Correction: Implementation of Genomic Surveillance of SARS-CoV-2 in the Caribbean: Lessons learned for sustainability in resource-limited settings

[This corrects the article DOI: 10.1371/journal.pgph.0001455.].

Implementation of genomic surveillance of SARS-CoV-2 in the Caribbean: Lessons learned for sustainability in resource-limited settings

The COVID-19 pandemic highlighted the importance of global genomic surveillance to monitor the emergence and spread of SARS-CoV-2 variants and inform public health decision-making. Until December 2020 there was minimal capacity for viral genomic surveillance in most Caribbean countries. To overcome this constraint, the COVID-19: Infectious disease Molecular epidemiology for PAthogen Control & Tracking (COVID-19 IMPACT) project was implemented to establish rapid SARS-CoV-2 whole genome nanopore sequencing at The University of the West Indies (UWI) in Trinidad and Tobago (T&T) and provide needed SARS-CoV-2 sequencing services for T&T and other Caribbean Public Health Agency Member States (CMS). Using the Oxford Nanopore Technologies MinION sequencing platform and ARTIC network sequencing protocols and bioinformatics pipeline, a total of 3610 SARS-CoV-2 positive RNA samples, received from 17 CMS, were sequenced in-situ during the period December 5th 2020 to December 31st 2021. Ninety-one Pango lineages, including those of five variants of concern (VOC), were identified. Genetic analysis revealed at least 260 introductions to the CMS from other global regions. For each of the 17 CMS, the percentage of reported COVID-19 cases sequenced by the COVID-19 IMPACT laboratory ranged from 0·02% to 3·80% (median = 1·12%). Sequences submitted to GISAID by our study represented 73·3% of all SARS-CoV-2 sequences from the 17 CMS available on the database up to December 31st 2021. Increased staffing, process and infrastructural improvement over the course of the project helped reduce turnaround times for reporting to originating institutions and sequence uploads to GISAID. Insights from our genomic surveillance network in the Caribbean region directly influenced non-pharmaceutical countermeasures in the CMS countries. However, limited availability of associated surveillance and clinical data made it challenging to contextualise the observed SARS-CoV-2 diversity and evolution, highlighting the need for development of infrastructure for collecting and integrating genomic sequencing data and sample-associated metadata.

Type 2 Diabetes Prevalence, Distribution and Risk Factors in St. Kitts and Nevis, West Indies

OBJECTIVES

This study in collaboration with the St. Kitts & Nevis Ministry of Health (MOH) investigated the prevalence of type 2 diabetes and its risk factors, the second leading cause of death in the country.

METHODS

Medical records of patients between the ages of 18 and 75 as of January 1, 2010 treated between January 1, 2010 and December 31, 2015 in the government-funded health centers (HCs) were eligible for inclusion (N = 2737). All HC visits (n = 4169) generated by a representative sample of patients (n = 761) were evaluated using Caribbean Public Health Association Public Health Association (CARPHA) guidelines for risk ranges.

RESULTS

The prevalence of type 2 diabetes is 23% and is concentrated in the 45-64 year-old cohort. Though women outnumber men 3:1 in the sample, gender-prevalence rates are similar (23% and 22% respectively). There is also evidence that comorbidities are prevalent among diabetics (76%) and many nondiabetics are at risk of diabetes (20%).

CONCLUSION

This study confirmed the MOH's concerns that type 2 diabetes presents local risk and brings into question historic assumptions that women are at greater risk of diabetes than men.

Non-communicable diseases in an older, aging population: a developing country perspective (Jamaica)

Changes in the non-communicable disease (NCD) profile of older adults living in a rapidly-aging, developing country are described.

METHODS

Data from a 2012 nationally representative survey of 2,943 older adults were used to determine the burden of NCDs important to elder health. Additionally, the percentage change in NCD prevalence over a 23-year period (1989-2012) was determined.

RESULTS

In 2012, approximately 75.3% of the sample reported at least one NCD; 47.5% reported comorbidities. High blood pressure (61%), arthritis (35%) and diabetes (26%) were the most reported conditions, peaking in the 70-79 age group. Females reported higher rates of disease than males. Significant increases in prevalence occurred for all conditions except arthritis; the most significant were in diabetes (157%) and cancer (118%).

CONCLUSION

Rapid increases in NCDs are of great public health importance. Strengthening of primary health care and improvements in human resources must occur if the well-being of older adults is to be improved.

Cardio-Vascular Disease and Cancer: A Dichotomy in Utilization of Clinical Preventive Services by Older Adults in a Developing Country

Objective: To report the level of utilization of clinical preventive services by older adults in Jamaica and to identify independent factors associated with utilization. Method: A nationally representative, community-based survey of 2,943 older adults was undertaken. Utilization frequency for six preventive, cardiovascular or cancer-related services was calculated. Logistic regression models were used to determine the independent factors associated with each service. Results: A dichotomy in annual utilization rates exists with cardiovascular services having much higher uptake than those for cancer (83.1% for blood pressure, 76.7% blood glucose, 68.1% cholesterol, 35.1% prostate, 11.3% mammograms, and 9.6% papanicolaou smears). Age, source of routine care, and having a chronic disease were most frequently associated with uptake. Discussion: Education of providers and patients on the need for utilizing preventive services in older adults is important. Improved access to services in the public sector may also help increase uptake of services.

Health status and health-seeking behaviour of Jamaican men fifty-five years and over

OBJECTIVE

The Caribbean including Jamaica is undergoing rapid population ageing with implications for health service planning and delivery. Such planning should take into account gender differentials. This study describes and analyses the health status and health-seeking behaviour of men 55 years and over in Jamaica.

METHOD

A quantitative cross-sectional survey employing cluster sampling techniques was utilized to recruit 2000 men, 55 years and older in the parish of St Catherine, Jamaica. A 126-item questionnaire was administered and standard instruments utilized to assess functional status.

RESULTS

Respondents (74%) rated their health status as excellent/good. Few men were highly dependent with regard to Activities of Daily Living with incontinence being a major concern. Medication management and shopping were the major Instrumental Activities of Daily Living domains where assistance was needed. Depression was associated with non-involvement in community/social organizations and not being in physical contact with their children. Major health conditions reported were cancers (16%), kidney/bladder conditions (12.7%), hypertension (9.2%) diabetes (6.5%) and prostate problems (7.3%). Most men (67.6%) had not visited a health provider in the year prior to the survey; 17.1% had been hospitalized after age 55 years. Only 35% of men ever had a prostate check/examination and 8.2% of men eligible for drug benefits under the Jamaica Drugs for the Elderly Programme registered for that programme.

CONCLUSION

There is need to focus on older men's health and ensure that primary prevention and early interventions reach middle-aged and older men while improving health literacy. Taking programmes to 'where men are" is suggested--the bars, race track and sports events. Gender and age-specific research should reduce gender disparities in health among older persons in Jamaica.