BACKGROUND: To assess the attitudes of women towards intimate partner violence (IPV) in Guyana.
METHODS: We used national data from the publicly available Multiple Indicator Cluster Survey (MICS) conducted in Guyana in 2019 for women aged 15 to 49 years. The prevalence of women who agreed that a husband is justified in beating his wife was analyzed. Respondent reasons included if she: \"goes out without telling him\", \"neglects the children\", \"argues with him\", \"refuses sex with him\", \"burns the food\", \"has another partner\", \"stays out late/partying\", \"refuses to cook or clean\", \"overspends\", and/or \"he doesn\'t have access to her cellphone\". Descriptive analyses were carried for all the variables. Logistic regression was used to identify factors associated with these 10 respondent reasons, separately and in combination.
RESULTS: The overall prevalence of women\'s attitudes justifying IPV against women if there was a \'yes\' response to any of the 10 reasons was 17.9% (95%CI: 16.6-19.3%), and varied from 2.7% if she \"goes out without telling him\", \"burns the food\", or \"overspends\" to 10.0% if she \"has another partner\". This prevalence ranged from 10.2% in urban areas to 19.3% in rural areas (p<0.001), and from 16.1% in coastal to 30.1% in interior areas (p<0.001). Similarly, 25.9% of women from the poorest household agreed that a husband has the right in beating his wife for any of the 10 reasons compared to 11.6% of the richest women (11.6%) (p<0.001). Rural place of residence, ethnicity, geographic region, level of education, wealth quintile, ever used of a computer, and frequency of listening to the radio were significant factors associated with women\'s attitudes justifying IPV against women (p<0.05).
CONCLUSIONS: Over one-sixth of the respondents agreed that a husband was justified in committing IPV against women in Guyana. Public health programs focusing on geographic locations, ethnicity, and economic status must be implemented to change attitudes justifying IPV and reduce this significant public health challenge.

UNASSIGNED: The suicide rate in Guyana has consistently ranked in the top ten globally, yet there is only limited literature related to the context in which these suicides occur. This study aims to better understand the psychosocial circumstances and characteristics of suicides in Guyana.
UNASSIGNED: This case series study utilised a qualitative psychological autopsy method. One to three informants per deceased person (N = 31) were interviewed regarding the lives of 20 Guyanese who died by suicide (14 M, 6 F, aged 10-74 years). Interpretative Phenomenological Analysis was utilised for the data.
UNASSIGNED: Four superordinate themes were identified: Interpersonal Conflict, Trauma, Health, and Unknown Reasons. Interpersonal conflict included subordinate themes of Domestic Abuse, Marital Separation, and Financial Disputes. Health included subordinate themes of Physical Health and Mental Health. Pesticide poisoning was the method used by Guyanese people whose suicide was triggered primarily by interpersonal conflict.
UNASSIGNED: The findings illustrate the complexities of suicide in Guyana and the importance of adopting a biopsychosocial perspective to suicide prevention. Suicide prevention should include mental health and suicide literacy training of medical professionals. It is recommended that the importation of highly toxic pesticides be restricted, and that less toxic substitutes be promoted. Convenience sampling, recall bias, and limited informants are limitations of this study. Future research should focus on suicidal behaviour using larger sample sizes.
UNASSIGNED: This research was supported by an Australian Government Research Training Program Scholarship through Griffith University Australia.

A virtual point-of-care ultrasound (POCUS) education program was initiated to introduce handheld ultrasound technology to Georgetown Public Hospital Corporation in Guyana, a low-resource setting. We studied ultrasound competency and participant satisfaction in a cohort of 20 physicians-in-training through the urology clinic. The program consisted of a training phase, where they learned how to use the Butterfly iQ ultrasound, and a mentored implementation phase, where they applied their skills in the clinic. The assessment was through written exams and an objective structured clinical exam (OSCE). Fourteen students completed the program. The written exam scores were 3.36/5 in the training phase and 3.57/5 in the mentored implementation phase, and all students earned 100% on the OSCE. Students expressed satisfaction with the program. Our POCUS education program demonstrates the potential to teach clinical skills in low-resource settings and the value of virtual global health partnerships in advancing POCUS and minimally invasive diagnostics.

To manage the rapid rise of misleading information on the coronavirus disease (COVID-19) during the pandemic, the Breakthrough ACTION project developed a theory-based rumor-tracking system to inform Guyana\'s COVID-19 communication campaign.
The rumor-tracking project used the extended parallel processing model (EPPM) to identify and categorize rumors reflecting perceived high versus low vulnerability to COVID-19 and high versus low efficacy of engaging in recommended COVID-19 prevention behaviors. The project designed contextually relevant social and behavior change messages, called \"MythBusters,\" responded to rumor categories with the following objectives: (1) high perceived vulnerability and high efficacy rumors included a call to action; high perceived vulnerability and low efficacy rumors educated about effective and achievable solutions; (3) low perceived vulnerability and high efficacy rumors educated about risk; and (4) low perceived vulnerability and low efficacy rumors educated about risk and effective and achievable solutions.
Most rumors emanated from regions 4 and 8 (29%). Over two-thirds of the rumors (71%) recurred. Rumors were typically related to COVID-19 treatment or prevention (40%) and transmission (35%). Most rumors (48%) reflected low perceived vulnerability and low efficacy, 29% reflected high perceived vulnerability and low efficacy, 13% reflected low perceived vulnerability and high efficacy, and 10% reflected high perceived vulnerability and high efficacy. The project rapidly developed 12 MythBusters from June through December 2020 and integrated them into the national COVID-19 communication campaign, disseminated via radio, television, and Facebook. Estimates indicate that they have reached most of the target Guyanese population.
The EPPM was a particularly useful tool, giving direction to countering myths with appropriate messaging to affect relevant behaviors. The COVID-19 MythBusters provided the Guyanese public with valid and verifiable information and promoted preventive and protective behaviors.

