Caribbean Countries Research Articles

Sickle Cell Disease Newborn Screening—An Audit of a Twin Island State Pilot Program

The prevalence of Sickle Cell Disease (SCD) within the Caribbean region remains second only to that of West Africa. The Newborn Screening (NBS) Program in Antigua and Barbuda remains heavily dependent on grants, therefore ultimately facing sustainability challenges. Early intervention and implementation of preventative measures post-NBS result in significant improvements in morbidity, quality of life, and survival. This audit reviewed the pilot SCD NBS Program in Antigua and Barbuda from September 2020 to December 2021. A conclusive result was received by 99% of babies eligible for screening, 84.3% of which were HbFA, whilst 9.6% and 4.6% were HbFAS and HbFAC, respectively. This was comparable to other Caribbean countries. Sickle Cell Disease was noted in 0.5% of babies screened, which translates to 1 in 222 live births. Eighty-two percent of mothers were aware of their sickle cell status, compared to 3% of fathers. The importance of instituting a quality improvement team post the initiation of a screening program and the need for a robust public education program have been demonstrated by this audit.

Psychosis as a potential mental health consequence of racism

Introduction Evidence shows that racism can have a negative effect on mental health in the lived experiences of Black people and People of Colour. In critical theory discourse including postcolonial and decolonial approaches, racism is suggested to be an everyday phenomenon. Additionally, racism specifically targets the perceived cultural and phenotypic foreignness of Black migrants and migrants Of Colour, as well as the ascribed migrant status attributed to the perceived foreignness of racialized persons who do not actually have any direct migration experiences. Objectives The stigma associated with severe mental disorders such as psychosis has historically been applied to Black people and People of Colour who have been engaged in anti-racist activism as a form of punishment and social control. Higher incidence rates of psychosis in racialized communities have frequently been conceptualized as cultural differences in family composition and levels of expressed emotion in families. The objective of this study is to sensitively investigate psychosis as a potential mental health consequence of racism. Methods The incidence rates of psychosis - positive symptoms, negative symptoms, non-affective psychosis disorders and first episode psychosis - among migrants by country of migration were compiled in an umbrella review, which offers a summary of meta-analyses. Quantitative research has the limitation of enabling the observation of patterns but not allowing an understanding of the reasons behind them to be theorized through the data. Therefore, qualitative methods complement the quantitative data. Twenty people of diverse genders who self-identified as Black people or People of Colour in Berlin were interviewed about their experiences of racism and sexism and about how those experiences affected their mental health. Results The umbrella review found an association between migration and psychosis, with migration from the Caribbean and African countries showing the strongest correlation. A constant comparative analysis of the qualitative data suggests that racism contributes to the emergence of a subclinical psychosis symptomatology profile that consists of a sense of differentness, negative self-awareness, paranoid ideation regarding general persecution, and self-questioning with self-esteem instability. Conclusions The findings are interpreted as a situational diagnosis, as coined by the psychiatrist and political philosopher Frantz Fanon in the seminal book ‘Black Skin, White Masks’ (1975). The findings are also contextualized within a critique of institutional racism, both historically and currently, and within an intersectional discussion of the need for structural competency and the provision of safety for racialized groups in clinical settings. Disclosure of Interest None Declared

Paradoxes and Anomalies in Caribbean Anti-Trafficking Law and Practice

This article critically assesses existing state practices on human trafficking in the Caribbean. More specifically, through analysis of empirical data gleaned from semi-structured interviews with fifty stakeholders (government officials and nongovernmental organization representatives) in twelve Caribbean countries, this article assesses the four main contentious areas of state practice with which regional stakeholders are most concerned: the description of "trafficking in persons" as "modern slavery," the illegitimacy of the US TIP Reports, investigations into trafficking in persons, and victim identification and referral. This article presents postcolonial critiques of anti-trafficking law and practice in the foregoing four areas.

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.

The ‘contract’ and its discontents: Can it address protection gaps for migrant agricultural workers in Canada?

