Parent and caregiver knowledge, beliefs and responses to seizures in Jamaican children

OBJECTIVE: To determine the knowledge and beliefs about seizures and actions during seizures of parents/ caregivers of children hospitalised for convulsive seizures. DESIGN AND METHODS: This was a cross-sectional study of parents and caregivers of children with acute convulsive seizures hospitalised at the Bustamante Hospital, Kingston, Jamaica between May 1 and October 31, 2013. Subjects were identified by admission records. Parents/caregivers were invited to participate. A questionnaire on the knowledge, beliefs and response of parents/ caregivers during the child’s current seizure episode was administered face to face. Data were analysed for frequencies; comparisons between groups using Chi Square analysis for categorical variables, and the Mann-Whitney U test for data not normally distributed. RESULTS: Fifty participants were enrolled; 39 (78%) mothers; mean age (SD) was 33.8 (10.1) years. All sought medical care first. Twenty-two (44%) had plausible beliefs about the cause of seizures. Twenty-seven (54%) knew of appropriate actions during a seizure, 10 (20%) knew of appropriate precautions and 11 (22%) responded appropriately during the seizure. Eleven (22%) reported receiving seizure education. Witnessing a previous seizure, education level and seizure education were positively associated with knowledge of seizures (p < 0.05). Socioeconomic status was higher in those with plausible beliefs about seizures and lower in those who took appropriate action during a seizure (p<0.05). CONCLUSION: Parents/caregivers of children with convulsive seizures have appropriate health-care seeking behaviour but inadequate knowledge. Seizure education should be prioritised to improve parental knowledge of and response to convulsive seizures.

Burden of caregivers of adult patients with schizophrenia attending public health clinics in Jamaica

OBJECTIVE: To determine the extent and socio-demographic determinants of burden of care of caregivers of adult schizophrenic patients. DESIGN AND METHODS: Cross-sectional study of 115 dyads of schizophrenic patients-caregivers attending public mental health clinics, March 24 – April 4, 2014 were consecutively recruited. Burden of care was evaluated using the 22-item Zarit Burden Scale (maximum score, 88). Multiple linear regression model explored factors associated with caregiver burden. RESULTS. Caregivers were predominantly females (75.7%) and were on average 50.8 ñ 15.0 years. Most schizophrenic patients were males (65.2%) and were on average 43.6 ñ 17.2 years old. Caregivers showed on average, mild to moderate burden (score, 30.0 ñ 14.7; median, 28.0). There was a tendency for caregivers of patients who were parents or spouses to have higher levels of burden. In multivariable analyses, higher burden of caregiving was associated with inability to perform self-care, closer kinship and higher numbers of psychotic episodes in the previous year. CONCLUSIONS: Functional and social factors were important determinants of caregiver burden. Further investigations are needed which consider factors such as health status and health expenditures as predictor variables of caregiver burden.

A phenomenological inquiry into approaches to informal caregiving of persons living with dementia

OBJECTIVE: To explore approaches use by informal caregivers in Barbados in caring for persons with dementia (PLWD). DESIGN AND METHODS: This study used a qualitative phenomenological approach. Recruitment was carried out via purposive sampling of adult primary informal caregivers of PLWD in Barbados. Data collection was carried out through in-depth, one-on-one, semi-structured interviews. Eight transcripts were analyzed according to Giorgi’s four-step analytic framework within ATLAS.ti data analysis software. RESULTS: The data were analysed and organized according to the following themes: 1. Guiding principles of care, including maintaining patience and optimizing the physical, social, and mental health of the PLWD, with a wide range of sources of personal guidance. 2. Facilitators to care, including intrinsic and extrinsic facilitators such as the assignment of meaning to the caregiving role, resignation from the caregiving role, having ample rest, support from the community, and support from children. 3. Barriers to care, including family issues, lack of time and money, dissatisfaction with formal care services, misunderstanding of the complexities of dementia symptomology, and recommendations for support. CONCLUSIONS: Each caregiver used unique strategies to manage his/her caregiving role by tapping on available resources while also strategically accommodating for difficulties encountered. There needs to be additional research in this extremely vital area. Services should be created/adapted to improve their support for informal caregivers to their unique needs.