Newborn screening (NBS) is a test done shortly after birth to detect conditions that cause severe health problems if not treated early. An estimated 71% of babies worldwide are born in jurisdictions that do not have an established NBS programme. Guyana currently has no NBS programme and has established a partnership with Newborn Screening Ontario (NSO) to initiate screening.
To assess the feasibility of implementing a NBS programme in Guyana for congenital hypothyroidism (CH) and haemoglobinopathies (HBG) and to report on screen positive rates and prevalence (Hardy-Weinberg equilibrium (HWE)) for CH and HBG.
Term, healthy Guyanese infants were evaluated (with consent) using heel prick dried blood spots (DBS) shortly after birth (closer to 24 hours of life). DBS samples were analysed at NSO. Screening test for CH was done using a human thyroid-stimulating hormone (hTSH) assay. Mean hTSH levels between the Guyanese sample and the Ontarian population were compared using Student\'s t-test with an alpha of 0.05. Screening test for HBG was performed with a cation-exchange high-performance liquid chromatography.
The pilot was conducted from 6 June 2016 to 22 September 2017. Georgetown Public Hospital Corporation recruited 2294 mothers/infants. Screen positive rate for CH in our sample was 0.0% (0/2038 infants). Mean TSH levels in Guyanese samples (1.7 µU/mL blood) was noticed to be significantly different than in the Ontarian population (4.3 µU/mL blood) (p<0.05). Screen positive rate for sickle cell anaemia (SCA) in our sample was 0.3% (7/2039 patients), and the carrier rate was 8.4% (172/2039 patients). Using the HWE, the SCA frequency (S allele frequency)2 is 0.0492=0.002 CONCLUSION: NBS for CH and SCA in Guyana could be beneficial. Future work should focus on conducting larger pilots which could be used to inform diagnosis and treatment guidelines for Guyanese people.

Diabetes prevalence has never been measured in Guyana. We conducted a nationally representative cross-sectional study to estimate the prevalence of diabetes and pre-diabetes, and the association between sex and diabetes.
In 2016, the Ministry of Public Health led Guyana\'s first national STEPS survey among adults aged 18-69 years. Half of the participants were randomly selected for hemoglobin A1c and fasting blood glucose testing. We estimated the prevalence of diabetes and pre-diabetes and measured the association between sex and diabetes prevalence using logistic regression to compute adjusted ORs.
We included 805 adults (511 women, 294 men, mean age 41.8 (SD 14.4) years). The national prevalence of diabetes was 18.1% (95% CI: 15.4% to 20.8%), with higher rates among women (21.4%, 95% CI: 18.0% to 24.7%) than men (15.1%, 95% CI: 10.9% to 19.3%). Sex-specific diabetes prevalence varied significantly across urban and rural areas (p=0.002 for interaction). In rural areas, diabetes was twice as common among women (24.1%, 95% CI: 20.1% to 28.2%) compared with men (11.8%, 95% CI: 7.7% to 15.9%). After adjusting for prespecified covariates, rural women had double the odds of diabetes compared with rural men (OR 2.1, 95% CI: 1.20 to 3.82). This prevalence pattern was reversed in urban areas (diabetes prevalence, women: 13.9%, 95% CI: 8.7% to 19.0%; men: 22.0%, 95% CI: 12.9% to 31.1%), with urban women having half the odds of diabetes compared with urban men (OR 0.4, 95% CI: 0.20 to 0.99). We estimated that nearly one-third of women and over a quarter of men had diabetes or pre-diabetes.
The burden of diabetes in Guyana is considerably higher than previously estimated, with an unexpectedly high prevalence among women-particularly in rural areas.

Point-of-care ultrasound (POCUS) is physician-performed at the bedside, and it is a powerful diagnostic tool, especially in resource-limited emergency medicine healthcare settings. This study aims to quantify both the use of ultrasound and its impact on patient care at the Accident and Emergency Department at the Georgetown Public Hospital Corporation (GPHC).
This is a cross-sectional observational descriptive analysis of data collected for quality assessment in the GPHC Accident and Emergency Department. Over the course of two months, physicians were asked to record each ultrasound exam performed and record whether the ultrasound results changed patient disposition or the medication used in management.
During the study period, there were 173 ultrasound data sheets collected representing 426 ultrasound studies. 196 studies were positive with pathologic findings (46.0%). The use of ultrasound in patient care either changed the patient\'s final disposition or medication 78.6% of the time.
Ultrasound is used frequently at the Georgetown Public Hospital Corporation for a wide variety of applications. When utilized, POCUS frequently influenced patient care.

