Vitals: A quarterly report of the Ministry of Health April 2017

This document looks at health trends and statistics in Jamaica. This issue focuses on data collected in the October to December 2016 quarter along with annual comparisons. Data, utilization of the health services and complaints to the Ministry are included.

Assessing the causes of under-five mortality in the Albert Schweitzer Hospital service area of rural Haiti

OBJECTIVES. Limited information is available regarding the causes of under-five mortality in nearly all countries in which mortality is the highest. The purpose of this study was to use a standard computerized protocol for defining the leading cause of death among children in a high-mortality rural population of Haiti and to highlight the need for similar studies elsewhere in Haiti and throughout the high-mortality areas of Latin America and the Caribbean. METHODS. In 2001 a standardized, closed-ended verbal autopsy questionnaire endorsed by the World Health Organization was administered to a representative, population-based sample of the mothers or other caregivers of 97 children who had died before reaching 5 years of age between 1995 and 1999 in the service area of the Albert Schweitzer Hospital, which is located in the rural Artibonite Valley of Haiti. With the data from the questionnaires we used a computerized algorithm to generate diagnoses of the cause of death; the algorithm made it possible to have more than one cause death. RESULTS. Acute lower respiratory infection (ALRI) was the leading diagnosis, present in 45 percent of all under-five deaths, followed by enteric diseases, present in 21 percent of deaths. Neonatal tetanus, preterm birth, and other early neonatal causes unassociated with ALRI or diarrhea were present in 41 percent of the neonatal deaths. Among children 1-59 months of age, ALRI was present in 51 percent of the deaths, and enteric diseases in 30 percent. Deaths were concentrated during the first few months of life, with 35 percent occuring during the first month. Among the neonatal deaths, 27 percent occurred on the first day of life and 80 percent occured during the first 10 days of life. CONCLUSIONS. In the Albert Schweitzer Hospital program area - and presumably in other areas of Haiti as well - priority needs to be given to the prevention of and early, effective treatment of ALRI, diarrhea, and early neonatal conditions. This study points to the need for more, similar standardized assessments to guide local, regional, and national programs (AU)

Comparison of prevalence and severity of asthma among adolescents in the Caribbean islands of Trinidad and Tobago: results of a nationwide cross-sectional survey

BACKGROUND: A nationwide cross-sectional survey was conducted to compare the prevalence of asthma symptoms among high school students in the two islands of the Republic of Trinidad and Tobago. METHODS: Questionnaire and video instruments based on those developed by the International Study of Asthma & Allergy in Childhood (ISAAC) were used to assess asthma prevalence among 6394 children (age range, 11–19 years; mean age, 14.08 yrs) in the second and third years of 35 randomly selected high schools in Trinidad and Tobago. RESULTS: A total of 4988 questionnaires were available for analysis (3519 in Trinidad and 1469 in Tobago); wheezing in the previous 12 months (13.1 per cent & 13.4 per cent, RR 0.98, 95 per cent CI 0.84–1.15); a previous or current diagnosis of asthma (12.8 per cent & 13.5 per cent, RR 0.95, 95 per cent CI 0.82–1.12) and night cough in the past 12 months (35.4 per cent & 38.3 per cent, RR0.93, 95 per cent CI 0.86–1.00). However, symptoms of severe asthma were significantly more common among students from Tobago and included having had more than one acute attack in the past year (13.4 per cent & 15.8 per cent, RR 0.85, 95 per cent CI 0.73–1.00, p = 0.0004), night waking as a result of wheeze (7.4 per cent & 10.9 per cent, RR 0.68, 95 per cent CI 0.56–0.83, p < 0.0001) and speech limitation in the past year (5.2 per cent & 8.7 per cent, RR 0.59, 95 per cent CI 0.47–0.74, p < 0.001) Exercise-associated wheezing was also more frequent among Tobagonian adolescents (17.5 per cent & 20.2 per cent, RR 0.87, 95 per cent CI 0.76 – 0.98, p = 0.04). CONCLUSION: Self-reported wheeze is common among adolescents in Trinidad and Tobago. Variation in symptoms was found between the two territories; high school students from Tobago, the less industrialized of the two islands, reported more symptoms of severe asthma and exercise-induced wheeze.

