Analysis of intervention and counselling for at-risk youth to reduce crime, violence and improve outcomesfor the individual, the schools and the family

OBJECTIVES: In this study, we examined how counselling of students and their parents can change youth misbehavior and reduce school violence and crime. Our primary objective was to derive empirical data on successful counselling therapies for at-risk secondary school students within Trinidad and Tobago. SUBJECTS AND METHODS: Participants included 145 secondary school students from selected secondary schools in one school district in Trinidad and Tobago. Of these, 49(17.3%) participants were referred by the school principals as suspended or at risk of being suspended. Participants had to complete a 12-week counselling programme consisting of individual, group and parent guidance sessions. RESULTS: After controlling for demographic characteristics, results indicate that a 12-week counselling intervention and participation in multi-modal therapeutic counseling sessions was statistically significant in changing at-risk youth negative mood states and student misbehaviour and school violence. CONCLUSION: The results of this study show that the socioeconomic environmental factors present in high-risk communities contribute to hopelessness and depression which manifest themselves in physical and mental health problems. In our study, more than 50% of school youth involved in school crime and violence are afflicted with health problems. These health problems include maladies such as depression, emotional, verbal, or physical abuse, unresolved grief and loss. Research is needed to determine the potential causal nature of the relationships between mental health problems (ie hopelessness, depression) on youth violence and crime and its potential effects on health and well-being.

Are country reputations for good and bad leadership on AIDS deserved? An exploratory quantitative analysis.

Some countries (e.g. Brazil) have good reputations on AIDS policy, whereas others, (notably South Africa) have been criticized for inadequate leadership. Cross-country regression analysis reveals that these 'poster children' for AIDS leadership have indeed performed better or worse than expected given their economic and institutional constraints and the demographic and health challenges facing them. Regressions were run on HAART coverage (number on highly active antiretroviral therapy as percentage of total need) and MTCTP coverage (pregnant HIV+ women accessing mother-to-child-transmission prevention services as percentage of total need). Brazil, Cambodia, Thailand and Uganda (all of whom have established reputations for good leadership on AIDS performed consistently better than expected-as did Burkina-Faso, Suriname, Paraguay Costa Rica, Mali and Namibia. South Africa, which has the worst reputation for AIDS leadership, performed significantly below expectations-as did Uruguay and Trinidad and Tobago. The paper thus confirms much of the conventional wisdom on AIDS leadership at country level and suggests new areas for research.

The relationship between nutritional and sociodemographic factors and the likelihood of children in the Dominican Republic having a BCG scar

OBJECTIVE: To critically assess the prevalence among schoolchildren 6 to 9 years of age throughout the Dominican Republic of a bacille Calmette-Guerin (BCG) vaccination scar, and to examine the relationship between nutritional and sociodemographic factors and the likelihood of having a BCG scar. METHODS: This correlational study used the database of the Second National Census on Height and Weight of Elementary School First Grade Students, which was conducted in the Dominican Republic August 2001-May 2002, to provide a critical assessment of BCG coverage nationwide. The Census information for the children included the presence of BCG scar, their nutritional status, and basic demographic data. We developed a new sociodemographic indicator, the "Rosa Index", to examine the potential influence of poverty and other environmental characteristics on scar presence. We used logistic regression models to predict the presence of a BCG scar. RESULTS: An overall BCG scar prevalence of 55.3 percent (85 644/154 887)was found. Malnourished children were less likely to have a BCG scar than were children with adequate nutritional status (odds ratio = 0.91; 95 percent confidence interval: 0.87, 0.95, P<0.05). Children who were 7-9 years old were less likely to have a BCG scar than were children 6 years old. Children in the areas of the country more than two hours' driving distance from the capital city of Santo Domingo more often exhibited lower BCG scar prevalence levels than did children in Santo Domingo. A higher Rosa Index (better level of socioeconomic characteristics) was correlated with higher BCG scar prevalence values (r=0.54, P<0.05). CONCLUSIONS: Our study findings indicate that BCG coverage appears to be inadequate for schoolchildren in the Dominican Republic. Nevertheless, the presence of a scar in a higher proportion of younger children suggests that coverage has improved in recent years. More programmatic and economic emphasis needs to be placed on extending early BCG vaccination coverage to the areas of the country where vaccination coverage is lower, and on examining the potential role that poverty may have on vaccination effectiveness (AU)

Perceived efficacy of herbal remedies by users accessing primary healthcare in Trinidad

