Assessment of the effects of solvents on lung function among paint industry workers in Mauritius

The study aimed to determine the respiratory effects of solvents among workers in the Mauritius paint industry. A total of 388 participants were selected using simple random sampling, and were subjected to a questionnaire for data collection. Lung function test was performed using a spirometer. Multiple regression was used to analyze the relationship between hours of exposure to solvents, while adjusting for socio-demographic factors. Independent t-test was also used to identify any difference between the means of lung function tests and the two exposed groups. Male participants were found less likely exposed to solvents compared to females (AOR, 3.39, CI 1.97-5.81). Those with secondary and lower secondary education, and worked for ≤12 hours per week, had an increased likelihood of being exposed to solvents (AOR 2.95, CI 1.20-7.28) (AOR 2.48, CI 1.19-5.16). Participants who were aware of occupational hazards (AOR 0.15, CI (0.05-0.46), and have used PPE (AOR 0.14, CI 0.08-0.25) were less likely to be less exposed to solvents. This study highlights the adverse effects of workplace exposures on respiratory health among paint factory workers. .

The effect of beverage taxes on youth consumption and body mass index: Evidence from Mauritius

Taxes on sugar-sweetened beverages (SSBs) are relatively new and there is limited evidence about their impact on SSB consumption or body mass index (BMI) (as opposed to prices, purchases, or sales), their impact on youth (as opposed to adults), or their impact in non-Western nations. This paper adds to the evidence across all these dimensions by estimating the effect of an SSB tax on SSB consumption and the BMI of youth in Mauritius, an island nation in the Indian Ocean, which we compare to Maldives, another island nation which did not implement an SSB tax during the time of our data. Results of difference-in-differences models indicate that the tax in Mauritius had no detectable impact on the consumption of SSBs or the BMI of the pooled sample of boys and girls. However, models estimated separately by sex indicate that the probability that boys consumed SSBs fell by 9.4 percentage points (11%). These are among the first estimates of the effect of SSB taxes on youth consumption and contribute to the limited evidence on the impact of SSB taxes on weight, and in non-Western countries.

The basic reproduction number of COVID-19 across Africa

The pandemic of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) took the world by surprise. Following the first outbreak of COVID-19 in December 2019, several models have been developed to study and understand its transmission dynamics. Although the spread of COVID-19 is being slowed down by vaccination and other interventions, there is still a need to have a clear understanding of the evolution of the pandemic across countries, states and communities. To this end, there is a need to have a clearer picture of the initial spread of the disease in different regions. In this project, we used a simple SEIR model and a Bayesian inference framework to estimate the basic reproduction number of COVID-19 across Africa. Our estimates vary between 1.98 (Sudan) and 9.66 (Mauritius), with a median of 3.67 (90% CrI: 3.31-4.12). The estimates provided in this paper will help to inform COVID-19 modeling in the respective countries/regions.

Re-analyzing the SARS-CoV-2 series using an extended integer-valued time series models: A situational assessment of the COVID-19 in Mauritius

This paper proposes some high-ordered integer-valued auto-regressive time series process of order p (INAR(p)) with Zero-Inflated and Poisson-mixtures innovation distributions, wherein the predictor functions in these mentioned distributions allow for covariate specification, in particular, time-dependent covariates. The proposed time series structures are tested suitable to model the SARs-CoV-2 series in Mauritius which demonstrates excess zeros and hence significant over-dispersion with non-stationary trend. In addition, the INAR models allow the assessment of possible causes of COVID-19 in Mauritius. The results illustrate that the event of Vaccination and COVID-19 Stringency index are the most influential factors that can reduce the locally acquired COVID-19 cases and ultimately, the associated death cases. Moreover, the INAR(7) with Zero-inflated Negative Binomial innovations provides the best fitting and reliable Root Mean Square Errors, based on some short term forecasts. Undeniably, these information will hugely be useful to Mauritian authorities for implementation of comprehensive policies.

Studying the trend of the novel coronavirus series in Mauritius and its implications

Mauritius stands as one of the few countries in the world to have controlled the current pandemic, the novel coronavirus 2019 (COVID-19) to a significant extent in a relatively short lapse of time. Owing to uncertainties and crisis amid the pandemic, as an emergency announcement, the World Health Organization (WHO) solicits the help of health authorities, especially, researchers to conduct in-depth research on the evolution and treatment of COVID-19. This paper proposes an integer-valued time series model to analyze the series of COVID-19 cases in Mauritius wherein the corresponding innovation term accommodates for covariate specification. In this set-up, sanitary curfew followed by sanitization and sensitization campaigns, time factor and safe shopping guidelines have been tested as the most significant variables, unlike climatic conditions. The over-dispersion estimates and the serial auto-correlation parameter are also statistically significant. This study also confirms the presence of some unobservable effects like the pathological genesis of the novel coronavirus and environmental factors which contribute to rapid propagation of the zoonotic virus in the community. Based on the proposed COM-Poisson mixture models, we could predict the number of COVID-19 cases in Mauritius. The forecasting results provide satisfactory mean squared errors. Such findings will subsequently encourage the policymakers to implement strict precautionary measures in terms of constant upgrading of the current health care and wellness system and re-enforcement of sanitary obligations.

Association between type 2 diabetes mellitus and disability: What is the contribution of diabetes risk factors and diabetes complications?

BACKGROUND

The aim of this study was to evaluate the association between type 2 diabetes and disability in Mauritius and to assess the extent to which the effect of diabetes is explained by diabetes risk factors and concomitant complications.

METHODS

Data from a national survey in the multiethnic nation of Mauritius, which comprises South Asians and African Creoles, were analyzed. Disability was measured using the Katz activities of daily living questionnaire in participants aged >50 years.

RESULTS

Among 3692 participants, 487 (13.2%) had some level of disability. Diabetes was associated with significantly higher risk of disability (odds ratio [OR] 1.67; 95% confidence interval [CI] 1.34-2.08). After adjusting for demographic, behavioral, and metabolic factors, as well as comorbidities, disability was significantly associated with diabetes among African Creoles (OR 2.03; 95% CI 1.16-3.56), but not South Asians (OR 1.27; 95% CI 0.98-1.66). Obesity explained much of the association between diabetes and disability (excess percentage of risk: 26.3% in South Asians and 12.1% in African Creoles). Obesity, history of cardiovascular disease (CVD), asthma-like symptoms, and depression together explained 46.5% and 29.0% of the excess risk in South Asians and African Creoles, respectively.

CONCLUSIONS

Diabetes is associated with a 67% increased risk of disability. Diabetes risk factors and comorbidities explain more of the association between diabetes and disability among South Asians than Africans. Obesity and history of CVD explained the largest percentage of the relationship between diabetes and disability, indicating that weight and CVD management may be helpful in controlling disability related to diabetes.

