Methodological and biological factors explaining the reduction in dental caries in Jamaican school children between 1984 and 1995

OBJECTIVE: To assess the methods used and results found in two surveys, one conducted in 1984 and the other in 1995, that indicated a large reduction in the prevalane and severity of dental caries among children in Jamaica, with special attention focused on methodological differences between the two surveys and the biological factors that may explain the large reduction in caries. METHODS: In 1984 a modified "pathfinder" methodology was used to measure the prevalence and severity of dental caries in 6-, 12-, and 25-year-old children in Jamaica. A similar survey was conducted in 1995. A comparison of the two surveys showed an 84 percent reduction in the severity of dental caries at age 12. Both surveys used the same diagnostic criteria and clincal procedures, but the 1984 survey included a higher proprtion of rural residents than did the 1995 one. RESULTS: The data show an epidemiological transition between 1984, when dental caries was highly prevalent and severe, and 1995, when the disease was less prevalent and was concentrated in a smaller proportion of the population. CONCLUSIONS: Most of the reduction in dental caries between 1984 and 1995 is attributable to the introduction, in 1987, of salt flouridation. While the 1995 survey included fewer rural areas than the 1984 survey did, that does not invalidate the observed reduction in dental caries. The use of flouride toothpaste and dietary flouride supplements as well as access to dental health promotion and preventive and curative services do not seem to be major contributors to the reductions observed. (AU)

The nutritional status of rural Jamaican school children

Three thousand, eight hundred and eighty-two (3,882) children in grades 2-5, attending 16 rural primary and all-age schools in central Jamaica were weighed and their weight-for-age standard deviation scores calculated using the World Health Organization/National Cancer for Health Statistics (WHO/NCHS) refernces. Heights were also measured in a random sample of the grade 5 children (n=793) and height-for-age and body mass index (BMI - kg/m2) calculated. Sixty-nine percent of the total sample were of normal weight-for-age, 2 percent were moderately undernourished (weight-for-age > -3 Z-score, <-2 Z-score), and a further 24 percent mildly undernourished (weight-for-age >-2 Z-score, <-1 Z-score). Few children were overweight. The frequency distribution of weight-for-age was similar in girls and boys. In the subsample of children in whom heights were measured, 25.8 percent were <-1 Z-score height-for-age, and of these 4.9 percent were <-2 Z-score. Compared with a survey conducted in a similar rural area in the 1960s, the children's mean weights for age group categories were 1.1 to 3.7 kg heavier. Children who were older than appropriate for their grade were more likely to be undernourished (Odds ratio 3.94, 95 percent CI 3.21,4.83), which suggests that undernourished children may be more likely to repeat a grade or start school later (AU)

Standardized comparison of glucose intolerance in West African-origin populations of rural and urban Cameroon, Jamaica, and Caribbean migrants to Britain

OBJECTIVE: To compare the prevalence of glucose intolerance in genetically similar African-origin populations within Cameroon and from Jamaica and Britain. RESEARCH DESIGN AND METHODS: Subjects studied were from rural and urban Cameroon or from Jamaica, or were Caribbean migrants, mainly Jamaican, living in Manchester, England. Sampling bases included a local census of adults aged 25-74 years in Cameroon, districts statistically representative in Jamaica, and population registers in Manchester. African-Caribbean ethnicity required three grandparents of this ethnicity. Diabetes was defined by the World Health Organization (WHO) 1985 criteria using a 75-g oral glucose tolerance test (2-h > or = 11.1 mmol/l or hypoglycemic treatment) and by the new American Diabetes Association criteria (fasting glucose > or = 7.0 mmol/l or hypoglycemic treatment). RESULTS: For men, mean BMIs were greatest in urban Cameroon and Manchester (25-27 kg/m2); in women, these were similarly high in urban Cameroon and Jamaica and highest in Manchester (27-28 kg/m2). The age-standardized diabetes prevalence using WHO criteria was 0.8 percent in rural Cameroon, 2.0 percent in urban Cameroon, 8.5 percent in Jamaica, and 14.6 percent in Manchester, with no difference between sexes (men: 1.1 percent, 1.0 percent, 6.5 percent, 15.3 percent, women: 0.5 percent, 2.8 percent, 10.6 percent, 14.0 percent), all tests for trend P < 0.001. Impaired glucose tolerance was more frequent in Jamaica. CONCLUSIONS: The transition in glucose intolerance from Cameroon to Jamaica and Britain suggests that environment determines diabetes prevalence in these populations of similar genetic origin.(Au)