BACKGROUND: The increasing global popularity of herbal remedies requires further investigation to determine the probable factors driving this burgeoning phenomenon. We propose that the users' perception of efficacy is an important factor and assessed the perceived efficacy of herbal remedies by users accessing primary health facilities throughout Trinidad. Additionally, we determined how these users rated herbal remedies compared to conventional allopathic medicines as being less, equally or more efficacious. METHODS: A descriptive cross-sectional study was undertaken at 16 randomly selected primary healthcare facilities throughout Trinidad during June-August 2005. A de novo, pilot-tested questionnaire was interviewer-administered to confirmed herbal users (previous or current). Stepwise multiple regression analysis was done to determine the influence of predictor variables on perceived efficacy and comparative efficacy with conventional medicines. RESULTS: 265 herbal users entered the study and cited over 100 herbs for the promotion of health/wellness and the management of specific health concerns. Garlic was the most popular herb (in 48.3% of the sample) and was used for the common cold, cough, fever, as 'blood cleansers' and carminatives. It was also used in 20% of hypertension patients. 230 users (86.8%) indicated that herbs were efficacious and perceived that they had equal or greater efficacy than conventional allopathic medicines. Gender, ethnicity, income and years of formal education did not influence patients' perception of herb efficacy; however, age did (p = 0.036). Concomitant use of herbs and allopathic medicines was relatively high at 30%; and most users did not inform their attending physician. CONCLUSION: Most users perceived that herbs were efficacious, and in some instances, more efficacious than conventional medicines. We suggest that this perception may be a major contributing factor influencing the sustained and increasing popularity of herbs. Evidence-based research in the form of randomized controlled clinical trials should direct the proper use of herbs to validate (or otherwise) efficacy and determine safety. In the Caribbean, most indigenous herbs are not well investigated and this points to the urgent need for biomedical investigations to assess the safety profile and efficacy of our popular medicinal herbs.

Midlife and older women: family life, work and health in Jamaica

... This study is essentially one about the family life, work and health of so-called midlife and older women in Jamaica in the early 1990s. Here reference is being made to two groups of women who are usually kept separate in demographic studies. At the point of data collection and in the data analysis these women are recognizble as being in "midlife" (fifty to pfifty-nine years old) and "older" (sixty to seventy-four years old)... The book argues that, while the familial contribution of older women is sometimes acknowledge by the society outside of academic discourse they tended, up to 1991, to have been seen as "carers" rather than "minders' (Rodman 1978). Even in the negative presentation of their sexuality, older women are portrayed as caregivers ... The book covers a range of issues, including family relationships, religion, financial security, migration, loneliness and sexuality. Midlife and Older Women will be of particular interest to sociologist, anthropologists, social workers, and labour, health and welfare workers (AU)

Global child survival initiatives and their relevance to the Latin American and the Caribbean region

We review two series of papers published in the Lancet: the Child Survival Series (2003) and the Neonatal Survival Series (2005). Both series drew attention to the nearly 11 million annual deaths of children under the age of five years, and to the fact that almost 4 million of these deaths occur in the first month of life. We show that two thirds of these deaths could be prevented through universal coverage with existing, low-cost interventions that are failing to reach most children in the world. The series also highlighted the importance of reducing inequities both between and within countries. The relevance of these series to Latin America and the Caribbean is examined. Although substantial progress has been made in reducing mortality and improving coverage, two major challenges remain: how to improve the quality of health interventions, and how to reach the most disadvantaged children in the Latin American and Caribbean Region (AU)

Global child survival initiatives and their relevance to the Latin American and Caribbean Region

We review two series of papers published by The Lancet:the Child Survival Series (2003) and the Neonatal Survival Series (2005). Both series drew attention to the nearly 11 million annual deaths of children under the age of five years, and to the fact that almost 4 million of these deaths occur in the first month of life. We show that two thirds of these deaths could be prevented through universal coverage with existing, low-cost interventions that are failing to reach most children in the world. The series also highlighted the importance of reducing inequities both between and within countries. The relevance of these series to Latin America and the Caribbean is examined. Although substantial progress has been made in reducing mortality and improving coverage, two major challenges remain: how to improve the quality of health interventions, and how to reach the most disadvantaged children in the Latin American and Caribbean Region(AU)

Historical and current predictors of self-reported health status among elderly persons in Barbados

