Ian Richard Hambleton

The CaribData project, funded by the Inter-American Development Bank and implemented by The University of the West Indies, aims to enhance data-handling, -sharing and reuse capabilities in the Caribbean. The project focuses on four main objectives: developing an online data-handling platform, creating a sustainable training and mentoring program, launching a data communication initiative and conducting data availability audits.

The widespread digitization of information, advances in data processing and the emergence of internet-connected devices have led to a proliferation of data, often loosely referred to as big data. With this digital transformation, offering open data – that is, data freely available for modification and reuse – has emerged as a key strategy for encouraging transparency and innovation. Data reuse holds particular importance in the small island developing states of the Caribbean, which have a limited resource pool from which to tackle the landscape of social priorities. Efforts made towards data-sharing must consider privacy, security and the ethical use of information, and the tension between data as a social good and data for commercial gain can be a determinant of data-sharing decisions. A multidisciplinary approach is needed to realize the potential of data-sharing. In this article, we describe techniques (or pathways) for growing the Caribbean’s stock of open data, classifying these into four types. Initiative pathways are techniques to broaden the range of data producers that share data. Infrastructure pathways deal with the practicalities of making data publicly available. Governance pathways are regulations and frameworks that guide data producers, including in meeting their legal data obligations. Training and communication pathways are efforts to raise awareness and knowledge about the benefits and practices of data-sharing. Data-sharing can offer a cost-effective evidence base for the Caribbean’s continuing digital transformation. Sustainable sharing is key, and it must include robust technical infrastructure and governance, and ongoing communication.

To quantify three aspects of data-related developmental progress across 57 Small Island Developing States (SIDS) recognized by the United Nations: statistical capacity measured using the Statistical Performance Indicators (SPI), data availability using the Sustainable Development Goal (SDG) indicators, and gender-stratified indicators. SIDS as a single country group were compared with other World Bank regions, using SPI, availability of SDG metrics, and availability of gender-stratified metrics. Using population size as a proxy for “smallness,” its association with data capacity and availability was modeled. SPI among SIDS was lower than in any world region – broadly equivalent to Sub-Saharan Africa. Two-thirds of SDG indicators were available for SIDS in 2022; other world regions having between 71% and 87% availability. One-third of gender-stratified indicators were available for SIDS in 2022; other world regions having between 58% and 68% availability. Population size was strongly associated with each outcome, with SIDS having a statistical capacity 18.0 percentage points lower than other countries [95% CI (8.5, 27.4)], SDG data availability 17.4 percentage points lower [95% CI (13.1, 21.7)], and gender-stratified indicator availability 28.8 percentage points lower [95% CI (24.5, 33.0)]. As global demand and associated rewards for electronic data increase, our analysis highlights the challenges introduced by island “smallness” in the global push for digital transformation. Regional cooperation mechanisms, sustained international support, and systematic monitoring of data availability are urgently required to monitor capacity development.

Visual impairment (VI) negatively affects a child’s quality of life. The prevalence of VI in the Caribbean is nearly three times higher than in the United States, but the causes remain uncertain. This study leverages Barbados’ unique eye care system to survey the eye diseases and VI prevalence in Barbadian children. Medical records of all patients aged <19 years who received ophthalmic care in Barbados’ two public eye care centers between January and December 2019 were reviewed, capturing the entirety of public pediatric eye care within the study period. Age at the first visit to the clinic and at the final visit in 2019, sex, best-corrected visual acuity (BCVA), past medical history, and clinical diagnoses were extracted and analyzed. VI was defined as a BCVA of 6/12 or worse in the better-seeing eye. There were 3278 patient records with a mean age at the first visit of 7.8 ± 3.9 years. There were 80 (2.4%) children with VI, 62.5% of which were attributed to amblyopia. A total of 94% of VI was preventable or treatable. The most common diagnoses were refractive error (87.5%), strabismus (27.5%), and allergic eye disease (20.0%). Amblyopia is the major cause of pediatric VI in Barbados and is largely avoidable.

