Haitian Health Research Articles

Where They Need Me: Local Clinicians and the Workings of Global Health in Haiti, by Pierre Minn

Where They Need Me: Local Clinicians and the Workings of Global Health in Haiti, by Pierre Minn

Providing healthcare under the threat of gang-violence: a survey of Haitian healthcare providers

In addition to having some of the worst health outcomes in the region, Haiti faces a political and economic crisis. The most recent humanitarian crisis includes an increase in homicides and kidnappings in the capital Port-au-Prince. This study is a cross-sectional, mixed methods online survey of health workers and medical students in Port-au-Prince from May 20 – September 15, 2023. It provides evidence of the kidnapping risk healthcare workers face and shares the perspective of a medical community operating in a challenging context to provide a continuity of care under the threat of violence. The survey of Haitian health workers and students show a significant risk of kidnapping with 44% of respondents reporting that they had a colleague kidnapped in the previous 2 years. 5 of the 249 respondents had been kidnapped and all were young, female health workers. 74% of health workers and students surveyed reported they plan to continue their profession abroad. Although teletraining was viewed as a positive opportunity to continue training cadres of medical professionals, health workers shared numerous limitations present for the expansion of telemedicine in the Haitian context. In addition to describing the experience of the Haitian healthcare professional during this crisis and documenting barriers to teletraining and telemedicine, this survey documents design considerations for mobile phone surveys with healthcare providers working in areas affected by conflict.

Changes in reproductive, maternal, and child health in Haiti during the pre- and peri-COVID-19 pandemic.

To assess changes in reproductive, maternal, newborn, child, and adolescent health (RMNCAH) in Haiti from August 2018 to September 2021, before and during the COVID-19 pandemic. A retrospective study using surveillance data from the Haitian Unique Health Information System, examining two periods: pre- and peri-COVID-19 pandemic. Health indicators at the national level in the two periods were compared using two-sample t-tests for proportions, and average absolute monthly changes were calculated using variance-weighted regression. There was a statistically significant decline in the proportion of most of the indicators assessed from the pre- to the peri-COVID-19 pandemic period. However, the most affected indicators were the proportions of pregnant women with four antenatal care visits, with five antenatal care visits or more, and those who received a second dose of tetanus vaccine, which decreased by over 4 percentage points during the two periods. Likewise, the proportions of children who received diphtheria, tetanus, and pertussis (DTaP), BCG, polio, pentavalent, and rotavirus vaccines also all declined by over 8 percentage points. In contrast, pneumococcal conjugate vaccine increased by over 4 percentage points. A statistically significant decrease was also observed in the average absolute monthly changes of several reproductive and child health indicators assessed. The COVID-19 pandemic may have contributed to the decline observed in several RMNCAH indicators in Haiti. However, the role played by the sociopolitical crisis and control exercised by armed groups over the population in the last three years cannot be ruled out.

Quantitative microbial risk assessment (QMRA) of the work of manual pit emptiers, commonly known as bayakous.

In Haiti, manual pit emptiers, known as bayakous, face significant health risks. They work by descending naked into latrine pits, exposing themselves to pathogens and contributing to environmental contamination. This study employs the quantitative microbial risk assessment (QMRA) method to evaluate the microbial risks associated with this practice, considering nine prevalent pathogens in Haiti. Three ingestion scenarios were developed: hand-to-mouth contact, ingestion while immersed in excreta, and a combination of both. A sensitivity analysis assessed the impact of input data on study outcomes. The results indicate a high probability of infection and illness during pit emptying operations annually for all scenarios and pathogens. Recommendations include adopting personal protective equipment (PPE) and using a manual Gulper waste pump to eliminate the need to descend directly into the pits, thereby reducing the risk of injury from sharp objects. The study proposes the establishment of intermediate disposal points approximately 5 km from collection sites to deter illegal dumping. National regulations and professionalization of the bayakou profession are suggested, along with awareness campaigns to promote PPE and Gulper pump usage. Addressing these issues is crucial for safeguarding the health of bayakou and public health in Haiti.