OBJECTIVE. To understand the relative contribution of past events and of current experiences as determinants of health status among the elderly in the Caribbean nation of Barbados, in order to help develop timely public health interventions for that population. METHODS. The information for this prevalence study was collected in Barbados between December 1999 and June 2000 as part of the "SABE project," a multicenter survey in seven urban areas of Latin America and the Caribbean that evaluated the determinants of health and well-being in elderly populations (persons 60 and older). We used ordinal logistic regression to model determinants of self-reported health status, and we assessed the relative contribution of historical socioeconomic indicators and three current modifiable predictor groups (current socioeconomic indicators, lifestyle risk factors, and disease indicators), using simple measures of association and model fit. RESULTS. Historical determinants of health status accounted for 5.2 percent of the variation in reported health status, and this was reduced to 2.0 percent when mediating current experiences were considered. Current socioeconomic indicators accounted for 4.1 percent of the variation in reported health status, lifestyle risk factors for 7.1 percent, and current disease indicators for 33.5 percent. CONCLUSIONS. Past socioeconomic experience influenced self-reported health status in elderly Barbadians. Over half of this influence from past events was mediated through current socioeconomic, lifestyle, and disease experiences. Caring for the sick and reducing lifestyle risk factors should be important considerations in the support of the elderly. In addition, ongoing programs for poverty reduction and increased access to health care and education should be considered as long-term strategies to improve the health of the future elderly (AU)

Commentary: Assessing food insecurity in Trinidad and Tobago

Gulliford and colleagues report in this issue of the International Journal of Epidemiology on a study in Trinidad and Tobago that investigated whether household food insecurity was associated with obesity in this middle-income country. They found that food insecurity was associated with underweight but not with obesity. Food insecurity was also associated with decreased consumption of fruits and vegetables, a result previously reported in several studies, and with physical limitations, a result previously reported for elders in the US.

Food insecurity, food choices, and body mass index in adults: nutrition transition in Trinidad and Tobago

BACKGROUND: This study evaluated whether food insecurity and obesity were associated in a population sample in Trinidad. METHODS: A sample was drawn of 15 clusters of households, in north central Trinidad. Resident adults were enumerated. A questionnaire was administered including the short form Household Food Security Scale (HFSS). Heights and weights were measured. Analyses were adjusted for age, sex, and ethnic group. RESULTS: Data were analysed for 531/631 (84%) of eligible respondents including 241 men and 290 women with a mean age of 47 (range 24-89) years. Overall, 134 (25%) of subjects were classified as food insecure. Food insecurity was associated with lower household incomes and physical disability. Food insecure subjects were less likely to eat fruit (food insecure 40%, food secure 55%; adjusted odds ratio [OR] = 0.60, 95% CI: 0.36-0.99, P = 0.045) or green vegetables or salads (food insecure 28%, food secure 51%; adjusted OR = 0.46, 95% CI: 0.27-0.79, P = 0.005) on >/=5-6 days per week. Body mass index (BMI) was available for 467 (74%) subjects of whom 41 (9%) had BMI <20 kg/m(2), 157 (34%) had BMI 25-29 kg/m(2), and 120 (26%) had BMI >/=30 kg/m(2). Underweight (OR = 3.21, 95% CI: 1.17-8.81) was associated with food insecurity, but obesity was not (OR = 1.08, 95% CI: 0.55-2.12). CONCLUSIONS: Food insecurity was frequent at all levels of BMI and was associated with lower consumption of fruit and vegetables. Food insecurity was associated with underweight but not with present obesity.

Availability, safety, and quality of blood for transfusion in the Americas

Objectives. This article has two objectives: (1) to present for countries and territories of the Region of the Americas data on the number of blood donations, proportion of voluntary blood donors versus remunerated blood donors, coverage of screening for infectious agents, and separation of donated blood into its components and (2) to explore the relationships of those characteristics with economic and organizational factors in the countries and territories. Methods. We carried out comparative analyses using population and health information gathered annually by the Pan American Health Organization (PAHO) from national health officials from the countries in the Americas, as well as economic information (gross national product (GNP) per capita) obtained from publications of the World Bank. Results. There is a direct correlation between the availability of blood for transfusion and GNP per capita. Seven countries with a GNP per capita above US$ 10 000 per year account for 38 percent of the Regional population but 68 percent of the Regional blood donations. Voluntary blood donation is more common in the countries with better blood availability. There is no association between GNP per capita and coverage of screening for infectious agents. Nevertheless, of the six countries with a GNP per capita below US$ 1 000, only one of the six screens all units for human immunodeficiency virus (HIV), hepatitis C virus (HCV), and hepatitis B surface antigen (HBsAg). Countries with a higher proportion of voluntary blood donors tend to have lower prevalence rates of infectious markers. Separation of blood into its components is also more common in countries with higher blood donation rates. Conclusions. The availability, safety, and quality of blood for transfusion in the Americas needs to be improved. As part of that effort, national policies and strategies must be put into place so that the resources already allocated for blood services are better utilized (AU)