AbstractCanada's Seasonal Agricultural Worker Program has often been portrayed as a model for temporary migration programmes. It is largely governed by the Contracts negotiated between Canada and Mexico and Commonwealth Caribbean countries respectively. This article provides a critical analysis of the Contract by examining its structural context and considers the possibilities and limitations for ameliorating it. It outlines formal recommendations that the article co‐authors presented during the annual Contract negotiations between Canada and sending states in 2020. The article then explains why these recommendations were not accepted, situating the negotiation process within the structural context that produces migrant workers' vulnerability, on the one hand, and limits the capacity of representatives of sending and receiving states to expand rights and offer stronger protections to migrant farmworkers, on the other hand. We argue that fundamental changes are required to address the vulnerability of migrant agricultural workers. In the absence of structural changes, it is nevertheless important to seek improvements in the regulation of the programme through any means possible, including strengthening the Contract.

Do remittances react to commodity windfall? Evidence from Latin America and the Caribbean

Remittance has been growing steadily in the past decades, along with the pace of globalization. The current literature has focused extensively on the impact of remittances on growth, while the causal evidence in identifying the relationship between income shocks and remittances is limited. Using a panel of 30 countries in Latin American and Caribbean (LAC) region from 1990–2014, we examine the effects of exogenous income from international commodity price windfall on remittances. Our paper finds that an increase in commodity windfall leads to a significant rise in remittance inflows. We also reveal that financial development underpins the “commodity windfall-remittances” relation. Remittance is a low-cost financing option in countries with low levels of financial development; hence they receive more remittance flow in response to the commodity windfall. Our finding calls for more policy attention to promote migrants’ access to financial services.

Quality of Life and Psychosocial Well-Being among Intersex-Identifying Individuals in Puerto Rico: An Exploratory Study.

Intersex is an umbrella term used to describe the diversity or differences in the characteristics of physical sexual development. Approximately 1.7% of the population are born intersex, and 1 in every 2000 babies at birth presents genital variation. Unfortunately, there is a lack of research on the health of intersex-identifying persons in Latin America. This study aimed to document experiences of discrimination and violence among self-identifying intersex individuals in Puerto Rico and to determine if there is a significant difference in the quality of life, psychological well-being, and social well-being between intersex-identifying and endosex individuals. This was a quantitative method pilot study with a cross-sectional approach and exploratory comparative group design. An online survey was used, where a total of 12 self-identifying intersex adult participants were recruited, and 126 endosex adult participants served as a comparative group. The findings show that 83% of the participants reported experiences of discrimination and different types of violence due to their intersexuality. There was a significant difference between the intersex-identifying and endosex groups in psychological well-being, including in three of its dimensions (positives relations, autonomy, and environmental mastery). However, there were no significant differences between the groups in quality of life or social well-being. The findings of this study provide a preliminary understanding of the health disparities of intersex-identifying individuals in Puerto Rico and suggest the need for more profound research, especially the inclusion of other Caribbean and Hispanic countries. The findings also preliminarily imply the need for local and global interventions to reduce physical and mental health disparities and to improve health, quality of life, and well-being among intersex-identifying individuals.

Building bridges through cultural adaptation: Examining the initial impact of a culturally adapted parent training intervention for the Chilean context.

Child exposure to maltreatment and neglect constitutes a significant public health problem throughout Latin American and Caribbean (LAC) countries. Although evidence-based parent training (PT) interventions constitute an empirically demonstrated alternative to prevent child maltreatment and neglect, multiple implementation barriers have prevented the large-scale dissemination of evidence-based PT interventions across LAC countries. This selective prevention study consisted of an exploratory quasi-experimental design implemented in Chile, aimed at examining the initial impact of a culturally adapted version of the evidence-based PT intervention known as GenerationPMTO©. The parenting intervention was adapted in a previous pilot study, according to a rigorous model of cultural adaptation. Based on self-reports completed by 281 caregivers, when compared to baseline measurements, significant improvements at intervention completion were observed in the majority of caregivers' parenting practices, as well as child internalizing and externalizing problematic behaviors. This study provides promising initial empirical evidence that efficacious PT interventions developed in the US can be transported to Latin American contexts, as long as they are thoroughly adapted to achieve high contextual and cultural relevance. The rates of child maltreatment across LAC countries constitute an urgent and permanent call for strongly promoting this line of prevention research.

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Health and economic benefits of achieving contraceptive and maternal health targets in Small Island Developing States in the Pacific and Caribbean

IntroductionReducing unmet need for modern contraception and expanding access to quality maternal health (MH) services are priorities for improving women’s health and economic empowerment. To support investment decisions, we estimated...