Traditional medicine in Belize. The original primary health care

While completing the clinical portion of my bachelor's in nursing degree in southern Belize in Central America, I had the unique opportunity to converse with and observe traditional healers in their natural surroundings, lush rain forests abounding with medicinal plants. The rain forests play a vital role in the lives of the several thousand Mopan and Ketchi Maya who live in southern Belize. Their strong cultural identity is rooted in tradition, especially among the older generations.(Au)

The prevalence of hypertension in seven populations of West African origin

OBJECTIVE: This study was undertaken to describe the distribution of blood pressures, hypertension prevalence, and associated risk factors among seven populations of West African origin. METHODS: The rates of hypertension in West Africa (Nigeria and Cameroon), the Caribbean (Jamaica, St. Lucia, Barbados), and the United States (metropolitan Chicago, Illinois) were compared on the basis of a highly standardized collaborative protocol. After researchers were given central training in survey methods, population-based samples of 800 to 2500 adults over the age of 25 were examined in seven sites, yielding a total sample of 10014. RESULTS: A consistent gradient of hypertension prevalence was observed, rising from 16 percent in West Africa to 26 percent in the Caribbean and 33 percent in the United States. Mean blood pressures were similar among persons aged 25 to 34, while the increase in hypertension prevalence with age was twice as steep in the United States as in Africa. Environmental factors, most notably obesity and the intake of sodium and potassium, varied consistently with disease prevalence across regions. CONCLUSION: The findings demonstrate the determining role of social conditions in the evolution of hypertension risk in these populations.(AU)

Does poor health nutrition affect school achievement in rural Jamaican children?

In recent years, increasing attention has been given to the effects of health and nutrition on schoolchildren's ability to learn. This study was conducted to determine whether nutritional status, anaemia and geohelminth infections were related to school achievement after controlling for a wide range of social variables. Eight hundred children were randomly selected from all those enrolled in grade 5 in 16 rural primary schools in Jamaica. School achievement was assessed by the Wide Range Achievement Test (WRAT). Children's weights and heights were converted to Z-scores using the NCHS references. Haemoglobin was measured using a haemoglobin photometer (Hemocue), and the presence and intensity (eggs per gram stool) of Trichuris trichura and Ascaris lumbricoides assessed by the Kato Thick Smear method. Socio-economic variables were assessed by questionnaire and observation, and school attendance obtained was from the class registers. The mean height-for-age of the children was -0.4 ñ 1.0 SD with 25.3 percent having heights <-ISD of the NCHS references. Fourteen point seven per cent (14.7 percent) of the children were anaemic (Hb < 1lg/dl), 38.3 percent were infected with Trichuris trichura and 19.4 percent with Ascaris lumbricoides. Height-for-age (p<0.001) was positively correlated with scores on the WRAT, and anaemia (p<0.05), Trichons and Ascaris infections (p<0.001) were associated with lower scores. In a multiple regression analysis, after controlling for attendance, sex, socio-economic status, possession of school books and uniform quality, the achievement of children with Trichuris infections was significantly worse than that of uninfected children in spelling, reading and the total WRAT score (p < 0.01). Height-for-age (p < 0.001) and anaemia (p < 0.05) contributed significantly to the variance in arithmetic. Despite the mild levels of undernutrition and the low intensity of the geohelminth infections, they were still associated with achievement. This suggests that efforts to increase school achievement levels in developing countries should include strategies to improve the health and nutritional status of children (AU)

Growth monitoring: the role of community health volunteers

A community volunteer programme was initiated in rural Jamaica in May 1990. The main aim of the programme was to monitor the growth of children less than 36 months of age through community health volunteers (CHVs) and improve their nutritional status. At the end of the second year the programme was evaluated to determine effectiveness. The results of the evaluation indicated that almost all (95.6 percent) of the children were covered by the CHVs. In addition the participation rate was high (78.5 percent). However, only 50 percent of the children were adequately covered. Nonetheless, 81 percent of them gained adequate weight. Indeed, malnutrition levels declined by 34.5 percent. The annual cost per child per year for the total programme was fairly moderate (US$14.5) with growth monitoring accounting for nearly half (42.7). The results suggest that CHVs can play an important role in primary health care programmes in developing countries(AU)

Community based, effective, low cost approach to the treatment of severe malnutrition in rural Jamaica

