (J. Ajayakumar, A. Curtis)
- Les Centres GHESKIO, Port-au-Prince, Haiti (V. Rouzier, J.W. Pape)
- Weill Cornell Medical College, New York, New York, USA (V. Rouzier, J.W. Pape)
- University of KwaZulu-Natal, Durban, South Africa (T. de Oliveira)
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa (T. de Oliveira)
- University of Washington, Seattle, Washington, USA (T. de Oliveira)
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17
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Ward MK, Fernandez SB, Sheehan DM, Li T, Dawit R, Fennie K, Beach MC, Brock P, Ladner R, Trepka MJ. Sex differences in psychosocial and demographic factors associated with sustained HIV viral suppression in the Miami-Dade County Ryan White Program, 2017. AIDS Care 2023; 35:1437-1442. [PMID: 35621306 PMCID: PMC9701240 DOI: 10.1080/09540121.2022.2080800] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 05/17/2022] [Indexed: 10/18/2022]
Abstract
This exploratory study examined sex differences in psychosocial and demographic factors associated with sustained HIV viral suppression (SVS). The study population included 6,489 Miami-Dade Ryan White Program (RWP) clients receiving services during 2017; administrative data was analyzed. SVS was defined as having all viral load tests during 2017 below 200 copies/ml. Multilevel logistic regression models accounted for clustering by medical case management site. Models were stratified by sex. Overall, a higher proportion of females did not achieve SVS (23.5%) than males (18.1%). For females (n = 1,503), having acquired HIV perinatally and not having a partner oradult household member were associated with not achieving SVS. For males (n = 4,986), lacking access to food, Black or Haitian race/ethnicity, problematic substance use, and unknown physician were associated with not achieving SVS. For both sexes, younger age, lower household income, ever having an AIDS diagnosis, feeling depressed or anxious, and experiencing homelessness were associated with not achieving SVS. Elements of the transition from adolescent to adult HIV care that may differentially impact female clients and factors associated with disclosure should be explored further. Male clients may require additional support for food security. Improving culturally specific care for Haitian and non-Hispanic Black male clients should also be explored.
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Affiliation(s)
- Melissa K. Ward
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
- Research Center in Minority Institutions, Florida International University, Miami, Florida, USA
| | - Sofia B. Fernandez
- Research Center in Minority Institutions, Florida International University, Miami, Florida, USA
- School of Social Work, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Diana M. Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
- Research Center in Minority Institutions, Florida International University, Miami, Florida, USA
- Center for Research on US Latino HIV/AIDS and Drug Abuse, Florida International University, Miami, Florida, USA
| | - Tan Li
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Rahel Dawit
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Kristopher Fennie
- Division of Natural Sciences, New College of Florida, 5800 Bay Shore Road, Sarasota, Florida, USA
| | | | | | - Robert Ladner
- Behavioral Science Research Corporation, Miami, Florida, USA
| | - Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
- Research Center in Minority Institutions, Florida International University, Miami, Florida, USA
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Edwards K, Nagy TR, Fabiano S, Jacotin J, Ellis D. Leptospirosis in the Air: A Case Review Series During Air Medical Transport in Haiti. Air Med J 2023; 42:380-383. [PMID: 37716813 DOI: 10.1016/j.amj.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 05/03/2023] [Accepted: 05/14/2023] [Indexed: 09/18/2023]
Abstract
Leptospirosis is an infectious illness encountered mostly in tropical climates and has been of particular concern in Haiti after natural disasters. Heavy rainfalls and natural disasters in combination with scarce resources to control and identify clusters of infections make certain populations and countries vulnerable. In some cases, patients who contract this disease may need air medical transport to hospitals that have a higher level of care. In this case report, a trio of cases is highlighted from an outbreak that required air transport to transfer patients to a facility with the availability of an intensive care unit. The goal of highlighting these cases is to increase the awareness of physicians and air transport providers to the manifestation and treatment of this disease and to provide pearls to stabilize patients during transport.
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Clutter CH, Klarman MB, Cajusma Y, Cato ET, Abu Sayeed M, Brinkley L, Jensen O, Baril C, De Rochars VMB, Azman AS, Long MT, Cummings D, Leung DT, Nelson EJ. Population-Based Serologic Survey of Vibrio cholerae Antibody Titers before Cholera Outbreak, Haiti, 2022. Emerg Infect Dis 2023; 29:1864-1867. [PMID: 37487168 PMCID: PMC10461687 DOI: 10.3201/eid2909.230174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023] Open
Abstract
A Vibrio cholerae O1 outbreak emerged in Haiti in October 2022 after years of cholera absence. In samples from a 2021 serosurvey, we found lower circulating antibodies against V. cholerae lipopolysaccharide in children <5 years of age and no vibriocidal antibodies, suggesting high susceptibility to cholera, especially among young children.
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Affiliation(s)
| | | | - Youseline Cajusma
- University of Utah, Salt Lake City, Utah, USA (C.H. Clutter, O. Jensen, D.T. Leung)
- University of Florida, Gainesville, Florida, USA (M.B. Klarman, Y. Cajusma, E.T. Cato, M.A. Sayeed, L. Brinkley, V.M. Beau De Rochars, M.T. Long, D. Cummings, E.J. Nelson)
- Université d'État d'Haïti, Port au Prince, Haiti (C. Baril)
- Johns Hopkins University, Baltimore, Maryland, USA (A.S. Azman)
| | - Emilee T. Cato
- University of Utah, Salt Lake City, Utah, USA (C.H. Clutter, O. Jensen, D.T. Leung)
- University of Florida, Gainesville, Florida, USA (M.B. Klarman, Y. Cajusma, E.T. Cato, M.A. Sayeed, L. Brinkley, V.M. Beau De Rochars, M.T. Long, D. Cummings, E.J. Nelson)
- Université d'État d'Haïti, Port au Prince, Haiti (C. Baril)
- Johns Hopkins University, Baltimore, Maryland, USA (A.S. Azman)
| | - Md. Abu Sayeed
- University of Utah, Salt Lake City, Utah, USA (C.H. Clutter, O. Jensen, D.T. Leung)
- University of Florida, Gainesville, Florida, USA (M.B. Klarman, Y. Cajusma, E.T. Cato, M.A. Sayeed, L. Brinkley, V.M. Beau De Rochars, M.T. Long, D. Cummings, E.J. Nelson)
- Université d'État d'Haïti, Port au Prince, Haiti (C. Baril)
- Johns Hopkins University, Baltimore, Maryland, USA (A.S. Azman)
| | - Lindsey Brinkley
- University of Utah, Salt Lake City, Utah, USA (C.H. Clutter, O. Jensen, D.T. Leung)
- University of Florida, Gainesville, Florida, USA (M.B. Klarman, Y. Cajusma, E.T. Cato, M.A. Sayeed, L. Brinkley, V.M. Beau De Rochars, M.T. Long, D. Cummings, E.J. Nelson)
- Université d'État d'Haïti, Port au Prince, Haiti (C. Baril)
- Johns Hopkins University, Baltimore, Maryland, USA (A.S. Azman)
| | - Owen Jensen
- University of Utah, Salt Lake City, Utah, USA (C.H. Clutter, O. Jensen, D.T. Leung)
- University of Florida, Gainesville, Florida, USA (M.B. Klarman, Y. Cajusma, E.T. Cato, M.A. Sayeed, L. Brinkley, V.M. Beau De Rochars, M.T. Long, D. Cummings, E.J. Nelson)
- Université d'État d'Haïti, Port au Prince, Haiti (C. Baril)
- Johns Hopkins University, Baltimore, Maryland, USA (A.S. Azman)
| | - Chantale Baril
- University of Utah, Salt Lake City, Utah, USA (C.H. Clutter, O. Jensen, D.T. Leung)
- University of Florida, Gainesville, Florida, USA (M.B. Klarman, Y. Cajusma, E.T. Cato, M.A. Sayeed, L. Brinkley, V.M. Beau De Rochars, M.T. Long, D. Cummings, E.J. Nelson)
- Université d'État d'Haïti, Port au Prince, Haiti (C. Baril)
- Johns Hopkins University, Baltimore, Maryland, USA (A.S. Azman)
| | - V. Madsen Beau De Rochars
- University of Utah, Salt Lake City, Utah, USA (C.H. Clutter, O. Jensen, D.T. Leung)
- University of Florida, Gainesville, Florida, USA (M.B. Klarman, Y. Cajusma, E.T. Cato, M.A. Sayeed, L. Brinkley, V.M. Beau De Rochars, M.T. Long, D. Cummings, E.J. Nelson)
- Université d'État d'Haïti, Port au Prince, Haiti (C. Baril)
- Johns Hopkins University, Baltimore, Maryland, USA (A.S. Azman)
| | - Andrew S. Azman
- University of Utah, Salt Lake City, Utah, USA (C.H. Clutter, O. Jensen, D.T. Leung)
- University of Florida, Gainesville, Florida, USA (M.B. Klarman, Y. Cajusma, E.T. Cato, M.A. Sayeed, L. Brinkley, V.M. Beau De Rochars, M.T. Long, D. Cummings, E.J. Nelson)
- Université d'État d'Haïti, Port au Prince, Haiti (C. Baril)
- Johns Hopkins University, Baltimore, Maryland, USA (A.S. Azman)
| | - Maureen T. Long
- University of Utah, Salt Lake City, Utah, USA (C.H. Clutter, O. Jensen, D.T. Leung)
- University of Florida, Gainesville, Florida, USA (M.B. Klarman, Y. Cajusma, E.T. Cato, M.A. Sayeed, L. Brinkley, V.M. Beau De Rochars, M.T. Long, D. Cummings, E.J. Nelson)
- Université d'État d'Haïti, Port au Prince, Haiti (C. Baril)
- Johns Hopkins University, Baltimore, Maryland, USA (A.S. Azman)
| | - Derek Cummings
- University of Utah, Salt Lake City, Utah, USA (C.H. Clutter, O. Jensen, D.T. Leung)
- University of Florida, Gainesville, Florida, USA (M.B. Klarman, Y. Cajusma, E.T. Cato, M.A. Sayeed, L. Brinkley, V.M. Beau De Rochars, M.T. Long, D. Cummings, E.J. Nelson)
- Université d'État d'Haïti, Port au Prince, Haiti (C. Baril)
- Johns Hopkins University, Baltimore, Maryland, USA (A.S. Azman)
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20
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Mercadel AJ, Sanchez-Covarrubias AP, Medina HN, Pinheiro PS, Pinto A, George SHL, Schlumbrecht MP. Intra-racial disaggregation reveals associations between nativity and overall survival in women with endometrial cancer. Gynecol Oncol 2023; 176:98-105. [PMID: 37480810 DOI: 10.1016/j.ygyno.2023.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/12/2023] [Accepted: 07/13/2023] [Indexed: 07/24/2023]
Abstract
OBJECTIVE Prior studies have demonstrated survival differences between Black women with endometrial cancer (EC) born in the US and Caribbean. Our objective was to determine if country of birth influences EC overall survival (OS) in disaggregated subpopulations of Black women. METHODS Using the Florida Cancer Data System, women with EC diagnosed from 1981 to 2017 were identified. Demographic and clinical information were abstracted. Women who self-identified as Black and born in the US (USB), Jamaica (JBB), or Haiti (HBB) were included. Statistical analyses were performed using chi-square, Cox proportional hazards models, and Kaplan-Meier methods with significance set at p < 0.05. RESULTS 3817 women met the inclusion criteria. Compared to USB, JBB and HBB had more high-grade histologies, more advanced stage disease, had a greater proportion of uninsured or Medicaid insured, and had a higher proportion of women who received chemotherapy (all p < 0.05). In multivariate analyses, age (HR 1.03 [1.02-1.05]), regional stage (HR 1.52 [1.22-1.89]), distant stage (HR 3.73 [2.84-4.89]), lymphovascular space invasion (HR 1.96 [1.61-2.39]), receipt of surgery (HR 0.47 [0.29-0.75]), and receipt of chemotherapy (HR 0.77 [0.62-0.95]) were independently associated with OS. Compared to USB, Haitian nativity was an independent negative predictor of OS when evaluating all histologies together (HR 1.54 [1.18-2.00]) and for endometrioid EC specifically (HR 1.77 [1.10-2.83]). Among women with serous EC, HBB had markedly worse median OS (18.5 months [13.4-46.5]) relative to USB (29.9 months [26.3-35.9]) and JBB (41.0 months, [34.1-82.6], p = 0.013). CONCLUSION Country of birth is associated with endometrial cancer survival in Black women, with HBB demonstrating worse outcomes.
