Reliability and validity of a short form household food security scale in a Caribbean community

BACKGROUND: We evaluated the reliability and validity of the short form household food security scale in a different setting from the one in which it was developed. METHODS: The scale was interview administered to 531 subjects from 286 households in north central Trinidad in Trinidad and Tobago, West Indies. We evaluated the six items by fitting item response theory models to estimate item thresholds, estimating agreement among respondents in the same households and estimating the slope index of income-related inequality (SII) after adjusting for age, sex and ethnicity. RESULTS: Item-score correlations ranged from 0.52 to 0.79 and Cronbach's alpha was 0.87. Item responses gave within-household correlation coefficients ranging from 0.70 to 0.78. Estimated item thresholds (standard errors) from the Rasch model ranged from -2.027 (0.063) for the 'balanced meal' item to 2.251 (0.116) for the 'hungry' item. The 'balanced meal' item had the lowest threshold in each ethnic group even though there was evidence of differential functioning for this item by ethnicity. Relative thresholds of other items were generally consistent with US data. Estimation of the SII, comparing those at the bottom with those at the top of the income scale, gave relative odds for an affirmative response of 3.77 (95% confidence interval 1.40 to 10.2) for the lowest severity item, and 20.8 (2.67 to 162.5) for highest severity item. Food insecurity was associated with reduced consumption of green vegetables after additionally adjusting for income and education (0.52, 0.28 to 0.96). CONCLUSIONS: The household food security scale gives reliable and valid responses in this setting. Differing relative item thresholds compared with US data do not require alteration to the cut-points for classification of 'food insecurity without hunger' or 'food insecurity with hunger'. The data provide further evidence that re-evaluation of the 'balanced meal' item is required.

Salud, desarrollo humano y gobernabilidad en America Latina y el Caribe a inicios del siglo XXI / Health, human development, and governance in Latin America and the Caribbean at the beginning of the 21st century

The issue of the reciprocal relationship between health and development has recently taken on greater importance in Latin America and the Caribbean (LAC), given the persistence of extreme poverty and the political and social difficulties due to macroeconomic imbalances and crises of governance. This piece reviews concepts of sustainable human development, social determinants of health in general and of health inequities in particular (gender, ethnic group, income level), and the relationship between health and economic growth in the medium term and the long term. An analysis is made of how persistent poverty in countries of LAC relates to disparities in health conditions, access to health services, and health care financing, as well as to such health determinants as nutrition and environmental sanitation. Health inequities most strongly affect the most excluded and vulnerable sectors of the population. In the face of this situation, the author stresses that putting a priority on health inequities is vital to safe-guarding the governability and the social and political stability of countries in LAC in the next decade (AU)

A concept of Caribbean fatherhood

OBJECTIVE: To investigate the manner in which Jamaican men view themselves and their relationships with women and their role in family life as partners and fathers. METHODS: A two-stage stratified random sample was used to select men aged 15-40 years in three parishes, Kingston, St.Andrew and Hanover. Enumeration districts and dwellings were selected in the first and second stages, respectively. In selected dwellings, all males 15-40 years were identified among the eligible males who had fathered at least one child. From these, one respondent was randomly selected. A questionnaire was administered to the sample yield of 714. Focus group discussions were held with a subset of the sample. Eight focus groups were held, four each in rural and urban areas among men 15-24 years, and similarly among men 25-40 years. RESULTS: The majority (64 percent) of the men who currently either in visiting or common-law unions and 23 percent had formed these unions between the ages of 15 and 19 years. Most (58 percent) had spent one to six years in their current union, of which the largest group (26 percent) spent one and a half to three years. Just over two-thirds of the children were born in current unions and those born outside of the current union were born in visiting unions (41 percent). Approximately 44 percent of the respondents' children were not living with them; 80 percent were living with their mothers. Respondents (87 percent) reported that they were involved in their children's lives. Major involvement was the provision of food (52 percent), clothes (51 percent) and health care (51 percent). The main obstacle identified for male participation in parenting was their marginal economic status. Significant relationships (p<0.1) were: the increase in the fathering role with age; fathers who were not household heads were less involved in their children's lives, especially when a step-father was present and the economic contribution of fathers was strongly related to their economic status. Contact between parents was significantly influenced by the age of both the father and the children. CONCLUSIONS: The findings indicate that fatherhood is hinged in the ability of the men to make economic and material contributions to their family. In general, men wanted a better life for their children but faced real constraints. Poverty was the major factor preventing men from performing the role they consider central to their concept of fatherhood. (AU)