Assessing climate change impacts on public health in Haiti: a comprehensive study of disease distribution, modeling, and adaptation strategies

This study examines the relationship between climate change and public health in Haiti, a country already facing socioeconomic challenges. The well-being of Haiti’s vulnerable population is expected to be further affected by climate change, leading to an increase in vector-borne, water-borne, and heat-related diseases. As one of the most vulnerable countries to climate change effects, Haiti is currently experiencing an increase in vector-borne diseases such as malaria, dengue, and chikungunya, as well as water-borne diseases and emerging zoonotic outbreaks. This study aims to improve planning, decision-making, and responses to public health challenges by utilizing health data, climatic information, and impact models. The methodology involves the creation of a comprehensive climate and health database to uncover detailed spatial-temporal relationships on a national scale. By evaluating disease indicators from historical periods (1950-2014) and future projections (2015-2100) using the Shared Socio-Economic Pathways (SSPs) from the multi-model ensemble mean of the CMIP6 models, target diseases, including malaria, meningitis, dengue, and heat-sensitive chronic diseases are assessed. Our results highlight a decrease in rainfall and a strong increase in temperatures, especially within western Haiti under the extreme SSP585 scenario. The ability of the impact models to simulate the seasonality and spatial distribution of malaria incidence, dengue and heatwaves was performed. The analysis of risks related to climate-sensitive diseases’ climatic parameters shows that Haiti’s west and central regions are mostly exposed to vector-borne and water-borne diseases. Models predict a decrease in malaria cases due to climate change with hot temperatures and a decline in rainfall, while dengue transmission patterns may undergo changes. These findings will inform the implementation of context-specific early-warning systems and adaptation strategies for climate-sensitive diseases while acknowledging the challenges of integrating climate-altered data into health policies.

Exposure to the global rice trade: A comparative study of arsenic and cadmium in rice consumed in Haiti

Rice makes up nearly a quarter of dietary intake in Haiti. Rice consumption began to rapidly increase during the mid-1980s and 1990s, corresponding to policy interventions that promoted the importation and consumption of U.S.-grown rice, soon making Haiti the second largest export market for Ameri­can rice worldwide. Haitian growers also cultivate and sell local rice. Rice consumption can be a significant source of exposure to toxic metals since rice plants accumulate arsenic and cadmium from their envi­ronment. In August 2020, we collected samples of local (n=48) and imported (n=50) rice from vendor sites in the Lower Artibonite Valley region of Haiti. Cadmium and arsenic concentrat­ions were meas­ured via inductively coupled plasma mass spec­trom­e­try. Levels were compared between local versus imported commercial rice samples. For arsenic, we conducted a simulation study to esti­mate the intake of arsenic from varied quantities of local or imported rice samples on a per-body weight basis for adults and young children. We found that median concentrations were nearly two-fold higher for both arsenic and cadmium in im­ported rice (0.15 µg/g and 0.007 µg/g) compared to local rice (0.07 µg/g and 0.003 µg/g). Our simu­lation of arsenic intake through rice consumption suggests that adults of varying weights consuming 3 or more cups of imported rice per day would exceed a daily minimum risk level for toxicity. The simulation also suggests that most children con­suming 1 or more cups of local or imported rice per day would exceed a health-based arsenic intake limit. In Haiti, imported rice had an average level of arsenic twice that of locally grown product, with some imported sources exceeding the international limits recommended to protect human health. Cur­rent consumption patterns of imported rice over the long-term for children and adults may adversely impact health in Haiti. Strengthening community food systems can promote better health.

