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Background Belize is a middle-income Caribbean country with poorly described cancer epidemiology and no comprehensive cancer care capacity. In 2018, GO, Inc., a US-based NGO, partnered with the Ministry of Health and the national hospital in Belize City to create the first public oncology clinic in the country. Here, we report demographics from the clinic and describe time intervals to care milestones to allow for public health targeting of gaps. Patients and Methods Using paper charts and a mobile health platform, we performed a retrospective chart review at the Karl Heusner Memorial Hospital (KHMH) clinic from 2018 to 2022. Results During this time period, 465 patients with cancer presented to the clinic. Breast cancer (28%) and cervical cancer (12%) were most common. Most patients (68%) presented with stage 3 or 4 disease and were uninsured (78%) and unemployed (79%). Only 21% of patients ever started curative intent treatment. Median time from patient-reported symptoms to a biopsy or treatment was 130 and 189 days. For the most common cancer, breast, similar times were seen at 140 and 178 days. Time intervals at the clinic: <30 days from initial visit to biopsy (if not previously performed) and <30 days to starting chemotherapy. Conclusion This study reports the first clinic-based cancer statistics for Belize. Many patients have months between symptom onset and treatment. In this setting, the clinic has built infrastructure allowing for minimal delays in care despite an underserved population. This further affirms the need for infrastructure investment and early detection programs to improve outcomes in Belize. In 2018, the first public oncology clinic was established in Belize. This article reports demographics from the clinic and describes time intervals to care milestones to allow for public health targeting of gaps and provide a roadmap for public cancer care in the country.

The study examines the potential influence of sub-regional variations in climate, and specifically heavy rain events, in determining relative vulnerabilities of locations in twelve Caribbean countries. An aggregate vulnerability index, referred to as the Caribbean Vulnerability Score (CVS), is created using historical demographic and socioeconomic data and climate data representing extreme rain events. Four scenarios are explored. Firstly, comparative vulnerabilities are determined when heavy rainfall is incorporated in CVS versus when it is excluded. The impact of climate change is also investigated using future climate data derived from statistical downscaling but holding demographic and socioeconomic sub-indices constant. The analysis is repeated with projections of future demographic structure from the Shared Socioeconomic Pathway data (SSP3), future climate projections and constant socioeconomic. Finally, the sensitivity of the results is examined with respect to applying different weights i.e. versus using equal weights for the climate and non-climatic components of CVS as is done for the first three scenarios. Results suggest that the inclusion of historical susceptibility to rainfall extremes influences relative vulnerabilities within the Caribbean when compared to the rankings of vulnerability derived using only socioeconomic and demographic inputs. In some cases significant increases in relative rankings are noted. Projected changes in the intensity of rain events across the Caribbean region in the 2030s and 2050s, do not significantly alter the top and lowest ranked vulnerable locations when demographic and socioeconomic indices are held constant. Changes may however occur in the order of the top ranked locations dependent on scenario and time slice. In general, future shifts in relative vulnerabilities were found to be dependent on (i) changes in both future climate and demographic scenarios, (ii) the time horizons being considered, and (iii) the weighting assigned to climate in the future.

Human activities create novel food resources that can alter wildlife–pathogen interactions. If resources amplify or dampen, pathogen transmission probably depends on both host ecology and pathogen biology, but studies that measure responses to provisioning across both scales are rare. We tested these relationships with a 4-year study of 369 common vampire bats across 10 sites in Peru and Belize that differ in the abundance of livestock, an important anthropogenic food source. We quantified innate and adaptive immunity from bats and assessed infection with two common bacteria. We predicted that abundant livestock could reduce starvation and foraging effort, allowing for greater investments in immunity. Bats from high-livestock sites had higher microbicidal activity and proportions of neutrophils but lower immunoglobulin G and proportions of lymphocytes, suggesting more investment in innate relative to adaptive immunity and either greater chronic stress or pathogen exposure. This relationship was most pronounced in reproductive bats, which were also more common in high-livestock sites, suggesting feedbacks between demographic correlates of provisioning and immunity. Infection with both Bartonella and haemoplasmas were correlated with similar immune profiles, and both pathogens tended to be less prevalent in high-livestock sites, although effects were weaker for haemoplasmas. These differing responses to provisioning might therefore reflect distinct transmission processes. Predicting how provisioning alters host–pathogen interactions requires considering how both within-host processes and transmission modes respond to resource shifts. This article is part of the theme issue ‘Anthropogenic resource subsidies and host–parasite dynamics in wildlife’.

