Polio, yellow fever, diphtheria, tetanus, pertussis and other deadly or debilitating diseases are routinely prevented and controlled with vaccines—when and where they are accessible.[1] Characterized as one of the most effective public health interventions ever available, WHO estimates that immunization saves four to five million lives every year.[2] And yet. After another year working to […]
Following identification of the coronavirus disease COVID-19, Cuba activated its National Action Plan for Epidemics and convened a National Intersectoral Commission to design measures to protect population health. Following approval of the COVID-19 Prevention and Control Plan, scores of measures were implemented to fight the pandemic. Internationally and in Cuba, these are organized according to […]
Dr Durán is a native of eastern Santiago de Cuba and his early medical career began in this mountainous region, where he also headed provincial prevention and treatment of HIV/AIDS. He went on to become rector of the Medical University of Santiago de Cuba and provincial health director. Later in Havana, Dr Durán was […]
Sickle cell anemia is the most common hereditary disease in Cuba. On average, 1 in 33 Cubans is a carrier of this severe hemolytic anemia that can cause early death. In early 1980, its incidence in Cuba was calculated at 1 in 1600 births. In 1982, the Cuban public health system established the Sickle Cell Anemia Prevention Program, which aims to prevent the disease through identification of carrier couples and antenatal diagnosis of fetuses with disease-associated genotypes. In 1982–2018, hemoglobin genotypes were tested in 4,847,239 pregnant women. Of these, 168,865 (3.5%) were found to be carriers or to have sickle cell disease. During the same period, 8180 at-risk couples were identified, of whom 79.2% agreed to an antenatal study for detection of the sickle cell gene in the fetus. Among fetuses diagnosed, 20.1% had the SS genotype, the most clinically severe; 76.2% of the associated couples decided to interrupt the pregnancy. This program has resulted in a 3-fold reduction in prevalence of sickle cell disease in Cuba, a
10-fold reduction in the number of infants born with it each year, and a 16-year average increase in life expectancy of sickle cell disease patients of both sexes. Key contributors to these results have been universal screening of pregnant women in primary care, installation of diagnostic laboratories in every province, genetic counseling for couples, testing of fetal DNA (allowing couples to decide whether to continue the pregnancy if the fetus tests positive for the disease) and guaranteed multidisciplinary clinical care for patients. The Cuban experience shows that a middle-income country can mitigate the impact of a genetic disease through a universal preventive program based in primary care, which also pays particular attention to afflicted patients.
KEYWORDS Sickle cell anemia, sickle cell disease, sickle cell disorders, hemolytic anemia, sickle cell trait, sickle cell hemoglobin C disease, HbS disease, prevention, antenatal screening, preventive health services, Cuba
INTRODUCTION In 19th century colonial Cuba, Boards of Health (Juntas de Sanidad) were created to administer public health, in tandem with and later replacing the older Royal Protomedicato Court (Real Tribunal de Protomedicato). Development of the Board of Health in the northeastern city of Holguín reflected local historical processes, as well as class relations and social issues characteristic of this period.
Among the highlights of the Board’s activities were epidemic control during cholera and smallpox outbreaks, monitoring the city’s sanitary conditions, and support for charitable work. Studying the history of such epidemiological surveillance activities may benefit design and implementation of related current research and prevention/control campaigns.
OBJECTIVE Describe the development of the 19th century Board of Health in the city of Holguín.
EVIDENCE ACQUISITION The research was conducted through a critical analysis of primary sources contained in the Historical Archives of (today’s) Holguín Province, specifically relevant documents from the regional and city government (Fondo Tenencia de Gobierno y Ayuntamiento) and town council (Cabildo). Cuban and international scientific publications were also consulted.
DEVELOPMENT The Board of Health was the main institution conducting health and hygiene control and charitable activities in the city of Holguín during the 19th century. It was created mainly to take preventive measures against diseases affecting the population, an effort it undertook with support from the Urban Health Police. Its efforts to confront smallpox and cholera epidemics greatly helped to reduce the toll of these diseases on the population, albeit not sufficiently to prevent their reccurrence. Beginning in the 1870s, weakened government support eroded the Board’s position, and health-related measures were implemented mainly by the Board of Charity, which focused on matters concerning the city’s Civil Hospital.
CONCLUSIONS Although established in 1820, Holguín’s Board of Health carried out preventive actions most actively from 1850 to 1865, with support from the Urban Health Police. Its gradual disappearance from the health policy arena beginning in the 1870s reflects its failure as an institution, in large part due to weak government support.