Meeting American Diabetes Association diabetes management targets: trends in Mauritius

AIMS

To examine the proportion of people with diabetes in the multi-ethnic country of Mauritius meeting American Diabetes Association targets in 2009 and 2015.

METHODS

Data from independent population-based samples of 858 and 656 adults with diagnosed diabetes in 2009 and 2015, respectively, were analysed with regard to recommended American Diabetes Association targets for HbA_1c , blood pressure and LDL cholesterol.

RESULTS

In 2015 compared with 2009, the proportion of people achieving American Diabetes Association targets for glycaemic control in Mauritius was higher in women (P≤0.01) and in those with only a primary education level (P=0.07), but not in men or people with a higher level of education. Achievement of blood pressure <140/90 mmHg was higher in 2015 compared with 2009 (60% vs 42%) in people of South Asian ethnicity (P<0.001), but not in those of African ethnicity (P=0.16). The percentages of people with LDL cholesterol <2.59 mmol/l were 42.1% and 50.4%, in 2009 and 2015, respectively (P=0.27). Better control of HbA_1c and blood pressure was observed in groups in which that control was poorest in 2009. The use of glucose-, blood pressure- and LDL cholesterol-lowering medication was higher in 2015 than in 2009.

CONCLUSIONS

In certain subgroups, namely women, those with poorer education and those of South Asian ethnicity, whose target achievement was the poorest in 2009, control of glycaemia and blood pressure was better in 2015 as compared with 2009. While these findings are encouraging, further work is required to improve outcomes.

Diabetes mellitus prevalence is increasing in South Asians but is stable in Chinese living in Singapore and Mauritius

BACKGROUND

Asia is experiencing a type 2 diabetes epidemic, but prevalence differs by ethnicity and level of socioeconomic development. Singapore and Mauritius have implemented comprehensive campaigns to address this public health problem. We compared diabetes and obesity prevalence trends among Chinese and South Asians living in Singapore and Mauritius to determine the contribution of ethnicity and economic development to diabetes.

METHODS

Age-specific data from serial national population-based surveys in Singapore and Mauritius between 1987 and 2010 were used to estimate age-standardized diabetes and obesity prevalence. Modified Breslow-Cox proportional hazard models were used to obtain rate ratios for diabetes risk factors.

RESULTS

In Singapore, the age-standardized prevalence of diabetes remained stable for Chinese (men: 14% in 1992, 13% in 2010; women: 12% in 1992, 10% in 2010), but increases were observed for South Asians (men: 20% in 1992, 26% in 2010; women: 18% in 1992, 20% in 2010). There were similar patterns in Mauritius. In both countries, obesity prevalence trends were stable for Chinese women, but increased for Chinese men and South Asians. Associations between obesity and diabetes were stronger in Chinese than South Asians regardless of country.

CONCLUSIONS

Despite different socioeconomic settings in Singapore and Mauritius, we observed rising diabetes prevalence among South Asians but stable prevalence in Chinese in both countries. This provides further evidence that ethnicity contributes to the development of diabetes, and that there should be an increased emphasis on future prevention strategies targeting South Asian populations in these countries.

Nicotine Metabolite Ratio (NMR) Prospectively Predicts Smoking Relapse: Longitudinal Findings From ITC Surveys in Five Countries

INTRODUCTION

The ratio of trans 3'-hydroxycotinine (3HC) to cotinine (nicotine metabolite ratio [NMR]) is a biomarker of the rate of nicotine metabolism, with higher NMR indicating faster metabolism. Higher NMR has been found to be associated with higher daily cigarette consumption and less success stopping smoking in cessation trials. This study examines differences in NMR among population-based samples of smokers in the five countries and explores the relationship between NMR and smoking abstinence.

METHODS

Participants (N = 874) provided saliva samples during International Tobacco Control (ITC) surveys in the United States, United Kingdom, Mauritius, Mexico, and Thailand conducted in 2010/2011 with follow-up surveys in 2012/2013. When all samples were received, they were sent to a common laboratory for analysis using liquid chromatography and tandem mass spectroscopy.

RESULTS

There was significant variation in NMR across countries (F = 15.49, p < .001). Those who reported smoking at follow-up had a mean NMR of 0.32, compared to a mean NMR of 0.42 in participants who reported that they had stopped (F = 8.93; p = .003). Higher mean NMR values were also associated with longer quit duration (p = .007). There was no substantial difference in NMR between current smokers who made a failed quit attempt and those who made no attempt-both had significantly lower NMR compared to those who quit and remained abstinent. Smokers with a higher NMR were more likely to report that they stopped smoking compared to those with a lower NMR (odds ratio = 2.67; 95% confidence interval: 1.25 to 5.68).

CONCLUSIONS

These results suggest faster nicotine metabolizers may be less likely to relapse following a quit attempt. This finding differs from results of clinical trials testing stop smoking medications, where slower metabolizers have been found to be more likely to maintain abstinence from smoking.

IMPLICATIONS

Results of this study suggest faster nicotine metabolizers may be less likely to relapse following a quit attempt. This finding differs from results of clinical trials testing stop smoking medications, where slower metabolizers have been found to be more likely to maintain abstinence from smoking.

The heterogeneous impact of a successful tobacco control campaign: a case study of Mauritius

BACKGROUND

Mauritius has one of the highest smoking prevalences in Africa, contributing to its high burden of non-communicable diseases. Mauritius implemented a series of tobacco control measures from 2009 to 2012, including tobacco tax increases. There is evidence that these policies reduced tobacco consumption, but it is not clear what impact they had across different socioeconomic groups.

METHOD

The impact of tobacco control measures on different income groups was analysed by contrasting household tobacco expenditures reported in 2006-2007 and 2012 household expenditure surveys. We employed the seemingly unrelated regression model to assess the impact of tobacco use on other household expenditures and calculated Gini coefficients to assess tobacco expenditure inequality.

RESULTS

From 2006 to 2012, excise taxes and retail cigarette prices increased by 40.6% and 15.3% in real terms, respectively. These increases were accompanied by numerous non-price tobacco control measures. The share of tobacco-consuming households declined from 35.7% to 29.3%, with the largest relative drop among low-income households. The Gini coefficient of household tobacco expenditures increased by 10.4% due to decreased spending by low-income households. Low-income households demonstrated the largest fall in their tobacco budget shares, and the impact of tobacco consumption on poverty decreased by 26.2%. Households that continued purchasing tobacco reduced their expenditures on transportation, communication, health, and education.

CONCLUSIONS

These results suggest that tobacco control policies, including sizeable tax increases, were progressive in their impact. We conclude that tobacco use increases poverty and inequality, but stronger tobacco control policies can mitigate the impact of tobacco use on impoverishment.