The COVID-19 pandemic may have impacted disabilities among people living with HIV; however, data on the association between COVID-19 pandemic-related healthcare disruptions and disabilities among people living with HIV is limited. We aimed to evaluate the association between COVID-19-affected HIV care behaviors and disability domains among people living with HIV in Belize. A cross-sectional study was conducted at the Western Regional Hospital and Southern Regional Hospital between August and October 2021 among people living with HIV in Belize aged ≥ 21 years and on antiretroviral therapy. A self-reported questionnaire captured data on demographic and clinical characteristics (gender, age, ethnicity, marital status, employment, education, CD4 count, and viral load), COVID-19-affected HIV care behaviors, and disability across six domains (physical, cognitive, and mental-emotional symptoms and impairments; uncertainty; difficulties carrying out day-to-day activities; and social inclusion challenges) using the Short-Form HIV Disability Questionnaire. Univariate and multivariate logistic regression analyses were employed to analyze the data. Of the 489 participants, 276 (56.4%) were women and 213 (43.6%) were men. After adjusting for covariates, (age, gender, employment, CD4 count, viral load, COVID-19-affected HIV care behaviours), our results showed that people living with HIV, whose HIV care behaviors were greatly affected by COVID-19, were more likely to have disabilities across various domains: physical (adjusted odds ratio (AOR): 1.61, 95% confidence interval (CI): 1.08–2.41, p  = 0.018), cognitive (AOR: 2.49, 95% CI: 1.58–3.94, p  < 0.001), uncertainty (AOR: 2.94, 95% CI: 1.68–5.12, p  < 0.001), difficulties carrying out day-to-day activities (AOR: 1.69, 95% CI: 1.06–2.69, p  = 0.027), and social inclusion challenges (AOR: 1.89, 95% CI: 1.27–2.81, p  = 0.002). Mitigating disruptions in care behaviors through the implementation of more accessible and comprehensive healthcare services may potentially address the multifaceted nature of HIV disabilities.

Background Belize is a small country in Central America with a growing burden of non-communicable disease (NCD), including hypertension and diabetes. Toledo District is the southernmost and poorest district in the country. Reliable national level health data for Belize is readily available, but the data is rarely disaggregated by sex or district. Reducing the burden of NCDs is a high priority for the Ministry of Health and Wellness. Belize’s progress to date on Sustainable Development Goal (SDG) 3 (Good Health and Wellbeing) has been modest with many indicators stagnating or progress increasing at less than 50% of the required rate. SDG 3 describes the need to reduce the risks of NCDs and to strengthen the capacities of the healthcare workforce. Objective The objective was to perform a men’s health needs assessment to identify and prioritize men’s health needs in the Toledo District. Methods This was a mixed methods study. Qualitative data were collected from semi-structured interviews. Interviews were recorded, transcribed, and analyzed using Thematic Analysis. Quantitative data included epidemiological data from national vital statistics or disease registries and other public sources. Data were collected between January and June 2017. Results Belizean men have among the highest risk for cardiac or diabetes related illness or death in the Americas. Diabetes and hypertension are responsible for 4.49% and 1.23% of Disability Adjusted Life Years in men respectively and are increasing by 2.51% annually. Fifty-seven interviews (55 individuals and two groups) from nine villages were carried out. Four themes emerged from the qualitative data. Men in Toledo: • have poor health literacy; • have reasonable access to health resources, but do not use them; • inability to clearly articulate health priorities; • do not process risk well. Conclusions Men in Toledo suffer from a high prevalence of NCDs including hypertension and diabetes and understand health and risks poorly. This may contribute to Belize’s struggle to achieve the goals of SDG 3.4.1. Strengthening the healthcare workforce by improved training of community health workers (CHWs) and providing health education to men in Toledo is required to address these concerns.