Cardiovascular diseases (CVD) are the leading causes of death for men and women in low-and-middle income countries (LMIC). The nutrition transition to diets high in salt, fat and sugar and low in fruit and vegetables, in parallel with increasing prevalence of diet-related CVD risk factors in LMICs, identifies the need for urgent action to reverse this trend. To aid identification of the most effective interventions it is crucial to understand whether there are sex differences in dietary behaviours related to CVD risk.
From a dataset of 46 nationally representative surveys, we included data from seven countries that had recorded the same dietary behaviour measurements in adults; Bhutan, Eswatini, Georgia, Guyana, Kenya, Nepal and St Vincent and the Grenadines (2013-2017). Three dietary behaviours were investigated: positive salt use behaviour (SUB), meeting fruit and vegetable (F&V) recommendations and use of vegetable oil rather than animal fats in cooking. Generalized linear models were used to investigate the association between dietary behaviours and waist circumference (WC) and undiagnosed and diagnosed hypertension and diabetes. Interaction terms between sex and dietary behaviour were added to test for sex differences.
Twenty-four thousand three hundred thirty-two participants were included. More females than males reported positive SUB (31.3 vs. 27.2% p-value < 0.001), yet less met F&V recommendations (13.2 vs. 14.8%, p-value< 0.05). The prevalence of reporting all three dietary behaviours in a positive manner was 2.7%, varying by country, but not sex. Poor SUB was associated with a higher prevalence of undiagnosed hypertension for females (13.1% vs. 9.9%, p-value = 0.04), and a higher prevalence of undiagnosed diabetes for males (2.4% vs. 1.5%, p-value = 0.02). Meeting F&V recommendations was associated with a higher prevalence of high WC (24.4% vs 22.6%, p-value = 0.01), but was not associated with undiagnosed or diagnosed hypertension or diabetes.
Interventions to increase F&V intake and positive SUBs in the included countries are urgently needed. Dietary behaviours were not notably different between sexes. However, our findings were limited by the small proportion of the population reporting positive dietary behaviours, and further research is required to understand whether associations with CVD risk factors and interactions by sex would change as the prevalence of positive behaviours increases.

Diabetic foot infection is a global epidemic and a major public health concern. Development of microbial resistance to many antimicrobial agents in foot ulcer leads to serious complications. Therefore, the study aims to identify the microbiological profile and the potential risk factors among diabetic and non-diabetic foot ulcer patients. A prospective cross sectional study was carried out among 183 ulcer patients from diabetic foot clinic and wound dressing clinic at the public health hospital, Guyana. A total of 254 bacteria were isolated from the study with an average of 1.4 organism per lesion. Gram negative bacteria (63.0%) were prevalent than gram positive bacteria (37.0%) in this study. Among DF patients, Pseudomonas aeruginosa (18.8%) was the most common isolate followed by Escherichia coli (13.9%) among gram negative group. Were as MRSA (12.1%) followed by MSSA (7.9%) dominated among gram positive group in diabetic foot patients. Almost 42.1% (95% CI 34.8-49.6) of the infections were caused by poly-microbial. Interestingly, a stepwise logistic regression model determined increasing age and lack of health education as independent risk factor identified for acquiring an MDR wound infection (OR = 1.1; p ≥ 0.05; 95% CI 1.0-1.1). Mild, moderate and severe infection among MDR and NMDR patients were recorded as 45.3% (95% CI 32.8-58.3), 26.5% (95% CI 16.3-39.1), 28.1% (95% CI 17.6-40.8) and 51.3% (95% CI 41.9-60.5), 32.8% (95% CI 24.4-42.0), 16.0% (95% CI 9.9-23.8). Therefore, it is concluded that there\'s an urgent need for surveillance of resistant bacteria in diabetic foot infections to reduce the risk of major complications.

The suicide rate in Guyana was five times higher than the world average in 2014 (WHO) which puts Guyana at the top of the list with 44.2 per 100,000 people, the highest suicide rate in the world. For every completed suicide, there are survivors who experience high levels of psychological, physical, and social distress, and report feelings of guilt, shame, social stigma, and search for meaning.
The aim of this qualitative study was to explore how family members coped and understand the suicide of their loved one, and to determine what resources were available to help them during this transition.
Ten family members were recruited to participate in a focus group. The focus group lasted approximately 90 min and was recorded. The audio recordings were later transcribed.
Four overarching themes emerged from the data: (1) perceived causes of suicide, (2) perceived solutions, (3) barriers to helping persons who are suicidal, and (4) personal and community reactions to suicide.
Nurses in Guyana are uniquely positioned to take a leadership role in creating and implementing postvention programs for suicide survivors that are culturally and ethnically relevant. Opportunities to partner with schools of nursing in higher income countries are explored.