The effects of socio-economic status, dengue knowledge and perception on source reduction and protective behavior in selected marginal areas of Belmopan

Dengue, a mosquito-borne disease is a major health concern worldwide. The Belize Ministry of Health mosquito control strategies include fumigating, distributing bed nets, conducting educational campaign, among other activities. The educational campaign, specifically, aims to increase both the source reduction of mosquito breeding sites and the protective behavior against mosquito bites. To understand the relationship between educational campaign and the mosquito preventative practices, a Knowledge, Attitude, and Practice (KAP) survey was conducted in two marginal areas of Belmopan that were considered high risk areas for dengue by the Ministry of Health. The two marginal areas were selected through stratified sampling according to their socio-economic status and within each area the houses were then randomly selected and questions pertaining to their knowledge, attitude and preventative practices for dengue were asked. By analyzing the relationship between demographic background, knowledge, attitude, and practice using bivariate analysis the results demonstrated that although the knowledge of dengue did not have a significant impact on the preventative practice of individuals, their attitudes had. Forty-eight percent of individuals who were considered to have a high concern towards dengue were practicing preventative and protective measures against mosquitos. We conclude that more educational programs should focus on increasing the concern towards dengue along with awareness and encouragement of conducting mosquito source reduction.(AU)

National policy on ageing for Trinidad and Tobago.

The needs of older persons must be assessed against the rapid demographic changes society is undergoing. Such changes may impact differently on the situation of older persons, unless effective countervailing measures are instituted. If mechanisms for treating with ageing issues in Trinidad and Tobago are to be effective, they must be located within a comprehensive policy framework. It is on this basis that the Government of Trinidad and Tobago has sought to develop a national policy on ageing. The overall goal of this policy is to promote the well being of older persons in a sustainable manner and provide older persons with the opportunity to be integrated into the mainstream of society.

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)

The impact of the women's centre of Jamaica foundation programme for adolescent mothers on repeat pregnancies

A random sample (n=260) of primiparous Jamaican adolescent mothers (12-16 years old) who gave birth in 1994 in the parishes of Kingston and St Andrew, St Catherine and Manchester was selected from vital records and interviewed in 1998 for this historical cohort study. Among programme participants, the incidence of repeat pregnancy was 37 percent compared with 60 percent among non-participants. Programme participation reduced the risk of one or more repeat pregnancies by 45 percent with 95 percent confidence interval (0.22, 0.91). Programme participants were also 1.5 times (1.005, 2.347) more likely to complete high school than non-participants; however, this effect did not achieve statistical significance. The results confirmed that the WCJF Programme exerts a considerable effect on the incidence of repeat pregnancy among participants. The benefits of programme participation were greatest among residents of the Kingston Metropolitan Area from single parent, female headed households with average incomes below J$10,000, who wanted to continue their education after the first live birth.(Au)

An evaluation of the Jamaica Drug for the Elderly programme in Kingston and St. Andrew

The presence of chronic diseases is accompanied by the threat of complications that can be averted if the elderly can obtain the necessary health care. In 1996, the government of Jamaica launched the Jamaica Drug for the Elderly Programme (JADEP) to assist persons 60 years and over with any six chronic diseases, in the purchase of medication. The study aims to evaluate public attitude toward and participation in the programme. A cross-sectional study was conducted in randomly selected pharmacies in Kingston and St. Andrew among 94 elderly persons with certain chronic diseases and 9 providers of JADEP. All elderly persons who entered the selected pharmacy, fulfilled the criteria and who consented to be interviewed were included in the study as was the main pharmacist for that location. A focus group discussion with ten persons helped to eludiate information already obtained. The study revealed that while most elderly persons had neither a positive nor negative attitude towards the programme, the level of registration was not high (52 percent, n=94). Among JADEP participants many (67.4 percent or 29/43) were unable to obtain all their medication at one time due to cost constraints. Both providers and the elderly raised concerns about the limited range of drugs available which was the reason commonly cited for not being able to use the benefit card. The study showed that the extent to which the programme was able to assist the elderly was dependent on their awareness of how the programme functioned and the availability of their medication. The service is a necessary one and its failure would have public health implications as chronic illnesses that are not well managed will increase the health burden of the population and overall health care costs. It is recommended that the range and quantity of drugs that can be prescribed for the particular chronic conditions be re-examined.(Au)

The role of the aedes aegypti surveillance and control in relation to the epidemiology, prevention and control of Dengue Fever in Jamaica

The control of dengue fever depends on the level of Aedes aegypti infestation and thus relies heavily on the measures for controlling the vector. Quite recently, despite the implementation of mosquito control measures, the Aedes aegypti population has still escalated. The vector apparently has adapted to or resisted most of the control methods. The failure of Aedes aegypti control programmes has been blamed on the vector's biological features fostering the development of species resistance to chemical control or environmental factors favouring the increase of the Aedes aegypti' population at a faster rate than the control methods can reduce them. Nevertheless, many Aedes aegypti control programmes are improperly planned and implemented or the control measures are often used as reactive methods of controlling dengue fever outbreaks, rather than as continuous proactive strategies preventing disease. Aedes aegypti breeding is basically a problem of domestic sanitation and therefore communities have an essential role to play in source reduction activities. The activities of some governmental departments, non governmental organizations and the private sector may encourage the increase of Aedes aegypti mosquitoes or play a positive role in vector control. Consequently, intra sectoral and intersectoral in vector control are very important. This study examined the control measures applied by the Jamaican Ministry of Health, Vector Control Department and the community for Aedes aegypti surveillance and control, and determined the effectiveness of and obstacles to the mosquito control activities presently being applied. The aim of the study was achieved through the execution of an entomology survey, an environmental survey, an insecticide susceptibility test, key informant interviews with vector control staff from the Ministry of Health and the administration of a Knowledge-Attitude-pracitce survey. The research results showed that the environmental conditions in the study area were conducive to Aedes aegypti breeding and proliferation, especially during the months of July to October. Aedes aegypti mosquitoes were present throughout the study area, with a higher density of Aedes aegypti larvae in Tavern and Gordon Town. Aedes aegypti larvae collected from Mona and Hermitage were highly susceptible to a 1 percent abate larvicide.(Au)

Users perceptions of the quality of MCH services in Grenada

This study was done to analyse the quality of Maternal and Child Health (MCH) Services delivered according to the perception of users. Data was collected using a pre-tested structured questionnaire, focus group discussions and natural group interviews. 237 users of MCH services were interviewed at randomly selected community health facilities. Ninety-six percent of users were of the opinion that their health workers showed interest and understanding and were friendly and courteous. Ninety-six percent of users were comfortable with the health workers who attended to them. Ninety-two percent of users were questioned by health workers. However, 26 percent received no explanations and instructions. Forty-nine percent of users perceived consultations with health workers to be short. The hours of service delivery were inconvenient for employed persons using the service. Statistically significant differences existed in user satisfaction by location of facility and type of facility at which care was received. Areas identified for improvement include health workers' interpersonal relations and infrastructure including the availability of sanitary facilities and supplies for users. 65 percent of users of MCH services were not gainfully employed (37 percent - unemployed, 28 percent - housewives). Occupational status and educational attainment levels of respondents reflected a disproportionately higher number from lower socioeconomic groups among users of the MCH services. Rescheduling of hours for service delivery is recommended to encouraged more employed persons to use the services. (AU)