Caregivers' practices, knowledge and beliefs of antibiotics in paediatric upper respiratory tract infections in Trinidad and Tobago: a cross-sectional study

BACKGROUND: Antibiotic overuse and misuse for upper respiratory tract infections in children is widespread and fuelled by public attitudes and expectations. This study assessed knowledge, beliefs, and practices regarding antibiotic use for these paediatric infections among children's caregivers' in Trinidad and Tobago in the English speaking Caribbean. METHODS: In a cross-sectional observational study, by random survey children's adult caregivers gave a telephone interview from November 1998 to January 1999. On a pilot-tested evaluation instrument, respondents provided information about their knowledge and beliefs of antibiotics, and their use of these agents to treat recent episodes (< previous 30 days) of upper respiratory tract infections in children under their care. Caregivers were scored on an antibiotic knowledge test and divided based on their score. Differences between those with high and low scores were compared using the chi-square test. RESULTS: Of the 417 caregivers, 70% were female and between 18-40 years, 77% were educated to high school and beyond and 43% lived in urban areas. Two hundred and forty nine (60%) respondents scored high (>or12) on antibiotic knowledge and 149 (34%) had used antibiotics in the preceding year. More caregivers with a high knowledge score had private health insurance (33%), (p < 0.02), high school education (57%) (p < 0.002), and had used antibiotics in the preceding year (p < 0.008) and within the last 30 days (p < 0.05). Caregivers with high scores were less likely to demand antibiotics (p < 0.05) or keep them at home (p < 0.001), but more likely to self-treat with antibiotics (p < 0.001). Caregivers administered antibiotics in 241/288 (84%) self-assessed severe episodes of infection (p < 0.001) and in 59/126 (43%) cough and cold episodes without visiting a health clinic or private physician (p < 0.05). CONCLUSIONS: In Trinidad and Tobago, caregivers scoring low on antibiotic knowledge have erroneous beliefs and use antibiotics inappropriately. Children in their care receive antibiotics for upper respiratory tract infections without visiting a health clinic or a physician. Educational interventions in the community on the consequences of inappropriate antibiotic use in children are recommended. Our findings emphasise the need to address information, training, legislation and education at all levels of the drug delivery system towards discouraging self-medication with antibiotics in children.

The volunteer in diabetes education

An evaluation system needs to be developed to measure what has been achieved by the Lay Diabetes Education Programme, focusing on its impact at community level. For the 50 percent of volunteers who are from the health sector, this could be done through the structured assessment scheme of the health service. A different approach will be required for other volunteers. However, the programme is already making a positive impact, as indicated by reduced routine visits to tertiary care centres, as well as increased discussion of diabetes in public settings, such as parent-teacher meetings, church groups, and media talk shows! Volunteer diabetes educators should be armed with enough information to assist the patient in the everyday care of his/her condition and to encourage improved compliance, thus reducing the rate of development of complications. Volunteers should promote a positive outlook on diabetes, to help allay the fears of the anxious patient. They should always remember the volunteers' motto: "The greatest service that one can do is that of service to your fellow man. The greatest exercise for the heart is to reach out and help someone in need!" (AU)

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

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

Home and community care: living positively with HIV/AIDS

This guide was written with the user in mind: the person living with HIV/AIDS, the caregiver whether you are a close relative or friend, home care assistant or professional nurse. Concerns and concepts related to care are threaded throughout the book, so as to highlight the psychological and social aspects of care. Attempts have been made to simpilfy the language to meet the needs of all caregivers. However, some technical information about HIV/AIDS has been included, since many persons living with the problem have a considerable amount of technical information about the disease and its management

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)

Formal handling routines in Jamaican infants. Knowledge, attitudes and behaviour

This study aimed to determine the frequency of use and the knowledge, attitudes and behaviour regarding the Formal Handling Routines (FHR) in rural and urban Jamaican infants. Analysis was made of the area of residence and educational level of the caregivers. The study included 194 caregivers, thirty-three community rehabilitation workers (CRWs) and 30 health care workers (HCWs). Depending on the level of understanding of the respondents, questionnaires were either self-administered or a personal interview was conducted. Caregivers with tertiary education differed significantly from the other caregivers both in frequency of use of the FHR and knowledge, attitudes and behaviour. Caregivers with tertiary education used the routine much less and had more negative attitudes towards it. This might be due to their better financial position, which allowed them to have helpers who cared for their children. HCWs also had significantly more negative beliefs about the FHR than CRWs and caregivers. It is possible that HCWs carried over their knowledge, attitudes and behaviour to the caregivers but if they did, it did not influence the majority of caregivers.(Au)