Body composition-derived BMI cut-offs for overweight and obesity in Indians and Creoles of Mauritius: comparison with Caucasians

BACKGROUND AND AIMS

Global estimates of overweight and obesity prevalence are based on the World Health Organisation (WHO) body mass index (BMI) cut-off values of 25 and 30 kg m-2, respectively. To validate these BMI cut-offs for adiposity in the island population of Mauritius, we assessed the relationship between BMI and measured body fat mass in this population according to gender and ethnicity.

METHODS

In 175 young adult Mauritians (age 20-42 years) belonging to the two main ethnic groups-Indians (South Asian descent) and Creoles (African/Malagasy descent), body weight, height and waist circumference (WC) were measured, total body fat assessed by deuterium oxide (D2O) dilution and trunk (abdominal) fat by segmental bioimpedance analysis.

RESULTS

Compared to body fat% predicted from BMI using Caucasian-based equations, body fat% assessed by D2O dilution in Mauritians was higher by 3-5 units in Indian men and women as well as in Creole women, but not in Creole men. This gender-specific ethnic difference in body composition between Indians and Creoles is reflected in their BMI-Fat% relationships, as well as in their WC-Trunk Fat% relationships. Overall, WHO BMI cut-offs of 25 and 30 kg m-2 for overweight and obesity, respectively, seem valid only for Creole men (~24 and 29.5, respectively), but not for Creole women whose BMI cut-offs are 2-4 units lower (21-22 for overweight; 27-28 for obese) nor for Indian men and women whose BMI cut-offs are 3-4 units lower (21-22 for overweight; 26-27 for obese).

CONCLUSIONS

The use of BMI cut-off points for classifying overweight and obesity need to take into account both ethnicity and gender to avoid gross adiposity status misclassification in this population known to be at high risk for type-2 diabetes and cardiovascular diseases. This is particularly of importance in obesity prevention strategies both in clinical medicine and public health.

Duration of Untreated Psychosis in Chinese and Mauritian: Impact of Clinical Characteristics and Patients' and Families' Perspectives on Psychosis

Background

Duration of untreated psychosis (DUP) is a potentially modifiable prognostic factor of course and prognosis of psychiatric disorders. Few studies have demonstrated that different cultural backgrounds or perspectives on psychosis may be important factors to the DUP. This study attempted to explore whether the DUP was different in Chinese and Mauritians and to clarify potential influencing factors to a long DUP (>3 months).

Methods

200 patients from China and 100 patients from Mauritius were enrolled in the study. Their respective family members were also recruited. Demographic and clinical characteristics were collected, and the Internalized Stigma of Mental Illness (ISMI) scale was adapted to measure the stigma in all subjects. Binary logistic regression analysis was used to find the potential influencing factors to the long DUP.

Results

35.3% of the enrolled patients had a long DUP. No significant difference was found in frequency of long DUP between the two countries. Chinese patients had relatively less perceptions of stigma. Furthermore, Chinese patients with a long DUP had more perception of breakup due to mental illness (OR = 2.22, p = 0.04) and more families’ perception of the patient being disinherited due to mental illness (OR = 6.47, p = 0.01). Mauritian patients with a long DUP were less likely to have high monthly income (OR = 0.12, p<0.01), while they had less patients’ awareness of mental illness (OR = 0.31, p<0.05) and less families’ awareness of mental illness (OR = 0.14, p<0.01).

Conclusion

The results of this study underlined the importance of DUP in economic conditions, racial and sociocultural factors, and public awareness on psychosis in developing countries.

High consumption of pulses is associated with lower risk of abnormal glucose metabolism in women in Mauritius

AIMS

To investigate if consumption of pulses was associated with a reduced risk of developing abnormal glucose metabolism, increases in body weight and increases in waist circumference in a multi-ethnic cohort in Mauritius.

METHODS

Population-based surveys were performed in Mauritius in 1992 and in 1998. Pulse consumption was estimated from a food frequency questionnaire in 1992 and outcomes were measured in 1998. At both time points, anthropometry was undertaken and an oral glucose tolerance test was performed.

RESULTS

Mauritian women with the highest consumption of pulses (highest tertile) had a reduced risk of developing abnormal glucose metabolism [odds ratio 0.52; 95% CI 0.27, 0.99) compared with those with the lowest consumption, and also after multivariable adjustments. In women, a high consumption of pulses was associated with a smaller increase in BMI.

CONCLUSIONS

High consumption of pulses was associated with a reduced risk of abnormal glucose metabolism and a smaller increase in BMI in Mauritian women. Promotion of pulse consumption could be an important dietary intervention for the prevention of Type 2 diabetes and obesity in Mauritius and should be examined in other populations and in clinical trials.

Plasma levels of soluble interleukin 1 receptor accessory protein are reduced in obesity

CONTEXT

Adipokines actuate chronic, low-grade inflammation through a complex network of immune markers, but the current understanding of these networks is incomplete. The soluble isoform of the IL-1 receptor accessory protein (sIL1RAP) occupies an important position in the inflammatory pathways involved in obesity. The pathogenetic and clinical influences of sIL1RAP are unknown.

OBJECTIVE

The objective of the study was to elucidate whether plasma levels of sIL1RAP are reduced in obesity, using affluent clinical, biochemical, and genetic data from two diverse cohorts.

DESIGN, SETTING, AND PARTICIPANTS

The study was conducted in two cohorts: the San Antonio Family Heart Study (n = 1397 individuals from 42 families) and South Asians living in Mauritius, n = 230).

MAIN OUTCOME MEASURES

Plasma sIL1RAP levels were measured using an ELISA. The genetic basis of sIL1RAP levels were investigated using both a large-scale gene expression profiling study and a genome-wide association study.

RESULTS

A significant decrease in plasma sIL1RAP levels were observed in obese subjects, even after adjustment for age and sex. The sIL1RAP levels demonstrated a strong inverse association with obesity measures in both populations. All associations were more significant in females. Plasma sIL1RAP levels were significantly heritable, correlated with IL1RAP transcript levels (NM_134470), showed evidence for shared genetic influences with obesity measures and were significantly associated with the rs2885373 single-nucleotide polymorphism (P = 6.7 × 10(-23)) within the IL1RAP gene.

CONCLUSIONS

Plasma sIL1RAP levels are reduced in obesity and can potentially act as biomarkers of obesity. Mechanistic studies are required to understand the exact contribution of sIL1RAP to the pathogenesis of obesity.