Access to hand hygiene (HH) resources in clinical settings is important to prevent healthcare-associated infections, including COVID-19. However, many countries, including Belize, have limited national data on the availability of HH resources and healthcare worker (HCW) hand hygiene adherence (HHA) in healthcare facilities (HCFs). We conducted a study in the 11 largest public HCFs across Belize to evaluate access to HH resources and HHA before and after an intervention (provision of alcohol-based hand rub (ABHR) wall mounts and HH training). Descriptive statistics and multilevel logistic regressions were used to assess changes in HH resources and HHA from baseline to follow-up and explore factors associated with HHA. There was a 19 percent increase in rooms with functional wall-mounted ABHR dispensers (44% to 63%) post-intervention. HHA did not improve from baseline (52%) to follow-up (50%). Combining baseline and follow-up data, HHA was higher when ABHR and soap and water were present (aOR = 4.19, 95% CI = 2.11, 8.32) and when only ABHR was present (aOR = 3.85, 95% CI = 1.92, 7.72) compared with when soap and water were present alone. The decreased perceived risk of COVID-19 at follow-up may explain the null HHA findings. However, our assessment of HH resources and practices provides a useful foundation for future HH programs in HCFs.

Access to water, sanitation, and hygiene (WASH) resources in schools is critical for disease prevention and control, especially during public health emergencies. In Belize, systematic, national data on WASH in schools are needed to inform public health decisions and interventions. From December 2021 to January 2022, a national survey was sent electronically to government and government-aided primary and secondary schools in Belize (N = 308) to gather information on WASH services. From the survey, 12 pilot schools were selected based on the highest self-reported need for WASH resources to participate in additional evaluation and intervention, which included environmental nudges, supplemental supply provision, and hand hygiene education. To understand how the progression of the COVID-19 pandemic may have influenced hand hygiene, facility assessments to evaluate access to hand hygiene resources were conducted in person when most schools reopened for face-to-face learning during the pandemic (March 2022) and 15 months later (June 2023). Among the schools participating in the national survey (N = 221), 55% reported times when water was not available at the schools. Almost 9 in 10 schools (89%) had a functional handwashing station, and 47% reported always having soap for handwashing. Between baseline and follow-up at the 12 pilot schools, we observed decreases in the proportion of functional handwashing access points (−11%), functional handwashing access points accessible for individuals with disabilities (−17%) and small children (−29%), and functional alcohol-based hand rub dispensers (−13%). Despite the ongoing COVID-19 pandemic, we observed gaps in WASH resources in schools in Belize during the onsite assessments at the pilot schools. Schools should be encouraged and provided with WASH resources to maintain vigilance for disease control measures.

Background The agents of spotted fevers in Latin America are Rickettsia rickettsii , R. parkeri , Rickettsia sp. strain Atlantic rainforest, and R. massiliae . In Continental Central America, R. rickettsii remains the only known pathogenic tick-borne rickettsia. In the present study, ticks were collected from wild mammals in natural areas of Belize. Besides providing new data of ticks from Belize, we investigated rickettsial infection in some of these ticks. Our results provide ticks harboring rickettsial agents for the first time in Central America. Methods Between 2010 and 2015, wild mammals were lived-trapped in the tropical broadleaf moist forests of central and southern Belize. Ticks were collected from the animals and identified to species by morphological and molecular analysis (DNA sequence of the tick mitochondrial 16S RNA gene). Some of the ticks were tested for rickettsial infection by molecular methods (DNA sequences of the rickettsial gltA and ompA genes). Results A total of 84 ticks were collected from 8 individual hosts, as follows: Amblyomma pacae from 3 Cuniculus paca ; Amblyomma ovale and Amblyomma coelebs from a Nasua narica ; A. ovale from an Eira Barbara ; A. ovale , Amblyomma cf. oblongoguttatum , and Ixodes affinis from a Puma concolor ; and A. ovale , A. coelebs, A . cf. oblongoguttatum , and I. affinis from two Panthera onca . Three rickettsial agents were detected: Rickettsia amblyommii in A. pacae, Rickettsia sp. strain Atlantic rainforest in A. ovale, and Rickettsia sp. endosymbiont in Ixodes affinis . Conclusions The present study provides unprecedented records of ticks harboring rickettsial agents in the New World. An emerging rickettsial pathogen of South America, Rickettsia sp. strain Atlantic rainforest, is reported for the first time in Central America. Besides expanding the distribution of 3 rickettsial agents in Central America, our results highlight the possible occurrence of Rickettsia sp. strain Atlantic rainforest-caused spotted fever human cases in Belize, since its possible vector, A. ovale , is recognized as one of the most important human-biting ticks in the Neotropical region.

