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Magnitude, Distribution, and Estimated Level of Underreporting of Acute Gastroenteritis in Jamaica
Fletcher, Stephanie M.; Lewis-Fuller, Eva; Williams, Hank; Miller, Zahra; Scarlett, Henroy P.; Cooper, Collin; Gordon-Johnson, Kelly-Ann; Vickers, Ivan; Shaw, Karen & Wellington, Iyanna
Abstract
Jamaica is the third largest island in the Caribbean. The epidemiology of acute gastroenteritis (AGE) is important
to Jamaica, particularly in the areas of health, tourism, and because of the potential impact on the
local workforce and the economy. Data collected by the National Surveillance Unit on the prevalence of
AGE transmitted by food are not accurate. To determine the true magnitude, risk factors, and the extent of
underreporting of AGE in Jamaica, we conducted a cross-sectional, population-based retrospective survey
during the periods of 21 February–7 March and 14-27 June 2009, corresponding to high- and low-AGE
season respectively. Of the total 1,920 persons selected randomly by a multistage cluster-sampling process,
1,264 responded (response rate 65.8%). Trained interviewers administered a standardized, validated
questionnaire during face-to-face interviews. The overall prevalence of self-reported AGE was 4.0% (95%
CI 2.9-5.1) at a rate of 0.5 episodes/per person-year. The highest monthly prevalence of AGE (14.6%) was
found among the 1-4 year(s) age-group and the lowest (2.1%) among the 25-44 years age-group. Of the 18
cases (36%) who sought medical care, 11% were hospitalized, 33% were treated with antibiotics, and 66.7%
received oral rehydration fluids. Only 2 cases who sought medical care reportedly submitted stool specimens.
The mean duration of diarrhoea was 3.1 days, which resulted in a mean loss of 4 productive days,
with over half of the cases requiring someone to care for them. The burden of syndromic AGE for 2009 was
extrapolated to be 122,711 cases, showing an underreporting factor of 58.9. For every laboratory-confirmed
AGE case, it was estimated that 383 more cases were occurring in the population. This research confirms
that the prevalence of AGE is underreported in Jamaica and not being adequately detected by the current
surveillance system. The components of the integrated surveillance system for AGE in Jamaica, particularly
the laboratory aspect, need to be strengthened.
Keywords
Acute gastroenteritis; Burden of Illness Study; Communicable diseases; Foodborne illness; Population survey; Surveillance systems; Jamaica
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