Overview of social inequalities in health in the Region of the Americas, using various methodological approaches

Over the past decade, according to several important indicators, health conditions have improved in the Region of the Americas. However, inequalities persist among the countries of the Region. This article has two primary objectives: 1) to provide some unbiased evidence on health inequalities among countries of the Region of the Americas and 2) to illustrate the application of some of the more frequently used methods for measuring inequalities, including effect measurements, population attributable risk, the slope index of inequality, the relative index of inequality, and the concentration index. Analyses have shown that there are great health disparities in the Region of the Americas. For example, residents of the poorest countries of the region live nearly 10 years less, on average, than do residents of the richest countries. If the other countries of the Americas had the same incidence of tuberculosis as does the subregion of North America (Bermuda, Canada, and the United States of America), there would be 76 percent fewer cases of this disease in the region. In the Americas, nearly 35 percent of deaths of infants under 1 year old are concentrated in the 20 percent of live births that occur in the group with the lowest income. As for maternal mortality in the Americas, fewer than 2 percent of maternal deaths occur in association with the 20 percent of live births in the group with the highest income. The analyses of health inequalities based on the use of various methods highlight the existence of important disparities among subregions and countries of the Americas that are not readily seen when using only the more-traditional methods for analyzing mortality and morbidity. There is also a need to incorporate the concepts of distribution and socioeconomic dimensions of health when interpreting a given situation. Using this approach will allow decisionmakers to target areas and populations that are in less-favorable conditions. A considerable body of aggregate data at the regional and country levels from routine information systems is already available-especially on morbidity, mortality, and other health-related factors-that can be used on a regular basis to analyze health inequalities. These kinds of analyses may be regarded as a first step toward the identification of health inequalities (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)

Suicide in Jamaica: some socio-demographic findings [abstract]

The objective of this study was to examine trends in suicide in Jamaica from 1974 to 2000; socio-demographic variables for suicide over the past 5 years and specific aspects of in the year 2000 were examined. Figures for suicide in Jamaica over the period 1974-2000, provided by the Police Computing Centre, were examined. The trends in respect of suicide methods used, and socio-demographic factors: age, gender, location (urban/rural), over the period 1996 to date were identified, and additionally, 57 cases (51 males, 6 females) of suicide in 2000, to date, were examined via month/ quarter of occurrence, and possible precipitating factors, including mental disorder, stressful life events, and larger social issues. The ages of the suicide cases ranged from 15 to 78 years with a mean age of 40 years. The data were analyzed at the Department of Administrative Computing. The SPSS package was used. There was a marked increase in suicide from 1992. Linear regression indicated a continued increase in suicide over the following three years unless there was appropriate intervention. Hanging emerged as the most commonly used method of suicide by both men (80.4 percent, (n= 41) and women (66.7 percent, (n= 4). Chi-square analysis showed no significant difference between the genders, both choosing hanging over all other methods. Regarding age and method, 100 percent of cases in age groups 20 to 29 years (n= 13) and 70 to 79 years (n= 6) used hanging, while 80 percent of cases in age group 50 to 59 years (n= 5) chose methods other than hanging, including shooting, setting self on fire, drowning, jumping from a height, throat and wrist slashing, and ingestion of poisonous liquids (levels of significance, p= 0.006). (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)

The use of herbal teas and remedies in Jamaica

We investigated the prevalence of the use of herbs among adults and children in Jamaica in 1996. Two concurrent surveys were conducted in randomly selected urban and rural area; among the adults and among caretakers of young children. From over 90 percent of the selected households, all caretakers of children under 6 years and one randomly selected adult (18 years or older) were interviewed using structured questionnaires. The 457 adults reportedly used 156 types of herbs: a mean of 6ñ3 (mean ñ standard deviation) by the urban adults, and 10ñ6 by the rural adults (t-test, p < 0.001). Almost 100 percent of respondents had at some time used herbs for teas or for treating illnesses. The most common methods of preparation was by infusion or boiling in water, then adding sugar. Urban respondents, women and those who were employed were more likely to buy medicines than to use herbal remedies. One hundred and sixty-seven caretakers of 203 children under 6 years were interviewed. The mean number of herbs given to each child was between 2 and 3. The most common herbs were introduced within the first 6 months of life. Many caretakers factors were associated with herbal use. Public health implications include the potential toxicity of some herbs, the possibilty that herbal teas given to young children may displace more nutritious foods and delay presentation to health care facilities. The findings will allow policy makers to target those most likely to use herbal preparations or to give them to young children, and target herbs to be analyzed for toxic or beneficial properties.(Au)

