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)

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.

Social class and pathways to care among psychiatric clinic referrals at the University Hospital of the West Indies [abstract]

OBJECTIVE: To determine the effects of social class on the pathways to outpatient psychiatric care at the University Hospital of the West Indies. METHODS: This was a prospective cohort study of patients attending the psychiatric screening clinic of the University Hospital of the West Indies. Demographic, clinical and outcome variables were collected over the period February to July 2001. RESULTS: The cohort consisted of 306 patients of whom 150 were male, 156 were female and 85.4 percent were from social classes III to V. Most of the patients came from urban St.Andrew (57 percent). More than half (51 percent) took the bus, 61 percent were brought by family members, 31.8 percent came alone. More than three-quarters (76.4 percent) were seen in the emergency outpatient department prior to being referred. Most (66.4 percent) patients presented within six months of onset symptoms. Once seen, 47.3 percent (142) were referred the government community mental health service while an equal number was distributed within the psychiatric service of the hospital. There was a statistically significant relationship between social class and method of transportation (p= 0.001). No association was found with social class and any other variable. CONCLUSIONS: For the majority of these patients, with the exception of the method of transportation to the clinic, there is no effect of social class on all the variables studied. The transporattion variable, which was significant, was not related to the services offered. (AU)

Vision screening in Jamaican children

OBJECTIVE: To determine the prevalence of vision impairment in Jamaican pre-school children. METHODS: A national sample of Jamaican children at the end of the pre-school years was identified using the quarterly Jamaican Labour Force Survey. Each year, this survey identifies 500 pre-school children (1 percent of the national population) using a two-stage stratified random sampling process based on electoral divisions. Over two successive years, a 1 percent and a 0.5 percent sample of children were identified (n=750). A total of 302 children had their distance and near visual acuity assessed. Information on socio-economic status and the parental perception of children's vision was obtained by parental interview. RESULTS: 10.4 Percent of the children were identified as being in need of further ophthalmological referral using the American Academy Screening Guidelines. 4.1 percent of the children were diagnosed as having "low vision" according to the World Health Organization classification. 45.8 percent of the children were unable to identify letters and required lap-card use for evaluation of vision. No gender or socioeconomic differences were identified between those children requiring further ophthalmological assessment and those who did not (p<0.05). Parental perception of children's visual impairment was shown to be an unsatisfactory tool to assist in determining children at high risk for vision impairment. CONCLUSION: Based on the rates of children requiring further ophthalmological evaluation and the rates of low vision identified in this study, the abscence of identifiable risk factors and the inaccuracy of parental perception, all Jamaican pre-school children should be offered vision screening. The inability to identify letters demands that screening programmes must have facilities available for using lap-cards. (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)

Chlamydial and gonococcal infections in Curacao: prevalence and determinants

OBJECTIVE: To determine prevalence and determinants of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections among asymptomatic women and men in Curacao. DESIGN AND METHODS: This was a cross-sectional population-based study. Urine samples (n=579) were collected from Antillean people, > 18 years, randomly selected from participants of a 1994 population survey (the Curacao Health Study, n=2,248). For the detection of CT and Erasmus Medical Center, Rotterdam. RESULTS: CT and NG infections were found in 6.1 percent and 1.0 percent of samples, respectively. Concomitant CT and NG infection did not occur. Most CT infections were found in persons <44 years of age, the highest prevalence was found in the 18-24 year age group, 17.4 percent (13/75). In contrast, most NG infections were found in persons >44 years. CT infection, but not NG infection, was correlated with indices of low socio-economic status. Multiple regression confirmed the association of CT infection with age and socio-economic class. CONCLUSION: In Curacao, CT and NG infections are not epidemiologically linked. CT infection is highly prevalent and calls for a screening-intervention model based on prevalence and risk factors. (Au)

Health Care for the disadvantaged: some preliminary observations of health centres in Trinidad and Tobago

This study seeks to identify background characteristics of the people who utilize health care services in Trinidad and Tobago and to investigate their perceptions of the services offered. Data were collected through a survey of health care users distributed throughout Trinidad and Tobago. Multi-stage sampling was used to select 1500 health care users and structured interviews were conducted on regular clinic days by trained personnel. Results indicate that there are fairly high levels of patient satisfaction with health care centres in Trinidad and Tobago and that the more disadvantaged groups (the elderly, women and the unemployed) utilize these services more frequently. Results also show variations with respect to pay, services that need improving and doctor's willingness to listen to problems. (AU)

Social environment, morbidity and use of health care among people with diabetes mellitus in Trinidad

