Dataset Information

Perceived discrimination in bateyes of the Dominican Republic: results from the Everyday Discrimination Scale and implications for public health programs.

ABSTRACT: BACKGROUND:Discrimination is a major driver of health disparities among minority groups and can impede the reach of public health programs. In the Dominican Republic, residents of bateyes, or agricultural 'company towns,' often face barriers to health care. This study examined the extent of perceived discrimination among batey populations and places the findings within the context of disease elimination efforts. METHODS:In March-April 2016, a stratified, multi-stage cluster survey that included the 9-item Everyday Discrimination Scale (EDS) was conducted among residents (n?=?768) of bateyes across the Dominican Republic. Exploratory factor analysis, differential item functioning, and linear and logistic regression were used to assess associations between EDS scores, ethnic group status, reasons for discrimination, and healthcare-seeking behavior. RESULTS:Three ethnic groups were identified in the population: Haitian-born persons (42.5%), Dominican-born persons with Haitian descent (25.5%), and Dominican-born persons without Haitian descent (32.0%). Mean EDS scores (range 0-45) were highest among persons born in Haiti (18.2, 95% confidence interval [CI]?=?16.4-20.1), followed by persons with Haitian descent (16.5, 95% CI?=?14.9-18.0), and those without Haitian descent (13.3, 95% CI?=?12.1-14.5). Higher EDS scores were significantly associated with Haitian birth (??=?6.8, 95% CI?=?4.2-9.4; p?

SUBMITTER: Keys HM

PROVIDER: S-EPMC6852895 | biostudies-literature | 2019 Nov

REPOSITORIES: biostudies-literature

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Perceived discrimination in bateyes of the Dominican Republic: results from the Everyday Discrimination Scale and implications for public health programs.

Keys Hunter M HM Noland Gregory S GS De Rochars Madsen Beau MB Taylor Thomas H TH Blount Stephen S Gonzales Manuel M

BMC public health 20191112 1

<h4>Background</h4>Discrimination is a major driver of health disparities among minority groups and can impede the reach of public health programs. In the Dominican Republic, residents of bateyes, or agricultural 'company towns,' often face barriers to health care. This study examined the extent of perceived discrimination among batey populations and places the findings within the context of disease elimination efforts.<h4>Methods</h4>In March-April 2016, a stratified, multi-stage cluster survey ...[more]

PMID: 31718594

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Project description:ImportancePerceived everyday discrimination is a psychosocial stressor linked to adverse health outcomes, including mortality.ObjectiveTo assess the association of vision impairment (VI), hearing impairment (HI), and dual sensory impairments (DSI) with everyday discrimination.Design, setting, and participantsCross-sectional analysis of the Health and Retirement Study 2006 and 2008 surveys, a US population-based survey that included noninstitutionalized adults 51 years and older. Analyses were weighted to account for complex sample design and differential nonresponse. Data were analyzed between October 2019 and November 2019.ExposuresParticipants rated their vision and hearing, using eyeglasses and/or hearing aids if applicable, on a Likert scale (poor, fair, good, very good, and excellent). Sensory impairment was defined as poor or fair ability in the relevant modality, and sensory impairment was categorized as neither sensory impairment (NSI), VI alone, HI alone, and DSI.Main outcomes and measuresPerceived everyday discrimination was measured on the validated 5-question Williams scale (range 0 to 5). Linear regression models estimated differences in discrimination scores by sensory categories, adjusting for age, sex, race, ethnicity, non-US birth, body mass index, relationship status, net household wealth, and number of chronic diseases (among diabetes, hypertension, heart disease, stroke, lung disease, nonskin cancer, and arthritis).ResultsThe sample included 13 092 individuals. After weighting the sample to be representative of the US population, 11.7% had VI alone, 13.1% HI alone, and 7.9% DSI. In the fully adjusted model, participants with VI alone (β [change in discrimination score], 0.07; 95% CI, 0.02-0.13), HI alone (β = 0.07; 95% CI, 0.02-0.11), and DSI (β = 0.23; 95% CI, 0.16-0.29) perceived greater discrimination compared with participants with NSI. The DSI group perceived greater discrimination than VI alone or HI alone.Conclusions and relevanceOlder adults with VI or HI in the United States perceive greater everyday discrimination than older adults with NSI, and those with DSI perceive even more discrimination than those with either VI or HI alone. These results provide insight into the social impact of sensory loss and highlight a need to identify and address reasons for discrimination toward older adults with VI and HI.