Relationship between stressful life events and pain in young adults age 20-34

Pain (including headache, neckache, backache, chest pain, abdominal pain or pain in the limbs) that is not managed properly in young adults results in decreased productivity and poor work attendance. Multiple diagnostic and therapeutic interventions can cost the health care system excessively and can lead to iatrogenic disease. Negative reactions in caregivers can ensue and overall, individuals can be left with a sense of hopelessness for recovery. Mental and physicaal health are inextricably linked. Neglect of the psychosocial components in the sea-i-rch for the etiology and management of physical pain at the primary level may be reducing the opportunity for speedy recovery. This study was done to determine the relationship between recent and remote stressful life events and the development of pain. A case-control study was conducted among adults age 20-34 years attending one private, one government and one university clinic in Kingston, Jamaica. 46 cases with pain and 70 controls who were pain-free were chosen. The findings suggest no relation between the actual number of life events and pain but there is a clear association between the perception of a negative impact of a series of life changes on the development of physical pain. The findings also show that of overriding significance in the development of pain is the perceived lack of social support available to the patient. A significant relationship was also found between the perception of a tumultuous childhood and pain although no relationship was found between specific remote childhood stressors and pain. This study highlights the need for greater attention to the integration of mental health and primary care beginning with the training of health workers and education at policy level, service delivery level and of the public.(Au)

Improving community care for persons with the acquired immunodeficiency syndrome in Jamaica

A brief review of the HIV/AIDS epidemic in Jamaica is presented along with the details of a pilot programme aimed at training lay persons and practical nurses to assist with home care of persons with AIDS. Current (1997) estimates are that 2 to 4/1,000 Jamaican adults are HIV positive. 2,301 AIDS cases have been reported to the Epidemiology Unit of the Ministry of Health, 55 percent of whom have died. Males represent 62 percent of reported cases (1421) and children < 9 years old, 7 percent (170 cases). In 1981 a Family Centre was started at the University Hospital of the West Indies to provide support to persons with AIDS and their families. This initiative identified the need to provide special training to persons who would be responsible for caring the AIDS patient at home, where most patient preferred to be managed. All but three of the 41 persons trained in the pilot programme achieved the required standards of attendance and proficiency. Certificates valid for two years were issued and refresher courses will follow.(AU)

The development of the Short Explanatory Model Interview (SEMI) and its use among primary-care attenders with common mental disorders

BACKGROUND: Recent anthropological studies have documented the importance of understanding the relation of culture to the experience of mental illness. The use of interviews that elicit explanatory models has facilitated such research, but currently available interviews are lengthy and impractical for epidemiological studies. This paper is a preliminary report on the development of a brief instrument to elicit explanatory models for use in field work. METHOD: The development of the SEMI, a short interview to elicit explanatory models is described. The interview explores the subject's cultural background, nature of presenting problem, help-seeking behaviour, interaction with physician/healer and beliefs related to mental illness. RESULTS: The SEMI was employed to study the explanatory models of subjects with common mental disorders among Whites, African-Caribbean and Asians living in London and was also used in Harare, Zimbabwe. Data from its use in four different ethnic groups is presented with the aim of demonstrating its capacity to show up differences in these varied settings. CONCLUSIONS: The simplicity and brevity of the SEMI allow for its use in field studies in different cultures, data can be used to provide variables for use in quantitative analysis and provide qualitative descriptions.(Au)

Knowledge, attitudes and practices of young persons with diabetes and their caregivers in Jamaica

In the Caribbean diabetes is a leading cause of chronic ill health. It is rated between the fourth and fifth cause of mortality. The prevalence and incidence continue to rise. Insulin dependent diabetes (IDDM) is not as prevalent as non insulin dependent diabetes (NIDDM) but the mortality risk of IDDM is higher than of NIDDM. The quantitative cross sectional study was conducted from February to April 1998 to determine the knowledge, attitudes, and practices of young persons with diabetes, and their caregivers. The data was collected by telephone surveys which were used at interviews to 27 young diabetics and 27 caregivers. Respondents were members of the Junior Diabetes Association and Camp Yellow Bird, as well as out-patients of the the University Hospital and Bustamante Hospital for Children. The surveys showed that the majority of caregivers and young diabetics had fairly good knowledge, attitudes and practices. The scores ranged from 51 percent of young diabetics to 70.3 percent for caregivers. The majority of young diabetics and their caregivers were concerned about the future of young diabetics. There were some areas which needed strengthening, such as education on self monitoring of blood glucose, insulin administration and the problems often seen as young diabetics.(AU)

Knowledge and attitude of primary health care workers and care givers in the parish of Trelawny towards schizophrenia and the impact of schizophrenia on the family

This is a cross sectional study conducted in the parish of Trelawny which investigated the knowledge and attitude of Primary Health Care (PHC) workers and care givers of schizophrenic patients towards schizophrenia, and the impact of schizophrenia on the family. The study population comprised the total population of care givers of schizophrenic patients and primary health care workers in the parish of Trelawny. Care givers numbered 84 and primary health care workers numbered 60. It was observed that the majority of care givers were females and over 50 percent were over the age of 50 years. PHC workers were all female with a wide range of working experience of under one year to over 34 years. Community Health Aides accounted for 57.7 percent of these PHC workers. On the average, knowledge and attitude of PHC workers could be regarded as fair. Knowledge of PHC workers when compared with that of care givers differed significantly but attitude scores did not. It was observed that the knowledge and attitude of PHC workers with family members affected with schizophrenia, when compared with PHC workers without, scores did not differ significantly statistically.(AU)