Investment in health: social and economic returns

This publication brings together the final reports from three research projects that explored how investments in health affected economic growth, household productivity, and poverty alleviation in Latin America and the Caribbean. The projects were carried out in 1998 and 1999, and came about through the coordinated efforts of the Pan American Health Organization (PAHO), the Inter-American Development Bank (IDB), the United Nations Development Program (UNDP), the United NAtions Economic Commission for Latin America and the Caribbean (UNECLAC), and the World Bank

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)

Los escenarios sociales en America Latina y el Caribe / The social setting in Latin America and the Caribbean

A wide range of sources have pointed out the magnitude and depth of the social problems that trouble Latin America and the Caribbean and the risks that these problems pose for democracy. Although there are other issues that merit consideration, this article briefly outlines nine key social problems: 1) the increase in poverty, 2) the impact of poverty, 3) unemployment and informal employment, 4) deficiencies in public health, 5) problems in education, 6) the newly poor, 7) the erosion of the family, 8) increasing crime, and 9) the perverse cycle of socioeconomic exclusion. Solving these problems must not be delayed. It is urgent to move to a comprehensive view of development that achieves a different balance between economic and social policies, and that recognizes the indispensable role of these policies in achieving truly sustainable development. At stake are problems that not only concern resources, but also priorities, levels of equity, and the organization of society. Facing up to this poverty and inequity requires an in-depth assessment of these economic policies' social consequences, of the crucial subject of Latin American inequity-the greatest in the world-and of the role of social and public policies (AU)

The important concepts in the management of microbial keratitis

Eye practitioners in the Caribbean must be aware of the issues involved in the management of microbial keratitis. A comprehensive literature review is presented in order to outline appropriate management strategies and to identify when referral may be indicated. (AU)

Obesity and poverty: a new public health challenge

Throughout history, obesity and overweight have been underestimated as public health problems in Latin America and the Caribbean. Both conditions are on the rise in the region, however, although this is difficult to measure, given the fact that the studies that have been carried out are not very representative. For many years, the harm to health from these conditions was overlooked. And even when it became apparent, it was viewed as an issue that was valid only in other socioeconomic contexts, and it was seen as insignificant or less important than protein-energy malnutrition and other nutritional deficiencies specifically linked to poverty ... The book is the product of an editorial endeavor that aims at defining the problem of obesity and establishing its particular features in the region, as well as its trends and determinants; it also highlights the most promising research efforts and activities for the near future (AU)

Social inequalities in morbidity from diabetes mellitus in public primary care clinics in Trinidad and Tobago

Associations between soci-economic status and non-communicable diseases in middle income countries have received little study. We conducted an interview survey to evaluate the asociations of morbidity with social conditions among people attending government primary care health centres with diabetes mellitus in Trinidad. Data collected included morbidity from hyperglycaemia, foot problems, visual problems and cardiovascular disease, as well as social demographic variables. Of 622 subjects, 35 percent were aged > or = 65 years, 54 percent were Indo-Trinidadian, 13 percent had no schooling, only 11 percent were in full-time employment, and 33 percent had no piped drinking water supply in the home. Prevalent symptoms included itching, reported by 215 (35 percent), nocturia in 315 (51 percent), burning or numbness in the feet in 350 (56 percent), and difficulty with eyesight in 363 (58 percent). A morbidity summary score was used as dependent variable in regression analyses. Comparing those with no schooling with those with secondary education, the mean difference in morbidity score was 1.77 (95 percent CI 1.15-2.39), attenuated to 0.71 (0.06-1.37) after adjusting for age, gender, ethnic group and diabetes duration. The equivalent differences for those with no piped water supply in the house, compared with those with, were 0.53 (0.17-0.88) and 0.57 (0.24-0.89). For the unemployed, compared with those in full-time jobs, at ages 15-59 years difference were 0.85 (0.14-1.56) and 0.58 (-0.11-1.27). We conclude that morbidity in persons with diabetes is associated with indicators of lower socio-economic status and that this association is partly explained by confounding with older age, female gender, longer duration of diabetes and Indo-Trinidadian ethnic group. A negative association between socio-economic status and morbidity from diabetes contributes to a justification for investment of public health resources in the control of diabetes and other non-communicable diseases(AU)

Lessons of the Human Development Report: wealth alone does not bring better lives; poverty does not mean only lack of income

