Right Steps & Poui Trees


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Births Fall in Jamaica in 2016…Because of #Zika Warning?

RJR birth decline in 2016 report - 4-5-17I heard the tail end of a report on RJR’s 5pm newscast yesterday (May 4, 2017), which said that there had been a significant decline in births in Jamaica last year. This seemed interesting in the context of the warning to delay pregnancy issued by the Ministry of Health (MOH) in January 2016, in advance of the country’s first confirmed case of the zika virus.

 

MOH warning to pregnant women 1-2016

During his Sectoral Debate presentation on May 3, 2017, Minister of Health Christopher Tufton tabled the first edition of Vitals, a new quarterly report published by his Ministry, which contains the following information:MOH reduced births 2016 chart

MOH reduced births 2016 text

(p.12, Vitals: Quarterly Report of the Ministry of Health – April 2017)

 

This 28% decline in the 4th Quarter of 2016 – nine to twelve months after the zika warning was issued – does on the face of it seem related to the warning. It certainly invites further study to understand how women and their partners responded to the warning and what part various factors, such as discussions and planning, increased use of contraceptives, access to abortion, for example, played in the subsequent decrease in births. It would also be interesting to compare this decrease in Jamaica with other countries which issued similar warnings. I also wonder whether there has been another recent year in which Jamaica has seen an annual decrease in births as large as 7.4%. (The RJR report mistakenly stated that the 28% decline was for the entire 2016, rather than only the 4th Quarter.)

Zika Update

The issue of Vitals also gives an update on the situation with zika in Jamaica up to the first week of April 2017:MOH zika update - Vitals 4-2017

It also reported on the cases of pregnant women with zika infections and the babies with suspected or probable cases of Congenital Syndrome Associated with Zika Virus (CSAZ).

There were 827 cases of notified Zika virus infection in pregnant women reported as at 10th April, 2017; 698 have been classified as suspected Zika based on the case definition. Of the 698 suspected cases, seventy-eight (78) have had positive PCR results confirming Zika virus infection. There were 170 notifications received regarding babies suspected as Congenital Syndrome Associated with Zika Virus Infection (CSAZ), 50 were classified as suspected cases of CSAZ (46 Microcephaly – 35 non-severe, 11 severe; 4 other congenital abnormalities). Three infants based on Pan American Health Organization/World Health Organization were classified as probable cases of CSAZ.

(p. 17, Vitals: Quarterly Report of the Ministry of Health – April 2017)

There is obviously more to be said about the cases of babies suspected to have been affected by the zika virus, including why the numbers were fewer than initially feared, how the cases of microcephaly compare to previous years in number and severity and how the programmes to support the babies, their mothers and families are proceeding.MOH Vitals 4-2017

Vitals – A New Publication by the Ministry of Health

 

When he introduced the new publication during his Sectoral Debate presentation, Minister Tufton said that he hoped it would be a source of information and a tool for accountability.Tufton sectoral debate presentation 3-5-17 Vitals

I welcome this new quarterly report and think that it can indeed be a useful source of information about a variety of topics that are part of the remit of the Ministry of Health. I hope, however, that it will be easily and widely available. I found the link to it on Minister Tufton’s Twitter account. Up to the time of publishing this blog post, it wasn’t available on the MOH website or via the Jamaica Information Service website. I hope it soon will be.

 

 

 

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Jamaica & #Zika One Year Later: First Probable Case of Zika-Related Microcephaly

On January 30, 2016, the Ministry of Health (MOH) notified the public of Jamaica’s first confirmed case of the zika virus. Almost a year later it has notified the public of the first probable case of a baby born with zika-related microcephaly.

The MOH post on its website gave brief information about the case and some background information regarding actions taken and to be taken by the Ministry. (Click here for full brief.)moh-1st-probable-case-zika-related-microcephaly-post-19-1-17

dr-winston-de-la-hayeIn media interviews, Chief Medical Officer Dr Winston De La Haye indicated that the baby had been born in late December 2016 at the Victoria Jubilee Hospital, that the mother had had a rash during her pregnancy and that tests done for other possible causes of microcephaly, such as HIV  and toxoplasmosis, had come back negative. He said that the Ministry is now awaiting results of tests for zika infection in the baby, which would confirm this as zika-related microcephaly, if the results are positive. He also spoke about the support which will be given to the family and the baby over the coming years.