Factors associated with term low birth weight at Victoria Jubilee Hospital

OBJECTIVES: To examine factors associated with low birth weight (LBW) in term infants as part of a longitudinal study on the effects of term LBW. METHODS: Term LBW and normal birth weight (NBW) infants were recruited from the Victoria Jubliee Hospital, Kingston, Jamaica, between March and October, 1999. All LBW infants meeting the recruitment criteria were enrolled. The next eligible NBW infant of the same gender was enrolled for two of every three LBW infants. Gestational age was determined by the Dubowitz method. Anthropometric measurements were made and a questionnaire administered to determine maternal characteristics and antenatal history. Maternal height was measured and socioeconomic status assessed at home one week later. RESULTS: A total of 234 term infants (140 LBW and 94 NBW) were enrolled. There were no significant differences between the groups in maternal age, height, education, occupation or socioeconomic status. Mothers who reported alcohol consumption during pregnancy were more likely to have a LBW infant (Odds Ratio (OR) 2.26; 95 percent CI 1.01, 5.05) LBW infants were more likely to be first born (OR 1.73; 95 percent CI 1.01, 2.97). Mothers who had a previous LBW infant were at increased risk of having another LBW infant (OR 4.89; 95 percent CI 2.21, 10.84). CONCLUSION: Socioeconomic factors did not distinguish mothers at the Victoria Jubliee Hospital, who were likely to have a term LBW infant. Primiparous mothers and mothers who have given birth to a previous LBW infant are at risk of having a LBW infant and need special attention during the antenatal period.(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)

Studies on plasma lipids in industrial workers in central Trinidad and Tobago

We assessed the plasma lipid profiles and other cardiovascular disease (CVD) risk factors in 187 (147 men, 47 women) apparently healthy employees of the Caribbean ISPAT industry in Trinidad and Tobago. Anthropometric indices and fasting plasma levels of total cholesterol (T-chol), triglyceride (TG), high-density lipoprotein (HDL), and low-density lipoprotein (LDL) were measured. The results indicate that: there was increased body mass and relative hyperlipidemia in the population studied, these CVD risk factors (increased body mass, increased blood T-chol, TG, and LDL) were more prevalent in men than women (p < 0.05), and these parameters did not differ significantly (p < 0.05) when compared among the three ethnic groups (African and Indian descendants and mixed descents). These features suggest a greater risk of CVD in men than in women. It is likely that this observation in the industrial workers might reflect the situation in the general population especially in men. Although further confirmatory studies are necessary across societal socioeconomic strata within Trinidad, we suggest that efforts should be directed at reducing excess body weight among the workers, and providing advice on increased complex carbohydrate diet in place of saturated fat.

Maternal and neonatal factors associated with poor cognitive outcomes at 11 years of age in a cohort of low birth weight infants in Jamaica

OBJECTIVE: To determine maternal and birth factors that are associated with poor cognitive outcome in a low-birth weight (LBW) cohort enrolled at birth and examined at 11 years of age. The identification of these factors will help to plan intervention strategies to improve cognitive outcomes in LBW infants. DESIGN AND METHODS: In September and October 1986, all Jamaican-born children were enrolled in the Jamaican Perinatal Mortality Survey. At that time, a Main Questionnaire, asking questions about maternal demographic, social, and medical conditions and reviewing aspects of the pregnancy, labour, and delivery, was administered. A geographical subset of children was examined for cognitive abilities at 11 years of age using the Peabody Picture Vocabulary Test and Ravens Progressive Matrices. Former LBW children were included in the testing even though they were outside of the geographical area. Of the 1569 children tested, 107 were former LBW infants. Linear regressiong models were developed associating variables from the Main Quesitionnaire with outcomes on the cognitive tests. Based on the regression models, a Nursery Checklist was developed that could be used to identify children for referral to early intervention programmes. RESULTS: Twenty-one (20 percent) of the 107 ex-LBW children performed two standard deviations below the mean of the entire cohort. Maternal and birth factors associated with poor outcome were: living in poor housing conditions, not taking prenatal iron, not working outside the home and the infant not crying at birth. The Nursery Checklist identified 90 percent of the infants with poor cognitive outcomes while only referring 56 percent of the LBW population to intervention services. CONCLUSION: The factors associated with poor cognitive outcome include two socio-economic factors, an indication of infant viability at birth, and a possible nutritional deficiency. These factors can be used to institute primary interventions to ameliorate these conditions and to identify children in need of secondary interventions in early childhood.(Au)