A quantitative ethnopharmacological documentation of natural pharmacological agents used by pediatric patients in Mauritius

The pediatric population constitutes the most vulnerable patients due to a dearth of approved drugs. Consequently, there is a pressing need to probe novel natural pharmacological agents in an endeavour to develop new drugs to address pediatric illnesses. To date, no studies have explored the use of natural therapies for pediatric health care in Mauritius. Parents (n = 325) from different regions of the island were interviewed. Quantitative indexes such as fidelity level (FL), informant consensus factor (F IC), and use-value (UV) were calculated. Thirty-two plants were reported to be used by pediatric patients. Gastrointestinal disorders (F IC = 0.97) encompassing regurgitation, infantile colic, and stomach aches were the most common ailments managed with herbs. Matricaria chamomilla used for infantile colic and its pharmacological properties has previously been documented for pediatric patients. Product from A. mellifera (UV = 0.75) was the most utilized zootherapy for managing cough. Most plants and animal products reported in this study have bioactive constituents supported by existing scientific literature but their use for the pediatric population is scant. The present ethnopharmacological study has opened new perspectives for further research into their pharmacology, which can subsequently support and facilitate timely pediatric medicinal product development.

Effectiveness of a theory-driven nutritional education program in improving calcium intake among older Mauritian adults

Background. Low calcium intake, a risk factor of osteoporosis and subsequent fractures, has been previously reported among post-menopausal women in Mauritius. Objective. To assess the effectiveness of a theory-based educational intervention in improving the calcium intake, self-efficacy, and knowledge of older Mauritians. Methodology. The study was conducted as a pre- and post-test design which was evaluated through a baseline, immediate postintervention, and 2-month follow-up assessments. Participants were adults (n = 189) aged ≥40 years old from 2 urban community-based centres. The intervention group (IG) (n = 98) participated in 6 weekly interactive lessons based on the health belief model (HBM). The main outcome measures were calcium intake, HB scale scores, knowledge scores, and physical activity level (PAL). Anthropometric measurements were also assessed. Results. The IG significantly increased its baseline calcium intake, knowledge and self-efficacy (P < 0.001) at post-assessments. A significant decrease in waist circumference in the IG was noted (P < 0.05) after intervention. PAL significantly increased by 12.3% at post-test and by 29.6% at follow-up among intervention adults when compared to the CG (P < 0.001). Conclusion. A theory-driven educational intervention is effective in improving the dietary calcium intake, knowledge, self-efficacy, and PAL of older community-based Mauritian adults.

Ethnomedicinal application of native remedies used against diabetes and related complications in Mauritius

ETHNOPHARMACOLOGICAL RELEVANCE

Notoriously, the tropical island of Mauritius has one of the highest prevalence of diabetes worldwide and the economic burden associated with it is alarming. The use of native remedies (NRs) is well anchored in the local culture and it continues to be the cornerstone of therapy for diabetic patients. However, there is currently a dearth of updated primary data on NRs used by Mauritians against diabetes and diabetes related complications (DRCs). This study was therefore designed to record, analyze and document orally transmitted ethnopharmacological knowledge from diabetic patients and traditional medicine practitioners (TMPs) in Mauritius concerning NRs commonly used against diabetes and DRCs which might open new avenues to initiate novel antidiabetic drugs discovery.

MATERIALS AND METHODS

Data was collected following interviews from diabetic patients (n=328) and TMPs (n=20). Eleven quantitative indexes, namely informant consensus factor (FIC), fidelity level (FL), use value (UV), relative frequency of citation (RFC), relative importance (RI), cultural importance index (CII), index of agreement on remedies (IAR), cultural agreement index (CAI), quality use value (QUV), quality use agreement value (QUAV) and ethnobotanicity index (EI) were calculated. Statistical analysis such as Pearson correlation and Chi-squared test were performed to determine any association.

RESULTS

A total of 111 plant species distributed over 56 families, 30 polyherbal formulations and 16 animal species were documented to be traditionally used against diabetes and DRCs. For the first time 8 endemic plants have been recorded to be used against diabetes and DRCs from Mauritius. The most encountered medicinal plant family was Asteraceae. According to the EI, 16.2% of the native plants in Mauritius were used against diabetes and DRCs. As far as we know, Vangueria madagascariensis, Apium graveolens, Petroselinum crispum and Rubus alceifolius with high RFC values are recorded against diabetes and DRCs for the first time. Sociodemographic characteristics (age, gender, income, religious belief, education and residence) were found to significantly (p<0.05) influence the use of NRs. The average FIC for all ailments for plant and animal products were 0.94 and 0.87 respectively. Bryophyllum pinnatum, a native plant to Mauritius scored a high FL value (100%) used against diabetic neuropathy, Allium sativum had the highest RI value (2.00) due to its versatility, Aloe vera had the highest RFC (0.61), the CII (0.640) and the highest CAI value (0.635), Psidium guajava had the highest QUAV (0.961) which indicates its high bioactivity and Allium cepa was reported as the most effective plant species (QUV=0.965). According to UV, the most important species was Morinda citrifolia (1.21). Panoply of animal products were reported whereby fish (39.7%) was recorded as the most utilised zootherapy and Salmo salar scored the highest FL (100%) for diabetes. Some animal species (n=14) not previously documented against diabetes and DRCs are reported in the present study.

CONCLUSION

Our present investigation revealed that the use of NRs constitutes the common legacy of Mauritians and despite the penetration of allopathic medicine; NRs continue to play a crucial role in the primary health care system of Mauritius. To this effect, it is of uttermost importance to record this knowledge before it disappears. In addition, further experimental investigations are required to elucidate the pharmacological properties of the reported medicinal flora and fauna of Mauritius.

Antimicrobial Resistance Among Enterobacteriaceae Causing Uncomplicated Urinary Tract Infections in Mauritius: Consequences of Past Misuse of Antibiotics

A study was conducted to determine the nature and antimicrobial susceptibility of uropathogens in Mauritius in order to provide guidance on the empirical treatment of uncomplicated urinary tract infections. The study was based on urine samples sent for bacteriological investigation at the Central Health Laboratory from unhospitalized patients over a 3-month period. Information on organisms isolated in pure growth and their antibiotic susceptibility was collected and analyzed. Entero - bacteriaceae accounted for over 80% of the 260 isolates obtained during the study period, and showed high rates of resistance to ampicillin (80%), co-trimoxazole (50%), nalidixic acid (34%) and ciprofloxacin (26%). Resistance to mecillinam and fosfomycin were only 2% and 0% respectively. The high rate of antimicrobial resistance in Enterobacteriaceae in urine is cause for concern. Fluoroquinolones may not be very reliable for empirical treatment of urinary tract infections in Mauritius. Alternatives such as pivmecillinam and fosfomycin should be considered.

