An investigation on the knowledge, attitudes and practice towards vaginal candidiasis amongst women of reproductive age attending the University of the West Indies, St. Augustine Campus

From 20th century, our views, understanding and treatment of pathogenic infections have drastically changed. Pathogenic organisms were discovered, classified and treatments were subsequently implemented. Candidiasis spp. was discovered and linked to the condition; Vulvovaginal Candidiasis (VVC), commonly known as yeast infection, which affects the female lower genital tract, vulva and vagina. Symtoms of such an infection include itching, burning, soreness and a creamy vaginal discharge. Given the nature, location and symptoms of such an infection, individuals are often self-conscious and hesitant to discus it or seek medical attention until symptoms become unbearable. VVC is one of the most common infections in reproductive age females with 75% of women experiencing infection at least once in their lives. Due to the qualitative gap in literature toward women affected by VVC in our country, this study aimed to highlight the knowledge, attitudes and practices towards VVC among reproductive age in Trinidad and Tobago.

Correlates of pelvic floor disorders in women 50 years and over attending gynaecology and urology clinics in Kingston, Jamaica

OBJECTIVE: To determine the association between pelvic floor disorders and selected sociodemographic and health related variables among outpatient gynaecology and urology clinic attendees 50 years and over. SUBJECTS AND METHODS: A total of 272 women 50 years and older were recruited from outpatient clinics at one tertiary hospital in Kingston. They were enrolled consecutively and data pertaining to sexual and genitourinary health, sociodemography, and health and social status were collected through use of an interviewer-administered questionnaire. Bivariate analyses were conducted to identify variables significantly associated with two pelvic floor disorders: symptomatic pelvic organ prolapse (POP) and urinary incontinence (UI). Based on these, a multivariate logistic regression model was developed to identify variables independently associated with having at least one pelvic floor disorder and to determine the strength of associations. RESULTS: Data relating to POP and UI were analysed for 268 and 263 women, respectively. More than half (51.7%) of the women had at least one pelvic floor disorder, withUI being more commonly reported (37.6%) than POP(25%). Controlling for education, hypertension, muscle/joint pain and menstrual status, each additional vaginal delivery was associated with a 15% (2.6%, 29.3%; p =0.017) increase in odds of having at least one pelvic floor disorder. CONCLUSION: Pelvic floor disorders are fairly common among outpatient clinic attendees and a higher number of vaginal deliveries significantly increase the likelihood of their occurrence. Due to their significant influence on health and well-being, risk factor identification is criticalfor informing prevention and mitigation strategies in women’s health.

Are women the main victims of violence within relationships? prevalence, type and frequency of intimate partner violence and aggression by sex in Barbados, Jamaica and Trinidad and Tobago

OBJECTIVE: In the Caribbean, studies of intimate partner violence and aggression (IPVA) have rarely incorporated the experiences of men. In this study we compare the sexes in examining types, frequency and prevalence of IPVA. DESIGN AND METHODS: Data were from a population-based study of 15–30 year olds in Barbados, Jamaica and Trinidad and Tobago. The Revised Conflict Tactics Scales (CTS2) were used to measure incidence levels of IPVA in the 12-months preceding the survey. IPVA was defined as the combination of three subscales: physical violence, sexual coercion and psychological aggression. Physical injury was measured. RESULTS: Of 3,401 participants, more than half had experienced IPVA (53.0%), comprising physical violence (22.1%), sexual coercion (14.5%) and psychological aggression (43.5%). There were no significant differences by sex in IPVA or any contributing subscale. More women experienced injury (odds ratio 1.52; 95% confidence interval 1.07 - 2.15) and women experienced significantly greater frequency of physical violence. Physical violence and psychological aggression were lowest in Trinidad, and sexual coercion was highest in Jamaica with no other statistically significant country-level differences. CONCLUSION: Most of our results do not support the idea that women are the main victims of IPVA. Studies should examine a variety of potential risk factors beyond the sex of victims and perpetrators, as suggested by country differences, with further attention to IPVA frequency. Services should respond to the range of risks. Longitudinal studies and age group comparisons should identify whether these results signify shifts in gender relations within couples.