Health and economic burden of disease of sugar-sweetened beverage consumption in four Latin American and Caribbean countries: a modelling study

ObjectiveOverweight and obesity are important contributors to the non-communicable disease burden. The consumption of sugar-sweetened beverages (SSBs) has been associated with an increased risk of type 2 diabetes mellitus (T2DM),...

Review of Intelligent Algorithms for Breast Cancer Control: a Latin America Perspective

Breast cancer in women is a worldwide health problem that is one of the main causes of death. This situation is accentuated in Latin America and the Caribbean countries, where about 159 women die daily from this disease. The World Health Organization recommends focusing on Prevention and Early Detection of cancer to reduce mortality. However, this requires a great deal of information processing and analysis by experts, who require the support of technology to perform these tasks promptly. In recent years, the use of so-called intelligent algorithms has increased to support the fight against breast cancer. The authors summarized the studies published between January 2016 and June 2021, highlighting the current situation and opportunities for Latin America and the Caribbean. Studies were selected using the following terms: intelligent algorithms, assessment metrics, stages of breast cancer control addressed, data sources, data types, female population with breast cancer under study and the countries of the authors who have written articles on this subject. In this study, after applying the inclusion and exclusion criteria 226 articles were selected from a total of 1,105 articles found in the ACM digital library, IEEE Explore, Nature, PubMed, Scopus (Science Direct) and Springer Link databases. Publication between January 2016 and June 2021, breast cancer as main interest, algorithm and data type information, along with compliance with the general question were the inclusion criteria, while, being a research article, compliance with the three subqueries and availability, were the exclusion criteria. Using a spreadsheet as based tool to collect and analyze the data, the study found that the most used elements were: SVM, RF and DT algorithms; accuracy as assessment metric; public information sources; data on tumors (size and shape, among others); USA information sources; India as the country of the first authors who wrote the most articles of the selected papers; and Diagnosis and treatment as the most addressed stage of cancer control. Results in this review paper provide an overview of the application of intelligent algorithms against breast cancer. In this regard, the gaps that were detected are: the Prevention stage of cancer control has not been addressed with intelligent algorithms, and the Early Detection stage has been very little addressed; private data sources could be beneficial in this type of research, but the difficulty in accessing them is a barrier for researchers. In addition, although Latin America and the Caribbean have a significant death rate from breast cancer, patients in this region have not been the subject of study and the participation of researchers on the subject has been almost nonexistent. Finally, there seems to be a great opportunity to generate proposals based on intelligent algorithms with low cost and time to implement that could directly impact patient survival, improving the health systems of the countries in the region.

Abstract TMP48: Current State Of Acute Stroke Thrombolysis In The MT2020+ Caribbean Region

Introduction: Alteplase is the only FDA approved thrombolytic agent for acute ischemic stroke, tenecteplase is rapidly emerging as an alternative. While both agents are readily available worldwide, low to middle income countries have limited access to acute treatment. To our knowledge, there is no validated tool available to objectively measure access to thrombolytic agents or barriers to routine clinical use. Methods: We develop the 17-item tPA Spot Check tool to assess utilization of acute stroke thrombolysis in multiple languages. This tool was used to evaluate the current state of clinical practices in the MT2020+ Caribbean Region. Data was analyzed via SPSS. Results: The survey was validated by three international experts with an Average Content Validity Index of 1 and a Universal Agreement index of 1 across three domains: local experience, financial constraints, and barriers to utilization.Survey response rate was 64% (73/114 responses) 46 in English, 14 in Spanish and 13 in French. Fifteen out of 44 MT2020+ Caribbean countries (34%) participated: Haiti, Dominican Republic, Jamaica, Puerto Rico, St. Lucia, Bermuda, Bahamas, Cayman Islands, Trinidad and Tobago, Barbados, Dominica, Venezuela, Nicaragua, Honduras, and Guadalupe. There was limited or no access to thrombolytic agents in 40% of countries surveyed, with 13% resorting to the use of streptokinase. Among cases treated with thrombolytics, 43% of patients had to pay out of pocket before treatment provided, 36% of treatment was paid by insurance plus patients and less than 10% were covered by insurance or governmental support respectively. Among 51% of countries survey, no acute thrombolytic treatment was provided for acute stroke in 2021 calendar year. Only 1 center treated more than 100 cases per year. Majority of respondents (88%) agreed there were barriers to acute stroke thrombolysis in the region. Absence of Stroke protocol (p&lt;0.001), upfront cost of alteplase (p= 0.003) and access to CT scan (p=0.03) were independent predictors of fewer patients treated per year. Conclusion: This this survey brings light to an enormous disparity in care of stroke patients around the world, specifically in the MT2020+ Caribbean region. We create a valid tool can be used to assess local access to thrombolytic.