BACKGROUND: This study aimed to identify social characteristics associated with higher levels of morbidity from diabetes and their relationship to health care utilization. METHODS: During a 6-month period 1149/1447 (79 percent) subjects admitted to Port of Spain Hospital, Trinidad with diabetes responded to a structured interview. Data collection included social factors, diabetes-related morbidity and health care utilization. Analyses were adjusted for age, sex, ethnic group and self-reported diabetes duration. RESULTS: Of 12 indicators of morbidity, nine were more frequently in subjects with no schooling compared with those with secondary education. At ages 15-59 years, nine morbidity indicators were less frequently among subjects in full-time jobs compared with those not in employment. The association of educational attainment was explained by confounding with age, sex, ethnic group and diabetes duration but five morbidity indicators were associated with employment status after adjusting for confounding. The type of water supply in the home was generally not associated with morbidity. Each of the indicators of lower socioeconomic status was associated with less use of private doctors and with more use of government health centres. CONCLUSIONS: Morbidity from diabetes was greater in groups with lower socioeconomic status. While morbidity associated with lower educational attainment was mostly explained by older age; the results suggested the possibility that diabetes may contribute to unemployment of those in the labour force. Private care was less accessible to social groups with higher levels of morbidity and the availabiltiy of government funded health services was important for reducing inequalities in health care utilization.(AU)

High prevalence of obesity in Curacao: data from an interview survey stratified for socio-economic status - abstract

The aim of this paper is to report the prevalence of obesity and abdominal fatness in different socioeconomic classes in Curacao. In 1993/1994 a health interview survey (the Curacao Health Study) was carried out among a random sample (n = 2248, response rate = 85 percent) of the adult non-institutionalized population of Curacao. We analyzed the association between body mass index (BMI) and socioeconomic status (SES) as well as the relationship between waist-hip ratio (WHR) and SES by logistic regression models for men and women separately. The overall prevalence of obesity among women peaked at age 46 to 55 years (OR 4.195 percent CI 2.6 - 6.6) and between 56 to 65 (OR 1.7 95 percent CI 1.0 - 3.1) years in men. Women of lower SES are approximately twice as much at risk of being obesed compared to women of higher SES (OR 2.4 95 percent CI 1.7 - 3.4) for the low SES group. The percentage of participants with an at risk WHR (cut off point 0.80 for women and 0.95 for men) is more than three times higher among women than among men (62.2 percent versus 20.4 percent). WHR increased significantly with age among both genders. Compared to women of higher SES, the lower SES women have a three times higher risk of a WHR exceeding th cut off point (OR 3.0 95 percent CI 2.0 - 4.5). The overall prevalence of obesity was much higher than in Spain, Brazil and the Netherlands. The high prevalence of obesity in Curacao justifies action and research on the prevention of obesity in Curacao. (AU)

Benign clinical course in homozygous sickle cell disease: a search for predictors

AIMS: (1) To estimate the proportion of subjects with homozygous sickle cell disease who have a benign clinical course, and (2) to assess factors that may be predictive of benign disease. MATERIAL: Subjects (n = 280) were participants in a longitudinal cohort study of sickle cell disease. They were classified as benign or control based on clinical history from birth to age 13 years old. Associations with growth, hematology, and an index of social status were investigated. RESULTS: Benign disease occurred in 43 (15 percent) patients. Neither growth nor social status were related to benign disease. There were only two statistically independent association: alpha thalassemia status and average steady state fetal hemoglobin (HbF). Patients with a normal complement of alpha globin genes were 2.2 (1.0, 4.9) times more likely to have frequent painful crises, dactylitis, and bone necrosis. The odds of having benign disease were 1.09 (1.02, 1.17) times higher for each unit increase in HbF, and 44 percent of subjects with HbF in the top decile (HbF > 13.8 percent) of the distribution had benign disease. There was no evidence for a threshold effect of high HbF on benign disease. CONCLUSION: A benign clinical course of sickle cell disease may occur in Jamaica and is associated with a normal alpha globin gene complement, and high levels of HbF. Ability to predict benign disease at birth is limited.(AU)

Lifestyle, education, and prevalence of hypertension in populations of African origin. Results from the International Collaborative Study on Hypertension in Blacks

Lifestyle Incongruity has been shown to be associated with elevated blood pressure in various developing societies. We sought to test this model in a international collaborative study of hypertension in populations of African origin. Data were available for 4770 men and women, aged 25-74, from Africa, the Caribbean, and the United States. The main effects of lifestyle score (LSS) and education on hypertension prevalence were explored, as well as interaction predicted by the Lifestyle Incongruity model. Significant interactions were observed, but only the U.S. men conformed to the pattern predicted. For this group, adjusted ORs for LSS were 4.45 among low-education and 0.71 among high-education subgroups (risk OR = 0.16, 0.03-0.84 95 percent CI). The Lifestyle Incongruity model therefore received limited support. The model was designed to describe processes in societies experiencing modernization and opportunities for lifestyle differentiation, conditions that may not have been met in some sites.(AU)