Inequalities in health in Latin America and the Caribbean: descriptive and exploratory results for self-reported health problems and health care in twelve countries

Objective: To explore and describe inequalities in health and use of health care as revealed by self-report in 12 countries of Latin America and the Caribbean. Methods: A descriptive and exploratory study was performed based on the responses to questions on health and health care utilization that were included in general purpose household surveys. Inequalities are described by quintile of household expenditures (or income) per capita, sex, age group (children, adults, and older adults), and place of residence (urban vs. rural area). For those who sought health care, median polishing was performed by economic status and sex, for the three age groups. Results: Although the study is exploratory and descriptive, its findings show large economic gradients in health care utilization in these countries, with generally small difference between males and females and higher percentages of women seeking health care than men, although there were some exceptions among the lower economic strata in urban areas. Conclusions: Inequalities in self-reported health problems among the different economic strata were small, and such problems were usually more common among women than men. The presence of small inequalities may be due to cultural and social differences in the perception of health. However, in most countries included in the study, large inequalities were found in the use of health care for the self-reported health problems. It is important to develop regional projects aimed at improving the questions on self-reported health in household interview surveys so that the determinants of the inequalities in health can be studied in depth. The authors conclude that due to the different patterns of economic gradients among different age groups, and among males and females, the practice of standardization used in constructing concentration curves and in computing concentration indices should be avoided. At the end is a set of recommendations on how to improve these sources of data. Despite their shortcomings, household interview surveys are very useful in understanding the dimensions of health inequalities in these countries (AU)

Using household surveys and other information sources to study health equity in Latin America and the Caribbean

There are many types of household surveys. The discussion that follows will focus on what is know as "general-purpose household surveys." Such surveys were devised to study household expenditures (and/or income), job and occupational conditions, education of the members of the household (both highest level of attainment and current enrollment), conditions of the dwelling, and access to and utilization of services, including health services. The surveys usually also include a few questions on self-assesment of health status and the presence of health problems. Some of the surveys also include modules for special population groups such as children and women of reproductive age. The modules may cover such topics as immunizations, prevalence of diarrhea, upper respiratory tract illnesses in children, complete birth histories for women, and women's use of contraceptive methods. While they almost never have information on expenditures or income, they do include data about conditions of the dwelling, education, crowding, and other characteristics. These data allow some limited analyses of the relationships that health-seeking behaviors, health outcomes, and access to and utilization of some types of health care services have some aspects of the social and economic determinants of inequalities (AU)

Presence of Anorexia Nervosa and Bulimia Nervosa in Jamaica

We could find no previous data describing the extent to which eating disorders are a public health problem in Jamaica, and so we carried out two exercises to assess this. We investigated the number of cases of anorexia nervosa (AN) and bulimia nervosa (BN) presenting at the University Hospital of the West Indies (UHWI) between 1985 and 1988, using case records, and carried out a survey among health professionals (psychiatrists, clinical psychologists, paediatricians and nutritionists/dietitians) to determine the number of patients with eating disorders seen by them between 1996 and 1998. We also examined the diagnostic criteria used and correlates of eating disorders. Only two cases of AN were treated at UHWI. Eleven cases each of AN and BN (two males) had presented to the health professionals surveyed, chiefly the psychiatrists. The AN patients ranged in age from 14 to 28 years (mean 20.9 years), and the BN patients from 11 to 35 years (mean 22.2 years). Eating disorders were reported primarily among urban dwellers (76 percent), and half of the cases were among students. Limiting food intake, excessive exercise and vomiting were the most frequently used metdods of weight control. Nine eating disorder patients (41 percent) were also diagnosed with depression, and five (23 percent) patients reported previous emotional trauma. The occurrence of eating disorders in Jamaica appears to be very low. (AU)

A preliminary study of the indices of obesity among select group of apparently healthy Caribbean subjects

The purpose of this study was to assess the anthropometric indices of obesity among apparently healthy Caribbean subjects who have the potentials of living an affluent lifestyle. One hundred and eleven (38 males, 73 females) young adults aged between 17 and 38 years participated in the study. Subjects provided information on age, ethnic group, educational attainment, occupation, and previous record of body mass index (BMI) and family history of diabetes mellitus in a self-administered research questionnaire. Waist and hip circumferences (cm), weight (kg) and height (m) were measured. Subsequently, BMI and waist-to-hip ratio (W/H) were calculated. The majority of the subjects (83 percent) had never measured BMI. Although the male subjects were significantly taller and heavier than the females (p<0.01), there was no significant difference in the prevalence rates of obesity between the male and female subjects (p>0.05). In this preliminary study there was a trend for more females than males to be under weight (BMI< 20 kg/m2). The male subjects had significantly higher waist circumference than the females (p< 0.01), but both genders had a similar percentage of male and female subjects with increased waist circumference (p>0.05). The limitations of this study are its small size and self selection bias and hence the results obtained must be interpreted with caution. We suggest that assesment of body mass index should be incorporated in the routine clinical measurements of all patients to facilitate early identification, evaluation and treatment of overweight and obesity. (AU)