Background Belize has one of the highest human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome prevalence rates in Central America, with women of reproductive age being particularly vulnerable to HIV. Therefore, this study examined the factors associated with HIV testing among women of reproductive age in Belize and trends in HIV testing in 2006, 2011, and 2015–2016. Methods Cross-sectional data were analyzed using three Belize Multiple Indicator Cluster Surveys. The number of participants were 1,675, 4,096, and 4,699 women aged 15–49 years in 2006, 2011, and 2015–2016, respectively. We used variance-weighted least-squares regression to estimate annual changes. Multivariate logistic regression analysis was performed to evaluate the associated factors. Analyses were conducted using Stata version 15, and weights were applied for generalization to the population. Results HIV testing rates increased from 47.7% in 2006 to 66.5% in 2015, with an average annual change of 0.082 (95% confidence interval: 0.07–0.09). Logistic regression models showed that women aged 15–24 years were less likely to have been tested for HIV compared to women aged 25–34 years. Women from the Mayan ethnic group were less likely to have been tested than those from other ethnic groups. Compared to women who spoke Spanish, those who spoke English/Creole were more likely to have been tested for HIV; additionally, those who spoke minority languages were less likely to have been tested. Being married and having given birth were associated with increased odds of HIV testing. Living in rural areas and households with the poorest wealth indices were associated with decreased odds of being tested for HIV. Women with good HIV knowledge and accepting attitudes towards people living with HIV were more likely to be tested. Conclusions From 2006 to 2015, HIV testing in women of reproductive age showed an increasing trend in Belize. We recommend interventions to expand HIV testing for women of reproductive age in Belize, particularly those aged 15–24 years, speaking minority languages, living in rural areas, and having a low socioeconomic status.

Among women in Belize, cervical cancer is both the leading cancer and the leading cause of cancer deaths. Both the quadrivalent and bivalent human papillomavirus (HPV) vaccines are licensed in Belize. The Ministry of Health of Belize convened a multidisciplinary team to estimate the costs, health benefits, and cost-effectiveness of adding an HPV vaccine to the national immunization schedule. The CERVIVAC cost-effectiveness model (Version 1.123) was used to assess the lifetime health and economic outcomes of vaccinating one cohort of girls aged 10 years against HPV. The comparator was no HPV vaccination. The PAHO Revolving Fund negotiated price of US$ 13.79 per dose was used (for the quadrivalent vaccine) and national data sources were used to define demography, cervical cancer incidence and mortality, cervical cancer treatment costs, and vaccine delivery costs. Estimates from international agencies were used in scenario analysis. In a cohort of ∼4000 Belizean girls tracked over a lifetime, HPV vaccination is estimated to prevent 69 new cases of cervical cancer (undiscounted), and 51 cervical cancer deaths (undiscounted). Considering the potential cervical cancer treatment costs and lost wages avoided by households (societal perspective), the cost per disability-adjusted life year (DALY) averted was estimated to be US$ 429. This increased to US$ 1320 when cervical cancer treatment costs and lost wages were excluded from the analysis. Both estimates are far below the gross domestic product (GDP) per capita of Belize (US$ 4795). The lifetime health care costs saved by the women and their families represent more than 60% of the investment cost needed by the Government for the vaccine. Routine HPV vaccination would be highly cost-effective in Belize. If affordable, efforts should be made to expedite the introduction of this vaccine into the Belizean national immunization program.