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Affiliation(s)
- Alyssa J Mercadel
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, Leonard M. Miller School of Medicine, University of Miami, 1121 NW 14(th) Street, Suite 345C, Miami, FL 33136, USA; Sylvester Comprehensive Cancer Center, 1475 NW 12(th) Avenue, Miami, FL 33136, USA
| | - Alex P Sanchez-Covarrubias
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, Leonard M. Miller School of Medicine, University of Miami, 1121 NW 14(th) Street, Suite 345C, Miami, FL 33136, USA; Sylvester Comprehensive Cancer Center, 1475 NW 12(th) Avenue, Miami, FL 33136, USA
| | - Heidy N Medina
- Department of Public Health Sciences, University of Miami School of Medicine, 1120 NW 14(th) Street, CRB 919, Miami, FL 33136, USA
| | - Paulo S Pinheiro
- Sylvester Comprehensive Cancer Center, 1475 NW 12(th) Avenue, Miami, FL 33136, USA; Department of Public Health Sciences, University of Miami School of Medicine, 1120 NW 14(th) Street, CRB 919, Miami, FL 33136, USA
| | - Andre Pinto
- Department of Pathology, University of Miami Miller School of Medicine, 1611 NW 12(th) Avenue, Holtz 2145, Miami, FL 33136, USA
| | - Sophia H L George
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, Leonard M. Miller School of Medicine, University of Miami, 1121 NW 14(th) Street, Suite 345C, Miami, FL 33136, USA; Sylvester Comprehensive Cancer Center, 1475 NW 12(th) Avenue, Miami, FL 33136, USA
| | - Matthew P Schlumbrecht
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, Leonard M. Miller School of Medicine, University of Miami, 1121 NW 14(th) Street, Suite 345C, Miami, FL 33136, USA; Sylvester Comprehensive Cancer Center, 1475 NW 12(th) Avenue, Miami, FL 33136, USA.
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21
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Matias WR, Guillaume Y, Augustin GC, Vissieres K, Ternier R, Charles RC, Harris JB, Franke MF, Ivers LC. Seroprevalence of Vibrio cholerae in Adults, Haiti, 2017. Emerg Infect Dis 2023; 29:1929-1932. [PMID: 37610182 PMCID: PMC10461664 DOI: 10.3201/eid2909.230401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023] Open
Abstract
In Haiti in 2017, the prevalence of serum vibriocidal antibody titers against Vibrio cholerae serogroup O1 among adults was 12.4% in Cerca-la-Source and 9.54% in Mirebalais, suggesting a high recent prevalence of infection. Improved surveillance programs to monitor cholera and guide public health interventions in Haiti are necessary.
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Burlotos A, Pierre TJ, Johnson W, Wiafe S, Joseph M. Small area analysis methods in an area of limited mapping: exploratory geospatial analysis of firearm injuries in Port-au-Prince, Haiti. Int J Health Geogr 2023; 22:19. [PMID: 37596625 PMCID: PMC10436655 DOI: 10.1186/s12942-023-00337-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 07/12/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND The city of Port-au-Prince, Haiti, is experiencing an epidemic of firearm injuries which has resulted in high burdens of morbidity and mortality. Despite this, little scientific literature exists on the topic. Geospatial research could inform stakeholders and aid in the response to the current firearm injury epidemic. However, traditional small-area geospatial methods are difficult to implement in Port-au-Prince, as the area has limited mapping penetration. Objectives of this study were to evaluate the feasibility of geospatial analysis in Port-au-Prince, to seek to understand specific limitations to geospatial research in this context, and to explore the geospatial epidemiology of firearm injuries in patients presenting to the largest public hospital in Port-au-Prince. RESULTS To overcome limited mapping penetration, multiple data sources were combined. Boundaries of informally developed neighborhoods were estimated from the crowd-sourced platform OpenStreetMap using Thiessen polygons. Population counts were obtained from previously published satellite-derived estimates and aggregated to the neighborhood level. Cases of firearm injuries presenting to the largest public hospital in Port-au-Prince from November 22nd, 2019, through December 31st, 2020, were geocoded and aggregated to the neighborhood level. Cluster analysis was performed using Global Moran's I testing, local Moran's I testing, and the SaTScan software. Results demonstrated significant geospatial autocorrelation in the risk of firearm injury within the city. Cluster analysis identified areas of the city with the highest burden of firearm injuries. CONCLUSIONS By utilizing novel methodology in neighborhood estimation and combining multiple data sources, geospatial research was able to be conducted in Port-au-Prince. Geospatial clusters of firearm injuries were identified, and neighborhood level relative-risk estimates were obtained. While access to neighborhoods experiencing the largest burden of firearm injuries remains restricted, these geospatial methods could continue to inform stakeholder response to the growing burden of firearm injuries in Port-au-Prince.
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Affiliation(s)
- Athanasios Burlotos
- Department of Emergency Medicine, Boston Medical Center, Boston, MA, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Tayana Jean Pierre
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Universite Notre Dame D'Haiti, Faculte de Medecine, Port-au-Prince, Haïti
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | - Walter Johnson
- Loma Linda University School of Public Health, Loma Linda, CA, USA
| | - Seth Wiafe
- Loma Linda University School of Public Health, Loma Linda, CA, USA
| | - Michelle Joseph
- Clinical Trials Unit, University of Warwick, Coventry, CV2 2DX, United Kingdom.
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA.
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23
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Hamre KES, Dismer AM, Rogier E, van den Hoogen LL, Williamson J, Kishore N, Travers A, McGee K, Pierre B, Fouché B, Impoinvil D, Holmes K, Stresman G, Druetz T, Eisele TP, Drakeley C, Lemoine JF, Chang MA. Spatial Clustering and Risk Factors for Malaria Infections and Marker of Recent Exposure to Plasmodium falciparum from a Household Survey in Artibonite, Haiti. Am J Trop Med Hyg 2023; 109:258-272. [PMID: 37277106 PMCID: PMC10397426 DOI: 10.4269/ajtmh.22-0599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 04/12/2023] [Indexed: 06/07/2023] Open
Abstract
Targeting malaria interventions in elimination settings where transmission is heterogeneous is essential to ensure the efficient use of resources. Identifying the most important risk factors among persons experiencing a range of exposure can facilitate such targeting. A cross-sectional household survey was conducted in Artibonite, Haiti, to identify and characterize spatial clustering of malaria infections. Household members (N = 21,813) from 6,962 households were surveyed and tested for malaria. An infection was defined as testing positive for Plasmodium falciparum by either a conventional or novel highly sensitive rapid diagnostic test. Seropositivity to the early transcribed membrane protein 5 antigen 1 represented recent exposure to P. falciparum. Clusters were identified using SaTScan. Associations among individual, household, and environmental risk factors for malaria, recent exposure, and living in spatial clusters of these outcomes were evaluated. Malaria infection was detected in 161 individuals (median age: 15 years). Weighted malaria prevalence was low (0.56%; 95% CI: 0.45-0.70%). Serological evidence of recent exposure was detected in 1,134 individuals. Bed net use, household wealth, and elevation were protective, whereas being febrile, over age 5 years, and living in either households with rudimentary wall material or farther from the road increased the odds of malaria. Two predominant overlapping spatial clusters of infection and recent exposure were identified. Individual, household, and environmental risk factors are associated with the odds of individual risk and recent exposure in Artibonite; spatial clusters are primarily associated with household-level risk factors. Findings from serology testing can further strengthen the targeting of interventions.