Nosocomial infection in an Intensive Care Unit in a private hospital

The nosocomial infection rate in an Intensive care unit (ICU) of a private hospital was assessed during an 18-month survey. From 629 admissions to the ICU, 139 hospital-acquired infections were identified. The rate was 22.1 percent compared to the overall nosocomial infection rate of 15.3 percent for the entire hospital. In the ICU, the main infections occurred in the respiratory tract, 41 (29.5 percent), followed by surgical wounds, 35 (25.2 percent), urinary tract, 28 (20.1 percent) and the blood stream, 24 (17.3 percent). From 165 bacterial isolates, 80 percent of isolates were gram-negative rods, with P aeruginosa, 48 (36.6 percent), being the predominant gram-negative isolate followed by Klebsiella pneumoniae, 27 (20.6 percent), and Enterobacter sp, 22 (16.8 percent). The main gram-positive isolates were S aureus, 23 (41.8 percent), coagulase-negative Staphylococci, 17 (30.9 percent), and Enterococci, 11 (20.0 percent). Of the 23 S aureus strains, 15 (65.2 percent) were methicillin-resistant (MRSA), (8 MRSA were from surgical wounds, 5 from the respiratory tract and 2 from infected urine). Only 2 of the 17 (11.8 percent) coagulase-negative staphylococci were methicillin-resistant, and both were isolated from wounds. Resistance to ampicillin and augmentin (amoxicillin-clavulanic acid) was high, 81.9 percent and 55.4 percent, respectively. Gentamicin, azteronam, piperacillin-tazobactam showed resistance rates of less than 15 percent. Infection control measures aimed at reducing nosocomial infections at the hospital are often frustrated by apathy of hospital administrators who apparently are insensitive to the high nosocomial infection rate. Effort by the infection control team through seminars, lectures and newsletters have begun to show improvements in attitude and awareness of staff to infection control and preventative measures within the institution. (AU)

Management of teeth requiring root canal treatment and views on continuing professional education in endodontics by dental practitioners in Trinidad and Tobago [abstract]

Many of the new materials and techniques used in endodontics (root canal treatment) require considerable practice to master and many require continuing education courses to allow formal instruction. Nothing is known regarding techniques employed and views on continuing professional education (CPE) in endodotics by dentists in Trinidad and Tobago. With the shift toward evidence-based dentistry and rising patient expectation of quality oral health care, a survey was conducted to describe these issues. A self-administered postal questionnaire was sent to all registered dentists in Trinidad and Tobago. Seventy dentists responded after two mailings. Most respondents worked primarily in private practice (85.5 percent). Years since qualification ranged from 2 to 45 years and 54.3 percent were qualified for more than 10 years. Most frequent treatment of an acute dental abcess involved opening, preparing the canal(s), dressing and prescribing antibiotics (40 percent). Forty-one respondents (58.6 percent) ocassionally completed root canal treatment in a single visit. Isolation of the tooth for molar root treatment always caused difficulty for thirty-five respondents (50 percent) and rubber dam isolation was used routinely by only nine respondents (12.9 percent). Most respondents either filed (20 percent) or reamed (18 .6 percent) for canal preparation usually using K files. Thirty-three respondents (47 percent) used sodium hypochlorite to irrigate the tooth and thirty-one (44.3 percent) used cold lateral condensation of gutta percha to obturate. Thirty-four respondents (48.6 percent) subscribed to professional journals and sixty-seven (95.7 percent) had attended some form of Continuing Professional Education. Sixty-seven (95.7 percent) of respondents would attend CPE in endodontics if available in Trinidad and Tobago, with most (72.9 percent) preferring a lecture/seminar format addressing problem-solving and new techniques. Respondents to this survey showed use of a wide range of techniques and materials but still expressed considerable interest in developing their skills in endodontics through formal CPE. (AU)