Project description:BackgroundThis study initiated the validation process of a translated and adapted version of the Malawi Developmental Assessment Tool (MDAT) for children in the Dominican Republic (DR). Like Malawi before the development of the MDAT, the DR did not have early childhood development (ECD) tools explicitly designed for low-resource areas that are also valid assessments of child development. We chose MDAT because it underwent a rigorous validation process and retained measurements of test items that were culturally adaptable from the Denver Developmental Screening Test II. We aimed to test the internal consistency and inter-rater reliability of the MDAT in children under the age of two years living in low-income neighborhoods in Santo Domingo in 2017.Methods and findingsForty-two children from 2 to 24 months of age (mean = 11.26, SD = 6.37, boys = 22, girls = 20) and their corresponding caregiver participated in the study. We conducted a cross-sectional, pre-experimental study. The primary outcome measure was an index of ECD, as assessed by the Dominican adaptation of the MDAT. The tool evaluates children in four domains: social, fine motor, language, and gross motor. To determine internal consistency, we obtained Spearman-Brown split-half reliability for each sub-scale. The results showed a good consistency (>.6) for social, fine motor, and gross motor, and an acceptable consistency (>.5) for language. Second, to test the inter-rater reliability, we conducted a Kendall's Taub test of independence for both the general scale and each sub-scale. Significant rτ scores ranged from .923 to .966, indicating appropriate inter-rater reliability. Third, we correlated the age variable with each subscale to determine if the development scale followed a progression of abilities that are expected to increase with maturation. The age variable correlated positively with all the subscales (social r = .887, p < .001; fine motor r = .799, p < .001; language r = .834, p < .001; gross motor r = .805, p < .001), indicating that the older the child, the better scores in the development measurements, as expected. There were no adverse events. This study, however, has multiple limitations. We did not gather information about socioeconomic position, which is an important variable when assessing child development; however, all participants lived in a low-income neighborhood. Given that this is the first ECD tool specific to the Dominican Republic, norm-referenced scores for the Dominican population do not yet exist. This study sample size is insufficient to make inferences about the national population.ConclusionsThis study represents the first attempt to obtain a valid tool to screen for development milestones in children living in poverty in the DR. More research is needed to refine the instrument. The availability of the tool will enable impact evaluations of ECD intervention programs and the development of evidence-based public policies in the DR.

Project description:BackgroundIn malaria elimination settings, available metrics for malaria surveillance have been insufficient to measure the performance of passive case detection adequately. An indicator for malaria suspected cases with malaria test (MSCT) is proposed to measure the rate of testing on persons presenting to health facilities who satisfy the definition of a suspected malaria case. This metric does not rely on prior knowledge of fever prevalence, seasonality, or external denominators, and can be used to compare detection rates in suspected cases within and between countries, including across settings with different levels of transmission.MethodsTo compute the MSCT, an operational definition for suspected malaria cases was established, including clinical and epidemiological criteria. In general, suspected cases included: (1) persons with fever detected in areas with active malaria transmission; (2) persons with fever identified in areas with no active transmission and travel history to, or residence in areas with active transmission (either national or international); and (3) persons presenting with fever, chills and sweating from any area. Data was collected from 9 countries: Belize, Colombia (in areas with active transmission), Costa Rica, Dominican Republic, El Salvador, Guatemala, Honduras, Nicaragua, and Panama (September-March 2020). A sample of eligible medical records for 2018 was selected from a sample of health facilities in each country. An algorithm was constructed to assess if a malaria test was ordered or performed for cases that met the suspected case definition.ResultsA sample of 5873 suspected malaria cases was obtained from 239 health facilities. Except for Nicaragua and Colombia, malaria tests were requested in less than 10% of all cases. More cases were tested in areas with active transmission than areas without cases. Travel history was not systematically recorded in any country.ConclusionsA statistically comparable, replicable, and standardized metric was proposed to measure suspected malaria cases with a test (microscopy or rapid diagnostic test) that enables assessing the performance of passive case detection. Cross-country findings have important implications for malaria and infectious disease surveillance, which should be promptly addressed as countries progress towards malaria elimination. Local and easy-to-implement tools could be implemented to assess and improve passive case detection.

Project description:BACKGROUND:Studies suggest that racial discrimination impacts health via biological dysregulation due to continual adaptation to chronic psychosocial stress. Therefore, quantifying chronicity is critical for operationalising the relevant aetiological exposure and hence maximising internal validity. Using one of the most common discrimination scales in the epidemiological literature, we develop a novel approach for more accurately assessing chronicity and compare it with conventional approaches to determine whether coding influences differential exposure classification and associations with hypertension and depression among African American women. METHODS:Data are from a socioeconomically diverse cross section of 208 mid-life African American women in Northern California (data collection: 2012-2013). Racial discrimination was assessed using the Everyday Discrimination Scale (?=0.95), and was coded using two conventional approaches: (1) situation-based coding: number of different situations ever experienced; (2) frequency-based coding: sum of Likert scale responses ranging from 'never' to 'almost everyday'; and (3) a new chronicity-based coding approach: sum of responses, weighted to capture annual chronicity (eg, 'a few times a month'=3×12=36×/year). Outcomes are hypertension and depressive symptomatology (10-item Center for Epidemiologic Studies-Depression Scale). FINDINGS:Exposure classification differed by coding approach, by up to 41%. There was a positive association between racial discrimination and hypertension prevalence for chronicity coding only (prevalence ratio=1.61, 95% CI 1.03 to 2.49). For depressive symptoms, a dose-response relationship of similar magnitude was observed for all three coding approaches. CONCLUSION:Scale coding is an important methodological consideration for valid exposure assessment in epidemiological research. Coding can impact exposure classification and associations with important indicators of African American women's mental and physical health.