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Affiliation(s)
- Karen E. S. Hamre
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
- CDC Foundation, Atlanta, Georgia
| | - Amber M. Dismer
- Emergency Response and Recovery Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Eric Rogier
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lotus L. van den Hoogen
- London School of Hygiene & Tropical Medicine, London, United Kingdom
- Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - John Williamson
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nishant Kishore
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
- CDC Foundation, Atlanta, Georgia
| | - Anyess Travers
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
- CDC Foundation, Atlanta, Georgia
| | - Kathleen McGee
- Population Services International/Organisation Haïtienne de Marketing Social pour la Santé, Peguy-ville, Haiti
| | - Baby Pierre
- Programme National de Contrôle de la Malaria, Ministère de la Santé Publique et de la Population, Port-au-Prince, Haiti
| | | | - Daniel Impoinvil
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kathleen Holmes
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Gillian Stresman
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Thomas Druetz
- Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
- University of Montreal School of Public Health, Montreal, Canada
| | - Thomas P. Eisele
- Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Chris Drakeley
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Jean Frantz Lemoine
- Programme National de Contrôle de la Malaria, Ministère de la Santé Publique et de la Population, Port-au-Prince, Haiti
| | - Michelle A. Chang
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
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Molina R, Enriquez M. Enhancing Diabetes Health Outcomes Among Haitian Migrants Living in Dominican Bateyes. Sci Diabetes Self Manag Care 2023; 49:281-290. [PMID: 37313730 DOI: 10.1177/26350106231178838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE The purpose of this study was to better understand the factors that influence the ability of batey adults to self-manage their type 2 diabetes mellitus (T2DM). METHODS A qualitative descriptive approach was used to conduct in-depth, individual interviews in Spanish. Participants (n = 12) were health care workers and members of a nongovernmental organization (NGO) that provides direct diabetes care to batey residents via free, pop-up, mobile medical clinics. Conventional content analysis was used to identify categories and common themes in the data. RESULTS Participants described daily existence in the bateyes as a constant "scarcity of resources." Additionally, four themes and one subtheme emerged that participants felt impacted diabetes health outcomes and the ability of NGO health care workers to provide diabetes care. CONCLUSIONS NGO members, while committed to serve and improve health outcomes for the batey population, often felt overwhelmed. Findings from this qualitative descriptive study may be used to inform novel interventions, which are needed, to enhance the diabetes outcomes of the batey residents who are living with T2DM. In addition, strategies are needed to build diabetes care infrastructure in the batey community.
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Affiliation(s)
- Rosalia Molina
- Research College of Nursing, Kansas City, Missouri
- Sinclair School of Nursing, University of Missouri, Columbia, Missouri
| | - Maithe Enriquez
- Research College of Nursing, Kansas City, Missouri
- Sinclair School of Nursing, University of Missouri, Columbia, Missouri
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25
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Chang MA, Impoinvil D, Hamre KES, Dalexis PE, Mérilien JB, Dismer AM, Fouché B, Desir L, Holmes K, Lafortune W, Herman C, Rogier E, Noland GS, Young AJ, Druetz T, Ashton R, Eisele TP, Cohen J, van den Hoogen L, Stresman G, Drakeley C, Pothin E, Cameron E, Battle KE, Williamson J, Telfort MA, Lemoine JF. Acceptability, Feasibility, Drug Safety, and Effectiveness of a Pilot Mass Drug Administration with a Single Round of Sulfadoxine-Pyrimethamine Plus Primaquine and Indoor Residual Spraying in Communities with Malaria Transmission in Haiti, 2018. Am J Trop Med Hyg 2023; 108:1127-1139. [PMID: 37160282 PMCID: PMC10540127 DOI: 10.4269/ajtmh.22-0623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 02/24/2023] [Indexed: 05/11/2023] Open
Abstract
For a malaria elimination strategy, Haiti's National Malaria Control Program piloted a mass drug administration (MDA) with indoor residual spraying (IRS) in 12 high-transmission areas across five communes after implementing community case management and strengthened surveillance. The MDA distributed sulfadoxine-pyrimethamine and single low-dose primaquine to eligible residents during house visits. The IRS campaign applied pirimiphos-methyl insecticide on walls of eligible houses. Pre- and post-campaign cross-sectional surveys were conducted to assess acceptability, feasibility, drug safety, and effectiveness of the combined interventions. Stated acceptability for MDA before the campaign was 99.2%; MDA coverage estimated at 10 weeks post-campaign was 89.6%. Similarly, stated acceptability of IRS at baseline was 99.9%; however, household IRS coverage was 48.9% because of the high number of ineligible houses. Effectiveness measured by Plasmodium falciparum prevalence at baseline and 10 weeks post-campaign were similar: 1.31% versus 1.43%, respectively. Prevalence of serological markers were similar at 10 weeks post-campaign compared with baseline, and increased at 6 months. No severe adverse events associated with the MDA were identified in the pilot; there were severe adverse events in a separate, subsequent campaign. Both MDA and IRS are acceptable and feasible interventions in Haiti. Although a significant impact of a single round of MDA/IRS on malaria transmission was not found using a standard pre- and post-intervention comparison, it is possible there was blunting of the peak transmission. Seasonal malaria transmission patterns, suboptimal IRS coverage, and low baseline parasitemia may have limited the effectiveness or the ability to measure effectiveness.
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Affiliation(s)
- Michelle A. Chang
- Malaria Branch, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Daniel Impoinvil
- Entomology Branch, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Karen E. S. Hamre
- Malaria Branch, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
- CDC Foundation, Atlanta, Georgia
| | | | - Jean-Baptiste Mérilien
- Programme National de Contrôle de la Malaria, Ministère de la Santé Publique et de la Population, Port-au-Prince, Haiti
| | - Amber M. Dismer
- Emergency Response and Recovery Branch, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Kathleen Holmes
- Malaria Branch, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Willy Lafortune
- Programme National de Contrôle de la Malaria, Ministère de la Santé Publique et de la Population, Port-au-Prince, Haiti
| | - Camelia Herman
- Malaria Branch, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Eric Rogier
- Malaria Branch, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Alyssa J. Young
- Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Thomas Druetz
- Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Ruth Ashton
- Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Thomas P. Eisele
- Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Justin Cohen
- Clinton Health Access Initiative, Washington, District of Columbia
| | | | - Gillian Stresman
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Chris Drakeley
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Emilie Pothin
- Clinton Health Access Initiative, Washington, District of Columbia
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Ewan Cameron
- School of Public Health, Curtin University, Bentley, Australia
| | - Katherine E. Battle
- Institute for Disease Modeling, Bill & Melinda Gates Foundation, Seattle, Washington
| | - John Williamson
- Malaria Branch, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Marc-Aurèle Telfort
- Programme National de Contrôle de la Malaria, Ministère de la Santé Publique et de la Population, Port-au-Prince, Haiti
| | - Jean Frantz Lemoine
- Programme National de Contrôle de la Malaria, Ministère de la Santé Publique et de la Population, Port-au-Prince, Haiti
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Chang MA, Fouché B, LaFortune W, Holmes K, Rigodon J, Juin S, Marseille S, Rogier E, Green M, Kheradmand T, Moore SG, Gaul DA, Boncy J, Telfort MA. Investigation of Four Cases of Stevens-Johnson Syndrome among Participants in a Mass Drug Administration Campaign with Sulfadoxine-Pyrimethamine and Primaquine in Haiti, 2020. Am J Trop Med Hyg 2023; 108:1140-1144. [PMID: 37127264 PMCID: PMC10540108 DOI: 10.4269/ajtmh.22-0625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 02/26/2023] [Indexed: 05/03/2023] Open
Abstract
In 2018, a mass drug administration (MDA) campaign for malaria elimination was piloted in Haiti. The pilot treated 36,338 people with sulfadoxine-pyrimethamine (SP) and primaquine; no severe adverse events were detected. In 2020, another MDA campaign using the same medications was implemented to mitigate an upsurge in malaria cases during the COVID-19 pandemic. Four cases of Stevens-Johnson syndrome (SJS) were identified among the 42,249 people who took the medications. Three of these individuals required hospitalization; all survived. In addition to SP ingestion, an investigation of potential causes for increased SJS cases identified that all four cases had human leukocyte antigens A*29 and/or B*44:03, another known risk factor for SJS. Additionally, three of the four case individuals had antibodies to SARS-CoV-2, and the fourth may have been exposed around the same time. These findings raise the possibility that recent SARS-CoV-2 infection may have contributed to the increased risk for SJS associated with SP exposure during the 2020 campaign.
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Affiliation(s)
- Michelle A. Chang
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Willy LaFortune
- Programme National de Contrôle de la Malaria, Ministère de la Santé Publique et de la Population, Port-au-Prince, Haiti
| | - Kathleen Holmes
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jonas Rigodon
- CDC-Haiti, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Port-au-Prince, Haiti
| | - Stanley Juin
- CDC-Haiti, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Port-au-Prince, Haiti
| | - Samson Marseille
- Laboratoire National de la Santé Publique, Ministère de la Santé Publique et de la Population, Port-au-Prince, Haiti
| | - Eric Rogier
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michael Green
- Entomology Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Taba Kheradmand
- Fred H. Allen Immunogenetics Laboratory, New York Blood Center, New York, New York
| | - Samuel G. Moore
- Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, Georgia
| | - David A. Gaul
- Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, Georgia
- School of Chemistry and Biochemistry, Georgia Institute of Technology, Atlanta, Georgia
| | - Jacques Boncy
- Laboratoire National de la Santé Publique, Ministère de la Santé Publique et de la Population, Port-au-Prince, Haiti
| | - Marc-Aurele Telfort
- Programme National de Contrôle de la Malaria, Ministère de la Santé Publique et de la Population, Port-au-Prince, Haiti
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Cervantes CE, Jaar BG. Burden of Kidney Disease in Haiti. Clin J Am Soc Nephrol 2023; 18:696-698. [PMID: 37081637 PMCID: PMC10278780 DOI: 10.2215/cjn.0000000000000183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 04/17/2023] [Indexed: 04/22/2023]
Affiliation(s)
- C. Elena Cervantes
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Bernard G. Jaar
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- The Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, Maryland
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28
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Roberts NL, Pierre JL, Rouzier V, Sufra R, St-Preux S, Yan LD, Metz M, Clermont A, Apollon A, Sabwa S, Deschamps MM, Kingery JR, Peck R, Fitzgerald D, Pape JW, Tummalapalli SL, McNairy ML. Prevalence and Severity of Chronic Kidney Disease in Haiti. Clin J Am Soc Nephrol 2023; 18:739-747. [PMID: 37081617 PMCID: PMC10278829 DOI: 10.2215/cjn.0000000000000175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 03/30/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND CKD is a major cause of morbidity and mortality in lower-income countries. However, population-based studies characterizing the epidemiology of CKD in these settings are lacking. The study objective was to describe the epidemiology of CKD in a population-based cohort in urban Haiti, including estimates of the prevalence by CKD stage, the magnitude of associated factors with CKD, and the proportion on guideline-recommended treatment. METHODS We assessed the prevalence of CKD and associated risk factors in the population-based Haiti Cardiovascular Disease Cohort. We analyzed cross-sectional data from 2424 adults who completed a clinical examination, risk factor surveys, and laboratory measurements for serum creatinine, urinary albumin, and urinary creatinine. We compared our results with US estimates from the National Health and Nutrition Examination Survey. CKD was defined as either a reduced eGFR <60 ml/min per 1.73 m 2 or urinary albumin-to-creatinine ratio ≥30 mg/g according to the Kidney Disease Improving Global Outcomes guidelines. Multivariable logistic regression identified associated factors with CKD. RESULTS The mean age was 42 years, 57% of participants were female, and 69% lived in extreme poverty on ≤1 US dollar per day. The age-standardized prevalence of CKD was 14% (95% confidence interval [CI], 12% to 15%). The age-standardized prevalence of reduced eGFR and elevated urinary albumin-to-creatinine ratio was 3% (95% CI, 2% to 4%) and 11% (95% CI, 10% to 13%), respectively. Diabetes (adjusted odds ratio, 4.1; 95% CI, 2.7 to 6.2) and hypertension (adjusted odds ratio, 2.9; 95% CI, 2.0 to 4.2) were significantly associated with CKD. Only 12% of participants with CKD and albuminuria were on guideline-recommended agents, such as angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers. CONCLUSIONS In a large population-based cohort of Haitian adults, CKD was highly associated with both diabetes and hypertension. The proportion of participants with CKD on treatment was low, underscoring the need for strengthening clinical management and nephrology care health infrastructure in Haiti. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER A Longitudinal Cohort Study to Evaluate Cardiovascular Risk Factors and Disease in Haiti, NCT03892265 .