KEYWORDS Board of Health, prevention, epidemics, Cuba
To the Editors: In his report in the October 2017 issue of MEDICC Review, Vega-Jiménez stressed that the design and integration of a prediabetes (intermediate hyperglycemia) registry would serve as an essential prevention strategy to improve population health outcomes in Cuba.[1] Cuba’s universal health system, with its robust health workforce and established primary care services […]
Helena J. Chapman MD MPH PhD, Luisa A. Armas-Pérez MD MS, Michael Lauzardo MDMS,
Edilberto R. González-Ochoa MD PhD
Global efforts to eliminate tuberculosis by 2050 continue to challenge health systems. In countries with low reported tuberculosis incidence, such as the USA (3.1/100,000 population) and Cuba (6.9/100,000), differences in classification by income level and health systems’ overall organizational structure are evident. However, the two countries’ low tuberculosis incidence, geographic proximity, robust research capacity and shared health priority for tuberculosis elimination provide fertile territory to strengthen collaboration for tuberculosis control in clinical, laboratory and community settings. Two tuberculosis symposia in Cuba—one at the Cuba Salud Convention in 2015 and the other at the International Forum on Hygiene and Epidemiology in 2016—were instrumental in stimulating dialogue on continued efforts towards eliminating tuberculosis by 2050. In this article, we describe tuberculosis burden in the USA and Cuba, critically analyze strengths and challenges experienced in areas of low tuberculosis incidence and provide recommendations for future institutional collaboration to support tuberculosis elimination and improved population health.
KEYWORDS Tuberculosis/epidemiology, Mycobacterium tuberculosis, prevention, communicable disease control, disease eradication, disease elimination, international cooperation, Cuba, USA
Erratum
Page 60, Table 1, rows 9 and 10: row labels “New cases (%)” and “Previously treated cases (%)” should be indented, to make clear that they are subsets of MDR-TB cases.
INTRODUCTION Mosquito-transmitted dengue remains an endemic threat to population health in various tropical and subtropical regions. Recommended dengue prevention practices focus on vector control and reducing human–mosquito interactions, by practices such as removing standing water, wearing protective clothing and using repellent, as well as seeking medical care when symptomatic. Health workers in the community educate and empower citizens about recommended prevention practices, and thus are indispensable in implementing national dengue initiatives at the local level. However, their health messages may not resonate with all community members, resulting in low adherence to recommended prevention practices. Understanding the factors associated with low adherence to dengue prevention and control measures is essential for strengthening national dengue initiatives.
OBJECTIVE Identify health workers’ perceived challenges for dengue prevention and control strategies and describe their recommendations for strengthening dengue control in the Dominican Republic.
METHODS From January through March 2005, a qualitative study was conducted in five provinces of the Dominican Republic. Based on literature review and consultations with clinical specialists, a semistructured interview guide of nine questions was designed. A purposive sample of 19 health workers (10 men, 9 women) was interviewed, including public health practitioners, entomologists, educators, clinicians and an administrator. Question topics included occupational experiences in dengue prevention and control; views on vector control in communities; perceived challenges for citizens’ adherence to recommended practices; and suggested measures for strengthening adherence to vector control at local and national levels. Thematic analysis was used to identify salient themes.
RESULTS Health workers described the following perceived challenges: 1) limited individual economic resources; 2) individual lack of awareness, education or action; 3) limited cohesion among community members; and 4) limitations in sustainability of government interventions. They made 14 recommendations related to the 4 perceived challenges.
CONCLUSIONS These findings evince the complex interplay of economic, environmental, health, political and social factors that can directly or indirectly influence individual and community adherence to recommended dengue prevention measures. By understanding how these intrinsic and extrinsic factors hinder adherence, health authorities can adapt national policies to strengthen community participatory action in vector control, empower leadership potential by health workers and community members, and provide an appropriate systemic approach to preventing disease transmission.
KEYWORDS: Dengue, dengue virus, arbovirus, community health, prevention, control, communicable disease control, qualitative research, Dominican Republic
To encourage development of negative attitudes toward alcohol use and thus prevent early onset of alcohol use, an intersectoral intervention was conducted from 2014 to 2015 among Cuban adolescents in 14 schools in Havana. The intervention included 312 students (189 girls and 123 boys) aged 14 to 15 years in 10th grade of high school or vocational school. Workshops were conducted using participatory techniques and group dynamics. Qualitative methods were applied, including narrative, desiderative and projective techniques. Indicators included attitudes, motivation, interests and perception of risk. Following the intervention, 82.7% (258/312) of participants reported healthy cultural and recreational interests and 61.9% (193/312) reinforced negative attitudes toward drinking. Such interventions can help prevent early onset of alcohol use in school settings. Given the positive results, the intervention is slated to be reproduced in other Cuban provinces.