Unexpectedly high injection drug use, HIV and hepatitis C prevalence among female sex workers in the Republic of Mauritius

Female sex workers (FSW) often have a disproportionately high prevalence of HIV infection and they, along with their clients, are considered a core group contributing to the transmission of HIV in many countries. In 2010, females who reported having vaginal/anal/oral sex in the last 6 months with a male in exchange for money or gifts, aged ≥15 years, and living in Mauritius were recruited into a survey using respondent driven sampling. Consenting females (n = 299) completed a behavioral questionnaire and provided venous blood for HIV, HCV and HBV testing. HIV seroprevalence among FSW was 28.9 % and 43.8 % were infected with HCV; among HIV seropositive FSW, 88.2 % were also infected with HCV. Almost 40 % of FSW reported injecting drugs sometime in their lives and 30.5 % of all FSW reported doing so in the previous 3 months. Among those who ever injected drugs, 82.5 % did so in the past 3 months and among those 60 % reported injecting drugs at least once a day. Among FSW who ever injected drugs, 17.5 % reported sharing a needle at last injection. Regression analyses found injection drug use behaviors to be positively associated with HIV seroprevalence. These findings indicate that FSW, especially those who inject drugs, are at high risk for HIV and HCV infection and transmission and illustrates the need for gender responsive HIV and injection drug use prevention and treatment models that respond to the unique situations that affect this population.

[Elevated coronary mortality in Mauritius: risk factors and genetic analyses]

In 1986, early mortality by acute myocardial infarction was found to be much higher in Mauritius than in the United States, among both males and females. For example, among 40-to-44 year olds there were 109 deaths/100,000 males per year in Mauritius, compared to only 34.5/100,000 in the U S. A study comparing two non hospital populations of Mauritian and U S. residents showed a higher prevalence of diabetes and glucose intolerance in Mauritius. Likewise, a case-control study comparing 60 young patients who had MI before age 45 years and age-matched Mauritian residents showed statistically significant differences in terms of abnormal glucose metabolism (P<0.001), LDL cholesterol (P<0.02), total cholesterol (P<0.04), HDL cholesterol (p<10-9), and triglycerides (P<0.01) in the patients with early MI. A genome-wide scan of Mauritian patients of North Indian origin (Francke et al) who had MI before age 52 years and patients with coronary heart disease occurring before age 60 years showed a significant relation between coronary heart disease and loci in chromosome regions 16p-13 (LOD 3.06), 10q23 (LOD 2,03; also linked to HDL cholesterol and the LDL/HDL ratio), and 3q27 (LOD 2.37). Genomic studies of Indo-Mauritian patients confirm the important role of the metabolic syndrome in the high prevalence of coronary heart disease in Mauritius, and show the polygenic nature of the disease.

The economic benefits of malaria elimination: do they include increases in tourism?

BACKGROUND

Policy makers have speculated that one of the economic benefits of malaria elimination includes increases in foreign direct investment, particularly tourism.

METHODS

This study examines the empirical relationship between the demand for travel and malaria cases in two countries with large tourism industries around the time in which they carried out malaria-elimination campaigns. In Mauritius, this analysis examines historical, yearly tourist arrivals and malaria cases from 1978-1999, accounting for the background secular trend of increasing international travel. In Dominican Republic, a country embarking upon malaria elimination, it employs a time-series analysis of the monthly, international tourist arrivals from 1998-2010 to determine whether the timing of significant deviations in tourist arrivals coincides with malaria outbreaks.

RESULTS

While naïve relationships exist in both cases, the results show that the relationships between tourist arrivals and malaria cases are relatively weak and statistically insignificant once secular confounders are accounted for.

CONCLUSIONS

This suggests that any economic benefits from tourism that may be derived from actively pursuing elimination in countries that have high tourism potential are likely to be small when measured at a national level. Rather, tourism benefits are likely to be experienced with greater impact in more concentrated tourist areas within countries, and future studies should seek to assess these relationships at a regional or local level.

Is there an association between socioeconomic status and body mass index among adolescents in Mauritius?

There are no documented studies on socioeconomic status (SES) and body mass index (BMI) among Mauritian adolescents. This study aimed to determine the relationships between SES and BMI among adolescents with focus on diet quality and physical activity (PA) as mediating factors. Mauritian school adolescents (n = 200; 96 males, 104 females) were recruited using multistage sampling. Participants completed a self-reported questionnaire. Height and weight were measured and used to calculate BMI (categorised into underweight, healthy-weight, overweight, obese). Chi-square test, Pearson correlation, and Independent samples t-test were used for statistical analysis. A negative association was found between SES and BMI (χ(2) = 8.15%, P < 0.05). Diet quality, time spent in PA at school (P = 0.000), but not total PA (P = 0.562), were significantly associated with high SES. Poor diet quality and less time spent in PA at school could explain BMI discrepancies between SES groups.

Chikungunya virus isolation using simplified cell culture technique in Mauritius

During the chikungunya outbreak of 2005 - 2006, the only laboratory facilities available in Mauritius were virus isolation in cell culture tubes and serology. The laboratory was submerged with large numbers of blood samples. Comparative isolation was made in human embryonic lung (HEL) and VERO cells grown in 96-well plate. Culture on HEL cells was found to be more sensitive and presence of cytopathic effect (CPE) was observed earlier than in VERO cells. Out of the 18 300 blood samples inoculated on HEL, 11 165 were positive. This virus isolation method was of great help for the surveillance and control of the vectors. In cases of an outbreak a cheap, rapid and simple method of isolating chikungunya virus is described.

Costs and financial feasibility of malaria elimination

The marginal costs and benefits of converting malaria programmes from a control to an elimination goal are central to strategic decisions, but empirical evidence is scarce. We present a conceptual framework to assess the economics of elimination and analyse a central component of that framework-potential short-term to medium-term financial savings. After a review that showed a dearth of existing evidence, the net present value of elimination in five sites was calculated and compared with effective control. The probability that elimination would be cost-saving over 50 years ranged from 0% to 42%, with only one site achieving cost-savings in the base case. These findings show that financial savings should not be a primary rationale for elimination, but that elimination might still be a worthy investment if total benefits are sufficient to outweigh marginal costs. Robust research into these elimination benefits is urgently needed.

[Status report on public health in Mauritius in 2009]

Mauritius is an island nation off the coast of Africa in the southwestern Indian Ocean. Improved socio-sanitation conditions over the past years have dramatically decreased the incidence of tropical diseases to levels comparable with those observed in developed countries. Some tropical illnesses including malaria, schistosomiasis, cysticercosis and lymphatic filariasis have been eradicated. Others such as amibiasis, typhoid fever and leprosy have become rare. However, because of the island's geographical proximity to countries with uncontrolled and suboptimal socio-sanitation conditions and its humid subtropical climate, there is a continued risk for certain vector transmitted tropical diseases such as Chikungunya and dengue. In addition, the incidence of HIV infection and AIDS has been rising rapidly since 2004 and tuberculosis remains a public health problem. Better living conditions have also been accompanied by an increase in cardiovascular and metabolic diseases that, along with cancer, are now the main causes of morbidity and mortality.

