The health of women in Latin America and the Caribbean

This report seeks to contribute to the debate about health policy and program design in Latin America and the Caribbean by focusing on the special topic of women's health. It aims to provide governments and program designers with information about priority needs in the region, and on how policies can yield optimal results. The report, which summarizes more than a dozen original background studies, represents the collaborative effort of three partners - the World Bank, the Inter-American Development Bank (IDB), and the Pan American Health Organization (PAHO). In addition, three regional consultations, sponsored by the IDB, were conducted in collaboration with the Population Council, Latin America and the Caribbean Office, to gain a deeper understanding of the issues related to reproductive health policy in the region. The study has two main objectives: (1) To analyze trends and differentials in women's health; examples of good practices in delivery and financing of women's health programs; and the key dimensions of women's health that are relevant for the health reforms currently underway in Latin America. (2) To provide guidance for governments and progam designers in addressing the most pressing causes of women's ill health, within the context of broader sectoral and national policies (AU)

Follow-up of clients with abnormal papanicalaou smears identified at the Cornwall Regional Hospital for the period January 1997 to December 1997 and January 1999 to June 2000

A cross sectional study was conducted at the Cornwall Regional Hospital for the period January 1997 to December 1997 and January 1999 to June 2000 on clients with abnormal Papanicalaou smears identified at the hospital's laboratory. One hundred and thiry-five (135) clients were included in the study. The clients reside in the four parishes of the Western Region (St. James, Hanover, Trelawny and Westmoreland). Relevant data were abstracted from the clients' dockets. Clients were then contacted and interviewed to assess what follow-up procedure and treatment is available to women after identification of an abnormal Pap smear. Among the 135 clients in the study, 71.9 percent cases were from St. James, 5.9 percent were from Hanover, 13.3 percent were from Trelawny and the remaining 8.9 percent were from Westmoreland. While most of the cases were from St. James, the more severe cases (CIN II, CIN III, CIS and invasive carcinoma) were from the other parishes. There was 68.1 percent (92) respondents. Seventy five percent of the clients who were identified with abnormal smear were referred or told to do a confirmatory test to see if the first result was cancerous. The study revealed that approximately 34.8 percent were treated with 26 percent not treated due to varying reasons such as lack of time, because they thought it was not necessary, they had no time or money and under the advise of their health practitioner. The other 39.1 percent were never followed-up to see if treatment was necessary. Cone biopsies (which may also be used as a confirmatory test) were the most common form of treatment (57.1 percent). Seventy five percent of the clients who accessed treatment were treated at the Cornwall Regional Hospital (AU)

Equity, gender and health policy reform in Latin America and the Caribbean

The recent impetus given to the reform of health and social security policies throughout the Region has given rise to an intense debate on the impact of these policies on equity in health and human development. Up to now, this debate has focused on concerns with respect to geographic location and social stratum, without considering gender. The absence of this concern has resulted in a lack of policies to correct the gender inequities created or exacerbated by health and social security reform that cannot be addressed with the same measures employed to reduce the gaps between socioeconomic strata and geographic regions. This study has two objectives. The first is to call attention to the most significant implications of health and social security reform for gender equity, with specific regard to: (a) the health situation and its determinants; (b) access to, use, and financing of health care; and (c) the contribution/reward ratio for health-related work. The second objective is to propose a series of strategies with the stakeholder participation to identify problems, mobilize resources and institutionalize responses. The study has been divided into four parts. The first discusses the institutional history and mandates of the Pan American Health Organisation that underlie the plan to incorporate the gender perspective into the reform processes. The second briefly outlines the conceptual framework of the proposal. The third indicates some of the most serious implications for gender equity of the most common sectoral reform policies in the Region of the Americas. Finally, the fourth lays out the prinicpal challenges posed by incorporating the gender equity perspective into sectoral reform policies and proposes a pluralistic strategy to document, prevent, and help to elimate gender inequities in health and social security reform (AU)