Barriers and facilitators to physical activity amongst overweight and obese women in the Caribbean: a qualitative study

OBJECTIVE: To identify modifiable barriers to physical activity and to explore factors that facilitate physical activity among overweight and obese women in Barbados. DESIGN AND METHODS: Seventeen women aged 25 to 35 years with a body mass index (BMI) ≥25, purposefully sampled from a population-based cross-sectional study, were recruited to participate in in-depth semi-structured interviews. Twelve women participated in one or more additional ethnographic sessions in which the researcher joined and observed a routine activity chosen by the participant. More than 50 hours of ethnographic data collection were accumulated and documented in field notes. Thematic content analysis was performed on transcribed interviews and field notes. RESULTS: Social, health-related, and structural barriers to physical activity were identified. Social factors related to gender norms and expectations. Women tended to be active with their female friends rather than partners or male peers, and reported peer support but also alienation. Being active also competed with family responsibilities and expectations. Health-related barriers included perceptions about chronic disease and competing strategies for weight loss. Structural barriers included few opportunities for active commuting, limited indoor space for exercise in the home, and low perceived access to convenient and affordable exercise classes. Several successful strategies associated with sustained activity were observed, including walking and highly social, low-cost exercise groups. CONCLUSIONS: This study highlights the role that gender norms and health beliefs play in shaping experiences of physical activity. Affordable and accessible group exercise classes are feasible within a Caribbean context and successful models have the potential to be replicated.

A study of health risk behaviour and social factors of women between ages 25-59 years in Trinidad

The three main objectives of this study were to (a)describe and compare health status of urban and rural women in Trinidad with respect to economic, demographic and educational factors, (b) evaluate women's knowledge of and attitude towards self-breast examination and cervical screening and (d) determine their utilization pattern of health care services. A total of 1,450 women were interviewed for the study. The overall sample size, n, was calculated to be approximately 1,450 households, given a 5 percent non-response rate. Probability sampling and a nationally representative sample of the population was used. The statistical techniques used to assemble, describe and infer were exploratory analysis, partial correlation analysis and multi-step wise regression. The study identified several factors that influenced a woman's decision to have a Pap Smear Test: education level, age, religion, ethnicity, marital status, employment and income status. Those with higher levels of education had a greater probability of having a Pap test. Of the women aged 40-44 years, 48.1 percent were more knowledgeable about the purpose of the Pap test. The influence of religion was apparent with the Christian community exhibiting a higher percentage of screening compared to the Hindu and Muslim women. The results of Ethnicity found that (10.6 percent) of women of African origin had abnormal test results compared to women of East Indian origin, (4.4 percent). Married women had lower levels or cervical cancer, compared to unmarried women. The percentage of women feeling confident to perform breast self-examinations was lowest among women with low education level (36.4 percent) compared to women with tertiary level education, (68.0 percent). Cervical cancer is more common in women of low socioeconomic status and educational levels. Our study shows these factors influence their inadequate utilization of Pap smear services. Knowledge of the purpose of a Pap smear also relates to their socioeconomic status. It indicates that dissemination of information pertaining to Pap test, cervical cancer and availability of healthcare must be tailored to women represented in these groups (AU)

Characteristics of HIV-infected childbearing women in Barbados

Objective. To describe the demographic profile, social and family characteristics, and life-style traits of HIV-infected childbearing women in the Caribbean nation of Barbados in comparison to a control group of HIV-negative women. Methods. Data for this report were drawn from the Pediatrics HIV Surveillance Program of the Queen Elizabeth Hospital in Barbados. The data covered all HIV-infected women in the country who delivered between 1986-2000, with similiar data coming from a control group of HIV-negative childbearing women ... Additional data were collected from interviews with the women. Results. There were 182 HIV-infected women who delivered during the study period, and a group of 202 childbearing women served as controls. In comparison to the control group, the HIV-infected women were younger, more often multiparous, and more likely to have been unemployed at the time of their pregnancy. The HIV-infected women also had had an earlier onset of sexual activity, had had more sexual partners during their lifetime, and were more likely to be involved with an older sexual partner. At the time of giving birth most of the HIV-infected women were asymptomatic for AIDS and were living with either their parents (mother or father or both) or the baby's father. In addition, at the time of their six-weeks-postnatal visit, the large majority of the HIV-infected women who were diagnosed prior to childbirth, increased significantly over the study period, rising from 25 percent during 1986-1990 to 82 percent during 1996-2000. Slightly over one-fifth of the HIV-infected women had had one or more subsequent pregnancies after they had learned that they were infected. Conclusions. The early age of sexual activity as well as repeated pregnancies, especially from different and older partners, may have contributed significantly to both vertical and horizontal HIV transmission in Barbados. Future studies of HIV incidence and its trend among childbearing women could be important for monitoring the HIV epidemic in this country. Many of the HIV-infected childbearing women in our study were unemployed, sick, and had multiple children. Therefore, to help them to plan for and cope with the disease and also the care of their children beyond the perinatal period, there is a need to provide the women with repeated counseling with continued follow-up and, where necessary, additional economic, social, and medical support (AU)