Perception of a healthy diet: a survey among fourth form students in Trinidad [abstract]

The objective of this study was to determine the percentage of students with the correct perception of a healthy diet and whether perception varied with gender, type and geographic location of schools, religion, ethnicity, family history of chronic disease and exposure to nutritional information. A cross-sectional survey of 795 randomly chosen 4th form students, from randomly chosen secondary schools throughout Trinidad, was conducted over two weeks. Students who passed all six sections of a self-administered, anonymous questionnaire, with at least 50 percent correct responses in each section, were deemed to have the correct perception of a healthy diet. One hundred and sixty-five (21 percent) students had the correct perception of a healthy diet and 102 (23.9 percent) females vs 63 (17.7 percent males passed (p= 0.036). A significantly higher proportion (p= 0.008) of government-assissted school students (30.8 percent) passed, compared with students from Government schools (19.6 percent). Concerning "Healthy Choices", 87.3 percent of students passed whereas the "Dietary Beliefs" section had the lowest pass rate of 30.8 percent. Of the 676 students who reported being exposed to nutritional information, 153 (22.6 percent) had the correct perception. However, 11.3 percent of the students who reported no previous exposure to such information passed (p= 0.008). Religion, ethnicity and family history of chronic disease had no significant influence on students' perception. In conclusion, it was found that the majority of students sampled had an incorrect perception of a healthy diet. Perception varied with gender, exposure to nutritional information, type and geographic location of school attended. (AU)

Predictors of mortality in patients with left ventricular failure [abstract]

We retrospectively reviewed the clinical presentation and five-year mortality of 64 consecutive adults who underwent echocardiography at the Eric Williams Medical Sciences Complex between January 1992 and December 1994 with a left ventricular ejection fraction < 40 percent. The mean age was 60ñ12 years and 68 percent of patients were male. The prevalence of diabetes mellitus and hypertension was 40 percent and 46 percent, respectively. The mean left ventricle ejection fraction was 30ñ9 percent. The most common primary cost of left ventricular failure was coronary artery disease (CAD) in 47 percent, idiopathic dilated cardiomyopathy (9 percent), hypertensive heart disease (9 percent), alcohol related dilated cardiomyopathy (8 percent) and valvular heart disease (6 percent). Angiotensin converting enzyme inhibitors were prescribed in 85 percent of cases, diuretics (82 percent), digoxin (61 percent), warfarin (18 percent), beta blockers (10 percent), and amiodarone (8 percent). Survival data were available for 84 percent. Mortality was 53 percent at 5 years. Independent predictors of mortality were age, the use of beta blockers and left ventricular internal diameter. In conclusion, CAD was the most common cause of left ventricular failure. Five-year mortality was high, particularly in elderly patients with marked ventricular dilatation. (AU)

Maternal stress associated with raising autistic children in Jamaica

OBJECTIVE: Our objective was to determine the level of stress associated with raising an autistic child in Jamaica, a developing nation with fewer available resources for affected families. METHODS: Fifty-two autistic children were identified through medical records of hospitals and private paediatricians, and from registers of special schools. Mothers completed the Parental Stress Index (PSI), the Brief Symptom Inventory (BSI) (a measure of mental health status), and a socioeconomic questionnaire. The PSI identified stress in two major domains, the Parent and Child Domains. It also included a life event stress scale. The severity of autism was assessed by using the Childhood Autism Rating Scale. Results were compared with national sample of healthy children, in which similar parent questionnaires had been completed. SPSS software version 7.5 was used for data analysis and a "p" value less than 0.05 was considered significant. The sample of autistic children consisted of 41 males (78.8 percent) and 11 females (21.2 percent) with a mean (ñ standard deviation) age of 6.5ñ3.7 years. The control group consisted of 72 males (50.3 percent) and 71 females (49.7 percent) with a mean/SD age of 6.0ñ0.4 years. RESULTS: Both study and control groups had similar Parent Domain scores, but parents of autistic children had significantly higher scores in the Child Domain (p<0.001). Mothers of non-autistic children obtained significantly higher scores in somatization, (p<0.001), depression (p<0.05), hostility (p<0.05) and paranoia (p<0.001) using the BSI Crowding (p<0.05), maternal level of education (p<0.05), and occupation (p<0.01) were significantly associated with stress in the control group, but not in the study group. The severity of autistic features (p<0.001) significantly contributed to stress associated with raising autistic children. Factors that did not significantly contribute to stress in either group included: socio-economic status, age and gender of the child, and stressful life events. CONCLUSIONS: Mothers of autistic children experienced significantly higher levels of stress than did mothers of non-autistic children. Parental stress was directly attributed to dificulties of the child (Child Domain), but not to parenting inadequacy (Parent domain). With autism on the increase, public services aimed at assissting parents by providing respite care and/or training in behaviour management will need to be developed. (AU)