Seroepidemiology of Helicobacter pylori infection in a Jamiaican community

We researched epidemiologic associations between environmental and demographic factors and prevalence of Helicobacter pylori infection in a suburban Jamaican community. Using a clustered sampling technique, 22 domestic yards enclosing 60 separate households were randomly selected from a local community. All household members (n=346) were invited to participate following informed consent; the overall compliance rate was 58.9 percent. A commercial enzyme immunoassay (HM-CAP) was used to detect IgG antibodies raised against H. pylori. Environmental and demographic information was obtained by questionnaire. The seroprevalence of H. pylori was 69.9 percent (n=202). Analysis of the independent variables revealed three major components. Component 1 described, collectively, good personal hygiene and sanitation, indoor water supply and absence of straying animals in the peridomestic area; Component 2 included older age, good personal hygiene and large yard size; Component 3 the presence of domestic animals (cats and dogs) and, again large yard size. These three complexes explained 42.2 percent of the variability in the data set. Logistic regression showed that Components 2 and 3 were independently associated with H. pylori seropositivity, indicating that a combination of demographic environmental and zoonotic factors is involved in the spread of H. pylori infections at the tropical community level (AU)

A study of consumers' knowledge, attitudes, practices and perception concerning selected food safety issues in the home

Household food safety poses a major challenge not only to the preparers of food but to public health and other food regulatory authorities. Studies have shown that family home rank high in the list of places where foodbourne disease are acquired and transmitted. To describe the knowledge, attitude, practices and perception of householders in North Central Saint Andrew one hundred and ten householders, eighteen years and over, were interviewed during January and March, 1999. The study, cross-sectional in design, included respondents who were randomly selected from three distinct socio-economic classes. Four key informants representing public sector and non-government organizations involved with food safety programmes were interviewed to explore additional ways of strengthening household food safety. The survey found that householders were very concerned about the food they purchased for preparation at home; displayed strong concerns about sanitation of food handling establishments; food handlers practices and the appearance of the foods purchased. There was significant gender difference in the concern for the appearance of food (X squared = 4.45; p<0.05). There were no other significant gender differences for the major concerns when purchasing food (p>0.05). Respondents adopted varying actions to improve food safety at home. Ninety-eight percent of respondents never contacted the Local Health Department or the Ministry of Health as part of their information seeking opportunity regarding food safety. The lifetime prevalence of food-borne illness was found to be approximately 46 percent. Diarrhoea, stomach pain, vomiting and nausea were the major symptoms reported. Milk/yogurt/ice cream, beef, chicken, pork and fish/shellfish were the main food items implicated as being associated with the foodborne illness. Respondents gave a low rating to Government departments/agencies for their contribution to the food safety efforts. While respondents reported a fairly high knowledge of safe food handling practices ... Most respondents had average or fair attitude concerning food safety. ... A properly designed and executed household food safety public education campaign; inclusion of safe handling instructions on raw meats, poultry and fish/shellfish and the operation of a food safety hotline are suggested as additional methods of enhancing household food safety (AU)

The prevalence of intestinal nematodes at the Adelphi all-age school in Saint James

A cross-sectional study of these rural school children was done to determine the level of infection in the school, and the types of geohelminths present. Data was collected through the use of one hundred and sixty-six (166) close-ended questionnaires, and the analysis of one hundred and nineteen (119) stool samples, and eighty (80) blood samples. A high prevalence of 22.3 percent was demonstrated in the school's population, with prevalence in the 10-12 age group reaching a high of 44 percent. Trichuris (13.4 percent), Ascaris (8.9 percent) and eosinophilia (6.4 percent), all showed significant prevalence. However, the prevalence of Hookworm (3.6 percent) and anaemia (2.6 percent), were not significant among the group. Infection strongly correlated with the eating of chalk and marl (a type of soil, composed chiefly of clay and limestone). The source of infection was identified as two marl pits located near the school, which are obviously used for indiscriminate defaecation. The construction of more latrines at the school, school health education, and public health education were recommended, to help eradicate worms from the school (AU)

Acne in black women

Although acne is rampant in young black women, many of them do not really understand the nature of the disease and what treatment is available. Common as acne is, there is no easily understood book available to black people, hence the need for this publication. In Acne in Black Women, in plain simple language, I address concerns such as cosmetics, and newer treatments for acne such as peels, facials and laser treatments. I discuss how to use certain medicines to get the most benefit from them. How certain drugs work on acne and how long a patient should be kept on the drug is also addressed. We also take a look at the patient's general health in the management of acne... This book contains information for all black people who have acne or who have relatives who suffer from this disease. You will find advice on how to prevent acne, and how to treat it. This book is not meant to replace a visit to your dermatologist. In most cases he/she alone has the experience to treat your acne, and to combine different medications, so that you can get the best results from them (AU)

Health and related needs of women at mid-life and their implications for programme planning