Moderate and severe malnutrition are endemic in much of the developing world and in association with pockets of deprivation in the developed world. The cost in terms of individual and social development is high. The principles of effective management are clearly documented. A low cost, community based treatment programme for moderately and severely malnourished children under three years of age was established at a health center in rural Jamaica. Children were followed up monthly and defaulters were rigorously recalled. Management consisted of carefully delivered dietary advice, antibiotics, anthelminthics and vitamin supplements. All children improved and the response of 36 children, who were treated in the first year, showed an accelerated weight gain. There was a significant increase in the weight for age, at 1.9 percent per month over six months, which exceeds the rate reported with food supplementation programmes and nutrition rehabilitation centers. (AU)

Periodontal treatment needs in 12 and 15 to 19 year old school children in the Caribbean island of Antigua, 1990

A national survey was undertaken in 1990 to investigate the periodontal treatment needs in 12 and 15 to 19 year olds residing in urban and rural areas of Antigua. Using the CPITN procedure, examination of 246 12 year old children and 456 adolescents (15 to 19) revealed that the CPITN scores of healthy, gingival bleeding, calculus, 4 or 5 mm and >6mm periodontal pockets were distributed similarly in urban and rural areas. Calculus was the most commonly recorded score, with a prevalence of 46 percent in 12 year olds and 56 percent in 15 -19 year olds. 4 or 5 mm pockets were found in 14 percent of adolescents, affecting on average less than one sextant per subject, but deep pockets were uncommon, 26 percent of 12 year olds and 14 percent of adolescents had priodontally healthy mouths. Scaling and hygiene instructions were the predominant treatment needs in both age groups, but the requirement for complex periodontal care in adolescents was low - 3 percent. (AU)

Ethnicity and the use of health services in Belize

Data from the 1991 Belize Family Health Survey show differentials in the use of maternal and child health services between ethnic groups (Creole, Mestizo, Maya/Ketchi and Garifuna). Multivariate analysis is used to explore whether such differentials can truly be attributed to ethnicity or to other characteristics that distinguish the ethnic groups. Health services considered are: family planning, place of delivery (hospital/other), postpartum and newborn check-ups after a birth, and immunisations for children. The language usually spoken in the household is found to be important for interpreting ethnic differentials. Mayan-speaking Maya/Ketchis are significantly less likely to use family planning services or to give birth in a hospital. Spanish-speakers (Mestizos and Maya/Ketchis) are less likely to use newborn and postpartum differentials check-ups, after controlling for other characteristics. There are no ethnic differentials for immunisations. Programmatic implications of these results are discussed(Summary)

Initial report of a hepatitis investigation in rural Belize

In spring 1991, Belizian health officials expressed concern about a possible hepatitis outbreak in a banana farming district. A study was designed to identify cases and to address the serological prevalence of hepatitis virus markers. Three populations were studied: (i) persons meeting a clinical case definition for hepatitis; (ii) designated banana workers; and (iii) people in a random sample of households in the community. Information was collected using questionnaires and sera were collected for laboratory testing. This report presents the preliminary results of a study conducted in June 1991. Among people who met the clinical case definition, 24 percent of 42 tested had immunoglobulin M antibody to hepatitis B virus (HBV) core antigen (anti-HBc IgM). In the worker and household survey populations, 248 and 280 people, respectively, were tested for anti-HBc IgM. In each group, 4 percent were positive. HBV surface antigen was found in 37 percent of 43 clinical cases, 18 percent of workers, and 13 percent of people in the household survey. Among the 3 study populations, the prevalence of HBV core antibody (anti-HBc) ranged from 73 percent to 81 percent. Almost all tested persons had evidence of prior infection with hepatitis viruses A and B was widespread, but an aetiology could not be established for most of the clinical cases. However, the prevalence of hepatitis B markers in this population was very high compared to other reports from the Caribbean (AU)

Rapid rural appraisal: its role in health planning in developing countries

There is an urgent need for a quick inexpensive and reliable method for identifying groups and individuals most in need of primary health care. The Rapid Rural Appraisal (RRA) is the most appropriate approach. It is a method by which resources can be quickly deployed to alleviate the problems of the poor. If properly used it can play a major role in identifying community health needs thereby aiding the health planning process and improving the health of the people. Nevertheless, RRA techniques should not be regarded as separate and apart from other research methodologies but complementary to them (AU)

Factors influencing medical interns trained at U.W.I. to work subsequently in a rural area in Jamaica