Satisfaction among patients attending a specialist medical clinic

OBJECTIVE: To determine the level of satisfaction among patients attending the Cardiac Specialists Clinic at the University Hospital of the West Indies (UHWI), Mona. METHOD: A 25-item pre-tested questionnaire was administered to a purposive sample (n=39), men (n=10) and women (n=29), 43.3 percent of a total population (n=90) attending the clinic in May and June 2001. Their median age was 59 years, range 31-90 years. RESULTS: There were no significant differences between the responses of the men and the women. Respondents travelled a median of eight miles, range 2-183 miles, to attend the clinic, and waited for a median of four hours, range 1-8 hours, before receiving attention. They had attended the clinic a median of four times. Despite this, they reported a high level of satisfaction with all categories of hospital personnel (median rating: 8/10). They, however, rated the caring behaviour of the physicians significantly higher than that of nurses (z=3.2, p<0.001). The majority (71.8 percent) regarded the clinic fees as "reasonable". Fifty percent were eligible for the Drugs for the Elderly Programme but only 21.5 percent were on it. This programme is not offered at the UHWI hospital pharmacy. Only two persons rated the overall facilities as "excellent". They all would recommend the services of the clinics to friends and relatives for "good treatment from knowledgeable doctors and nurses" and "cleanliness of the surroundings". CONCLUSION: Overall, patients were satisfied with the services. The waiting time and time taken to find the dockets were the areas of greatest concern. (AU)

Obstetric complications and autism in Jamaican children [abstract]

OBJECTIVE: There has been an increased prevalence of autism worldwide. Research in developed countries has identified a number of associations, though no direct agent has been identified. Mothers of autistic children have been shown to have more obstetric complications than others. There is little information available about autistic disorder in developing countries. This study sought to determine the relationship between obstetric and perinatal history and the diagnosis of autistic disorder in Jamaican children. METHODS: Children with autistic disorder were identified from public hospital records, private paediatricians' records and from registers of special schools. Parents of 55 Jamaican children were interviewed about the pre-natal and peri-natal periods. Their experiences were compared with those of a national sample of young children for whom pre-natal and peri-natal information was already available. The same questionnare was administered to both groups of parents. RESULTS: The mean ñ Standard Deviation age of autistic children was 6.3 ñ 4.3 years. There was a male preponderance in the autistic group (79 percent), compared with the control group (forty eight percent). Families with autistic children had significantly fewer children (mean/SD 2.54 ñ 1.5) than the non-autistic control group (mean/SD4.02 ñ 2.5) (p<0.05). Mothers of autistic children had higher rates of complications during labour (30.2 percent compared with 12.8 percent) and pregnancy (30.2 percent compared with 13.4 percent), but these did not achieve statistical significance. A greater proportion of autistic children was either born prematurely or late and was admitted to the hospital but these differences were not statistically significant. Breast feeding rates were similar. CONCLUSION: This study showed that mothers of autistic children in Jamaica have a higher rate of obstetric complications, as has been found in other countries. Mothers have a significantly higher mean age at the birth of an autistic child and have significantly fewer children. Parents may opt not to have any more children once a child with a disability has been born. (AU)

Failure to screen for sickle cell disease at the University Hospital of the West Indies