KEYWORDS Adolescents, prevention, alcoholism, attitudes, Cuba
INTRODUCTION Hypertension and obesity in adults have been linked to increased EKG P-wave dispersion; the association has been shown in relation to hypertension, left ventricular hypertrophy and atrial enlargement. Though studies in children have linked P-wave dispersion to left ventricular hypertrophy, scant pediatric literature relates P-wave dispersion to hypertension and obesity.
OBJECTIVE Assess the association of P-wave dispersion with blood pressure and nutritional status in a pediatric population.
METHODS This cross-sectional study is part of the PROCDEC II project for pediatric hypertension diagnosis and control in Santa Clara, Cuba. Twelve-lead EKG and four blood pressure readings were conducted on a sample of 656 children aged 8–11 years. Blood pressure <90th percentile for age, sex and height was considered normal; 90th–95th percentile, prehypertension; and >95th percentile, hypertension. The main study variables were P-wave dispersion and systolic, diastolic and mean arterial pressure (MAP). Secondary variables were sex, height, weight, and body mass index. Comparisons of means, analysis of variance and linear correlations were done.
RESULTS Mean P-wave dispersion differed significantly (p ≤0.05) among normotensive (30.10 ms), prehypertensive (32.99 ms) and hypertensive children (39.14 ms), as did mean MAP (p <0.05). P-wave dispersion and MAP were significantly correlated in prehypertensive and hypertensive children. Most overweight and obese children with high P-wave dispersion were prehypertensive or hypertensive.
CONCLUSIONS Associations observed between P-wave dispersion and MAP in normotensive, prehypertensive and hypertensive children suggest potential for early detection of EKG patterns showing vulnerability. Given the relationship between increased P-wave dispersion and hypertension already described in adults, use of P-wave dispersion could be a simple, economical and noninvasive method of predicting risk of hypertensive cardiomyopathy in prehypertensive and hypertensive children; this in turn could guide timely, effective treatment and secondary prevention. Similar studies on a larger sample are needed to corroborate these results.
KEYWORDS Arterial hypertension, pediatrics, prevention, electrocardiogram, ECG, EKG, mean arterial pressure, P-wave dispersion, Cuba
Translated from the Spanish and reprinted with permission from the Revista Anales de la Academia de Ciencias de Cuba, [online] Vol. 2, No. 2, 2012. Original available at: http://www.revistaccuba.cu/index.php/acc/article/view/126
Dementia is a syndrome that has great repercussions for quality of life of patients and their families, as well as a high social cost. A [2009] systematic review of research evidence and consensus of expert opinions showed that 36 million people live with dementia worldwide, with 4.6 million new cases every year (similar to the global incidence of nonfatal stroke). The prevalence of dementia in older Cubans is high, with rates ranging from 6.4% to 10.2%, or about 130,000 persons (1.1% of the total population). This number is expected to rise to 260,000 by 2030. The age-standardized annual incidence of dementia is also high: 21 per 1000 population, with 28,750 new cases annually. Dementia is the leading cause of disability among older adults and is the main cause of dependency, financial burden and caregiver stress.
In this review, we highlight the importance of epidemiological research to obtain greater knowledge of the disease, improve health services, promote actions for prevention and early diagnosis, and implement a national strategy to address dementia in the Cuban population, itself now immersed in two processes: accelerated demographic aging and epidemiologic transition.
KEYWORDS Dementia, Alzheimer disease, epidemiology, risk factors, prevention, diagnosis, treatment
INTRODUCTION With 333 million cases worldwide predicted for 2015, type 2 diabetes mellitus presents an important global health challenge. Its rising tide calls for health policies emphasizing prevention at the primary care level, including public education as well as early risk identification and intervention.
OBJECTIVES Estimate risk of developing type 2 diabetes in persons with no known glucose abnormalities, registered in a primary care setting in Pinar del Río city, Cuba, using FINDRISK.
METHODS A descriptive, cross-sectional study applied FINDRISK to 620 persons aged ≥18 years randomly selected from a universe of 1058 patients with no known glucose abnormalities, registered in family-doctor-and-nurse office No. 23 in the Turcios Lima Teaching Polyclinic health area, Pinar del Río city.
RESULTS The study population was predominantly aged ≤45 years (53.5%) and 80.2% was overweight or obese. At least moderate risk of diabetes was found in 74.4% of the sample, and 10.5% was at very high risk, meaning an estimated 120 patients in the sample could be expected to develop type 2 diabetes within the next 10 years.
CONCLUSIONS Type 2 diabetes prevalence can be expected to increase substantially in this population over the next decade. We recommend design and timely implementation of intensive lifestyle change programs to eliminate or slow development of type 2 diabetes in at-risk individuals. We propose following cohorts identified by FINDRISK to assess its prognostic value in the Cuban population.
KEYWORDS Diabetes mellitus, risk factors, risk prediction, prevention, Cuba