Rescuing Precarious Bodies: Biopolitics and Haitian Health in Edwidge Danticat’s Diasporic Writing

ABSTRACT Centering on the precarious bodies that are diseased or faced with health problems in Danticat’s oeuvre, this article from a biopolitical perspective examines how the malfunction of power exacerbates the health condition of individuals, and how those precarious bodies both expose the existing problems in Haiti’s health management and provide enlightenment to its improvement. This article argues that external causes of the diseased or health-threatened bodies in Danticat’s writing can be attributed to the abuse, misuse, or absence of authoritative power in health management, including the state’s inefficiency in managing people’s health and security, the neglect in environmental protection, and the authorities’ abuse of medical power, which demonstrate Danticat’s denunciation of the Haitian authoritative power’s inaction in health management and her appeals for urgent measures to be taken to improve people’s health. This article contributes to the discussions surrounding the disease narrative and health issues in Danticat’s writing, enhances people’s understanding of Haitian health issues from a non-Euro-American-centric lens, and enriches the research on biopolitical theories of health.

Trends and factors associated with recent HIV testing among women in Haiti: a cross-sectional study using data from nationally representative surveys

IntroductionIn 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.MethodsData 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.ResultsHIV 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.ConclusionsTo 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).

Recommendations for Integrating Traditional Birth Attendants to Improve Maternal Health Outcomes in Low- and Middle-Income Countries.

Adverse maternal health outcomes and high rates of maternal mortality continue to disproportionately affect low- and middle-income countries (LMICs). With limited access to health facility care, many women in LMICs rely on traditional birth attendants (TBAs) to meet their maternal health needs. While some studies consider the use of TBAs to be problematic, others suggest the integration of TBAs into maternal healthcare to improve health outcomes. The aim of this study is to utilize extant research to provide recommendations for optimizing the role of TBAs in maternal healthcare in Haiti, a LMIC. Each recommendation builds upon previous global health research, programmatic work, and a series of research studies conducted in Haiti to better understand and improve maternal healthcare in low-resource settings. Recommendations for integrating TBAs in maternal health include: (1) Integrate TBAs throughout prenatal, perinatal, and postpartum care to provide culturally relevant physical and emotional support to mothers; (2) Build capacity among TBAs to identify high-risk situations and link patients to care; (3) create TBA-led efforts to improve coordination and care; (4) Establish a collaborative pipeline from TBAs to facility-based care; and (5) create inclusive facility environments for TBAs to help reduce medical mistrust among patients. TBAs occupy an important role in the maternal health of women in LMICs and have the potential to contribute toward improved maternal health outcomes. The recommendations provided herein can be used to aid practitioners and researchers in reducing maternal morbidity and mortality globally.

Decolonization of Global Health in Haiti: A Call for Equity, Partnerships, Scholarship, and Informed Action.

Decolonization of Global Health in Haiti: A Call for Equity, Partnerships, Scholarship, and Informed Action.

Individual and community-level factors associated with caesarean section in Haiti: secondary analysis of data from the 2016–2017 Haitian Demographic and Health Survey

IntroductionFor several decades, the rate of caesarean section (CS) has been increasing in the world. In some countries, the CS rate is below the WHO recommended range (10–15%), while in other countries, it is significantly higher. The aim of this paper was to identify individual and community-level factors associated with CS in Haiti.MethodsSecondary data analysis was conducted on nationally representative cross-sectional survey data from the 2016–2017 Haitian Demographic and Health Survey (HDHS). The analysis was restricted to 6303 children born in 5 years prior the survey (of the interviewed women). The study population’ characteristics, and the prevalence of CS were analysed using descriptive analysis (univariate/bivariate). In addition, multilevel binary logistic regression analysis was performed to identify factors associated with CS. Both descriptive and multivariate analysis were conducted using STATA 16.0 software (Stata Corp, Tex, USA). Statistical significance was declared at p < 0.05.ResultsThe overall prevalence of CS delivery was estimated at 5.4% (95% CI 4.8–6.0) in Haiti. Results also revealed that mothers aged 35 and above (aOR = 1.38; 95% CI 1.00–1.96); who attended secondary (aOR = 1.95; 95% CI 1.39–2.76) and higher education level (aOR = 3.25; 95% CI 1.92–5.49); who were covered by health insurance (aOR = 2.57; 95% CI 1.57–4.19); with less than 3 children (aOR = 4.13; 95% CI 2.18–7.85) or 3–4 children (aOR = 2.07; 95% CI 1.09–3.94); who received 9 or more antenatal visits (aOR = 2.21; 95% CI 1.40–3.50) were significantly more likely to deliver by CS. Children in communities with high preponderance of private health facilities had greater odds to be delivered through CS (aOR = 1.90; 95% CI 1.25–2.85). Furthermore, children with an average birth weight (aOR = 0.66; 95% CI 0.48–0.91) were less likely to be delivered through CS than their counterparts with high birth weight.ConclusionsWhile the CS prevalence was low in Haiti, it masks significant geographic, social and economic disparities. To better develop and implement maternal and child health programs that address CS deliveries, the government authorities and NGOs operating in the field of women’s health in Haiti should take these disparities into account.