Recognising the present paucity of doctors trained at the University of the West Indies who are working in rural government health facilities in Jamaica, and its impact on the health services, this study was done to determine the factors influencing the decision of UWI-trained interns to work in these facilities post-internship. A questionnaire was administered to 57 UWI-trained medical graduates presently doing their internship in Jamaica. The results showed that there was no significant difference in the choice of placement with respect to sex, or residential background of the intern, though the latter seemed to indicate a trend. Of those who thought they would work in a rural government health facility, two-thirds would do so immediately post-internship but 50 percent did not plan to work there for more than five years. Opportunities for postgraduate training and lack of equipment were the most important deterrents to working in a rural government health facility. (AU)

An investigation of some risk factors for severe leptospirosis on Barbados

Between November 1979 and the end of December 1986 (7.17 years), 248 cases of leptospirosis were confirmed among hospital patients on Barbados (mean 35 per year; range 25-57). Considering the 235 who were greater than or equal to 15 years of age, the annual incidence of leptospirosis was 19.2/100,000 population (14.0 for all age groups). There were 173 males and 62 females, and for cases aged 15-34 leptospirosis was 9.6 times more common in men than women. Among men, incidence increased fairly steadily with age, and an even steadier increase was apparent in women up to age 64, with some decline in later years. The incidence of disease was much higher among agricultural than other workers and the un-employed. Highest case numbers were recorded in the parishes of St Michael (65 or 28 percent) and Christ Church (36 or 15 percent), though the incidence was lowest in these two parishes (13.1/100,000 and 17.4/100,000, respectively). The highest incidence rates were in St Andrew and St Joseph ((50.2 and 36.1/100,000, respectively). The incidence in areas with rainfall greater than or equal to 1600 mm (32.6/100,000) was nearly twice that in areas with rainfall less than 1600 mm (17.3/100,000). There is a clear link between cases of severe disease and recent rainfall. Using 134 patients greater than or equal to 15 years of age with fever due to other illnesses as controls, a higher proportion of cases than controls came from rural areas. The risk of contracting leptospirosis was increased for all categories of manual workers relative to the group at lowest risk (non-manual indoor workers). Sugar-cane workers were five times more likely to contract leptospirosis than were non-manual indoor workers, while those with rodents in their garden/yard were 1.8 times more likely to do so. Other risk factors examined did not show significant associations with the disease. Despite increasing mechanization and the use of more protective clothing, agricultural workers are still at high risk from leptospirosis. The annual range of cases is likely to stay much as it is in the foreseeable future. (AU)

Leptospires in Rattus spp. on Barbados

Among 138 Rattus norvegicus and 98 R.rattus trapped on Barbados in 1964-65 and examined for evidence of leptosporal infection, sero-positivity prevalence rates were similar (34 and 39 percent, respectively), but isolation/dark field microscopy rates were higher in R. norvegicus (27 percent) than R. rattus (15 percent). R. norvegicus carried mainly serogroup Autumnalis. These two serogroups cause 90 percent of severe human leptospirosis on the island. (AU)

Leptospiral infection: a household serosurvey in urban and rural communities in Barbados and Trinidad

A longitudinal study of leptospiral agglutinins in subjects five years of age and over was undertaken in Trinidad and Barbados between 1980 and 1982. Households were sampled randomly from one urban and two rural communities on each island, giving a total of 576 eligible individuals in Barbados and 524 in Trinidad. Participants were examined three times at approximately annual intervals. The prevalance of seropositivity at a titre of 1:50 using the microscopic agglutination test was 18.5 percent in Barbados and 21.9 percent in Trinidad. Prevalence increased steeply with age in both sexes and was higher in males than females on both islands. There was a marked difference in predominating serogroups on the two islands--Autumnalis (42 percent of positive cases) predominated in Barbados while Bataviae (29 percent of positive cases) predominated in Trinidad. Estimates of incidence rates for seroconversion were 2.9 percent per annum for Barbados and 3.5 percent per annum for Trinidad. Occupational risk varied between the islands, but in both cases highest seropositivity rates (greater than 50 percent) were found in outdoor labourers and lowest were found in indoor non-manual workers and urban homeworkers. In Barbados seroprevalence was higher among persons who cleared drains or who had contact with livestock. Lack of an island toilet was associated with an increase in seropositivity on both islands. There was little evidence of household clustering of seropositive cases. (AU)

Proceedings of the inaugural meeting and conference

The document is organized into four sections- a general overview of the inaugural meeting and conference, a review of health development in the geographical area , a record of progress in specified health areas, a vision(derived from research) of new strategies and plans of action