Dr De La Haye noted that to date there have been 21 suspected cases of zika-related microcephaly in Jamaica, but only this one probable case and no confirmed cases.Suspected, probable and confirmed cases are classified as follows:

We wait to see if this probable case is confirmed and if there are more babies born with probable or confirmed conditions related to zika infection. Jamaica, like so many other countries which have had a zika outbreak, may not experience the level of problematic conditions in babies that has been documented in Brazil.

Other Caribbean countries, including Trinidad & Tobago, Grenada and Guadeloupe, have reported confirmed cases of Zika congenital syndrome.

Zika Outbreak Data

The following chart showing zika data from August – December 2016 is compiled from data posted in periodic updates on the MOH website. The actual number of zika infections would be significantly higher than given, taking into consideration those who had symptoms but never visited a doctor or clinic, those doctors who may not have reported all cases they saw and those people who had a zika infection but never displayed any symptoms. moh-zika-data-chart-aug-dec-2016

The October 26, 2016 MOH brief, also on the website,  contains further information about the status of the zika outbreak in Jamaica at that point in time, such as this figure showing the distribution of zika across the parishes:moh-zika-brief-26-10-16

and this section giving figures for cases of dengue and chikungunya during the same period.moh-zika-brief-26-10-16-arboviruses

A year after the first confirmed case of zika in Jamaica, the outbreak is long past its peak; the number of reported cases has been on a downward trend for months. Now we wait to see what level of impact the virus has on babies being born in the wake of the outbreak. It will also be useful to see at some point an assessment of the government’s overall response to the outbreak.

 

 


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Jamaica: #Zika At The Beginning of September

After a hiatus of more than three weeks, Jamaica’s Ministry of Health (MOH) has posted a new zika update on its website. This update gives data received by the MOH as of August 26, 2016, which I have incorporated into the chart below:MOH zika data 26-8-16 - chart(The 8 reports are all posted on the MOH website, in the Press Releases section.)

More cases of zika than the numbers show

The numbers in this chart reflect the changing situation over a two month period regarding the zika outbreak. It is important to note, however, that the actual situation on the ground is vastly different for a variety of frequently articulated reasons:

  • it is estimated that as many as 80% of people who become infected with the zika virus never show any symptoms, and therefore wouldn’t be represented in the  data;
  • many people experience only mild symptoms during a zika infection and do not seek medical care;
  • doctors and other medical staff do not necessarily report all those they suspect of having zika, although it is a Class 1 Notifiable disease, requiring notification within 24 hours.

Increasing numbers in two-month period

The increased numbers being reported are indicative not only of the actually increasing numbers of zika infections, but probably also of increased awareness of the disease, as well as increased reporting. The figures over the two-month period show the following:

  • the numbers of zika notifications and suspected cases of zika have both more than doubled;
  • the number of confirmed cases of zika has more than tripled;
  • there has been a dramatic increase in suspected cases of zika in pregnant women, from 88 to 470;
  • the number of confirmed cases of zika in pregnant women has increased significantly from 4 to 31.

Guillain Barre Syndrome – increased cases & 6 deaths

The number of Guillain Barre Syndrome (GBS) notifications has more than doubled during this two month period, as has the number of suspected cases among these notifications. Suspected cases are those that on further evaluation fit the case definition for GBS based on clinical signs, symptoms and investigation results. To date, zika has been lab confirmed in only 3 of these suspected cases of GBS.

Dr De La HayeHowever, the situation with GBS is of increasing concern, with Acting Chief Medical Officer Dr Winston De La Haye confirming that as of September 2 there have been 6 GBS-related deaths. In none of these cases has it yet been confirmed that the deceased had a zika infection; test results have come back negative in two cases and the results are pending in the others. The first of these GBS-related deaths was on June 26, and in this instance the deceased tested negative for zika, but positive for both dengue and chikungunya. The two most recent deaths occurred this week.

Communication in the context of zika

Earlier this week, the Opposition Spokesman on Health Horace Dalley (who is the former Minister of Health) made a public statement about the death of a patient at the Kingston Public Hospital (KPH) on Tuesday. Initially the MOH was unable to confirm the death. In subsequent interviews, Dr De La Haye said that communication with the MOH was being improved, as it was obviously a problem that Mr Dalley knew of the death at KPH, when he did not.