The study investigates, analyses and comments on the health of 103 Jamaican women 45-49 years. These women are referred to as women at mid-life. This is the period when women experiences a lot of psychological and physiological changes. These women were chosen using a haphazard sampling method. Women were identified at the Norman Manley International Airport, Barbican Community, Maxfield, Old Habour, Santa Cruz, Papine Market, University Hospital and Soverign Plaza. The methods of investigation were focus group discussions and a questionnaire. The study revealed that academic status had no bearing on the perception of health or the concept. Only 18.7 percent of those who responeded to the concept of "good health" gave an appropriate response and 15.5 percent gave an appropriate response to the concept of "bad health". This is probably one of the reasons why most of the respondents focused only on the physical aspects of health when asked about how they rated their health and reasons for their responses. Their was no significant differences between age, income, educational status and health seeking behaviours. However, there was a significant difference between age group and illness (p<0.01) and perception of one's health and present illness (p<0.001). Respondents who said their health was bad were thirteen times more likely to indicate that they were presently suffering from an illness, 85 perecent (11/13). Major illness were indicated as hypertension and diabetes. A few women reported having some cardiac conditions. Employment status was high, and income ranged from less that J$5,000 to over J$10,000. For those women who got check-ups, 51 percent did so at a private facility, whilst 33.8 perecent did so at a public facility. Main reasons for choosing the particular facility were stated as convenience (59.9 percent), and quality of services (39.4 percent). Income was not a considering factor. The women in this study identified some of their needs as education and counseling, affordable health care, a home, respect and money. They also felt that with an increase in salary and a decrease in the cost of living they will be able to obtain and maintain an acceptable standard of health and well-being. Of the 103 women interviewed only 14 persons has no form of savings. Nineteen percent of them indicated that the future was good while the remaining 81 percent gave negative responses ... equip women with the tools for self development ... (AU)

Intestinal worm infestation of children under 9 years of age in Annotto Bay, St. Mary

A study of gastrointestinal parasitic infection was conducted in Annotto Bay community in the Parish of St. Mary, Jamaica. 64.7 percent of stool specimen (n=85) contained ova/cyst of one or more 3 helminth species. The prevalence was markedly age-dependent, with infection occurring most commonly in pre-school children. It is concluded that gastrointestinal parasitic infection is also related to low socioeconomic status, lack of education in personal hygiene and environmental sanitation, prevalence level of intestinal infection likely to have a significant impact on community health until and unless treatment and control programmes are combined with other public health measures such as health education, environmental sanitation, proper personal hygiene and most of all community participation.(AU)

The ecology of health services utilization in Grenada, West Indies

Few empirical investigations into the nature of health services utilization fully acknowledge that the home environment may act as a socio-geographical focus of both disease transmission and of learned health behaviour. This paper examines the role of the home environment, as well as of personal characteristics and accessibility, in the utilization of health services in Grenada, West Indies. Bivarite and logit analysis of household survey data are employed to identify markers of high user individuals and households. Aspects of each domain of the home environment (physical and behavioral environment, demographies, and residential mobility) emerge as contributors to the utilization phenomenon in the study communities. Both etiological and socio-economic linkages are postulated to underlie the observed relationships. The implications of this work for health planning in developing countries is discussed. (AU)

The risk approach in diarrheal disease intervention in Grenada

In a previous paper (Soc Sci Med 23, 995-1002, 1986), we described the development of a method for identifying households at high risk of childhood diarrhea based on a logit analysis of data collected as part of a diarrhea disease control project in Grenada. In this paper, we report the results of a follow-up study designed to replicate the first using data on diarrhea incidence and risk factors collected in a different set of rural communities in Grenada. The findings of the first study were not replicated. There was no significant association between the risk factors and diarrhea in the follow-up study in contrast to the very strong associations found in the first study. As a consequence, it was not possible to construct a logit model from the second data set. The possible reasons for the contrasting sets of results and their implications for the application of the risk approach are discussed with reference to a two by two true-false table. (AU)

The epidemiology of pyoderma in Jamaican children

Preschool and school-aged children from a small area of rural Jamaica were examined in an attempt to assess the epidemiologic factors predisposing certain persons to pyoderma. Twenty-three children were included in the affected group; their disease consisted of secondarily infected insect bites or infestations as well as primary pyoderma. The control group was composed of twenty-three children who had no evidence of infected skin disease. Comparison of the two groups revealed a significant difference in the socioeconomic status of the control and difference in nutritional status, size of family, bathing frequency, or water supply.(AU)

The status of school health instruction in primary schools of the metropolitan area of Kingston and St. Andrew, Jamaica