Microvascular diabetic complications are more prevalent in India compared to Mauritius and the UK due to poorer diabetic control

Type 2 diabetes mellitus (T2DM) is a growing worldwide problem with WHO estimates suggesting that 300 million people will be affected by 2025. T2DM could result in both microvascular and macrovascular complications but the presentation of these complications could vary globally and be influenced by diabetic control. We investigated the prevalence of these complications by surveying 787 patients of south-Asian origin in diabetic clinics in the UK (n=351), Mauritius (n=173) and India (n=263). We found the prevalence of microvascular complications such as retinopathy (India 16.3%; Mauritius 2.3%; UK 2.6%), nephropathy (India 20.5%; Mauritius 10.5%; UK 2.3%) and neuropathy (India 8.4%; Mauritius 1.2%; UK 5.1%) complications to be significantly higher in India compared to Mauritius and the UK (p<0.05). Interestingly, macrovascular complications such as cardiovascular disease were significantly more prevalent in Mauritius and the UK compared to India (p<0.05). The use of diabetic medication such as Metformin, Sulphonylureas and Insulin was significantly higher in the UK and Mauritius compared to India (p<0.05). The mean HbA1c was significantly higher in India compared to the UK (India 8.68%; UK 8.30%). Our results suggest that microvascular complications are higher in India due to poorer diabetic control. Our findings could be explained by late-onset presentation of diabetic patients in India due to the lack of primary care initiatives to screen and monitor treatment of T2DM. Furthermore, the poor diabetic control in India could reflect a dearth of clinical, evidence-based-knowledge regarding diabetic medication amongst Indian physicians. In view of the global increase in T2DM, this is a major concern for Indian healthcare.

Risk prediction models for the development of diabetes in Mauritian Indians

AIMS

To develop risk prediction models of future diabetes in Mauritian Indians.

METHODS

Three thousand and ninety-four Mauritian Indians (1141 men, aged 20-65 years) without diabetes in 1987 or 1992 were followed up to 1992 or 1998. Subjects underwent repeated oral glucose tolerance tests and diabetes was diagnosed according to 2006 World Health Organization/International Diabetes Federation criteria. Cox regression models for interval censored data were performed using data from 1544 randomly selected participants. Predicted probabilities for diabetes were calculated and validated in the remaining 1550 subjects.

RESULTS

Over 11 years of follow-up, there were 511 cases of diabetes. Among variables tested, family history of diabetes, obesity (body mass index, waist circumference) and glucose were significant predictors of diabetes. Predicted probabilities derived from a simple model fitted with sex, family history of diabetes and obesity ranged from 0.05 to 0.64 in men and 0.03 to 0.49 in women. To predict the onset of diabetes, area under the receiver operating characteristic (ROC) curve (AROC) of predicted probabilities was 0.62 (95% confidence interval, 0.56-0.68) in men and 0.64 (0.59-0.69) in women. At a cut-off point of 0.12, the sensitivity and specificity were 0.72 (0.71-0.74) and 0.47 (0.45-0.49) in men and 0.77 (0.75-0.78) and 0.50 (0.48-0.52) in women, respectively. Addition of fasting plasma glucose (FPG) to the model improved the prediction slightly [AROC curve 0.70 (0.65-0.76) in men, 0.71 (0.67-0.76) in women].

CONCLUSIONS

A diabetes prediction model based on obesity and family history yielded moderate discrimination in Mauritian Indians, which was slightly inferior to the model with the FPG but may be useful in low-income countries to promote identification of people at high risk of diabetes.

The health impact of nonhazardous solid waste disposal in a community: the case of the Mare Chicose landfill in mauritius

The disposal of nonhazardous solid waste on the island of Mauritius is centered on the Mare Chicose landfill. Because of health concerns in the community, the authors conducted a health impact survey, took measurements of height and weight, and compared the results with a control locality. After adjusting for confounding factors, the authors observed that numerous complaints were significantly higher in the target population. After elimination of reporting bias, however, nausea and vomiting remained as the only significant self-reported outcomes. The mean body mass index (BMI) of target men was significantly lower when compared with the control. This result was not observed in the populations of women and children, and suggests a gender difference in the health impact of the landfill.

BMI compared with central obesity indicators as a predictor of diabetes incidence in Mauritius

The aim of the study was to compare BMI with waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-stature ratio (WSR) as a predictor of diabetes incidence. A total of 1,841 men and 2,104 women of Mauritian Indian and Mauritian Creole ethnicity, aged 25-74 years, free of diabetes, hypertension, cardiovascular disease, and gout were seen at baseline in 1987 or 1992, and follow-up in 1992 and/or 1998. At all time points, participants underwent a 2 h 75 g oral glucose tolerance test. Hazard ratios for diabetes incidence were estimated applying an interval-censored survival analysis using age as timescale. Six hundred and twenty-eight individuals developed diabetes during the follow-up period. Multivariable adjusted hazard ratios for diabetes incidence corresponding to a 1 s.d. increase in baseline BMI, WC, WHR, and WSR for Mauritian Indians were 1.49 (1.31-1.71), 1.58 (1.38-1.81), 1.54 (1.37-1.72), and 1.61 (1.41-1.84) in men and 1.33 (1.17-1.51), 1.35 (1.19-1.53), 1.39 (1.24-1.55), and 1.38 (1.21-1.57) in women, respectively; and for Mauritian Creoles they were 1.86 (1.51-2.30), 2.07 (1.68-2.56), 1.92 (1.62-2.26), and 2.17 (1.76-2.69) in men and 1.29 (1.06-1.55), 1.27 (1.04-1.55), 1.24 (1.04-1.48), and 1.27 (1.04-1.55) in women. Paired homogeneity tests showed that there was no difference between BMI and each of the central obesity indicators (all P > 0.05). The relation of BMI with the development of diabetes was as strong as that for indicators of central obesity in this study population.

Serum uric acid and incident diabetes in Mauritian Indian and Creole populations

OBJECTIVE

To investigate the predictive value of serum uric acid (UA) for the development of diabetes in Asian Indians and Creoles living in Mauritius.

METHODS

A total of 1941 men (1409 Indians, 532 Creoles) and 2318 non-pregnant women (1645 Indians, 673 Creoles), aged 25-74 years and free of diabetes, cardiovascular disease and gout at baseline examinations in 1987 or 1992, were re-examined in 1992 and/or 1998. Diabetes was determined according to WHO/IDF 2006 criteria. The relationship between baseline UA and the development of diabetes during the follow-up was estimated using interval censored survival analysis.