Scaling Surgical Resources: A Capacity Analysis of C-arm Machines in Haiti Following the 2021 Earthquake

BackgroundIn 2021, a 7.2 magnitude earthquake struck Haiti resulting in a surge of orthopaedic trauma requiring immediate surgical treatment. Safe and efficient operative management of orthopaedic trauma injuries requires intraoperative fluoroscopy through C-arm machines. The Haitian Health Network (HHN) received a philanthropic donation of three C-arm machines and considered an analytical tool may guide efficacious placement of those machines. The study objective was to develop and apply a clinical needs and hospital readiness measuring tool relevant to C-arm machines, which may guide decision-makers, such as HHN, in response to an emergency situation with a surge in need for orthopaedic treatment.MethodsAn online survey to assess surgical volume and capacity was created and then completed by a senior surgeon or hospital administrator based at hospitals within the HHN. Multiple-choice and free-text answer data were collected and classified into five categories: staff, space, stuff, systems, and surgical capacity. Each hospital received a final score out of 100, calculated by equal weighting of each category.ResultsTen out of twelve hospitals completed the survey. The average weighted score for the staff category was 10.2 (SD 5.12), the space category was 13.1 (SD 4.09), the stuff category was 15.6 (SD 2.56), the systems category was 12.25 (SD 6.50), and the surgical capacity category was 9.5 (SD 6.47). The average final hospital scores ranged from 29.5 to 83.0.ConclusionThis analysis tool provided data as to the clinical demand and capabilities of hospitals within the HHN to receive a C-arm machine and reaffirmed the critical need for more C-arms in Haiti. This methodology may be utilised by other health systems to provide data to distribute orthopaedic trauma equipment, which would benefit communities during periods of surge capacity, such as natural disasters.

The Ceremonial Bath, a Surrender to the Spirits

Abstract: In a time of ecological devastation, Haiti must once again turn to its sacred ecologies. Vodou is the lifeline of Haitian national identity, serving multiple social functions, “healing” among them. This piece argues that Haitian Vodou is a model of ecological healing that runs counter to Western medicine, a biologically reductionist system grounded in the ecological, racialized scientific research-based exploitation of the island and its inhabitants. Focusing on the history of ritual bathing through the rise of balneological science in Saint-Domingue, I argue that the question of health in Haiti encompasses a larger colonial relationship with empire-making that is tied to the subjugation of sacred epistemologies and their ecologies––a history that tethers humanity to the Earth and the spirits.