The Human Mobility Transition model describes shifts in mobility dynamics and transport systems. The aspirational stage, ‘human urbanism’, is characterised by high active travel, universal public transport, low private vehicle use and equitable access to transport. We explored factors associated with travel behaviour in Africa and the Caribbean, investigating the potential to realise ‘human urbanism’ in this context. We conducted a mixed-methods systematic review of ten databases and grey literature for articles published between January 2008 and February 2019. We appraised study quality using Critical Appraisal Skills Programme checklists. We narratively synthesized qualitative and quantitative data, using meta-study principles to integrate the findings. We identified 39,404 studies through database searching, mining reviews, reference screening, and topic experts’ consultation. We included 129 studies (78 quantitative, 28 mixed-methods, 23 qualitative) and 33 grey literature documents. In marginalised groups, including the poor, people living rurally or peripheral to cities, women and girls, and the elderly, transport was poorly accessible, travel was characterised by high levels of walking and paratransit (informal public transport) use, and low private vehicle use. Poorly controlled urban growth (density) and sprawl (expansion), with associated informality, was a salient aspect of this context, resulting in long travel distances and the necessity of motorised transportation. There were existing population-level assets in relation to ‘human urbanism’ (high levels of active travel, good paratransit coverage, low private vehicle use) as well as core challenges (urban sprawl and informality, socioeconomic and gendered barriers to travel, poor transport accessibility). Ineffective mobility systems were a product of uncoordinated urban planning, unregulated land use and subsequent land use conflict. To realise ‘human urbanism’, integrated planning policies recognising the linkages between health, transport and equity are needed. A shift in priority from economic growth to a focus on broader population needs and the rights and wellbeing of ordinary people is required. Policymakers should focus attention on transport accessibility for the most vulnerable.

Objectives: To provide ultrasound baselines for spleen length in homozygous sickle cell disease (HbSS) and in normal controls with a HbAA genotype. Methods: The Jamaican cohort study identified 311 babies with HbSS and 246 matched HbAA controls during the screening of 100,000 consecutive deliveries in Kingston, Jamaica from 1973 to 1981. Ultrasonography commenced in 1988 when the youngest patients were aged 6 years at which time deaths, emigrations and default had reduced the numbers to 206 HbSS and 89 controls. It continued annually until 2000. Results: The spleen was visualized in all HbAA controls but in only 1103/2138 (52%) scans in HbSS. Where available, mean splenic lengths were significantly lower in HbSS (77–103 mm in males, 70–83 mm in females) compared to normal controls (89–101 mm in males, 86–95 mm in females). Assessed by statistical modelling after adjusting for body height, the splenic ratio (splenic length/body height) declined over the age range 12–20 years in HbSS, consistent with progressive splenic fibrosis. Genetic factors known to inhibit sickling, α thalassemia and fetal hemoglobin level (HbF) significantly reduced the decline in splenic ratio. Clinical splenomegaly was an insensitive measure of splenic enlargement as only 50% of patients aged 18 years and above with spleens measuring ≥150 mm on ultrasonography had palpable spleens. Conclusions: An age-related decline in splenic length occurred in HbSS and occurred more slowly with genetic factors known to inhibit sickling. The standards provided may be of value in assessing minor degrees of subclinical acute splenic sequestration. Advances in knowledge: These are the first standards available for splenic length in HbSS. They may be useful in detecting red cell sequestration, not apparent from clinical splenomegaly and also provide a model for identifying factors inhibiting vaso-occlusion.

Background Travel has individual, societal and planetary health implications. We explored socioeconomic and gendered differences in travel behaviour in Africa, to develop an understanding of travel-related inequity. Methods We conducted a mixed-methods systematic review (PROSPERO CRD42019124802). In 2019, we searched MEDLINE, TRID, SCOPUS, Web of Science, LILACS, SciELO, Global Health, Africa Index Medicus, CINAHL and MediCarib for studies examining travel behaviour by socioeconomic status and gender in Africa. We appraised study quality using Critical Appraisal Skills Programme checklists. We synthesised qualitative data using meta-ethnography, followed by a narrative synthesis of quantitative data, and integrated qualitative and quantitative strands using pattern matching principles. The review was conducted through a global public health research network (https://gdarnet.org/). In this project, we aspired to forge equitable partnerships though the provision of bespoke systematic review training to junior team members; multiple rounds of co-interpretation of findings and co-production of their meaning; and transparent and inclusive authorship opportunities. Results We retrieved 103 studies (20 qualitative, 24 mixed-methods, 59 quantitative). From the meta-ethnography, we observed that travel is: intertwined with social mobility; necessary to access resources; associated with cost and safety barriers; typified by long distances and slow modes; and dictated by gendered social expectations. We also observed that: motorised transport is needed in cities; walking is an unsafe, ‘captive’ mode; and urban and transport planning are uncoordinated. From these observations, we derived hypothesised patterns that were tested using the quantitative data, and found support for these overall. In lower socioeconomic individuals, travel inequity entailed reliance on walking and paratransit (informal public transport), being unable to afford travel, travelling less overall, and travelling long distances in hazardous conditions. In women and girls, travel inequity entailed reliance on walking and lack of access to private vehicles, risk of personal violence, societally-imposed travel constraints, and household duties shaping travel. Limitations included lack of analytical rigour in qualitative studies and a preponderance of cross-sectional quantitative studies (offering a static view of an evolving process). Discussion Overall, we found that travel inequity in Africa perpetuates socioeconomic and gendered disadvantage. Proposed solutions focus on improving the safety, efficiency and affordability of public transport and walking. Through the conduct of this systematic review, we reflect on the strengths and challenges of collaborative research in the global health arena.