Health needs of a place of safety for children in Kingston metropolitan (Glenhope Hospital)

This cross-sectional study was based on determining the health needs of children at a place of safety in Kingston metropolitan namely Glenhope Nursery. The level of care being provided for the children at the institution as well as the children's physical, mental and social health status were determined. The institution suffered from overcrowding and shortage of caregivers and was inadequate in meeting some of the children's needs. The most important need of the children as perceived by the caregivers (83 percent) was "someone to talk to". All the caregivers (n=18) stated that of the needs that were not adequately addressed by the institution the physical need was most outstanding. The high prevalence of common illness (skin infection, ear, nose and throat infection and upper respiratory infection) indicate that overcrowding was a contributing factor. The Denver II Development Screening Test showed that 88 percent of the children had a language development problem and that a significant amount of the children had personal - social and motor developmental problems. Anthropometry revealed that there was a moderately high level of malnutrition. The dietary survey showed that the diet was deficient in some nutrients while excessive in others. Because of the small population of caregivers and childern whatever significant association was made could not be considered as being final.(AU)

Neighbourhood support of families with a disabled child: observations on a coping strategy of caregivers in a Jamaican community-based rehabilitation programme

In Jamaica, a low degree of practical helpfulness of neighbours of families with a disabled child has been described. This seems to cast doubt on the World Health Organisation's concept of community-based rehabilitation which simply assumes that the community is a source of support. Our study tries to elucidate which reasons, in a Jamaican socio-cultural setting, make neighbours give support to or withhold it from disabled children and their caregivers. A concept of neighbourhood help is identified, according to which help is something to asked for and provided under exceptional circumstance only. Caregivers claim to give and receive support in child rearing within the limits of this definition, generally irrespective of the presence of a disability. The impression that neighbours are unconcerned can arise when the support needed becomes too extensive to fit into the local definition of neighbourhood help which is more likely in the case of disabled children.(AU)

Level of mental impairment in the Jamaican elderly and the issues of screening levels, caregiving, support systems, carepersons, and female burden

Jamaica, although a developing country, has an aging population and is facing the many issues confronting aging. A community-based study using the Folstein minimental screening tool identified 2.3 percent of the over-60 population as severely impaired and 11.8 percent as questionable. The family was identified as the main source of support, and female relatives the main carepersons. Mentally impaired persons were less likely than physically impaired persons not to have a support syustem or careperson needed (AU).

Alzheimer's disease: the care givers' concerns, knowledge, coping ability and views of a support system

Alzheimer's disease affects the aged population worldwide. Initially it was considered rare and was believed to occur in people under 60, now research findings indicate that it is seen mostly in the older population. The incidence increases further with age; approximately 20 percent are aged over 80 years. It is a leading cause of death in the United States and studies indicate that up to 50 percent of nursing home population is afflicted with Alzheimer's disease although many may not have been diagnosed. Patients will need constant help when they develop cognitive, physical, emotional or social disabilities. The care-giving role can be demanding and the ability of public health practitioners and community groups to offer support can help to create a positive emotional climate for caregivers. This study was carried out in the Kingston and St. Andrew parishes of Jamaica during the period January to April 1995. Information collected examined Alzheimer's disease and the knowledge and attitude of caregivers. Caregivers identified were family doctors, registered nurses, practical nurses, a house mother, domestic helpers and family members. Findings revealed Alzheimer's disease was more common over age 60. The incidence is higher in females, and the disease knows no socio-economic boundary. Main caregivers are health workers and the majority of patients are cared for in nursing homes. Major fears of doctors was the patients hyperactivity, while for nurse managers it was the increase stress for the caregiver, and communication difficulties the patient may experience. Families are concerned about finding a cure and the safety of the patient. Caregivers were not found to be unduly stressed but there was a knowledge gap about the disease. All categories of caregivers identified the need for support systems. The primary function for an Alzheimer's disease association as seen by the caregivers would be education of all persons. (AU)

Nuturing by male kin among female university students in Jamaica: some preliminary findings

Looks at the behaviours of males who were psychologically present in the life of their family. Looks at the relationship between women and the males in both the nuclear and extended family systems in Jamaica, examining in particular, the ways in which females experience nurturing behaviour shown to them by their male kin(AU)