Russian-Latin American diplomatic and trade-economic relations as the multipolar world’s formation basis

The article is dedicated to diplomatic and trade-economic relations between Russia and Latin American countries as one of bases of multipolar world’s formation. Clearly, the emergence of the multipolar world is a difficult and long-term process. Yet, this world is now being created by states, political and economic associations, regions and whole continents. Latin American and Caribbean countries are actively participating in the formation of this new world order. The countries of the region hold quite independent views on many international problems including the formation of new world order, and these views share much similarity with Russian opinion on the matter. These states support the leading role of the UN and its Security Council; they did not join the western sanctions against Russia and practically stopped being the USA’s “backyard”. Moreover, the majority of Latin American countries have introduced the visa-free regime for Russian citizens. This lets us consider the Latin America to be the element in the building of the new world order. Many states seek to develop and support the stable diplomatic and trade-economic relations with Latin American countries, especially China, the USA and the European Union. Russia has a long history of international relations with Latin American countries. In the XIX century the Russian Empire established the diplomatic relations with Argentina, Brazil and Venezuela. Later, the USSR supported close diplomatic and trade-economic relations with a number of Latin American states. After the dissolution of the USSR the Russian relations with these countries were recreated, developed and strengthened. Our cooperation is growing in all areas: diplomacy, trade, science, education, medicine, energy etc. Now the questions of creating the common bank and trading in national currencies are being discussed. Russia enjoys the diplomatic relations with all Latin American countries; these relations are evolving, and there are perspectives of their future enhancement.

Review of threats and implementation of the Regional Action Plan for the Conservation of Marine Mammals in the Wider Caribbean Region

The Action Plan for the Conservation of Marine Mammals in the Wider Caribbean Region (MMAP) was adopted in 2008 by Contracting Parties under the Protocol concerning Specially Protected Areas and Wildlife (SPAW) of the Cartagena Convention, administered by the United Nations Environment Programme (UN Environment). After more than a decade of MMAP-related programmatic work under SPAW, this paper presents a synthesis of major threats to marine mammals in the Region and an assessment of progress achieved by the 17 Contracting Parties to the SPAW Protocol toward achieving implementation of the MMAP and based upon a scientific and technical analysis conducted in 2020. The country assessment focused on 11 threat categories (indicators), along with two additional indicators relating to country legislation and national action plans. As part of this scientific and technical analysis, surveys were sent to SPAW Contracting Party focal points and individual interviews were conducted with key regional organizations and experts. For every SPAW Contracting Party, each indicator was assigned a relative level of its current intensity (Low, Moderate, High, or Unknown). A similar scheme was utilized to represent each country’s response to that threat. The results highlighted those threats that were of concern for several countries and hence may be considered a management priority at the regional scale. In terms of threat mitigation, these priorities are: interaction between marine mammals and fisheries, pollution, and acoustic disturbance. Regarding needs, the development of national marine mammal action plans, as well as the implementation of research and monitoring programmes dedicated to marine mammals, should be considered a priority. Finally, two threats were found to be of high priority for knowledge enhancement: acoustic disturbance and vessel strikes. It is important to note that this review was not intended to single out insufficient country effort, but rather assist Wider Caribbean countries to identify threats and/or issue areas which would benefit from attention.

A review of immunization legislation for children in English- and Dutch-speaking Caribbean countries.