Gender, Food Security, and Social Determinants of Health in Haiti: A Systematic Review

Abstract: In the aftermath of the 2010 Haitian earthquake, gender equity and food security are key priorities for the Haitian state, bilateral organizations, and nongovernmental organizations (NGOs). Yet there is very little research on the gendered dimensions of food insecurity in Haiti, specifically the nexus between gender, food security, and health. Literature on these themes tends to be divided by discipline: literature in the health sciences and nutrition tends to explore dietary diversity, food choice, and food availability; literature and donor publications in community development and public health focus on peasant and women’s organizations, the impact of NGO projects, and community food cultures; and literature in the social sciences explores the impacts of colonization on Haitian food systems and the intersectional inequalities that bear on Haitian food insecurity and gendered inequity. In this article, we mobilize Charlotte Reading and Fred Wien’s “social determinants of health” framework to unite this literature. Drawing from an extensive review of scholarly research; white papers by bilateral organizations, NGOs, and international financial institutions; and the policy landscape in Haiti, we use the meta themes of gender, Haiti, and food (in)security to frame our analysis. We argue that given the interscalar mechanisms impacting women’s health, intersectional, interdisciplinary, and intersectoral approaches are necessary for understanding the gendered dimensions of food insecurity. We hope that this article inspires scholars and NGOs to mainstream gender in food security research in Haiti. Rezime: Apre tranbleman tè 2010 ki sakaje Ayiti a, kesyon “gender osnon rapò sosyal fanm/gason” ak ensekirite alimantè se yon kokennchèn priyorite pou Leta ayisyen, òganizasyon bilateral yo ak òganizasyon non-gouvènmantal (ONG) yo. Poutan, pa gen anpil rechèch sou sekirite alimantè ann Ayiti ki mete pwojektè sou dimansyon “gender” espesyalman lyen ki genyen ant “gender”, sekirite alimantè ak sante. Literati sou tèm sa yo deplòtonnen nan divès disiplin : literati nan syans sante yo ak nitrisyon gen tandans eksplore divèsite dyetetik, chwa alimantè, ak disponiblite manje; literati nan devlòpman kominotè, sante piblik ak piblikasyon donatè yo konsantre sou òganizasyon peyizan ak fanm, enpak pwojè ONG yo ak kilti alimantè kominote yo; epi literati nan syans sosyal yo eksplore enpak kolonizasyon yo sou sistèm alimantè ayisyen an, ak inegalite entèseksyonèl ki gen sou ensekirite alimantè ayisyen ak inegalite sèks yo. Nan atik sa a, travay Charlotte Reading ak Fred Wien sou detèminan sosyal sante sèvi nou gid pou mete tout literati sa yo ansanm. Atik sa a se rezilta yon analiz pwofon sou literati syantifik ak liv blan an ki pale sou “gender osnon rapò sosyal fanm/gason” ak sekirite alimantè òganizasyon bilateral, ONG ak enstitisyon finansye entènasyonal redije. Analiz la tou chita sou peyizaj politik Ayiti a apati gwo bout tèm “gender” a, Ayiti ak ensekirite alimantè kòm kad analiz nou. Finalman, akoz mekanism entèskalè ki gen enpak sou sante fanm yo, nou soutni lide konpreyansyon dimansyon sekso-espesifik ensekirite alimantè a egzije yon apwòch entèseksyonèl, entèdisiplinè ak entèsektoryèl. Nou espere atik sa a ensite fouyapòt (chèchè) yo ak ONG yo konsidere rapò sosyal fanm/gason nan rechèch sou sekirite alimantè a.

An analysis of factors associated with neonatal, post-neonatal and child mortality in Haiti, including breastfeeding as a time-dependent variable.

The main objective of the study was to identify factors associated with neonatal, post-neonatal and child mortality. The study also investigated breastfeeding status as a time-dependent variable. The 2016-2017 Haitian Demographic and Health Survey was analysed. The analysis was done on 6530 live births. Time-constant and time-dependent multivariable Royston-Parmar spline models were used to identify associated factors for all three age groups. Restricted mean survival times were calculated for the different levels of the breastfeeding variable for each age group. Neonates and post-neonates who were not breastfed were associated with increased mortality, hazard ratio (HR) 22.13 (95% confidence interval (CI), 16.40-29.87) and HR 4.99 (95% CI, 3.29-7.56), respectively. Males in the child age group were associated with increased mortality, HR 2.04 (95% CI, 1.29-3.23) and HR 2.03 (95% CI, 1.28-3.21) under the time-constant and time-dependent models, respectively. Early initiation of breastfeeding and breastfeeding throughout the post-neonatal period is recommended. Outreach programmes that provide support and education for vulnerable families are also recommended.