Project description:BACKGROUND:The island of Hispaniola, shared by Haiti and the Dominican Republic (DR), is the only remaining malaria-endemic island in the Caribbean and accounts for 95% of the lymphatic filariasis (LF) burden in the Americas. Both countries aim to eliminate the diseases by 2020. Migration from Haiti, where both diseases are more prevalent, may promote transmission in the DR. Historically, Haitian migrant labourers live in rural Dominican agricultural 'company towns' called bateyes, many of which received mass drug administration (MDA) for LF elimination. This study sought to determine the prevalence of malaria and LF in bateyes of the DR and to describe related risk factors for disease. METHODS:From March to April 2016, a cross-sectional, cluster survey was conducted across Dominican bateyes stratified into three regions: southwest, north and east. A household questionnaire (n = 776), captured demographics, ethnic origin, mobility patterns, malaria intervention coverage, and knowledge, and recent fever and treatment-seeking. Two individuals per household (n = 1418) were tested for malaria parasites by microscopy and rapid diagnostic test (RDT) and LF antigen by filariasis test strip (FTS). Population-level estimates and confidence intervals (CI) were computed adjusting for the survey design. Two-sided t-tests compared differences in knowledge scores. RESULTS:No (0%) blood sample was Plasmodium-positive by microscopy or RDT. Six individuals were FTS-positive (0.5%; 95% CI: 0.2-1.5), but none (0%) of these were microfilariae-positive. Most batey residents were born in the DR (57.8%), documented (85.0%), and permanent residents (85.1%). Very few respondents (9.4%) reported travel to Haiti in the past year. Overall, half (53.8%) of respondents owned a bed net, and 82.3% of net owners reported using it the previous night. Indoor residual spraying (IRS) differed by region (range: 4.7%-61.2%). Most of those with recent fever sought care (56.0%), yet only 30.5% of those seeking care were tested for malaria. Compared to Dominican-born populations, Haitian-born respondents more frequently reported recent fever, did not seek care for the fever, had not heard of malaria, and could not name symptoms or prevention methods. CONCLUSIONS:Malaria and LF transmission appear absent or extremely low in Dominican bateyes, which are a mixture of Haitian and Dominican residents. Travel to Haiti is rare, meaning risk of malaria and LF importation is low. Addressing identified gaps in intervention coverage, malaria knowledge, treatment seeking and service delivery will improve the quality of surveillance for these diseases, particularly among marginalized populations and promote island-wide elimination.

Project description:BACKGROUND:Zika remains an epidemiological threat in Latin America, including the Dominican Republic. Although transmitted by the same mosquito as Dengue and Chikungunya, Zika is unique in the potentially harmful consequences for babies born to women infected during pregnancy. Experts highlight the feminization of Zika, in terms of burden of disease and women's caregiving responsibilities. Understanding gender's role in Zika prevention, therefore, is key to strengthening current and future programs. METHODOLOGY/PRINCIPAL FINDINGS:This qualitative study, comprised of 12 focus group discussions and eight in-depth interviews, explored gender's role in Zika among pregnant and non-pregnant women as well as male partners of pregnant women in the Dominican Republic. Topics included perceptions about Zika and perceived feasibility and effectiveness of prevention behaviors (e.g. cleaning water storage containers, using condoms during pregnancy). Researchers applied grounded theory through a process of deductive coding-classifying data around predetermined categories-followed by inductive coding-identifying themes that emerged from coded data. Study findings uncovered three ways in which gender may influence Zika prevention. First, women are largely responsible for household chores-including cleaning water storage containers-with men as assistants. Second, men described their role in the family as the protector. Finally, men and women believed that partners would perceive suggesting condom use or abstinence during pregnancy as a sign of infidelity. CONCLUSIONS:Current/future Zika programs should address knowledge gaps, especially around water storage cleaning techniques and sexual transmission. Programs should also integrate gender into programming in culturally-relevant ways that avoid reinforcing stereotypes. Furthermore, programs should tailor activities for men, women, as well as the couple. In the end, integrating gender in a way that is mindful of the local context while not exploiting existing gender roles is critical for preventing Zika and similar mosquito-borne diseases, both in the Dominican Republic and throughout the region.

Dataset Information

Perceived discrimination in bateyes of the Dominican Republic: results from the Everyday Discrimination Scale and implications for public health programs.

Publications

Perceived discrimination in bateyes of the Dominican Republic: results from the Everyday Discrimination Scale and implications for public health programs.

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