Factors affecting prepubertal growth in homozygous sickle cell disease

OBJECTIVE: To investigate the role of hematological indices, socioeconomic status, and morbidity in prepubertal growth in homozygous sickle cell (SS) disease from birth to 9 years at the sickle cell clinic of the University Hospital of the West Indies, Kingston, Jamaica. RESULTS: Height increment between 3 and 9 years correlated positively with total haemoglobin at age 7 years in boys but not girls. Attained height and weight at 7 years correlated positively with haemoglobin and fetal haemoglobin in boys but not girls. Only the correlation between haemoglobin and weight showed a significant gender difference. Partial correlation analysis suggested that the effect of haemoglobin was accounted for by the effect of fetal haemoglobin and further analysis indicated that height correlated with F reticulocyte count (a measure of fetal haemoglobin production) in both sexes but not with the ratio of F cells to F reticulocytes (a measure of F cell enrichment). Growth was not significantly related to mean red cell volume, proportional reticulocyte count, alpha thalassaemia, socioeconomic status, or morbidity. CONCLUSION: A high concentration of fetal haemoglobin in boys with SS disease is associated with greater linear growth. It is postulated that in boys, low concentrations of fetal haemoglobin increase haemolysis and hence metabolic requirements for erythropoiesis, putting them at greater risk of poor growth. Differences in the relationship to haemotoloy and growth between boys and girls with SS disease dictate that future analyses of growth take gender into account (AU).x

Psychopathology of white mentally ill immigrants to Jamaica

OBJECT: To test the hypothesis that white immigrants to a predominantly black country have a different pattern of psychopathology from the native population. METHOD: The psychopathology (DM 111-R) of white immigrants to Jamaica seen in the author's private practice between 1979 and 1990 was compared with the psychopathology of a control sample of native Jamaicans matched with the immigrant sample for age sex, and social class. RESULTS: There was not statistical difference in the major diagnoses mood disorder (35 percent), anxiety states (27 percent), and schizophrenia (20 percent) between the immigrant and control groups. White immigrants to this black country did not develop schizophrenia at higher rates that native born. White mentally ill immigrants to Jamaica move into social class positions at a significantly higher level (p < 0.005) than those of their parents with whom they grew up in their home country. This was significantly different (p < 0.005) from their Jamaican controls. Two case studies are presented to illustrate these findings. CONCLUSIONS: The political/economic situation which exists in black postcolonial countries like Jamaica provides a protective social environment for white immigrants, which buffers them from the etiological conditions that engenders schizophrenia in immigrants to other countries with predominantly white populations. (AU)

Retroviruses and schizophrenia in Jamaica

Reports of an 18-fold higher incidence of schizophrenia among second-generation Afro-Caribbeans, and especially Jamaican migrants in the United Kingdom were soon called an epidemic of schizophrenia, with the inference that a novel virus, likely to be perinatally transmitted, was a possible etiological agent. This intriguing observation led us to explore a possible link with human T-cell lympotropic virus type one (HTLV-I), because it is a virus that is endemic in the Caribbean Island, is perinatally transmitted, known to be neuropathogenic, and the cause of a chronic myelopathy tropical spastic paraparesis/HTLV-I associated myelopathy. We therefore examined inpatients as the Bellevue Mental Hospital, Kingston, Jamaica and did standard serological tests for retroviruses HTLV-I and HTLV-II and HIV-I and HIV-II on 201 inpatients who fulfilled ICD-9 and DSM II-R criteria for schizophrenia. Our results produced important negative data, since the seropositivity rates for HTLV-I, the most likely pathogen, were no greater than the seropositivity range for HTLV-I carriers in this island population, indicating the HTLV-I and the other retroviruses tested do not play a primary etiological role in Jamaican schizophrenics(AU)

The use of the Papanicolaou smear as a screening tool for the detection of early carcinoma of the cervix in a university community