Assessment of the Functional Capacity and Preparedness of the Haitian Healthcare System to Fight against the COVID-19 Pandemic: A Narrative Review

Low-income countries, such as Haiti, are facing challenges in fighting the COVID-19 pandemic due to resource shortages and fragile healthcare systems. This study assessed the functional capacity and preparedness of the Haitian healthcare system regarding the COVID-19 pandemic. It employed a narrative review approach to analyze secondary data and used the Donabedian model and the global health security index as the theoretical frameworks to evaluate preparedness. The findings reveal that Haiti faces challenges in tackling the COVID-19 pandemic due to a lack of biosafety and biosecurity regulations, inadequate laboratory systems for COVID-19 testing, and shortages of human resources and personal protective equipment. Moreover, poverty remains widespread, and people lack access to clean water and sanitation services, resulting in a high risk of COVID-19 infection. Furthermore, a lack of communication, rumors, the circulation of fake news regarding COVID-19, and stigmatization cause distrust and reduce the number of people seeking healthcare services. Haiti faces challenges with respect to tackling the pandemic. The Haitian government can strengthen and improve the capacity of the healthcare system to fight against the COVID-19 pandemic and infectious diseases emerging in the future.

Uterine fibroid: a socially malignant illness in Haiti

This qualitative study documented the effects of uterine fibroids on the suffering of women in Haiti. It makes a unique contribution by re-socializing this disease, by making visible the social inequalities and what is at stake for the women, for their families, and for healthcare delivery. Uterine fibroid is a benign tumor of the uterus, common in gynecology, but profoundly malignant in how it affects women’s lives. Little has been reported on their lived experiences. Haiti has historical, social, and economic factors that hinder the search for treatment. The study explores how and why patients seek surgical care for uterine fibroids at Mirebalais University Hospital. Seventeen in-depth interviews with patients and seven accompanying family members were conducted and recorded in Creole and translated into English, along with participant observations in two patients’ homes. Content and narrative analysis were done iteratively, and the processual ethnographic method was used to relate our findings to Haitian history, to the context of the study, and to future implications. The women’s experience of accompaniment, their suffering in their pèlerinage (care-seeking journey), and the troubling social impact of uterine fibroids make it a socially malignant illness. The study shows that it is critical to address the suffering of women afflicted with uterine fibroids by strengthening the Haitian health system, improving economic advantages, and establishing ways for them to gain access to social goods and participate in community activities.

Improving access to care and community health in Haiti with optimized community health worker placement.

The national deployment of polyvalent community health workers (CHWs) is a constitutive part of the strategy initiated by the Ministry of Health to accelerate efforts towards universal health coverage in Haiti. Its implementation requires the planning of future recruitment and deployment activities for which mathematical modelling tools can provide useful support by exploring optimised placement scenarios based on access to care and population distribution. We combined existing gridded estimates of population and travel times with optimisation methods to derive theoretical CHW geographical placement scenarios including constraints on walking time and the number of people served per CHW. Four national-scale scenarios that align with total numbers of existing CHWs and that ensure that the walking time for each CHW does not exceed a predefined threshold are compared. The first scenario accounts for population distribution in rural and urban areas only, while the other three also incorporate in different ways the proximity of existing health centres. Comparing these scenarios to the current distribution, insufficient number of CHWs is systematically identified in several departments and gaps in access to health care are identified within all departments. These results highlight current suboptimal distribution of CHWs and emphasize the need to consider an optimal (re-)allocation.

Diabetes Epidemiology Among Adults in Port-au-Prince, Haiti: A Cross-Sectional Study.