RESULTS

In this cohort 337 (17.4%) men and 379 (16.4%) women developed diabetes during the follow-up. Individuals who developed diabetes during the follow-up had a lower serum UA levels at follow-up compared with their baseline UA levels, but this is not observed for post-menopausal women. Multivariate adjusted hazard ratios (HRs) (95% CIs) for the development of diabetes corresponding to one S.D. increase in UA concentration at baseline were 1.14 (1.01, 1.30) in Indian men and 1.37 (1.11, 1.68) in Creole men. They were 1.07 (0.95, 1.22) and 1.01 (0.84, 1.22), respectively, in Indians and Creole women.

CONCLUSION

Elevated serum UA is an independent risk marker for future diabetes in Mauritian men, whereas the prediction is weak in women.

The metabolic syndrome as a predictor of incident diabetes mellitus in Mauritius

AIMS

To assess the utility of the metabolic syndrome (MetS) and a Diabetes Predicting Model as predictors of incident diabetes.

METHODS

A longitudinal survey was conducted in Mauritius in 1987 (n = 4972; response 80%) and 1992 (n = 3685; follow-up 74.2%). Diabetes status was retrospectively determined using 1999 World Health Organization (WHO) criteria. MetS was determined according to four definitions and sensitivity, positive predictive value (PPV), specificity and the association with incident diabetes before and after adjustment for MetS components calculated.

RESULTS

Of the 3198 at risk, 297 (9.2%) developed diabetes between 1987 and 1992. The WHO MetS definition had the highest prevalence (20.3%), sensitivity (42.1%) and PPV (26.8%) for prediction of incident diabetes, the strongest association with incident diabetes after adjustment for age and sex [odds ratio 4.6 (3.5-6.0)] and was the only definition to show a significant association after adjustment for its component parts (in men only). The low prevalence and sensitivity of the International Diabetes Federation (IDF) and ATPIII MetS definitions resulted from waist circumference cut-points that were high for this population, particularly in men, and both were not superior to a diabetes predicting model on receiver operating characteristic analysis.

CONCLUSIONS

Of the MetS definitions tested, the WHO definition best identifies those who go on to develop diabetes, but is not often used in clinical practice. If cut-points or measures of obesity appropriate for this population were used, the IDF and ATPIII MetS definitions could be recommended as useful tools for prediction of diabetes, given their relative simplicity.

TRICHOMONAS GALLINAE IN MAURITIAN COLUMBIDS: IMPLICATIONS FOR AN ENDANGERED ENDEMIC

Although well known as a widespread parasitic disease of columbids and birds of prey, there have been few studies of trichomonosis in populations of wild birds. In Mauritius, trichomonosis has been highlighted as a major threat to an endangered endemic, the Pink Pigeon (Neosoenas [Columba] mayeri). In this study, we examined the role that populations of other columbids in Mauritius might be playing as infectious reservoirs of the causal flagellate protozoan, Trichomonas gallinae. We screened 296 wild individuals of three columbid species (Madagascan Turtle Dove [Streptopelia picturata], Spotted Dove [Streptopelia chinensis], and Zebra Dove [Geopelia striata]) between September 2002 and April 2004. Prevalence varied significantly among species (ranging from 19% in S. chinensis to 59% in G. striata) and between S. picturata sampled from upland and coastal sites; S. picturata from upland sites (>500 m) were significantly less likely to be infected with T. gallinae than those from lowland sites (<50 m; 62% and 27% prevalence, respectively). There was no significant difference in the prevalence of T. gallinae at sites where Pink Pigeons were also present compared to those sampled at sites without Pink Pigeons. We show that T. gallinae infection prevalence is higher at sites and times of warmer temperatures and lower rainfall.

Leptin predicts the development of diabetes in Mauritian men, but not women: a population–based study

OBJECTIVE

To determine if levels of the adipocyte-derived hormone, leptin, predict the development of type 2 diabetes.

METHODS

Population-based surveys were undertaken in the multiethnic nation of Mauritius in 1987, 1992 and 1998. Questionnaires, anthropometric measurements, and a 2-h 75-g oral glucose tolerance test were included. A cohort of 2330 participants who were free of diabetes, aged 25-79 years in 1987, and who were followed-up in 1992 and 1998 was studied. Serum leptin was measured in baseline samples. Glucose tolerance was classified according to WHO (World Health Organization) 1999 criteria.

RESULTS

In total, 456 subjects developed diabetes over 11 years with similar incidences in all ethnic groups (P=0.2). Baseline leptin correlated positively with anthropometric measurements, fasting and postload insulin and homeostasis model assessment indices (all P<0.001), and inversely with subsequent weight increase. Participants with incident diabetes had higher serum levels of leptin at baseline than those remaining nondiabetic (P<0.001). After adjustment for confounders, high leptin levels and high leptin/body mass index ratio were independently associated with incident diabetes over 11 years in men (odds ratio for top versus bottom quartile of leptin 2.18; 95% CI: 1.09-4.35), but not in women.

CONCLUSION

We conclude that high leptin levels are associated with the future development of diabetes, and the association is independent of other factors in men, but not in women.

Avian blood parasites in an endangered columbid: Leucocytozoon marchouxi in the Mauritian Pink Pigeon Columba mayeri

There is increasing evidence that pathogens can play a significant role in species decline. This study of a complete free-living species reveals a cost of blood parasitism to an endangered host, the Pink Pigeon Columba mayeri, endemic to Mauritius. We investigated the prevalence and effect of infection of the blood parasite, Leucocytozoon marchouxi, in the free-living Pink Pigeon population. Overall, L. marchouxi infection prevalence detected was 18.3%. Juveniles were more likely to be infected than older birds and there was geographical variation in infection prevalence. Survival of birds infected with L. marchouxi was lower than that of uninfected birds to 90 days post-sampling. This study suggests that while common haematozoa are well tolerated in healthy adults, these parasites may have greater pathogenic potential in susceptible juveniles. The study is unusual given its completeness of species sampling (96%) within a short time-period, the accurate host age data, and its focus on blood parasites in a threatened bird species. Species for which long-term life-history data are available for every individual serve as valuable models for dissecting the contribution of particular pathogens to species decline.

Six year incidence and progression of diabetic retinopathy: results from the Mauritius diabetes complication study

AIMS

To determine the incidence, progression and risk factors for diabetic retinopathy in the multiethnic population of Mauritius.