The Human Development Index ranks Canada first overall, with Cyprus and Barbados atop developing countries; A new poverty index is created. (AU)

Early childhood supplementation does not benefit the long-term growth of stunted children in Jamaica

The long-term benefits of early childhood supplementation and the extents to which catch-up growth occurs following linear growth retardation remain controversial. Stunted children (height-for-age < -2 SD of NCHS reference, n = 122) recruited from a survey of poor neighborhoods in Kingston, Jamaica, participated in a 2-yr randomized, controlled trial of supplementation beginning at ages 9-24 mo. A group of 32 non-stunted children from the same neighborhoods was also followed. Four years after the intervention ended, when children were 7 to 8 y old, there were no effects of supplementation on any anthropometric measure. From the end of the trial until follow-up, the children who had been supplemented gained 1.2 cm less (P < 0.05) than the non-supplemented children, approximately the same amount as they had gained during the trial compard with the non-supplemented children. After adjustment for regression to the mean, the height-for-age of stunted children (supplemented and non-supplemented combined) increase from enrollment to follow-up by 0.31 Z-score (95 percent CI 0.17, 0.46). The height-for-age of the non-stunted children also increase (0.96 Z-score; 95 percent CI 0.70, 1.22). Our results suggest that some catch-up growth is possible even when children remain in poor environments. Long-term benefits of supplementation to growth may not be achieved when intervention begins after age 12 mo in children who have already become undernourished.(AU)

Seminar on poverty reduction and social policy in the Caribbean: the role of health and education: report

Identifies the poor and reasons for their poverty, proposes policy priorities for poverty reduction, and devises appropriate ways of collaborating among among agencies working to achieve poverty reduction. Recommendations include increased access to health and education; improvement of health status; primary education for basic training; access to higher levels of education; skills training; and the improvment of inter-sectoral links between health, education and the other social services. (AU)

Poverty and interventions in health and education: Guyana

Considers poverty and interventions in health and education in Guyana by first overviewing poverty surveys, describing the current poverty situation, and raising issues pertaining to the conceptualization and application of poverty studies. Presents an incisive picture of the present poverty situation and health and education; looks at interventions in poverty alleviation; and asseses "national plans" in health and education. (AU)

Seminar on poverty and social policy in the Caribbean: the role of health and education

Focuses on issues in health and education and their possible role in strategies for poverty reduction in the Caribbean. Examines the major methods of investigating poverty, accepting the measure of `absolute poverty' as the most expedient for comparative analyses. Country profiles of Guyana, the Dominican Republic, and Trinidad and Tobago were established on the basis of epidemiological and socio-economic trends. These profiles indicate that despite the cluster of problems common to the three countries poverty intervention is meaningful only when targeted to specific country or community based issues. Preventive strategies common to all three countries relate to improvements in basic health status and levels of education. Finally, the options available are outlined, and include employment schemes and food programs, and targeting needy and vulnerable groups including infants, the aged, and women, especially those in the lower income groups.(AU)

Poverty reduction strategies: the role of health and education

The study assess the role and performance of the health and education sectors in the context of poverty reduction policies and strategies. With respect to health, it looks at the clinical services which are provided in the primary health care system, selected public health programmes and identifies high risk groups for whom programmes are organized. In the case of the education sector, the study examines certain aspects of the educational system such as technical and vocational training and mechanisms for facilitating students attendance. There are descriptions of the operations of the Barbados Drug Service and the Barbados Vocational Training Board. There is a description of the activities of traditional Welfare programmes. The study also looks at the process of decentalization and the role of NGOs and community-based organizations. It also contains recommendations designed to enhance the capacity of the health and education sectors to contribute to poverty reduction. (AU)

Health and socioeconomic status in St. Lucia

This dissertation examines the relationship between health status and socioeconomic status in St. Lucia. Data for the study were collected during a nationwide survey carried out in St Lucia in 1990. Using bivarite and multivariate analyses, the pattern of relationship between health and socioeconomic status was examined and defined. The analyses showed that there was a persistent pattern in the relationship between health and socioeconomic status generally, the higher the socioeconomic status of an individual, the better the health status. Recognizing that the link between health and socioeconomic status is the access to health facilities, the accessibility and utilization of the private and public health facilities by the various socioeconomic groups are also examined. The study reveals that the disadvantaged socioeconomic groups generally have more diabilities, possess less access to better quality care and utilize the public health care facilities more than the other socioeconomic groups. The study ends with some guidelines for future research in the Caribbean. (AU)