Population
The Salmonella epidemic in the Caribbean affected a significant portion of the population. Concerns were raised in the 1980s about a Salmonella epidemic in the Caribbean due to an upsurge in diarrhea cases among natives and visitors on several islands (Indar-Harrinauth et al., 2004).
A research study was undertaken in Trinidad and Tobago between 1988 and 1997 to ascertain the origins and type of organism impacting the region’s citizens, given that numerous known varieties of Salmonella cause infections, such as Enteritidis and Typhimurium. The disease was indiscriminate in its attacks, and people of every age, gender, or region of residence were affected. To contain the epidemic, it was vital to determine how, where, and when the disease began.
Social and Behavioral Determinants
Government, low socio-economic status, and low health-seeking behavior are the three social and behavioral determinants linked to public health concerns in Trinidad and Tobago. The government lacked effective surveillance and monitoring structures to ensure and persuade enterprises to follow safety rules to protect the public’s well-being (Indar-Harrinauth et al., 2004). The prevalent low socio-economic status of most of the island’s residents meant that they had limited access to vital medical care services. Lastly, a reluctance to seek medical attention among the population meant that many of the disease cases went unreported, given that the affected individuals seldom sought help from healthcare facilities.
Disparities
Among the key disparities prevalent in the Caribbean region that Salmonella impacted was a lack of sanitation education among farmers. Farmers lacked the skills needed to securely tend to their flocks, thus putting vendors and customers at risk. The second disparity is the unequal implementation of government standards governing cleanliness and food product handling. This meant that most farmers kept their flocks in unsanitary conditions that facilitated the growth and spread of Salmonella (Indar-Harrinauth et al., 2004). Finally, unequal access to essential health care services among island populations is a serious health inequality that led to the disease’s spread.
The Link Between Social Determinants and Disparities
There is a close association between the social determinants and disparities that facilitate the spread of Salmonella in the Caribbean. Firstly, the lack of a suitable government surveillance system encouraged farmers, who were poorly educated on sanitation, to keep their flocks in unclean environments. Secondly, the low socio-economic status aggravated the healthcare inequality on the island, which meant that poor households did not have the resources to access essential healthcare services. Finally, low health-seeking behavior was aggravated by low socio-economic status since poverty forced individuals to buy food rather than seek healthcare services.
Salmonella Infection
Risk Factors
There are a variety of risk factors that contribute to the spread of Salmonella in the population. For instance, poor eggshell quality may facilitate the penetration of the organization and the facilitation of horizontal spread (Cardoso et al., 2021). It is also worth noting that the egg storage temperature impacts the growth of Salmonella. Storing eggs at room temperature or temperature ranges between 7 and 48 degrees centigrade significantly increases the organism’s growth to hazardous levels (Cardoso et al., 2021). Finally, purchasing food products such as eggs from unsilenced vendors and poor hygiene when handling food increases the risk of infection.
Mode of Transmission
Salmonella species are one of the most common foodborne pathogens. They are the third greatest cause of mortality from diarrheal illnesses globally (Ferrari et al., 2019). This pathogen’s principal source is animals, and animal-based foods are the primary route of transmission to humans (Ferrari et al., 2019). The most prevalent reservoir is the digestive tract of a wide variety of animals, as well as a variety of dietary matrices that often act as vehicles for Salmonella species transmission to humans via fecal contamination (Ferrari et al., 2019). In the Caribbean case, chicken and eggs were the main agents through which the illness was transmitted (Indar-Harrinauth et al., 2004). When these microbes are introduced into food preparation facilities, they multiply in food products due to incorrect storage temperatures, poor cooking, and cross-contamination, as well as direct contact with diseased animals and people.
Incidence, Prevalence, and Mortality Rate
Statistical assessment is vital for the elucidation of meaning from collected data. The incidence is an indicator of the regularity with which an event, such as the discovery of a new instance of a disease or the isolation of an infectious agent, happens in a population over time (Spronk et al., 2019). The numerator is the number of occurrences that occur throughout a certain period, while the population in danger is the common denominator (Spronk et al., 2019). Therefore, incidence = the number of events /population at risk. The incidence of lab-confirmed salmonellosis = 109 isolates per 1,265,000 people per year, which translates to 0.0000862 isolates per person per year. Therefore, the incidence of Salmonella is 8.6 isolates per 100,000 persons per year.
The prevalence is calculated by multiplying the incidence by the duration of the illness. The table provided by Indar-Harrinauth et al. (2004) demonstrates that there were a total of 246 cases of enteritidis, meaning the prevalence rate is calculated by dividing 246 by 1,265,000 and then multiplying by 100,000, giving the result of 19.45. The table also shows that a total of 231 Typhimurium cases were detected. Therefore, the prevalence is 231 divided by 1,265,000 multiplied by 100,000, which gives a rate of 18.26. The mortality rate is calculated by taking the number of deaths divided by the total population multiplied by 100,000. The equation is 4/1,265,000 x 100,000 to give a mortality rate of 3.16.