OBJECTIVE: Universal neonatal screening for sickle cell disease using cord blood has taken place in the University Hospital of the West Indies (UHWI) since 1997. Comprehensive quality control of the screening programme has not been implemented. Our aim was to determine how many deliveries were left unscreened, and to ascertain factors contributing to failure to screen for sickle cell disease. METHODS: All live births in 1999 entered in the delivery book of the Labour Ward, UHWI, were scrutinized against the sample book of the Neonatal Screening Laboratory, Sickle Cell Unit. Identified unscreened infants were matched with a randomly chosen control, born on the same day. Time and mode of delivery, persons assisting the delivery, birth weight, level of urgency, location of delivery and Apgar scores at 1 and 5 minutes were collected for unscreened infants and screened controls. Secular variation within the year was assessed by comparing the frequency of unscreened births in each month to the previous month. Frequencies of potential determinants of failure to screen were tabulated. The independent predictive power of these potential determinants was assessed using conditional logistic regression, to account for correlations between predictors, and for the case-control design of the study. RESULTS: Of 2,763 live births in 1999, 139 (5 percent) infants were not screened for sickle cell disease. There was no statistically significant secular variation within the year (relative risk 1.02, 95 percent confidence interval 0.97, 1.07, x2 = 0.77, p = 0.38). Independently significant predictors of failure to screen were: emergency delivery (odds ratio 4.8, 95 percent confidence interval 2.3, 10.0), nigttime delivery (OR2.5, 0.9) CONCLUSIONS: This study identified that 5 percent of infants born in UHWI in 1999 were discharged from hospital without having been screened for sickle cell disease. Statistically significant associations with failure to screen were found to be emergency delivery, night-time delivery, and low 5 minute Apgar score. The risk of being left unscreened increased 5-fold for emergency deliveries. Increased awareness of these risk factors may reduce failure to screen. Of course, such effort does not obviate the need for regular quality control, including timely identification and tracing of unscreened infants. (AU)

Early termination of breast-feeding in periurban Santo Domingo, Dominican Republic: mothers' community perceptions and personal practices

The objectives of this study were to determine: 1) whether mothers' perceptions of typical community practice for breast-feeding duration influence their personal practices and 2) whether the mothers' reports of community reasons for terminating breast-feeding identify barriers not elicited through self-report. The study was conducted in 1997 in a sample of poor neighborhoods in a periurban district of Santo Domingo, the capital of the Dominican Republic. A representative sample of 220 mothers from these neighborhoods was interviewed with a structured questionnaire. While the duration of the brest-feeding was similar for self-report and for mothers' perceptions of typical community practice, there was no statistically significant correlation between these two variables. "Mother-driven" reasons for early termination of breast-feeding, such as "fear of loss of figure or breast shape" and " not wanting to breast-feed" were frequently perceived as community reasons but rarely given as personal reasons. Personal reasons were predominantly "child-driven," including " the child not wanting the breast," or reasons beyond the mothers' control such as having "insufficient" milk. Maternal report of community reasons for early termination may be a useful way to identify factors that would not otherwise be revealed on self-report. These additional reasons may guide health promotion efforts aimed at increasing breast-feeding duration (AU)

Caring for the chronically III elderly in Trinidad: the informal situation

This paper comments on research data, from a survey, which sought to determine the health and social circumstances of persons in Trinidad who were providing informal care for the chronically ill elderly during the period, March to August 1998. The research also sought to ascertain the main concerns of the caregivers in their caregiving role. One hundred caregivers in North, Central and South Trinidad were chosen using a convenience sampling method. Caregivers selected had to be at least eighteen years old and residing in their own homes or in the home of the cared. The caregivers ranged in age from 20-89 years. Eighty two percent of the caregivers were females. Wives, daughters and daughters-in-laws were the main caregivers. Daughters-in-laws were especially instrumental in providing informal care in Indo-Trinidadians households, being 28 percent of caregivers in those households compared to 4 percent for daughters-in-laws in Afro-Trinidadian households. Fifty percent of the caregivers reported their health to be good. The main health conditions reported by the others were hypertension (14 percent), diabetes mellitus (9 percent) and arthritis (18 percent). The main concern which the caregivers reported was stress (50 percent). The study revealed that caregiving was perceived by mot of these caregivers to be extremely stressful. Daughters, daughters-in-law and wives bore the greatest burden of care and desired greater assistance from family members and friends. The paper make reference to a government programme which trains young adults to work with the chronically ill elderly, in their own home. It make a case for the greater use of such young persons in order to relieve relatives of some of the burden of care.(Au)

Age - specific incidence of cancer in Kingston and St. Andrew, Jamaica, 1993-1997