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Affiliation(s)
- Nicholas L.S. Roberts
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, New York
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Jean L. Pierre
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Vanessa Rouzier
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Rodney Sufra
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Stefano St-Preux
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Lily D. Yan
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, New York
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Miranda Metz
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Adrienne Clermont
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, New York
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Alexandra Apollon
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Shalom Sabwa
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Marie M. Deschamps
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Justin R. Kingery
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, New York
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Robert Peck
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, New York
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Daniel Fitzgerald
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, New York
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Jean W. Pape
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Sri Lekha Tummalapalli
- Division of Healthcare Delivery Science & Innovation, Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
- The Rogosin Institute, New York, New York
| | - Margaret L. McNairy
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, New York
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
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Sternberg CA, Jackyvens C, Jean RM, Chery MJ, Batalien B, Maddy K, Richard D, Duthely LM, Botero V, Rodriguez A, Boulanger C, Blanc J, Bartholomew TS, Tookes HE, Dale SK, Alcaide ML. Viv Byen (Live Well): A Qualitative Pilot Study to Assess Telehealth Use for HIV Care Among People of Haitian Descent. AIDS Patient Care STDS 2023; 37:279-283. [PMID: 37205862 PMCID: PMC10280212 DOI: 10.1089/apc.2023.0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023] Open
Affiliation(s)
- Candice A. Sternberg
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Camille Jackyvens
- Department of Obstetrics and Gynecology, Mirebalais University Hospital, Mirebalais, Haiti
| | | | - Maurice Junior Chery
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Blonsky Batalien
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Krisna Maddy
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Danelle Richard
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Lunthita M. Duthely
- Department of Obstetrics and Gynecology, and University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Valeria Botero
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Allan Rodriguez
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Catherine Boulanger
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Judite Blanc
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Tyler S. Bartholomew
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Hansel E. Tookes
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Sannisha K. Dale
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | - Maria L. Alcaide
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
- Department of Obstetrics and Gynecology, and University of Miami Miller School of Medicine, Miami, Florida, USA
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Dorvil N, Rivera VR, Riviere C, Berman R, Severe P, Bang H, Lavoile K, Devieux JG, Faustin M, Saintyl G, Mendicuti MD, Pierre S, Apollon A, Dumond E, Forestal GPL, Rouzier V, Marcelin A, McNairy ML, Walsh KF, Dupnik K, Reif LK, Byrne AL, Bousleiman S, Orvis E, Joseph P, Cremieux PY, Pape JW, Koenig SP. Same-day testing with initiation of antiretroviral therapy or tuberculosis treatment versus standard care for persons presenting with tuberculosis symptoms at HIV diagnosis: A randomized open-label trial from Haiti. PLoS Med 2023; 20:e1004246. [PMID: 37294843 PMCID: PMC10292694 DOI: 10.1371/journal.pmed.1004246] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 06/26/2023] [Accepted: 05/25/2023] [Indexed: 06/11/2023] Open
Abstract
BACKGROUND Same-day HIV testing and antiretroviral therapy (ART) initiation is being widely implemented. However, the optimal timing of ART among patients with tuberculosis (TB) symptoms is unknown. We hypothesized that same-day treatment (TB treatment for those diagnosed with TB; ART for those not diagnosed with TB) would be superior to standard care in this population. METHODS AND FINDINGS We conducted an open-label trial among adults with TB symptoms at initial HIV diagnosis at GHESKIO in Haiti; participants were recruited and randomized on the same day. Participants were randomized in a 1:1 ratio to same-day treatment (same-day TB testing with same-day TB treatment if TB diagnosed; same-day ART if TB not diagnosed) versus standard care (initiating TB treatment within 7 days and delaying ART to day 7 if TB not diagnosed). In both groups, ART was initiated 2 weeks after TB treatment. The primary outcome was retention in care with 48-week HIV-1 RNA <200 copies/mL, with intention to treat (ITT) analysis. From November 6, 2017 to January 16, 2020, 500 participants were randomized (250/group); the final study visit occurred on March 1, 2021. Baseline TB was diagnosed in 40 (16.0%) in the standard and 48 (19.2%) in the same-day group; all initiated TB treatment. In the standard group, 245 (98.0%) initiated ART at median of 9 days; 6 (2.4%) died, 15 (6.0%) missed the 48-week visit, and 229 (91.6%) attended the 48-week visit. Among all who were randomized, 220 (88.0%) received 48-week HIV-1 RNA testing; 168 had <200 copies/mL (among randomized: 67.2%; among tested: 76.4%). In the same-day group, 249 (99.6%) initiated ART at median of 0 days; 9 (3.6%) died, 23 (9.2%) missed the 48-week visit, and 218 (87.2%) attended the 48-week visit. Among all who were randomized, 211 (84.4%) received 48-week HIV-1 RNA; 152 had <200 copies/mL (among randomized: 60.8%; among tested: 72.0%). There was no difference between groups in the primary outcome (60.8% versus 67.2%; risk difference: -0.06; 95% CI [-0.15, 0.02]; p = 0.14). Two new grade 3 or 4 events were reported per group; none were judged to be related to the intervention. The main limitation of this study is that it was conducted at a single urban clinic, and the generalizability to other settings is uncertain. CONCLUSIONS In patients with TB symptoms at HIV diagnosis, we found that same-day treatment was not associated with superior retention and viral suppression. In this study, a short delay in ART initiation did not appear to compromise outcomes. TRIAL REGISTRATION This study is registered with ClinicalTrials.gov NCT03154320.
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Affiliation(s)
- Nancy Dorvil
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Vanessa R. Rivera
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Cynthia Riviere
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Richard Berman
- The Analysis Group, Boston, Massachusetts, United States of America
| | - Patrice Severe
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Heejung Bang
- University of California, Davis School of Medicine, Davis, California, United States of America
| | - Kerlyne Lavoile
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Jessy G. Devieux
- Florida International University, Miami, Florida, United States of America
| | - Mikerlyne Faustin
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Giovanni Saintyl
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Maria Duran Mendicuti
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Samuel Pierre
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Alexandra Apollon
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Emelyne Dumond
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | | | - Vanessa Rouzier
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
- Weill Cornell Medicine, New York, New York, United States of America
| | - Adias Marcelin
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | | | - Kathleen F. Walsh
- Weill Cornell Medicine, New York, New York, United States of America
| | - Kathryn Dupnik
- Weill Cornell Medicine, New York, New York, United States of America
| | - Lindsey K. Reif
- Weill Cornell Medicine, New York, New York, United States of America
| | - Anthony L. Byrne
- St. Vincent’s Hospital, Darlinghurst, New South Wales, Australia
| | | | - Eli Orvis
- The Analysis Group, Boston, Massachusetts, United States of America
| | - Patrice Joseph
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | | | - Jean William Pape
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
- Weill Cornell Medicine, New York, New York, United States of America
| | - Serena P. Koenig
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
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Arps S. Body composition and nutritional status of school-aged Haitian children living in urban and peri-urban areas of Puerto Plata, Dominican Republic. Am J Hum Biol 2023; 35:e23873. [PMID: 36708069 DOI: 10.1002/ajhb.23873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 12/20/2022] [Accepted: 01/11/2023] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVES This study examines body composition and nutritional status of Haitian children and adolescents living in urban and peri-urban communities in the Dominican Republic to provide estimates of stunting, underweight, overweight, and obesity for this under-researched population. METHODS Anthropometric measures including height, weight, mid-upper arm circumference, and skinfold thicknesses (triceps and subscapular) were obtained for Kreyòl-speaking school-aged children (n = 105, males = 51, females = 54, ages 4-17). Z-scores for height, body mass index (BMI), and upper arm muscle area by height were used to classify children's nutritional status. Variation among sex and age groups was assessed. RESULTS Relatively low rates of stunting (4.8%) and thinness (2.9%) were identified. The total prevalence of overweight was 5.7% and 2.9% of children were classified as having obesity. Girls had a higher prevalence of overweight/obesity and risk of overweight (16.7%) than boys (3.9%, p = .033). CONCLUSIONS The prevalence of overweight and obesity (8.6%) suggests that Haitian children in these urban and peri-urban communities are experiencing the nutrition transition. Interventions should address the development of excess weight, especially among girls, as well as persisting undernutrition and stunting.