Why do some women bypass their family physician in seeking preventive care?: a qualitative study [abstract]

The Health Watch clinic at Women's College Hospital, Toronto, provides screening and preventive services primarily to women in Ontario. These services can be seen as a duplication of those that can be provided by family physicians. Nevertheless, some Ontario women continue to bypass their family physicians and attend this clinic. This study was done to understand the decision-making processes women go through in deciding to bypass their family physician when seeking preventive health services and to understand which features of this model of preventive care are so attractive. Seventeen women attending the Health Watch Clinic agreed to participate. In-depth interviews were carried out until saturation was achieved. The interviews were taped and later transcribed. The data were analyzed using qualitative methods, specifically, grounded in theory. Emergent themes were extracted while listening to tapes and reading transcripts. Themes were discussed between researchers and an agreement was arrived at. These themes were relayed back to participants to confirm interpretation. The emerging themes suggest that women bypass the family physician for several reasons, including: "Women negative" experiences, the inherent qualities of the woman, such as her locus of control, normative influences, and perceived positive aspects of the Health Watch Clinic and the Women's College Hospital. The findings suggest that women who bypass their family doctor have generally had a negative experience with the traditional healthcare system. The women in this study were highly educated with high internal motivation and tended to have extensive family and friend support and advice regarding health matters. (AU)

Acne in black women

Although acne is rampant in young black women, many of them do not really understand the nature of the disease and what treatment is available. Common as acne is, there is no easily understood book available to black people, hence the need for this publication. In Acne in Black Women, in plain simple language, I address concerns such as cosmetics, and newer treatments for acne such as peels, facials and laser treatments. I discuss how to use certain medicines to get the most benefit from them. How certain drugs work on acne and how long a patient should be kept on the drug is also addressed. We also take a look at the patient's general health in the management of acne... This book contains information for all black people who have acne or who have relatives who suffer from this disease. You will find advice on how to prevent acne, and how to treat it. This book is not meant to replace a visit to your dermatologist. In most cases he/she alone has the experience to treat your acne, and to combine different medications, so that you can get the best results from them (AU)

Medical education, women's status, and medical issues' effect on women's health in the Caribbean

At an international conference in 1992 on women and health, an attempt was made to redefine health concerns for women of the English-speaking Caribbean in the 1990s. Medical practices in developing countries change as advances are made in public health; clinical issues on the islands now resemble those in the United States (e.g hypertension, cancer, sexually transmitted diseases, domestic violence, and abortion). In the Caribbean, however, these problems exist in a unique socioeconomic context, and women's health there suffers indirectly because of cultural mores. Gender bias in medical education and practice influence treatment of women and obstructs their advancement to policy-making levels in the design and delivery of programs that bear on maternal and child health, among others. The effect of local cultural beliefs and practices on women's health must be considered when setting goals and direction of health policy if aid or educational programs are to be effective.(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).

The impact of alcohol abuse on women's health in Jamaica

Alcohol abuse among women in Jamaica remains a "hushed" subject, although the effects of alcohol can have deleterious effects, not only on the the woman in question, but also on the unborn child, if she is pregnant, and the rest of the family. It therefore assumes public health signifcance. This project was a case control study in which 22 cases and 22 controls was identified, based the definition of alcohol dependency syndrome (Alcohol Abuse Handbook, 1990). The cases were taken from various situations between January 1996 to March 1996, where one would find alcoholic females. The controls were matched based on age and socio-economic status. Questionnaires were used to gain data from these individuals with regards to demography, natural history of disease, physical and emotional effects of alcoholism, and influence of family history of alcoholism. Significant statistical associations were found between age at which alcoholics had their first drink, having a low self-esteem, and having a family member who is an alcoholic. Although the sample used was small, the signifcant findings can be useful in planning programmmes and to do further research which is necessary in Jamaica. (AU)

The challenge for women with a drug-abusing family member: the Jamaican perspective