The MOH is also seeking to increase access to information about zika through the provision of two additional phone numbers that the public can call with questions about zika. This is being done through the MOH’s National Emergency Operation Center (NEOC) and is aimed particularly at providing information for pregnant women. The numbers are 537-1709 & 536-9125 and can be called Mondays to Fridays, 8:00am to 4:00pm.

I was very encouraged when the MOH began to post updates of the zika numbers on its website two months ago, and I was disappointed when the effort seemed to falter. I hope that the MOH will try to post the new figures regularly, perhaps on a weekly basis. This would be one useful – and fairly straightforward way – of providing ongoing data to the public.

 

 

 


Ministry of Health Jamaica: 6 weeks of #zika numbers

On July 5, the Ministry of Health (MOH) in Jamaica began posting updates on its website regarding the number of zika cases. The first update was for data as of June 25, 2016 and since then the MOH has posted a further 6 updates, the most recent of which was posted on August 8 and contained the numbers up to August 5, 2016. All 7 updates are currently available on the MOH website, but for easy review I have included the chart below:

MOH zika updates June 25 - August 5 2016

One of the questions which remains for me is why there have been so few confirmed cases, given the steadily increasing numbers of reported and suspected cases. It would be useful for the MOH to publish data regarding the number of samples submitted for testing, the number of tests completed and the outcomes of these tests.

It would also be useful for the MOH to make public any reports on any problems being experienced with the testing that has been and is being done. I had asked some time ago, for example, about a doctor’s comment on having heard from two sources that a lack of a reagent had been hampering the testing of samples.

Sloper on FB

Dr Tufton had said via Twitter that he would check on that report. I haven’t heard an update from Dr Tufton on that reported lack of reagent, but it is entirely possible that I missed his update.

I heard CMO Dr De La Haye saying on a radio programme this morning (Nationwide News Network) that routine testing of all pregnant women could cost as much as J$100 million. If such an expenditure is being contemplated, it would be good to have an assurance that the process would be reliable.

The zika outbreak and its impacts continue to unfold, and the provision of information continues to be an important aspect of the government response.

 


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350 Words Or Less: #Zika & Pregnant Belly Photos

So, another news report about zika and pregnancy illustrated by a photo of a pregnant belly.

zp1It’s almost as though a shorthand has been adopted at some media houses…without the pregnant belly, the readers won’t know that this is a story about  zika’s impact  on pregnant women or the risk to developing fetuses.zp2a                                (Same pregnant belly; different angle.)zp3                             (Same pregnant belly, different country.)

A belly, very pregnant, bare and disembodied. That’s what readers need.

Even when the story is about zika in pregnant monkeys.zp7At one point the belly may be connected to an actual person with a name…zp8…but not for long…as the photo becomes disconnected from the name, just as the belly becomes disconnected from the woman…

Stock photos, attached to stories. Will more people click and read because of this?…

 

Pregnant bellies are beautiful and iconic and women nearing birth, with bare or clothed bellies, are a powerful and profound subject for photography.

Stories about zika and pregnancy are really about whole women, their lives, children, families and communities that are being, may be or will be affected by the virus that is the subject of the article. The whole story can’t be told in one article. It can’t be reduced to one photo. That’s a given. But this almost thoughtless use of a disembodied belly to advertise information, is a bit reminiscent of other uses of women’s body parts to sell other commodities.

 


Jamaica: Increased #Zika Numbers & Some Questions

I wrote about zika on Tuesday (July 5) and here I am writing about it again, primarily because I heard Minister of Health Christopher Tufton talking with journalist Cliff Hughes on his programme on Power106FM yesterday, and there was some updated information that caught my attention.

Minister Tufton MOH photo

Minister Tufton

Cliff Hughes NNN photo

Cliff Hughes

Additionally, some other questions and concerns have been milling around in my head for a while, and I thought I would transfer them from brain to blog.

 

Ministry of Health Zika Update, as of July 1, 2016

At the beginning of the interview, Minister Tufton shared that his son now has zika, with mild symptoms so far, and he reiterated that the World Health Organization (WHO) projection is that approximately 70% of the population will get zika. He also noted that the majority of zika cases have mild symptoms, with approximately 1% being severe.