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Affiliation(s)
- Shahna Arps
- Department of Sociology and Anthropology, University of Toledo, Toledo, Ohio, USA
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32
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Ayele W, Gage A, Kapoor NR, Kassahun Gelaw S, Hensman D, Derseh Mebratie A, Nega A, Asai D, Molla G, Mehata S, Mthethwa L, Mfeka-Nkabinde NG, Joseph JP, Pierre DM, Thermidor R, Arsenault C. Quality of routine health data at the onset of the COVID-19 pandemic in Ethiopia, Haiti, Laos, Nepal, and South Africa. Popul Health Metr 2023; 21:7. [PMID: 37210556 PMCID: PMC10199286 DOI: 10.1186/s12963-023-00306-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 05/14/2023] [Indexed: 05/22/2023] Open
Abstract
BACKGROUND During the COVID-19 pandemic, governments and researchers have used routine health data to estimate potential declines in the delivery and uptake of essential health services. This research relies on the data being high quality and, crucially, on the data quality not changing because of the pandemic. In this paper, we investigated those assumptions and assessed data quality before and during COVID-19. METHODS We obtained routine health data from the DHIS2 platforms in Ethiopia, Haiti, Lao People's Democratic Republic, Nepal, and South Africa (KwaZulu-Natal province) for a range of 40 indicators on essential health services and institutional deaths. We extracted data over 24 months (January 2019-December 2020) including pre-pandemic data and the first 9 months of the pandemic. We assessed four dimensions of data quality: reporting completeness, presence of outliers, internal consistency, and external consistency. RESULTS We found high reporting completeness across countries and services and few declines in reporting at the onset of the pandemic. Positive outliers represented fewer than 1% of facility-month observations across services. Assessment of internal consistency across vaccine indicators found similar reporting of vaccines in all countries. Comparing cesarean section rates in the HMIS to those from population-representative surveys, we found high external consistency in all countries analyzed. CONCLUSIONS While efforts remain to improve the quality of these data, our results show that several indicators in the HMIS can be reliably used to monitor service provision over time in these five countries.
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Affiliation(s)
- Wondimu Ayele
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Anna Gage
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Neena R Kapoor
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA
| | | | | | - Anagaw Derseh Mebratie
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Adiam Nega
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Daisuke Asai
- World Health Organization, Vientiane, Lao People's Democratic Republic
| | - Gebeyaw Molla
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Suresh Mehata
- Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal
| | - Londiwe Mthethwa
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | | | - Jean Paul Joseph
- Division d'Épidémiologie et de Laboratoire, Zanmi Lasante, Mirebalais, Plateau Central, Haiti
| | - Daniella Myriam Pierre
- Programme National de Lutte contre les IST/VIH/SIDA (PNLS) Unite de Coordination des Maladies Transmissibles (UCMIT), Ministère de la Sante Publique et de la Population (MSPP), Port-au-Prince, Haiti
| | - Roody Thermidor
- Studies and Planning Unit, Ministry of Public Health and Population, Port-au-Prince, Haiti
| | - Catherine Arsenault
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA.
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Walters C, Chen J, Stroika S, Katz LS, Turnsek M, Compère V, Im MS, Gomez S, McCullough A, Landaverde C, Putney J, Caidi H, Folster J, Carleton HA, Boncy J, Lee CC. Genome Sequences from a Reemergence of Vibrio cholerae in Haiti, 2022 Reveal Relatedness to Previously Circulating Strains. J Clin Microbiol 2023; 61:e0014223. [PMID: 36877025 PMCID: PMC10035305 DOI: 10.1128/jcm.00142-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023] Open
Affiliation(s)
- Cynney Walters
- Enteric Diseases Laboratory Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA
| | - Jessica Chen
- Enteric Diseases Laboratory Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Steven Stroika
- Enteric Diseases Laboratory Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lee S. Katz
- Enteric Diseases Laboratory Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Maryann Turnsek
- Enteric Diseases Laboratory Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Monica S. Im
- Enteric Diseases Laboratory Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Suzanna Gomez
- Enteric Diseases Laboratory Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA
| | - Andre McCullough
- Enteric Diseases Laboratory Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Clarissa Landaverde
- Enteric Diseases Laboratory Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA
| | - Jordan Putney
- Enteric Diseases Laboratory Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA
| | - Hayat Caidi
- Enteric Diseases Laboratory Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jason Folster
- Enteric Diseases Laboratory Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Heather A. Carleton
- Enteric Diseases Laboratory Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jacques Boncy
- Laboratoire National de Santé Publique, Port-au-Prince, Haiti
| | - Christine C. Lee
- Enteric Diseases Laboratory Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Rene C, Faustin M, Bonhomme J, Deschamps MM, Jean-Gilles M, Rosenberg R, Ibrahim M, McNairy M, Pape JW, Devieux JG. An Adapted Self-screening Tool for Peripartum Cardiomyopathy in Haiti. Crit Pathw Cardiol 2023; 22:19-24. [PMID: 36812340 PMCID: PMC9976336 DOI: 10.1097/hpc.0000000000000312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
BACKGROUND Peripartum cardiomyopathy (PPCM) is considered rare in the United States; however, the literature notes that the disease has a higher prevalence in developing countries such as Haiti. Dr. James D. Fett, a US cardiologist, developed and validated a self-assessment measure for PPCM in the United States to aid women to easily differentiate the signs and symptoms of heart failure from those related to a normal pregnancy. Although this instrument was validated, it lacks the adaptation necessary to account for the language, culture, and education of the Haitian population. OBJECTIVE The aim of this study was to translate and culturally adapt the Fett PPCM self-assessment measure for use among a Haitian Creole speaking population. METHODS A preliminary Haitian Creole direct translation was developed from the original English Fett self-test. A total of four focus groups with medical professionals and 16 cognitive interviews with members of a community advisory board were conducted to refine the preliminary Haitian Creole translation and adaptation. RESULTS The adaptation focused on incorporating cues that would be tangible and connected to the reality of the Haitian population while maintaining the intended meaning of the original Fett measure. CONCLUSIONS The final adaptation provides an instrument suitable for administration by auxiliary health providers and community health workers to help patients distinguish symptoms of heart failure from symptoms related to normal pregnancy and further quantify the severity of signs and symptoms that might be indicative of heart failure.
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Affiliation(s)
- Cassandra Rene
- From the Robert Stempel College of Public Health & Social Work, Miami, FL
| | - Mikerlyne Faustin
- From the Robert Stempel College of Public Health & Social Work, Miami, FL
| | | | | | | | - Rhonda Rosenberg
- From the Robert Stempel College of Public Health & Social Work, Miami, FL
| | | | - Margaret McNairy
- Weill Cornell Medical Center, Center for Global Health & Division of Medicine, New York, NY
| | - Jean W Pape
- The GHESKIO Centers, Port-au-Prince, Haiti
- Weill Cornell Medical Center, Center for Global Health & Division of Medicine, New York, NY
| | - Jessy G Devieux
- From the Robert Stempel College of Public Health & Social Work, Miami, FL
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Cénat JM, Dalexis RD, Clorméus LA, Lafontaine MF, Guerrier M, Michel G, Hébert M. Lifetime and Child Sexual Violence, Risk Factors and Mental Health Correlates Among a Nationally Representative Sample of Adolescents and Young Adults in Haiti: A Public Health Emergency. J Interpers Violence 2023; 38:2778-2805. [PMID: 35576436 PMCID: PMC9850395 DOI: 10.1177/08862605221102484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Very little is known in Haiti and the Caribbean regarding child and lifetime sexual victimization. Using a nationally representative sample of adolescents and young adults aged 15-24, this study aimed to document the prevalence, risk factors and mental health correlates of lifetime and child sexual violence in Haiti. A national cross-sectional surrvey was conducted in Haiti, using a multistage sampling frame, stratified by geographical department, urban or rural setting, gender, and age groups (15-19 and 20-24 years). The final sample included 3586 household participants (47.6% female). A weighted sample of 3945 individuals was obtained and used in the following analyses. Overall rate of lifetime and child sexual violence was, respectively, 27.44% (95% CI 25.94-28.94) and 11.27% (95% CI 10.18-12.35). Lifetime sexual violence rate was significantly higher among female participants (29.02%; 95% CI 27.5-30.55) compared to male (25.73%, 95% CI 24.26-27.2), χ2 = 4.63, p < .05, but there was no significant gender difference for child sexual victimization. Experiences of family physical violence, emotional abuse by mother and father, divorce of parents, and other physical violence were strongly associated with higher odds of sexual victimization. Participants who reported having experienced sexual violence are more at risk to meet criteria of PTSD (OR = 1.96, 95% CI 1.66-2.32; p < .0001), depression (OR = 1.73, 95% CI 1.47-2.02; p < .0001), psychological distress (OR =1.72, 95% CI 1.47-2.02; p < .0001), and substance abuse (OR = 1.33, 95% CI 1.13-1.57; p < .0001). Findings demonstrate that sexual violence is a public health emergency in Haiti. They provide evidence for the development of prevention and intervention programs.
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Affiliation(s)
| | - Rose Darly Dalexis
- Interdisciplinary School of Health
Sciences, University
of Ottawa, Ontario, Canada
| | | | | | | | | | - Martine Hébert
- Department of Sexology,
Université du
Québec à Montréal, Québec, Canada
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36
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Vega Ocasio D, Juin S, Berendes D, Heitzinger K, Prentice-Mott G, Desormeaux AM, Jn Charles PD, Rigodon J, Pelletier V, Louis RJ, Vertefeuille J, Boncy J, Joseph G, Compère V, Lafontant D, Andrecy LL, Michel E, Pierre K, Thermidor E, Fitter D, Grant-Greene Y, Lozier M, Marseille S. Cholera Outbreak - Haiti, September 2022-January 2023. MMWR Morb Mortal Wkly Rep 2023; 72:21-25. [PMID: 36634024 PMCID: PMC9869732 DOI: 10.15585/mmwr.mm7202a1] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
On September 30, 2022, after >3 years with no confirmed cholera cases (1), the Directorate of Epidemiology, Laboratories and Research (DELR) of the Haitian Ministry of Public Health and Population (Ministère de la Santé Publique et de la Population [MSPP]) was notified of two patients with acute, watery diarrhea in the metropolitan area of Port-au-Prince. Within 2 days, Haiti's National Public Health Laboratory confirmed the bacterium Vibrio cholerae O1 in specimens from the two patients with suspected cholera infection, and an outbreak investigation began immediately. As of January 3, 2023, >20,000 suspected cholera cases had been reported throughout the country, and 79% of patients have been hospitalized. The moving 14-day case fatality ratio (CFR) was 3.0%. Cholera, which is transmitted through ingestion of water or food contaminated with fecal matter, can cause acute, severe, watery diarrhea that can rapidly lead to dehydration, shock, and death if not treated promptly (2). Haiti is currently facing ongoing worsening of gang violence, population displacement, social unrest, and insecurity, particularly in the metropolitan area of Port-au-Prince, including Belair, Bas-Delmas, Centre-Ville, Martissant, Cité Soleil, Croix-des Bouquets, and Tabarre, creating an environment that has facilitated the current resurgence of cholera (3). This report describes the initial investigation, ongoing outbreak, and public health response to cholera in Haiti. Cholera outbreak responses require a multipronged, multisectoral approach including surveillance; case management; access to safe water, sanitation, and hygiene (WASH) services; targeted oral cholera vaccine (OCV) campaigns; risk communication; and community engagement. This activity was reviewed by CDC and was conducted consistent with applicable federal law and CDC policy.