The aim of this study was to identify factors whichmight influence the use of the Papanicolaou (Pap) smear as a screening tool for the early detection ofcarcinoma of the cervix within a university staff population. The study was conducted on the Mona Campus of the University of the West Indies, Kingston, Jamaica, between July 1995 and February 1996. The different union groupings were used as a proxy for educational level and socioeconomic status. These union groups were West Indies Group of University Teachers (WIGUT), representing academic and senior administrative staff, Mona Non-Academic Staff Union(MONASA) representing non-academic/junior administrative staff and University and Allied Workers Union (UAWU) representing ancillary staff. A questionnaire was administered to a random sample of forty persons from the female members of each group, giving a total sample size of one hundred and twenty. There was an overall 72.5 percent response rate - 80 percent in the WIGUT group, 70 percent in the MONASA group and 67.5 percent in the UAWU group. Results showed that while 95.4 percent of the respondents were able to correctly identify early detection of cervical cancer as the main use of the Pap smear and all respondents thought that it was important to have regular Pap smears, only 51.7 percent actually had them regularly. A breakdown of Pap smear frequency by union group showed the lowest rate in the UAWU group. This group also had the highest overall level of risk factors for cervical cancer. It was also noted that members of the UAWU were more likely to use the facilities of the University Health Centre when they did Pap smears as compared to the use of private facilities by the other groups. Based on the findings it was recommended that any Pap smear educational or promotional programme on the Mona Campus should be focussed on the UAWU group which was shown to have the greatest need of this service and was most likely to make use of the University Health Centre facilities(AU)

Psychosis with good prognosis in Afro-Caribbean people now living in the United Kingdom

OBJECTIVES - to compare the course and outcome of psychotic illness in a group of Afro-Caribbean patients resident in the United Kingdom and a group of white British patients. DESIGN - cohort study of consecutive admissions followed up for four years. SUBJECTS - 113 patients with psychotic illness of recent onset admitted to two south London hospitals. MAIN OUTCOME MEASURES - course of illness, history of self harm, social disability, treatment received, and hospital use adjusted for socioeconomic origin. RESULTS - the Afro-Caribbean group spent more time in a recovered state during the follow up period (adjusted odds ratio 5.0; 95 percent confidence interval 1.7 10 14.5), were less likely to have had a continuous illness (0.3; 0.1 to 0.8), were less at risk of self harm (0.2; 0.1 to 0.8), and were less likely to have been prescribed antidepressant treatment (0.3; 0.1 to 0.9). There were no differences in hospital use, but the Afro-Caribbean group had more involuntary admissions (8.9; 2.1 to 35.6) and more imprisonments over the follow up period (9.2; 1.6 to 52.3). CONCLUSIONS - Afro-Caribbean patients in the United Kingdom have a better outcome after psychiatric illness than do white people. The combination of high incidence and more benign course of illness of psychotic illness in this group may be due, at least in part, to a greater exposure to precipitants in the social environment. (AU)

Body mass index distribution in the Curacao health study: differences in socio-economic factors - abstract

The objective of this paper was to determine the prevalence of underweight, normal weight and over weight based on the body mass index (BMI) for sex and age groups, as well as for socio-economic factors. This is important since obesity is a risk factor for prevalent diseases (diabetes mellitus, in Curacao. From a random sample of 3000 persons > 18 years of age in Curacao, weight and length were measured in 2248 (75 percent) individuals. Using the U.S. National Center for Health Statistics ((NCHS) cut-off values of BMI for over-weight (male = 27.8; female = 27.3) we found a markedly higher prevalence of overweight in both sexes when comparing the data to international findings, but more so in females. Fifty per cent of women > 25 years of age are overweight, peaking at 62.2 percent in the 45 to 64-year of age gruop. In females socio-economic status (SES) was inversely related to mean BMI, lowest SES groups having the highest mean BMI. Approximately one-third of the male population greater than and equal to 18 years of age were overweight. Further, it was found that length was proportionately related to SES for both sexes (AU)

A health profile of Curacao: results from the Curacao health study - abstract

Based on the outcomes of the Curacao Health Study, a health profile of the adult non-institutionalized population of Curacao was drawn. A randomly drawn sample of 2248 participants has been surveyed in face-to-face interviews. Data were collected on the prevalence of chronic disorders and functional limitations, and on the subjects' self-perceived health. Of the total sample 58.8 percent reported to be suffering from one or more chronic disorders. The most prevalent chronic conditions are hypertension (14.5 percent), arthrosis and arthritis (11.1 percent), dizziness (10.85 percent), chronic back problems (10.1 percent) and psychological problems (9.6 percent). As regards functional limitations, 4.7 percent of the total sample have very serious visual disabilities and 1.4 percent are (practically) deaf; the prevalence of limitations in activities of daily living can be estimated at 0.3 to 2.8 percent, depending on the kind of activities that are taken as a criterion. A general conclusion is that women, the elderly and individuals from the lower socio-economic strata (SES) are relatively disadvantaged as regards health. The disadvantage for women and individuals from the lower SES applies to both their physical and their mental health. Ageing is soley related to a worsening of the physical health status. The subjective health perceptions of the participants are in accordance with their more objective health status; women, individuals from the lower SES and the elderly have a relatively poorer perceived health. The particular value of these profiles lies in their usefulness for the establishment of priority areas in health policy, by identifying relatively disadvantaged groups who need specific attention (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)