The Ministry of Health has completed a one- year study of the Burden of Gastroenteritis Illness in Dominica. The study was conducted in collaboration with the Pan American Health Organization (PAHO), Ross University and with technical assistance from the Caribbean Epidemiology Centre (CAREC). The methodology used was developed by the World Health Organization.
The objective of the study which was conducted in 2009-2010 was to determine the magnitude, distribution and under-reporting rate for Acute Gastroenteritis (AGE) and the most important causes of foodborne diseases (FBD) in Dominica.
The results show that the prevalence of AGE was higher in females and highest in the under 5 year age-group. Prevalence of AGE was lowest in 45-64 years age-group. The occurrence of AGE varied by health district, with the highest monthly prevalence of self-reported cases of AGE reported in the Portsmouth District (13.1%) followed by St. Joseph (12.6%) and Roseau (9.3%). The Grand Bay health district had the lowest prevalence (2.1%). This difference across health regions was statistically significant (p= 0.0144).
The average number of days an individual suffered with AGE ranged from 1- 28 days. Of the 84 AGE cases, 42 reported restricted activity and had to spend time at home due to their illness. The range of days spent at home was 1 – 7 days.
The predominant pathogen isolated was Norovirus (29%) followed by parasites (12%), Salmonella (7%) and Shigella (4%) suggesting that viruses are the main cause of FBD in Dominica.
The economic cost of the burden of AGE on the public health system was estimated to be $3,727,187.19 (US$1,395,950) or EC$51.80 (US$19.40) per capita implying the huge economic burden of AGE on Dominica. This estimate was based on the average cost of basic medical services, supplies, hospitalization in the public health system as well as working days lost and care-giver needed. These factors were calculated using value in proportion from the study and basic cost at the public health system.
The Burden of AGE Study is the first of its kind in Dominica and has provided evidence that AGE is a significant public health and economic burden in Dominica. Recognizing the significant amount of under-reporting is essential in designing appropriate interventions and assessing the impact of these pathogens in the population.
Based on this study the following recommendations are being made in order to reduce the burden and morbidity associated AGE:
• Improve the collection of stool specimens from persons with diarrhea – patients with diarrhoea are encouraged to submit a sample when requested by health professionals
• Continue testing stool specimens for the increased range of causes of AGE introduced during this study
• Improved procurement methods and funding for laboratory media and supplies, in particular Norovirus kits
• Improve timely reporting of all laboratory confirmed pathogens to the Ministry of Health
• Enhance food safety practices along the farm to table continuum
• Continue public health food safety messages and related educational activities
• Target the identified risk factors for FBD when allocating resources for education, food safety, and infrastructure.
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“The predominant pathogen isolated was Norovirus (29%)”
Noroviruses are highly contagious and can spread easily from person to person…hand shaking,poor hand washing and use of contaminated utensils. Therefore good hygiene must be encouraged at all times especially in the prearation of foods. Carers of persons with D and V must also be vigilant to help prevent the spread of the virus.