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37
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Affiliation(s)
- Richard P Wenzel
- From the Department of Internal Medicine, Virginia Commonwealth University, Richmond
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38
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Rubin DHF, Zingl FG, Leitner DR, Ternier R, Compere V, Marseille S, Slater D, Harris JB, Chowdhury F, Qadri F, Boncy J, Ivers LC, Waldor MK. Reemergence of Cholera in Haiti. N Engl J Med 2022; 387:2387-2389. [PMID: 36449726 PMCID: PMC9901182 DOI: 10.1056/nejmc2213908] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | - Fahima Chowdhury
- International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Firdausi Qadri
- International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Jacques Boncy
- Laboratoire National de Santé Publique, Port-au-Prince, Haiti
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41
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Taylor L. Haiti's cholera treatment centres are overwhelmed as cases surge. BMJ 2022; 379:o2831. [PMID: 36418029 DOI: 10.1136/bmj.o2831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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42
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Rasul R, Rouzier V, Sufra R, Yan LD, Joseph I, Mourra N, Sabwa S, Deschamps MM, Fitzgerald DW, Pape JW, Nash D, McNairy ML. Extreme Food Insecurity and Malnutrition in Haiti: Findings from a Population-Based Cohort in Port-au-Prince, Haiti. Nutrients 2022; 14:4854. [PMID: 36432540 PMCID: PMC9695391 DOI: 10.3390/nu14224854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 10/27/2022] [Accepted: 11/13/2022] [Indexed: 11/18/2022] Open
Abstract
Haiti is one of the most food-insecure (FIS) nations in the world, with increasing rates of overweight and obesity. This study aimed to characterize FIS among households in urban Haiti and assess the relationship between FIS and body mass index (BMI) using enrollment data from the Haiti Cardiovascular Disease Cohort Study. FIS was characterized as no/low, moderate/high, and extreme based on the Household Food Security Scale. Multinomial logistic generalized estimating equations were used to evaluate the association between FIS categories and BMI, with obesity defined as BMI ≥ 30 kg/m2. Among 2972 participants, the prevalence of moderate/high FIS was 40.1% and extreme FIS was 43.7%. Those with extreme FIS had higher median age (41 vs. 38 years) and were less educated (secondary education: 11.6% vs. 20.3%) compared to those with no/low FIS. Although all FIS categories had high obesity prevalence, those with extreme FIS compared to no/low FIS (15.3% vs. 21.6%) had the lowest prevalence. Multivariable models showed an inverse relationship between FIS and obesity: moderate/high FIS (OR: 0.77, 95% CI: 0.56, 1.08) and extreme FIS (OR: 0.58, 95% CI: 0.42, 0.81) versus no/low FIS were associated with lower adjusted odds of obesity. We found high prevalence of extreme FIS in urban Haiti in a transitioning nutrition setting. The inverse relationship between extreme FIS and obesity needs to be further studied to reduce both FIS and obesity in this population.
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Affiliation(s)
- Rehana Rasul
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York, New York, NY 10017, USA
- Institute of Implementation Science in Population Health, City University of New York, New York, NY 10027, USA
| | - Vanessa Rouzier
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), 33 Boulevard Harry Truman, Port-au-Prince 6110, Haiti
- Center for Global Health, Weill Cornell Medicine, 402 East 67th Street, New York, NY 10065, USA
| | - Rodney Sufra
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), 33 Boulevard Harry Truman, Port-au-Prince 6110, Haiti
| | - Lily D. Yan
- Center for Global Health, Weill Cornell Medicine, 402 East 67th Street, New York, NY 10065, USA
| | - Inddy Joseph
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), 33 Boulevard Harry Truman, Port-au-Prince 6110, Haiti
| | - Nour Mourra
- Center for Global Health, Weill Cornell Medicine, 402 East 67th Street, New York, NY 10065, USA
| | - Shalom Sabwa
- Center for Global Health, Weill Cornell Medicine, 402 East 67th Street, New York, NY 10065, USA
| | - Marie M. Deschamps
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), 33 Boulevard Harry Truman, Port-au-Prince 6110, Haiti
| | - Daniel W. Fitzgerald
- Center for Global Health, Weill Cornell Medicine, 402 East 67th Street, New York, NY 10065, USA
| | - Jean W. Pape
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), 33 Boulevard Harry Truman, Port-au-Prince 6110, Haiti
- Center for Global Health, Weill Cornell Medicine, 402 East 67th Street, New York, NY 10065, USA
| | - Denis Nash
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York, New York, NY 10017, USA
- Institute of Implementation Science in Population Health, City University of New York, New York, NY 10027, USA
| | - Margaret L. McNairy
- Center for Global Health, Weill Cornell Medicine, 402 East 67th Street, New York, NY 10065, USA
- Division of General Internal Medicine, Weill Cornell Medicine, 402 East 67th Street, New York, NY 10065, USA
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Jaramillo-Underwood A, Impoinvil D, Sutcliff A, Hamre KES, Joseph V, van den Hoogen L, Lemoine JF, Ashton RA, Chang MA, Existe A, Boncy J, Drakeley C, Stresman G, Druetz T, Eisele T, Rogier E. Factors Associated With Human IgG Antibody Response to Anopheles albimanus Salivary Gland Extract, Artibonite Department, Haiti, 2017. J Infect Dis 2022; 226:1461-1469. [PMID: 35711005 PMCID: PMC10982684 DOI: 10.1093/infdis/jiac245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 06/14/2022] [Indexed: 11/14/2022] Open
Abstract
Serological data can provide estimates of human exposure to both malaria vector and parasite based on antibody responses. A multiplex bead-based assay was developed to simultaneously detect IgG to Anopheles albimanus salivary gland extract (SGE) and 23 Plasmodium falciparum antigens among 4185 participants enrolled in Artibonite department, Haiti in 2017. Logistic regression adjusted for participant- and site-level covariates and found children under 5 years and 6-15 years old had 3.7- and 5.4-fold increase in odds, respectively, of high anti-SGE IgG compared to participants >15 years. Seropositivity to P. falciparum CSP, Rh2_2030, and SEA-1 antigens was significantly associated with high IgG response against SGE, and participant enrolment at elevations under 200 m was associated with higher anti-SGE IgG levels. The ability to approximate population exposure to malaria vectors through SGE serology data is very dependent by age categories, and SGE antigens can be easily integrated into a multiplex serological assay.
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Affiliation(s)
- Alicia Jaramillo-Underwood
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Daniel Impoinvil
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alice Sutcliff
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Karen E. S. Hamre
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Vena Joseph
- Center for Applied Malaria Research and Evaluation, Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Lotus van den Hoogen
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jean Frantz Lemoine
- Programme National de Contrôle de la Malaria, Ministère de la Santé Publique et de la Population, Port-au-Prince, Haiti
| | - Ruth A. Ashton
- Center for Applied Malaria Research and Evaluation, Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Michelle A. Chang
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alexandre Existe
- Laboratorie National de Santé Publique, Ministère de la Santé Publique et de la Population, Port-au-Prince, Haiti
| | - Jacques Boncy
- Laboratorie National de Santé Publique, Ministère de la Santé Publique et de la Population, Port-au-Prince, Haiti
| | - Chris Drakeley
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Gillian Stresman
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Thomas Druetz
- Center for Applied Malaria Research and Evaluation, Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
- Department of Social and Preventive Medicine, University of Montreal School of Public Health, Montreal, Québec, Canada
| | - Thomas Eisele
- Center for Applied Malaria Research and Evaluation, Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Eric Rogier
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Alam MM, Mavian C, Okech BA, White SK, Stephenson CJ, Elbadry MA, Blohm GM, Loeb JC, Louis R, Saleem C, Madsen Beau de Rochars VE, Salemi M, Lednicky JA, Morris JG. Analysis of Zika Virus Sequence Data Associated with a School Cohort in Haiti. Am J Trop Med Hyg 2022; 107:873-880. [PMID: 36096408 PMCID: PMC9651511 DOI: 10.4269/ajtmh.22-0204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/11/2022] [Indexed: 11/07/2022] Open
Abstract
Zika virus (ZIKV) infections occurred in epidemic form in the Americas in 2014-2016, with some of the earliest isolates in the region coming from Haiti. We isolated ZIKV from 20 children with acute undifferentiated febrile illness who were part of a cohort of children seen at a school clinic in the Gressier region of Haiti. The virus was also isolated from three pools of Aedes aegypti mosquitoes collected at the same location. On phylogenetic analysis, three distinct ZIKV clades were identified. Strains from all three clades were present in Haiti in 2014, making them among the earliest isolates identified in the Western Hemisphere. Strains from all three clades were also isolated in 2016, indicative of their persistence across the time period of the epidemic. Mosquito isolates were collected in 2016 and included representatives from two of the three clades; in one instance, ZIKV was isolated from a pool of male mosquitoes, suggestive of vertical transmission of the virus. The identification of multiple ZIKV clades in Haiti at the beginning of the epidemic suggests that Haiti served as a nidus for transmission within the Caribbean.