Odds Ratio Interpretation
A case-control study’s measure of association is the odds ratio. It is the ratio of two odds, namely the chances of being exposed to a factor among cases and the chances of being exposed to the factor among controls (George et al., 2020). An odds ratio indicates how many times exposure is more likely among cases in comparison to controls (George et al., 2020). Cases and controls in the Trinidad and Tobago case-control research were similar in terms of age, gender, ethnic distribution, and location of residence. However, exposure to probable Salmonella sources differed across cases and controls.
Table 1. Sources of Exposure to Salmonella.
The odds ratios in Table 1 above demonstrate that affected individuals had approximately nine times the likelihood of consuming eggshells compared to the control group. Cases were over 20 times more likely than controls to consume dishes containing raw or undercooked eggs. Among cases, the likelihood of purchasing refrigerated eggs was one-tenth that of controls. Cases were less than one-tenth as likely as controls to refrigerate eggs after purchasing them. The chances of consuming chicken, beef, or powdered milk or being exposed to live chickens were comparable in cases and controls.
Connection Between Population and Salmonella
There are specific connections that can be drawn between the population and the health issue in question. The case-control research data show that the consumption of eggshells and the inclusion of raw or undercooked eggs in dishes were major risk factors for recurrent S. Enteritidis infection in Trinidad and Tobago. Protective elements identified in the study included the purchase of refrigerated eggs and the storage of eggs in a refrigerator at home.
Levels of Prevention
Specific primary prevention strategies have been implemented in Trinidad and Tobago. For instance, The Ministry of Agriculture established standards and guidelines for egg farmers on production and food safety, as well as public health education initiatives for customers, food service outlets, and food workers (Indar-Harrinauth et al., 2004). The focus of the education initiatives was effective handwashing and the implementation of appropriate food handling techniques. The implementation of monitoring standards and education initiatives ensures that chickens are kept in hygienic conditions, eggs are stored properly, and food is handled correctly, thus limiting the emergence and spread of Salmonella.
The secondary prevention strategies that were implemented included screening programs and serotyping measures to facilitate early detection and reporting of positive cases. The documentation of the number of persons who presented with symptoms, the means through which they were exposed, and the common features in the cases aided in the implementation of disease prevention measures (Indar-Harrinauth et al., 2004). Furthermore, the data facilitated the identification of the farms from which the illness originated, the isolation of risk factors, and the development of appropriate treatment interventions.
The treatment of symptoms and the implementation of rehydration protocols to prevent dehydration from vomiting and diarrhea were among the tertiary intervention strategies that were applied. It is worth noting that antibiotics were required in several severe cases to help manage the disease despite the fact that some of the patients demonstrated resistance (Indar-Harrinauth et al., 2004). Tertiary strategies are vital in view of the fact that they halt disease progression and prevent morbidity and mortality.
There are key differences between primary, secondary, and tertiary intervention strategies. In epidemiology, prevention encompasses a wide variety of actions designed to alleviate health risks or hazards and reduce the impact of disease. The primary preventive strategies are focused on the prevention of the occurrence of specific disease conditions, while secondary preventive strategies are created to mitigate the effects of an already occurring illness. Therefore, primary strategies prevent the occurrence of Salmonella infections, while secondary measures ensure that the spread is contained. Finally, unlike the first two strategies, tertiary prevention aims to lessen the burden of an ongoing disease that may have a variety of long-term consequences.
Conclusion
The spread of Salmonella and its impact on the population demands further study. The proposed research question is: To what degree do egg-producing farms implement safety practices designed to reduce the risk of promoting and spreading salmonellosis? An observational research study would be ideal to investigate the proposed research question. This is because observation is a straightforward and inexpensive process. It is not necessary for the observer to interrogate subjects about their behavior or compile reports from others. Data may be collected in real-time, given that the investigator observes how the farmers act and practice. The assessment of farmer behavior through further research is important because it contextualizes the conditions under which Salmonella is likely to flourish. It also explicates the effectiveness or the existence of government policies intended to prevent disease outbreaks, which is vital for the protection of the public’s health.
References
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Ferrari, R. G., Rosario, D. K. A., Cunha-Neto, A., Mano, S. B., Figueiredo, E. E. S., & Conte-Juniora, C. A. (2019). Worldwide epidemiology of Salmonella serovars in animal-based foods: A meta-analysis. Applied and Environmental Microbiology, 85(14), 1–21. Web.
George, A., Stead, T. S., & Ganti, L. (2020). What’s the risk: Differentiating risk ratios, odds ratios, and hazard ratios? Cureus, 12(8), 1–8. Web.
Indar-Harrinauth, L., Daniels, N., Prabbakar, P., Brown, C., Baccus-Taylor, G., Commissiong, E., Reid, H., & Hospedales, J. (2004). Salmonella in the Caribbean. Modifed from Stehr-Green, J., Caribbean Epidemiology Centre: Pan American Health Organization, World Health Organization, & Centers for Disease Control and Prevention. (2016). Web.
Spronk, I., Korevaar, J. C., Poos, R., Davids, R., Hilderink, H., Schellevis, F. G., Verheij, R. A., & Nielen, M. M. J. (2019). Calculating incidence rates and prevalence proportions: Not as simple as it seems. BMC Public Health, 19(1), 1–9. Web.