METHOD

A longitudinal, population-based study was conducted in Mauritius, during 1987, 1992 and 1998. Participants identified through the study as having diabetes (both known and newly diagnosed, by self-report and oral glucose tolerance test) and one in four participants with impaired glucose tolerance (IGT) underwent complications screening in 1992 and 1998. Retinal photographs were taken using a TRC-50VT retinal camera in three fields of the right eye (centred on the optic disc; macula (temporal to the optic disc); and nasal to disc). Photographs were graded according to a simplified version of the Wisconsin grading system.

RESULTS

The 6-year incidence of diabetic retinopathy was 23.8% (sight-threatening in 0.4%). Among those with known diabetes mellitus (KDM) and free of retinopathy at baseline the incidence of non-proliferative diabetic retinopathy (NPDR) was 29.2% and proliferative diabetic retinopathy (PDR) was 1.0%. Among those with newly diagnosed diabetes mellitus (NDM) at baseline the incidence of NPDR was 19.1% (no incident cases of PDR were found). Independent risk factors for retinopathy using the baseline population characteristics were duration of diabetes and fasting plasma glucose.

CONCLUSIONS

This is one of the few recent population-based studies of diabetic retinopathy undertaken in a developing nation. The incidence of retinopathy in Mauritius was high among those with NDM at baseline, with one in five developing retinopathy over 6 years. These results support the concept that screening for diabetes is important.

[Epidemiology and prevention of malaria in the southwestern islands of the Indian Ocean]

Malaria epidemiology differs greatly in the geographically close islands of the southwestern Indian Ocean. In Madagascar and the Comoros Union malaria is still a major public health problem. In Mayotte indigenous transmission resumed in 1995 and is currently high in some communities. In the Mascarene Islands (Reunion and Mauritius), indigenous transmission has been eradicated (Reunion) or become rare (Mauritius). The Seychelles Islands are malaria-free since local conditions are unfavorable for Anopheles mosquitoes. The level of resistance to antimalarials also differs from one island to another. Resistance to chloroquine ranges from moderate in Madagascar to high in the Comoros Union. Health recommendations for travelers must be adapted to the epidemiological features on each island.

[Chikungunya on Reunion Island: chronicle of an epidemic foretold]

Chikungunya is a viral disease transmitted by a mosquito of the genus Aedes. It is currently epidemic on Reunion Island, in the Indian Ocean. It is essentially characterized by an influenza syndrome but associated with polyarthralgia and an eruption. The disabling and chronic nature of the arthralgia is the most remarkable clinical aspect of chikungunya infection. Severe and unusual forms have appeared, not previously described in the literature. These forms must be studied to determine whether there is a direct relation between the chikungunya virus and the severity factors. Treatment is solely symptomatic, combining analgesic and/or antiinflammatory agents. There is no vaccine. The epidemic is not limited to Reunion: cases of chikungunya have also been reported in neighboring islands (Maurice, Seychelles, and Madagascar). Travelers planning to visit the region should be counseled.

Domestic violence against women--an international concern

Domestic violence is a pattern of assault and coercive behaviour including physical, sexual and psychological attacks, by a person against his/her own intimate partner. Women are more frequently the victims. After a global overview of the prevalence and nature of domestic violence against women especially in Mauritius, this articles provides a discussion about health problems and risk factors among the female victims with the objective of giving preventive measures to eradicate it from society. NGOs, along with legislative measures, have proven helpful in improving quality of life and preventing violence-related injuries among women. The health sector also plays an important role as part of multi-sector efforts in early detection and prevention of cases of domestic violence. Psychiatrists are in a unique position for early identification of such patients as well as intervention.

PATTERNS OF COCCIDIAL PREVALENCE IN LIZARDS OF MAURITIUS

This paper reports prevalence of coccidial oocysts in fecal samples from 6 endemic and 2 introduced lizard species on Mauritius, an island nation in the Indian Ocean. Total coccidian prevalence was 54% (n = 341) for the endemic 'ornate day gecko,' Phelsuma ornata; 48% (n = 159) for the endemic 'Durrell's night gecko,' Nactus durrelli; 53% (n = 15) for the endemic 'Serpent Island night gecko,' N. serpensinsula; and 78% (n = 248) for the introduced gecko, Hemidactylus frenatus. These high prevalences may reflect lack of long-lasting immune response to coccidial infection. There were few significant differences in prevalence among age, island, sex, or body condition within species, suggesting that these coccidia are relatively nonpathogenic and have little effect on host fitness. Prevalence was higher in the dry season than the wet season. These data suggest other factors, such as low host immune response to reinfection, affect overall prevalence more significantly than the effect of humidity on oocyst survival on Mauritius. No coccidia were found in samples from the endemic 'Gunner's Quoin night gecko,' N. coindemirensis (n = 155), probably reflecting parasite extinction due to a host population bottleneck following historical introduction of rats. There was no evidence of competitive or facilitative interactions between Eimeria sp. and Isospora sp., but evidence of competition between 2 Eimeria species in the 'ornate day gecko,' Phelsuma ornata. No evidence was found of cross-species infection, suggesting that reptile coccidia have high host specificity and are, therefore, poor subjects for studies of parasite-mediated competition and the evolution of sex.

Epidemiology of typhoid fever in Mauritius

BACKGROUND

The epidemiology of typhoid fever in Mauritius was studied to determine whether there was any need for tourists visiting Mauritius to be vaccinated against the disease, and where Mauritians with typhoid fever had been infected. Data on antibiotic susceptibility of Salmonella typhi isolates from Mauritius were also analyzed.

METHODS

Since 1997 every time S. typhi is isolated from blood cultures at our laboratory, an epidemiologic inquiry is conducted to determine the likely origin of the infection and the outcome of treatment, and the information collected is recorded. Results of antibiotic susceptibility testing are also noted. Data recorded on cases between 1997 and 2004 were reviewed and analyzed.

RESULTS

S. typhi was isolated on 25 occasions during the 8-year period. The infection was likely to have been acquired in Mauritius in only 6 cases (24%). Another 6 cases (24%) occurred in expatriate workers from the Indian subcontinent. Of the 13 Mauritians (52%) who probably acquired the infection abroad, 11 had a history of recent travel to India. Thirteen of 14 S. typhi isolates from cases acquired in India were resistant to nalidixic acid. Of the 6 cases acquired in Mauritius, 4 occurred in children under 12 years and 1 was caused by a multiply resistant strain. Twenty-two patients made an uneventful recovery. One death was indirectly caused by typhoid fever, and there was 1 case each of intestinal perforation and relapse.

CONCLUSIONS

In Mauritius typhoid fever is mainly an imported disease, but indigenous cases of the illness occur rarely and sporadically. Travelers to Mauritius need not be vaccinated against typhoid fever as the risk of acquiring the disease in the country is negligible. Mauritians traveling to India must be made aware of the risk of typhoid fever and of preventive measures. Ceftriaxone should be used as the initial first-line treatment of infection acquired in India.