To assess the legislative frameworks concerning childhood vaccination in the English- and Dutch-speaking Caribbean and propose a model legislative framework for Caribbean countries. This study included a survey of 22 countries and territories in the Caribbean regarding legal vaccination mandates for school entry, budget allocations, sanctions, or exemptions. A legal consultant conducted a comprehensive search and analysis of legislation regarding vaccination among 13 Caribbean countries/territories. A comparative analysis of the legislation under five themes-legislative structure, mandatory vaccination, national immunization schedule, sanctions, and exemptions-formed the basis for the proposed model legislation. Among the 22 Caribbean countries/territories, 17 (77%) had legislation mandating vaccination, 16 (94%) mandated vaccination for school entry, 8 (47%) had a dedicated budget for immunization programs, and 13 (76%) had no legislated national schedules. The source of legislation includes six (35%) using the Education Act, eight (47%) the Public Health Act, and five (29%) a free-standing Vaccination Act. Three countries/territories-Jamaica, Montserrat, and Saint Lucia-had immunization regulations. In 12 (71%) of the 17 countries with legislation, sanctions were included, and 10 (59%) permitted exemptions for medical or religious/philosophical beliefs. Several countries in the Caribbean have made failure to vaccinate a child an offense. By summarizing the existing legislative frameworks and approaches to immunization in the Caribbean, the analysis guides policymakers in making effective changes to immunization legislation in their own countries.

The impact of tourism on the women employment in South American and Caribbean countries

Purpose This study aims to explore the relationship between tourism and women’s employment in 32 South American and Caribbean countries from 1996 to 2020. Design/methodology/approach In this paper, both static (fixed effects and random effects) and dynamic panel data models (system and differenced generalized method of moments) are used. In addition to gross domestic product, trade, education and urban population are also considered in this study. Findings According to the findings, a boost in tourism led to an increase in women’s engagement in the economy and service sectors. This paper also explores the efficiency of alternate methods to deal with various models of women labor force (WLF) involvement in various sectors. Women’s employment opportunities in the service sector expand as a result of tourism, but in the agricultural and industrial sectors, that employment opportunity is reduced. Research limitations/implications This study investigated the impact of tourism on WLF participation and found that it had a significant impact. This study, on the other hand, specifically contributed to the tourism sector in some specific study areas, such as tourism and agriculture, service and industry sectors. This study also displays that female participation in South America and the Caribbean countries is increasing and women are shifting away from traditional economic sectors. Originality/value This is the pioneering study to discover tourism and female participation in employment in South American and Caribbean countries. The findings of this study have important implications for future studies and policy debates examining the consequence of the tourism industry on WLF.

Age of autism diagnosis in Latin American and Caribbean countries.

An earlier diagnosis of autism spectrum disorder might lead to earlier intervention. However, people living in Latin American and Caribbean countries do not have much knowledge about autism spectrum disorder symptoms. It has been suggested that the older a child is when diagnosed, the fewer opportunities he or she will have to receive services. We asked 2520 caregivers of autistic children in six different Latin America and Caribbean Countries, the child's age when they noticed some developmental delays and their child's age when they received their first autism spectrum disorder diagnosis. Results indicate that, on average, caregivers were concerned about their child's development by 22 months of age; however, the diagnosis was received when the child was 46 months of age. In addition, older children with better language abilities and public health coverage (opposed to private health coverage) were diagnosed later. On the contrary, children with other medical problems and more severe behaviors received an earlier diagnosis. In our study, children were diagnosed around the time they entered formal schooling, delaying the access to early intervention programs. In summary, the characteristics of the autistic person and the type of health coverage influence the age of diagnosis in children living in Latin America and Caribbean Countries.

Analysis of Governance for Food and Nutrition Security in Three Caribbean Countries

Analysis of Governance for Food and Nutrition Security in Three Caribbean Countries

The COVID-19 Pandemic in Latin American and Caribbean countries: Gender Differentials in Labor Market Dynamics

Abstract We study gender differences in changes in labor market dynamics before the pandemic and during the COVID-19 pandemic in four Latin American and Caribbean (LAC) countries: Brazil, Chile, Dominican Republic, and Mexico. Specifically, we look at differences in labor market states and at differences in the transitions of workers across labor market states. To identify the pandemic's impact, we compare labor market stocks and labor market flows for a number of balanced panels of workers during the pandemic and before the pandemic. We find that the pandemic has negatively affected employment and labor market participation of both men and women, but that the effect is significantly stronger for women, magnifying the already large gender gaps observed in LAC countries. The main channel generating this stronger impact is the increase in child care work performed by women with school-age children.