IntroductionDiabetes mellitus is a chronic noncommunicable disease associated with death and major disability, with increasing prevalence in low- and middle-income countries. There is limited population-based data about diabetes in Haiti. The objective of this study was to assess the prevalence of diabetes and associated factors among adults in Port-au-Prince, Haiti using a population-based cohort.MethodsThis study analyzes cross-sectional enrollment data from the population-based Haiti Cardiovascular Disease Cohort Study, conducted using multistage sampling with global positioning system waypoints in census blocks in the metropolitan area of Port-au-Prince, Haiti. A total of 3,005 adults ≥18 years old were enrolled from March 2019 to August 2021. We collected socio-demographic data, health-related behaviors, and clinical data using standardized questionnaires. Diabetes was defined as any of the following criteria: enrollment fasting glucose value ≥ 126 mg/dL or non-fasting glucose ≥ 200 mg/dL, patient self-report of taking diabetes medications, or study physician diagnosis of diabetes based on clinical evaluation.ResultsAmong 2985 (99.3%) with complete diabetes data, median age was 40 years, 58.1% were female, and 17.2% were obese. The prevalence of diabetes was 5.4% crude, and 5.2% age standardized. In unadjusted analysis, older age, higher body mass index (BMI), low physical activity, low education were associated with a higher odds of diabetes. After multivariable logistic regression, older age [60+ vs 18-29, Odds Ratio (OR)17.7, 95% CI 6.6 to 47.9] and higher BMI (obese vs normal/underweight, OR 2.7, 95% CI 1.7 to 4.4) remained statistically significantly associated with higher odds of diabetes.ConclusionThe prevalence of diabetes was relatively low among adults in Port-au-Prince, but much higher among certain groups (participants who were older and obese). The Haitian health system should be strengthened to prevent, diagnose, and treat diabetes among high-risk groups.

Developing and Implementing Noninvasive Ventilator Training in Haiti during the COVID-19 Pandemic.

BackgroundNoninvasive ventilation (NIV) is an important component of respiratory therapy for a range of cardiopulmonary conditions. The World Health Organization recommends NIV use to decrease the use of intensive care unit resources and improve outcomes among patients with respiratory failure during periods of high patient capacity from coronavirus disease (COVID-19). However, healthcare providers in many low- and middle-income countries, including Haiti, do not have experience with NIV. We conducted NIV training and evaluation in Port-au-Prince, Haiti.ObjectivesTo design and implement a multimodal NIV training program in Haiti that would improve confidence and knowledge of NIV use for respiratory failure.MethodsIn January 2021, we conducted a 3-day multimodal NIV training consisting of didactic sessions, team-based learning, and multistation simulation for 36 Haitian healthcare workers. The course included 5 didactic session and 10 problem-based and simulation sessions. All course material was independently created by the study team on the basis of Accreditation Council for Continuing Medical Education–approved content and review of available evidence. All participants completed pre- and post-training knowledge-based examinations and confidence surveys, which used a 5-point Likert scale.ResultsA total of 36 participants were included in the training and analysis, mean age was 39.94 years (standard deviation [SD] = 9.45), and participants had an average of 14.32 years (SD = 1.21) of clinical experience. Most trainees (75%, n = 27) were physicians. Other specialties included nursing (19%, n = 7), nurse anesthesia (3%, n = 1), and respiratory therapy (3%, n = 1). Fifty percent (n = 18) of participants stated they had previous experience with NIV. The majority of trainees (77%) had an increase in confidence survey score; the mean confidence survey score increased significantly after training from 2.75 (SD = 0.77) to 3.70 (SD = 0.85) (P < 0.05). The mean knowledge examination score increased by 39.63% (SD = 15.99%) after training, which was also significant (P < 0.001).ConclusionThis multimodal NIV training, which included didactic, simulation, and team-based learning, was feasible and resulted in significant increases in trainee confidence and knowledge with NIV. This curriculum has the potential to provide NIV training to numerous low- and middle-income countries as they manage the ongoing COVID-19 pandemic and rising burden of noncommunicable disease. Further research is necessary to ensure the sustainability of these improvements and adaptability to other low- and middle-income settings.