A total of 4285 malignant neoplasms were recorded in Kingston and St. Andrew during the period 1993-1997. 2344 in females and 1941 in males. The crude incidence rate per 100,000 (CIR) for males was 121.6 and for females 129.2. Age standardized rates per 100,0000 (ASR) were 156.7 and 176.7 for males and females respectively. In males, the leading sites for cancer were prostate (619 cases), bronchus (265 cases) and large bowel (144 cases) while in females the leading sites were breast (627 cases) cervix uteri (376 cases) and large bowel (204 cases). The crude and age standardized incidence rates have remained stable as compared to those for the previous five year period (1988-1992). The leading sites for both males and females have also been maintained in the same order but there was a marked increase in prostate cancer (ASR 56.4 versus 36). Invasive cervial cancer has shown no significant change in incidence (ASR 25.2 versus 26.3) but the rate for in-situ cancers has decreased (ASR 27.4 versus 43.8). The incidence of cancer of the female breast has remained relatively stable (ASR 43.2 versus 47.1). The trends exhibited by both prostate cancer and in-situ cervical cancer probably represent the influence of screening methods for prostate cancer and ablative management for low grade dysplastic lesions of the cervix uteri respectively.(Au)

Chronic disease control and compliance - the HOPE worldwide Jamaica experience

HOPE worldwide Jamaica has provided mobile curative and preventative services to fourteen rural government clinics since 1994. The patients records of 1,091 chronic disease patients, aged>30 years between January and December 1999 were reviewed. They were all above 30 years of age with an average age of 64 years; 81 percent were female and 60 percent were hypertensive, 16 percent diabetic and 24 percent had both diabetes and hypertension. There were 2,390 visits for hypertension, with an average of 2 visits per patient. Thirty-four per cent of patients had BP of < 140/90 mmHg while 43 percent had BP < 160/95 mmHg. Compliance was defined as daily consistency in taking prescribed medication. Forty-four per cent of hypertensive were non-compliant at the time of their visit. Anti-hypertensive treatment included thiazide diuretics (65 percent), reserpine (50 percent), ACE inhibitors (30 percent) and methyldopa (5 percent). There were 1,129 visits for diabetes, with an average of 2 visits for diabetes, with an average of 2 visits per patient. Twenty-four per cent of diabetic patients were controlled to fasting blood glucose FBG levels of <6.7 mmol/l and 38 percent controlled to (FBG) levels <8 mmol/l. Thirty per cent of diabetics were non-complaint at the time of their visit. The most frequently used oral hypoglycaemic agents were metformin (78 percent), glyburide (43 percent) and chlorpropamide (30 percent). Fourteen per cent of diabetics were on treatment with insulin 70/30 (12 percent) and lente insulin (2 percent). Electrocardiograms (ECG) were done on 24 percent (n=267) of patients in the previous two years. Thirty-six percent had evidence of left ventricular hypertrophy and 15 percent had evidence of ischaemic heart disease. The level of blood pressure and blood glucose control is inadequate, despite the provision of regular monitoring, surveillance and improved access to pharmaceuticals. It is perceived that poor socioeconomic conditions, lack of education, cultural beliefs, in addition to other factors, continue to militate against improved compliance and control.(Au)

Concepts of obesity among outpatients of a Jamaican hospital

Obesity is an important risk factor for the development of chronic non-communicable diseases such as diabetes and hypertension, which affects large numbers of Caribbean people. There is a perception that Caribbean culture is not only tolerant of obesity but actually encourages this state, especially among women. We carried out a survey among normal-weight and overweight adults in order to investigate their attitudes to obesity. Three hundred adults (245 women and 55 men) present at the Casualty department at the University Hospital during the study period were asked to participate. A questionnaire was given, and heights and weights were measured to determine Body Mass Index (BMI). The relation between BMI and attitudes to obesity was explored. Forty percent of the respondents agreed that fatness was a sign of happiness, 15 percent thought it represented wealth, and 10 percent thought it represented health. Just over half (58 percent) of the women who were overweight perceived themselves to be fat, while of the overweight men (42 percent) thought themselves fat. Fifty-six percent of the men, and 38 percent of the women preferred a slim partner. Most respondents were aware of the diseases associated with obesity and could name foods which contributed to obesity e.g. fried foods and sweets. These data suggest that obesity is viewed favourably, or not unfavourably, by nearly half of the sample, or the converse, over half of the respondents did not view obesity favourably. Although the problems of obesity are recognized, overweight people are not necessarily aware that they are in fact overweight and at risk. Health promotion efforts should take this into account. (AU)