The abuse of alchol and other drugs presents a multiplicity of problems for the abuser, family members and the wider community. The psychosocial, as well as the economic, probelms can produce an environment of chaos and misery. Women in families in which there is an abuser are challenged in a variety of ways and, depending on the severity of the situation and their capacity to cope, they may confront the problem, seek help or withdraw from it. The present article reviews the impact of drug abuse within the family on Jamaican women from the viewpoint of treatment and rehabilitation specialists and the women themselves and on the basis of case histories and the work experience of the author. Although there have been efforts through demand reduction strategies and culturally relevant treatment and rehabilitation programmes to control the epidemic of drug abuse, the specific needs of women have been left largely unattended. Both men and women are however critical in the fight against drug abuse and women have skills and experience that can contribute to making such programmes achieve their desired objectives. Addressing their needs would not only help them, but also the family and the wider community. In order to address these needs effectively with the limited resources available, however, a credible basis for action has to be established, which can only be done by research and analysis so that the issues can be clearly defined and a plan of action developed.(AU)

A study of gender relationships and their association with the practice of safe sex by women who call into the National HIV/STD helpline

The heterosexual spread of HIV/AIDS is greatly increased by the inability of many women to protect themselves from the disease. Applying a gender aware approach to combat the HIV/AIDS epidemic is to examine how the social relationships between women and men reveal new perspectives on the epidemic and to provide new responses to it. A study was done of women who called into the National HIV/STD Helpline. The objectives of the study were to determine the socio-demographic distribution of callers, to determine factors that contributed to knowledge and practice of safe sex, to determine the role of gender relationships in the practice of safe sex and finally to determine the links between risk status and personal behaviour. A convenience sample was taken. A total of fifty women were interviewed. Significant results from the study centered around gender relationships and risk taking behaviour. Risk taking activities such as multiple partners, irregular condom use, and self reported incidence of STDs were an indicator of the reality of risk and need for intervention of this group. General views of callers were that they had a "good relationship" with their partners, however, 56 percent of callers stated that their partner would become angry at request of a condom. Seventy-two percent of the callers stated that they were at-risk for HIV/AIDS. Suspicion of out-side heterosexual or bisexual relationships were seen as the main reasons for perception of risk. Current studies have shown that women of all ages, socio-economic backgrounds are being affected with HIV/AIDS. Having control over her body, feeling empowered within her sexual relationships enable women to practice and request safe sex. Producing optimal behaviour change is the goal of Haelth Education and Promotion. Issues of gender awareness and gender relationships must be instituted into programmes for change to take place. (AU)

An epidemiological study of the health concerns of imprisoned women in Jamaica

Holistic health care does not stop when someone is incarcerated. It may well be that, at such a crucial time in their lives, inmates may be more receptive to anyone who displays a genuine concern for them. This cross-sectional study addressed the health concerns of imprisoned women in Jamaica. The eighty-six inmates studied represented 91.5 percent of the total population; 7.4 percent declined to participate and one person had to be excluded because of mental illness. The inmates were mostly Jamaicans, incarcerated for a variety of crimes including murder. The non-Jamaicans were imprisoned exclusively for drug related crimes. The mean age was 32.6 years with a range of 17 - 62 years. Eighty-eight percent of these women were in child bearing age group and three of them were pregnant. Biomedical indicators revealed that 16 percent of the inmates had positive VDRL tests and 32 percent were anaemic. Obesity was observed in 52 percent of the inmates. Elevated diastolic blood pressure was noted in 22 percent and elevated random blood glucose detected in 7 percent. It is being recommended that all female inmates have routine physical assessments including HIV testing and Pap Smears on admission to prison. In addition to the existing rehabilitative efforts, physical education and peer counselling are among the recommendations being made. For the control of sexually transmitted diseases, contact tracing is also being recommended (AU)

Women's health beliefs regarding hypertension

Two hundred and forty female clients attending primary health care centres in Montego Bay and the Kingston Metropolitan Area were interviewed to obtain information about their beliefs with regard to hypertension. This study revealed that the variables - perceived susceptibility, perceived severity and 'cue to action' - identified in the Health Belief Model need to be strengthened if patient compliance and adoption of health-promoting behaviours are to be realized. This study also pointed out the pressing need for health care providers to enhance health promotion programmes relative to hypertension. These programmes should be aimed at increasing clients' knowledge base and self-care abilities in order to help prevent and/or control this disorder (AU)

Gender stress: a preliminary survey with specific reference to female physicians

Practising female physicians in Trinidad and Tobago were studied to identify major casual factors of negative stress. Results indicated that major stressors were as follows: job (36 percent), finance (32 percent), children (20 percent) relationships (20 percent). The minor stressors identified were: children (48 percent), finance (36 percent), relationships (36 percent), job (32 percent), and health (20 percent). The physicians showed the ability to cope with the stress and this was attributed to, inter alia, self-sufficiency, empowerment, self-fulfilment and gender. (AU)