The updated figures for zika that he gave stood out for me, particularly the number of pregnant women with suspected zika infection, which was significantly higher than the figure he had given at the Ministry of Health (MOH) press briefing two days before. This sent me to the MOH website, but I didn’t seriously think I would find the new data there. O ye of little faith! The website had been updated today, and there was a document entitled Zika Update as at July 01, 2016. (Is a trend in posting regular updates now underway? That would be good.)

The following  changes are reflected between the June 25 & July 1 reports:

  • Number of notifications                      – from 2825 to 3088
  • Number of suspected cases                – from 2135 to 2183
  • Number of confirmed cases               – from 24 to 26
  • Number of suspected cases in pregnant women    – from 88 to 142
  • Number of notifications for GBS      – from 42 to 53

The most striking change was the reported number of suspected cases of zika infection in pregnant women, which had gone from 88 to 142.

MOH zika in pregnant women 1-7-16

Minister Tufton said it is expected that there will be cases of zika-related microcephaly in babies born later this year. With the first confirmed case of zika in Jamaica being in late January, it is thought that such cases may affect some babies born in September and beyond. He reminded that not all babies born to mothers who have had zika are affected by microcephaly, though he gave a possible figure of 10%. He said that the hospital system was being prepared for this eventuality and that counselling was being and would be provided to pregnant women.

MOH GBS 1-7-16

Speaking about the cases of Guillain-Barre Syndrome (GBS), the Minister told Cliff Hughes that not all cases of GBS require treatment in Intensive Care Units (ICU), but that there have been some severe cases requiring ICU care. He said that during a visit he made to Kingston Public Hospital (KPH) this week, there had been 2 or 3 patients with GBS in ICU there.

Some Questions for the Minister

 

 

 

In speaking with Mr Hughes, Minister Tufton indicated that he and others at the MOH were committed to handling the zika outbreak with transparency, having learned lessons from the handling of the chikungunya epidemic in 2014. He said:

Jamaicans need to know what they are confronting, what the risk factors are and what they need to do in preventing and, if they can’t prevent, how they need to follow up…We shouldn’t hide anything from the public; we should go out of our way to explain to the public the issues at hand. – Minister Tufton (transcribed from recording of interview with Cliff Hughes on Power106FM, July 7, 2016)

The MOH has been providing more information about zika than it did for ChikV and the Minister certainly seems to be committed to providing such information. With that in mind, I ask the following questions:

Blog questions 1

blog question zika

blog questions 2

(Click for copy of MOH Zika-update-of-as-at-July-1-2016)

 

 


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Jamaica: #Zika Update…On the Ministry of Health Website, No Less!

Christopher-Tufton-WebListening to the news at midday today, I heard a report of an update given by Minister of Health Christopher Tufton about the current situation with the zika virus here in Jamaica. As the news report was read, I madly tried to scribble down the figures being given…number of reported, suspected and confirmed cases, etc. I was particularly interested in the number of pregnant women reported with suspected cases of zika. I thought I heard 88, and began to comb the news sites online and on social media to see if I could track down the figure. No luck. I was about to send Minister Tufton a tweet or to call Power 106 to see if I could speak with someone in their news room.

And then I decided to check the Ministry of Health website, though I had little hope of finding any current figures there, based on past experience.

Eureka! Look what I found! A downloadable, written document entitled “Zika update as at June 25, 2016“, posted on the website today, July 5, 2016! Hallelujah!MOH zika update 25-6-16

 

Seriously though, this is a significant development in keeping the public informed, that on the same day the Minister gives an update to the media, a document containing the figures is posted on the MOH website. I sincerely hope that this is the beginning of a trend.

The full document (3 pages long) is available on the website and I have included it here: MOH Zika-update-of-as-at-June-25

Of particular note are the general update regarding number of cases, with 24 confirmed cases as of June 25, 2016:

MOH zika cases 25-6-16

and the number of pregnant women with suspected cases of zika:

MOH zika and pregnancy 24-6-16

Providing reliable, easily accessible official information to the public on a regular basis is essential during a public health situation such as this.