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Affiliation(s)
- Md. Mahbubul Alam
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida
- Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, Florida
| | - Carla Mavian
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida
- Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, Florida
| | - Bernard A. Okech
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida
- Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, Florida
| | - Sarah K. White
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida
- Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, Florida
| | - Caroline J. Stephenson
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida
- Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, Florida
| | - Maha A. Elbadry
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida
- Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, Florida
| | - Gabriela M. Blohm
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida
- Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, Florida
| | - Julia C. Loeb
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida
- Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, Florida
| | - Rigan Louis
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida
- State University of Haiti Faculty of Medicine and Pharmacy, Port-au-Prince, Haiti
| | - Cyrus Saleem
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida
| | - Valery E. Madsen Beau de Rochars
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida
- Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida
| | - Marco Salemi
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida
- Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, Florida
| | - John A. Lednicky
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida
- Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, Florida
| | - J. Glenn Morris
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida
- Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida
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Dade E, Metz M, Pierre JL, Rouzier V, Sufra R, Fox E, Preval F, St-Preux S, Zephir JR, Ariste W, Rasul R, Sabwa S, Roberts N, Deschamps MM, Severe P, Fitzgerald D, Pape JW, Yan LD, McNairy ML. High prevalence of obesity among women in urban Haiti: Findings from a population-based cohort. Front Public Health 2022; 10:976909. [PMID: 36276356 PMCID: PMC9581236 DOI: 10.3389/fpubh.2022.976909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/23/2022] [Indexed: 01/25/2023] Open
Abstract
Introduction Obesity is associated with increased risk of non-communicable diseases and death and is increasing rapidly in low- and middle-income countries, including Haiti. There is limited population-based data on body mass index (BMI) and waist circumference (WC) and associated risk factors in Haiti. This study describes BMI and WC, and factors associated with obesity using a population-based cohort from Port-au-Prince. Methods Baseline sociodemographic and clinical data were collected from participants in the Haiti CVD Cohort Study between March 2019 and August 2021. Weight was categorized by BMI (kg/m2) with obesity defined as ≥30 kg/m2. Abdominal obesity was defined using WC cutoffs of ≥80 cm for women and ≥94 cm for men based on WHO guidelines. Sociodemographic and behavioral risk factors, including age, sex, educational attainment, income, smoking status, physical activity, fat/oil use, daily fruit/vegetable consumption, and frequency of fried food intake were assessed for their association with obesity using a Poisson multivariable regression. Results Among 2,966 participants, median age was 41 years (IQR: 28-55) and 57.6% were women. Median BMI was 24.0 kg/m2 (IQR: 20.9-28.1) and 508 (17.1%) participants were obese. Women represented 89.2% of the population with BMI ≥30 kg/m2. A total of 1,167 (68.3%) women had WC ≥80 cm and 144 (11.4%) men had WC ≥94 cm. BMI ≥30 kg/m2 was significantly more prevalent among women than men [PR 5.7; 95% CI: (4.3-7.6)], those 40-49 years compared to 18-29 years [PR 3.3; 95% CI: (2.4-4.6)], and those with income >10 USD per day compared to ≤1 USD [PR 1.3; 95% CI: (1.0-1.6)]. There were no significant associations with other health and behavioral risk factors. Discussion In Haiti, women have an alarming 6-fold higher obesity prevalence compared to men (26.5 vs. 4.3%) and 89.2% of participants with obesity were women. Abdominal obesity was high, at 44.3%. Haiti faces a paradox of an ongoing national food insecurity crises and a burgeoning obesity epidemic. Individual, social, and environmental drivers of obesity, especially among women, need to be identified.
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Affiliation(s)
- Eliezer Dade
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Miranda Metz
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Jean Lookens Pierre
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Vanessa Rouzier
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Rodney Sufra
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Elizabeth Fox
- Department of Public and Ecosystem Health, Cornell University, Ithaca, NY, United States
| | - Fabyola Preval
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Stephano St-Preux
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Jean Ronald Zephir
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Wilson Ariste
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Rehana Rasul
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, United States
| | - Shalom Sabwa
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Nicholas Roberts
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Marie Marcelle Deschamps
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Patrice Severe
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Daniel Fitzgerald
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, NY, United States
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Jean William Pape
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Lily Du Yan
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, NY, United States
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Margaret L. McNairy
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, NY, United States
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, United States
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Derose KP, Han B, Armenta G, Palar K, Then-Paulino A, Jimenez-Paulino G, Sheira L, Acevedo R, Lugo C, Veloz I, Donastorg Y, Wagner G. Exploring antiretroviral therapy adherence, competing needs, and viral suppression among people living with HIV and food insecurity in the Dominican Republic. AIDS Care 2022; 34:1234-1242. [PMID: 34581230 PMCID: PMC8958167 DOI: 10.1080/09540121.2021.1981218] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 09/09/2021] [Indexed: 01/26/2023]
Abstract
Understanding factors related to suboptimal adherence to antiretroviral therapy (ART) and detectable viral load (VL), especially among vulnerable populations, is needed to improve HIV outcomes. The Caribbean is highly impacted by HIV and socioeconomic inequalities, but few studies have been conducted there to explore food insecurity among people with HIV and factors associated with viral suppression in this vulnerable population. Using baseline data from a pilot intervention trial among people living with HIV and food insecurity in the Dominican Republic, we examined psychosocial and behavioral factors associated with viral suppression, ART adherence, and competing needs. Among participants (n = 115), 61% had a detectable VL; the strongest factor associated with detectable VL was having missed taking ART in the last six months due to not having food (OR = 2.68, p = 0.02). Greater odds of reporting missed ART doses due to not having food were associated with severe food insecurity (OR = 4.60, p = 0.006), clinical depression (OR = 2.76, p = 0.018), Haitian background (OR = 6.62 p = 0.017), and internalized HIV stigma (OR = 1.09, p = 0.041), while lower odds were associated with social support (OR = 0.89, p = 0.03) and having health insurance (OR = 0.27, p = 0.017). Ensuring that people with HIV and food insecurity have food to take with their ART is essential for viral suppression.
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Affiliation(s)
- Kathryn P. Derose
- Behavioral and Policy Sciences Department, RAND Corporation, Santa Monica, CA
- Department of Health Promotion and Policy, University of Massachusetts, Amherst
| | - Bing Han
- Economics, Sociology, & Statistics Department, RAND Corporation, Santa Monica, CA
| | | | - Kartika Palar
- Division of HIV, ID and Global Medicine, University of California, San Francisco, San Francisco, CA
| | - Amarilis Then-Paulino
- Facultad de Ciencias de la Salud, Universidad Autónoma de Santo Domingo, Santo Domingo, Dominican Republic
- Ministerio de Salud Pública, Santo Domingo, Dominican Republic
| | - Gipsy Jimenez-Paulino
- Facultad de Ciencias de la Salud, Universidad Autónoma de Santo Domingo, Santo Domingo, Dominican Republic
| | - Lila Sheira
- Division of HIV, ID and Global Medicine, University of California, San Francisco, San Francisco, CA
| | - Ramón Acevedo
- Consejo Nacional para el VIH y Sida (CONAVIHSIDA), Santo Domingo, Dominican Republic
| | - Claudio Lugo
- Facultad de Ciencias de la Salud, Universidad Autónoma de Santo Domingo, Santo Domingo, Dominican Republic
| | - Isidro Veloz
- Facultad de Ciencias de la Salud, Universidad Autónoma de Santo Domingo, Santo Domingo, Dominican Republic
| | - Yeycy Donastorg
- Unidad de Vacunas e Investigación, Instituto Dermatológico Dominicano y Cirugía de Piel Dr. Huberto Bogaert Díaz, Santo Domingo, Dominican Republic
| | - Glenn Wagner
- Behavioral and Policy Sciences Department, RAND Corporation, Santa Monica, CA
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Lucien MAB, Pierre K, Jean-Denis G, Rigodon J, Worrell CM, Couture A, Flynn A, Calderon MC, Codina LF, Vicari AS, Marseille S, Jean Baptiste KT, Fouche B, Joseph G, Journel I, Rendel K, Grant-Greene Y, Jean-Charles NP, Lafontant D, Amouzou S, Pierre W, Clement MGR, Juin S, Boncy J, Dely P. Epidemiology and risk factors related to severity of clinical manifestations of COVID-19 in outpatients: A retrospective study in Haiti. PLoS One 2022; 17:e0274760. [PMID: 36129879 PMCID: PMC9491605 DOI: 10.1371/journal.pone.0274760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 09/05/2022] [Indexed: 11/19/2022] Open
Abstract
Background Haiti’s first COVID-19 cases were confirmed on March 18, 2020, and subsequently spread throughout the country. The objective of this study was to describe clinical manifestations of COVID-19 in Haitian outpatients and to identify risk factors for severity of clinical manifestations. Methods We conducted a retrospective study of COVID-19 outpatients diagnosed from March 18-August 4, 2020, using demographic, epidemiological, and clinical data reported to the Ministry of Health (MoH). We used univariate and multivariate analysis, including multivariable logistic regression, to explore the risk factors and specific symptoms related to persons with symptomatic COVID-19 and the severity of symptomatic COVID-19 disease. Results Of 5,389 cases reported to MOH during the study period, 1,754 (32.5%) were asymptomatic. Amongst symptomatic persons 2,747 (75.6%) had mild COVID-19 and 888 (24.4%) had moderate-to-severe disease; the most common symptoms were fever (69.6%), cough (51.9%), and myalgia (45.8%). The odds of having moderate-to-severe disease were highest among persons with hypertension (aOR = 1.72, 95% Confidence Interval [CI] (1.34, 2.20), chronic pulmonary disease (aOR = 3.93, 95% CI (1.93, 8.17)) and tuberculosis (aOR = 3.44, 95% CI (1.35, 9.14)) compared to persons without those conditions. The odds of having moderate-to-severe disease increased with age but was also seen among children aged 0–4 years (OR: 1.73, 95% CI (0.93, 3.08)), when using 30–39 years old as the reference group. All of the older age groups, 50–64 years, 65–74 years, 75–84 years, and 85+ years, had significantly higher odds of having moderate-to-severe COVID-19 compared with ages 30–39 years. Diabetes was associated with elevated odds of moderate-to-severe disease in bivariate analysis (OR = 2.17, 95% CI (1.58,2.98) but, this association did not hold in multivariable analyses (aOR = 1.22,95%CI (0.86,1.72)). Conclusion These findings from a resource-constrained country highlight the importance of surveillance systems to track emerging infections and their risk factors. In addition to co-morbidities described elsewhere, tuberculosis was a risk factor for moderate-to-severe COVID-19 disease.