A survey was conducted among 19 primary schools, that is 50 percent of primary schools in the metropolitan area of Kingston and St. Andrew, to assess the status of school health instruction. The reference group was Grade 5 and involved both teachers and students. Structured questionnaires were used for both groups. All schools offered health instruction to students, but to varying degrees. The schools' administration endorsed the inclusion of the subject in the curricula, however there was great disparity in terms of frequency and intensity. Very few schools timetabled the subject. Methods used to incorporate the subject in the school curriculum were mainly as unit of traditional subjects or by infusion. Students' attendance was compulsory in the majority of the institutions. The Ministry of Education's centrally developed syllabus was the guideline used by most teachers. The upper grades of primary schools were more likely to be exposed to health instruction than the lower grades. Talk/discussion was the most popular method of instruction, none-the-less a variety of methods were used including those which offered scope for maximum student participation. Students were most likely to practise what they were taught where they had most control over their behaviour. For example students' behavior was most positive for personal hygiene and least positive in food and nutrition. Few teachers got special training to equip them to discharge their health instruction responibilities and those trained identified areas of weakness in their training. However, the teachers trained rated their capabilities as health instructors higher than their untrained colleagues. The infrastructure in schools to support healthful behaviours needs improvement. Technical, financial and material assistance were given schools by governmental and non-governmental agencies (AU)

Nutritional status and development of St. Lucian children at day care centres

This was a comparative study of children who attended day-care centres with those who stayed at home in St. Lucia. The children came from very similar social backgrounds and were compared using anthropometry and their performances at the Bettye Caldwell Preschool Inventory and the Peabody Picture Vocabulary tests. The quality of the service given in the day care centres was assessed. Finally the environment of the centres was compared with that of the homes of the community children. The sample consisted of 60 children, 30 in three rural government centres and 30 from the communities nearest the centres. There were 28 boys and 32 girls with an age range of 40 - 64 months and a mean age of 51.7ñ5.7 months. It was found that there was no significant difference between the combined centre and the combined community anthropometry values. No significant difference was found between the centre and community children in the Peabody Picture Vocabulary raw scores (centre mean - 16.5ñ4.6; community mean - 15.9ñ6.9). However significant differences was found in the Bettye Caldwell Preschool Inventory total scores between centre ( mean = 33.8ñ7.7) and community children ( mean = 27.7ñ8.1), p<0.01. School achievement and language development test scores were similar to those of four year old Dominican children, but lower than those of Jamaican children. The centres were found to offer an environment richer in play equipment than that of the homes, but not necessarily safer or with greater adult-child interactions. The centres were found to be deficient in safety measures such as fire safety, first aid, monitoring of health and nutritional status, furniture available, toilet facilities for the children and staff, and space available for the children to play. The staff had duties other than child care, and although reasonably qualified, with a reasonable staff-child ratio of 1:12.5, interaction with the children was limited. It was concluded that a higher school achievement was associated with attendance at the centre and may be attributed mainly to the presence of the higher level of play equipment offered at the centre. Attention should be paid to the improvement of safety measures, monitoring of health and nutritional status and availability of outdoor space. It is suggested that possibly training of the mothers to interact with their children may improve the school achievement scores of the community children (Summary)

An assessment of the nutritional status of the elderly residents of the Eventide Home

The nutritional status of the elderly residents in a public Home was assessed by means of anthropometric measurements, clinical signs and qualitative analysis. The general features of life in the Home were recorded, and an attempt was made to elucidate the major influences on nutritional status in this institution. Two hundred and thirty residents participated in this study. Analysis revealed that protein energy malnutrition (PEM) exists in at least 24 percent of the men, and 18 percent of the women as determined by anthropometric measurements. Muscle circumferences were adequate, but mean triceps skinfold measurements were less than 60 percent of standard in both men and women. Energy intake were 75 percent of the recommended dietary allowance (RDA) in men, and 90 percent of the RDA in women. Thiamine and vitamin C intakes may have been low due to cooking losses, but vitamin A, iron riboflavin and protein intakes were adequate. Clinical signs confirmed the finding of PEM, and suggested that anemia exists. Age, the length of stay and poor eyesight had minor influences on nutritional status in the women, but had no apparent effect on nutritional status in the men. Alcohol consumption influenced nutritional status to a minor degree in men. Mobility, impaired hearing, mental disability, masticatory inefficiency, visitors and impaired appetite had no appreciable effect on nutritional status in either men or women. (summary)