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Affiliation(s)
- Mentor Ali Ber Lucien
- National Public Health Laboratory (LNSP)/ Ministry of Public Health and Population (MSPP), Port au Prince, Haiti
| | - Katilla Pierre
- Directorate of Epidemiology, Laboratories and Research (DELR)/MSPP, Port au Prince, Haiti
| | - Gladzdin Jean-Denis
- Pan American Health Organization, World Health Organization (PAHO/WHO), Port-au-Prince, Haiti
| | - Jonas Rigodon
- U.S. Centers for Disease Control and Prevention, Port-au-Prince, Haiti
- * E-mail:
| | - Caitlin M. Worrell
- Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Alexia Couture
- COVID-19 International Task Force Emergency Response Capacity Team, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Aspen Flynn
- COVID-19 International Task Force Emergency Response Capacity Team, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Mauricio Cerpa Calderon
- Pan American Health Organization, World Health Organization (PAHO/WHO), Port-au-Prince, Haiti
| | - Luis Felipe Codina
- Pan American Health Organization, World Health Organization (PAHO/WHO), Port-au-Prince, Haiti
| | - Andrea S. Vicari
- Pan American Health Organization, World Health Organization (PAHO/WHO), Washington, DC, United States of America
| | - Samson Marseille
- Directorate of Epidemiology, Laboratories and Research (DELR)/MSPP, Port au Prince, Haiti
| | | | | | - Gerard Joseph
- National Public Health Laboratory (LNSP)/ Ministry of Public Health and Population (MSPP), Port au Prince, Haiti
| | - Ito Journel
- National Public Health Laboratory (LNSP)/ Ministry of Public Health and Population (MSPP), Port au Prince, Haiti
| | - Kenold Rendel
- Directorate of Epidemiology, Laboratories and Research (DELR)/MSPP, Port au Prince, Haiti
| | | | | | - Donald Lafontant
- Directorate of Epidemiology, Laboratories and Research (DELR)/MSPP, Port au Prince, Haiti
| | - Senou Amouzou
- Directorate of Epidemiology, Laboratories and Research (DELR)/MSPP, Port au Prince, Haiti
| | - Wilnique Pierre
- Directorate of Epidemiology, Laboratories and Research (DELR)/MSPP, Port au Prince, Haiti
| | | | - Stanley Juin
- U.S. Centers for Disease Control and Prevention, Port-au-Prince, Haiti
| | - Jacques Boncy
- National Public Health Laboratory (LNSP)/ Ministry of Public Health and Population (MSPP), Port au Prince, Haiti
| | - Patrick Dely
- Directorate of Epidemiology, Laboratories and Research (DELR)/MSPP, Port au Prince, Haiti
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Louis R, Pu R, Logan TD, Trimmer-Smith L, Chamblain R, Gallagher A, De Rochars VMB, Nelson E, Cummings DAT, Long MT, Morris JG. SARS-CoV-2 infections in infants in Haiti 2020–2021; evidence from a seroepidemiological cohort. PLoS One 2022; 17:e0273482. [PMID: 36006976 PMCID: PMC9409576 DOI: 10.1371/journal.pone.0273482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/10/2022] [Indexed: 11/21/2022] Open
Abstract
Few data are available on frequency of SARS-CoV-2 infection among very young children in low- to middle-income countries (LMIC), with the studies that are available biased towards higher income countries with low reported infection and seroconversion rates. Between February 2019 and March 2021, 388 dried blood spot (DBS) samples were obtained from 257 children less than 30 months of age as part of a prospective observational cohort study of pregnant women and their infants in Haiti; longitudinal samples were available for 107 children. In a subsequent retrospective analysis, DBS samples were tested by ELISA for antibody targeting the receptor binding domain of the SARS-CoV-2 S1 protein. Over the course of the study, 16·7% of the infants became seropositive. All seropositive samples were collected after March 19, 2020 (the date of the first reported COVID-19 case in Haiti) with the highest hazards measured in August 2020. Sampling date was the only covariate associated with the hazard of seroconversion. Our data provide an estimate of SARS-CoV-2 infection rates among very young children without prior SARS-CoV-2 exposure during the initial pandemic waves in Haiti, and demonstrate that these children mount a detectable serological response which is independent of patient age.
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Affiliation(s)
- Rigan Louis
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, United States of America
- Faculte de Medicine et de Pharmacie, Universite d’Etat d’Haiti, Port-au-Prince, Haiti
| | - Ruiyu Pu
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, United States of America
- Department of Comparative Diagnostic and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL, United States of America
| | - Tracey D. Logan
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, United States of America
- Department of Comparative Diagnostic and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL, United States of America
| | - Luke Trimmer-Smith
- Department of Comparative Diagnostic and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL, United States of America
| | - Richard Chamblain
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, United States of America
- Faculte de Medicine et de Pharmacie, Universite d’Etat d’Haiti, Port-au-Prince, Haiti
| | - Adriana Gallagher
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, United States of America
- Department of Comparative Diagnostic and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL, United States of America
| | - Valery Madsen Beau De Rochars
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, United States of America
- Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States of America
| | - Eric Nelson
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, United States of America
- Department of Pediatrics, College of Medicine, University of Florida, Gainesville, FL, United States of America
- Department of Environmental and Global Health, University of Florida, Gainesville, FL, United States of America
| | - Derek A. T. Cummings
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, United States of America
- Department of Biology, College of Liberal Arts and Sciences, University of Florida, Gainesville, FL, United States of America
| | - Maureen T. Long
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, United States of America
- Department of Comparative Diagnostic and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL, United States of America
| | - J. Glenn Morris
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, United States of America
- Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, United States of America
- * E-mail:
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49
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Ikejezie J, Langley T, Lewis S, Bisanzio D, Phalkey R. The epidemiology of diphtheria in Haiti, December 2014–June 2021: A spatial modeling analysis. PLoS One 2022; 17:e0273398. [PMID: 35994502 PMCID: PMC9394811 DOI: 10.1371/journal.pone.0273398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 08/08/2022] [Indexed: 11/29/2022] Open
Abstract
Background Haiti has been experiencing a resurgence of diphtheria since December 2014. Little is known about the factors contributing to the spread and persistence of the disease in the country. Geographic information systems (GIS) and spatial analysis were used to characterize the epidemiology of diphtheria in Haiti between December 2014 and June 2021. Methods Data for the study were collected from official and open-source databases. Choropleth maps were developed to understand spatial trends of diphtheria incidence in Haiti at the commune level, the third administrative division of the country. Spatial autocorrelation was assessed using the global Moran’s I. Local indicators of spatial association (LISA) were employed to detect areas with spatial dependence. Ordinary least squares (OLS) and geographically weighted regression (GWR) models were built to identify factors associated with diphtheria incidence. The performance and fit of the models were compared using the adjusted r-squared (R2) and the corrected Akaike information criterion (AICc). Results From December 2014 to June 2021, the average annual incidence of confirmed diphtheria was 0.39 cases per 100,000 (range of annual incidence = 0.04–0.74 per 100,000). During the study period, diphtheria incidence presented weak but significant spatial autocorrelation (I = 0.18, p<0.001). Although diphtheria cases occurred throughout Haiti, nine communes were classified as disease hotspots. In the regression analyses, diphtheria incidence was positively associated with health facility density (number of facilities per 100,000 population) and degree of urbanization (proportion of urban population). Incidence was negatively associated with female literacy. The GWR model considerably improved model performance and fit compared to the OLS model, as indicated by the higher adjusted R2 value (0.28 v 0.15) and lower AICc score (261.97 v 267.13). Conclusion This study demonstrates that GIS and spatial analysis can support the investigation of epidemiological patterns. Furthermore, it shows that diphtheria incidence exhibited spatial variability in Haiti. The disease hotspots and potential risk factors identified in this analysis could provide a basis for future public health interventions aimed at preventing and controlling diphtheria transmission.
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Affiliation(s)
- Juniorcaius Ikejezie
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- * E-mail:
| | - Tessa Langley
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Sarah Lewis
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Donal Bisanzio
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- RTI International, Washington, District of Columbia, United States of America
| | - Revati Phalkey
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Climate Change and Health Unit, UK Health Security Agency, London, United Kingdom
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
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50
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Chen Y, Rafful C, Mercado M, Carte L, Morales-Miranda S, Cheristil J, Rocha-Jiménez T. Hoping for a Better Future during COVID-19: How Migration Plans Are Protective of Depressive Symptoms for Haitian Migrants Living in Chile. Int J Environ Res Public Health 2022; 19:9977. [PMID: 36011611 PMCID: PMC9408526 DOI: 10.3390/ijerph19169977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/05/2022] [Accepted: 08/10/2022] [Indexed: 06/15/2023]
Abstract
This paper explores the migration experiences, perceived COVID-19 impacts, and depression symptoms among Haitian migrants living in Santiago, Chile. Ninety-five participants from eight neighborhoods with a high density of Haitian migrants were recruited. Descriptive statistics, univariate analysis, and logistic regression analysis were conducted. Chi-squared tests were used to confirm univariate results. We found that 22% of participants had major depressive symptoms based on the CESD-R-20 scale, 87% reported major life changes due to COVID-19, and 78% said their migration plans had changed due to the pandemic. Factors associated with more depressive symptoms were being in debt (OR = 3.43) and experiencing discrimination (ORs: 0.60 to 6.19). Factors associated with less odds of depressive symptoms were social support (ORs: 0.06 to 0.25), change in migration plans due to COVID-19 (OR = 0.30), and planning to leave Chile (OR = 0.20). After accounting for relevant factors, planning to leave Chile is significantly predictive of fewer symptoms of depression. Haitian migrants living in Chile had a high prevalence of depression. Planning to leave Chile was a significant protector against depressive symptoms. Future studies should explore how nuanced experiences of uncertainty play out in migrants' lives, mental well-being, and planning for their future.
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Affiliation(s)
- Yijing Chen
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY 10032, USA
| | - Claudia Rafful
- Faculty of Psychology, Universidad Nacional Autonoma de Mexico, Circuito Ciudad Universitaria Avenida, C.U., Mexico City 04510, Mexico
- Center for Global Mental Health, National Institute of Psychiatry, Calz México-Xochimilco 101, Colonia, Huipulco, Tlalpan, Mexico City 14370, Mexico
| | - Mercedes Mercado
- Faculty of Psychology, Universidad Diego Portales, Santiago 8320000, Chile
| | - Lindsey Carte
- Núcleo de Ciencias Sociales y Humanidades, Universidad de la Frontera, Francisco Salazar 1450, Temuco 4811230, Chile
| | - Sonia Morales-Miranda
- Consorcio de Investigación sobre VIH SIDA TB CISIDAT, Dwight W. Morrow 8, Apt. 7, Centro, Cuernavaca 62000, Mexico
| | - Judeline Cheristil
- Project “When Reality Overcomes the Intention”, Las Condes 7560908, Chile
| | - Teresita Rocha-Jiménez
- Society and Health Research Center, Facultad de Ciencias Sociales y Artes, Universidad Mayor, Las Condes 4780000, Chile
- Millennium Nucleus on Sociomedicine (SocioMed), Las Condes 7560908, Chile
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