Health education and health communication projects in two rural villages in Belize

This chapter describes ongoing health communication and health education efforts in two rural villages in Belize, Central America. In 2002 the Department of Communication joined efforts with the University of Louisville International services learning programme (ISLP) and began work in Belize. Our project was linked to previous ISLP work in the country and began with an initial visit to assess needs and possible service-learning projects. During this initial trip, several rural sites were visited, discussions were held with community member, meetings took place with village council members and leaders, and input from the government was solicited. In addition, a number of subsequent contacts were made, via electronic mail and telephone. Based on the analysis of all the information collected, the university's ISLP compiled a team of faculty and students from Communication, Medicine, Nursing, and Dentistry to deliver health care and health education to residents in one rural community, Gales Point (see chapter 7). This work continued for several years, and eventually the team broadened its efforts to include a second rural village, Red Bank. In this chapter, we chronicle the health communication and health education work of this interdisciplinary health team, a type of team considered particularly important in delivering health care rurally (Amundson 2001). First, we provide more specific information on the composition of the team, our approach to researching and designing health programmes and the implementation of these programmes. Second, we describe Belize and provide overviews of the communities in which we worked. Third, we detail several of our health communication and education efforts, including the topics and formats. Finally, we conclude with an assessment of the efforts to date and a discussion of best practices.

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.

Lead posisoning in a rural community in Jamaica

OBJECTIVE: A proliferation of "backyard battery repair shops" in Frazer's Content (Red Pond), St Catherine led to a number of cases of lead poisoning in that community. A lead decontamination project was instituted by Blue Cross of Jamaica Environmental Health Foundation in 1994 to address this problem. The aim of the present study was to evaluate the impact of that intervention. METHODS: Questionnaire were developed and filled in during interviews with 214 volunteers in Frazer's Content. Volunteers awareness of the environmental effects of lead and the success of the socioeconomic programmes were assessed. The medical records from five nearby hospitals were also checked for new cases of lead poisoning. In addition, soil and water samples were collected and analyzed by atomic absortion spectrophotometry for levels of lead. RESULTS: The results indicated that knowledge of lead poisoning had increased significantly since 1994. However, there was a marked decrease in entrepeneurial activities. Two new cases of lead posioning were noted. Seven of the soil samples had elevated lead levels (123-317 ppm) but none of the water samples had lead concentration above the critical level (10 hg/l). CONCLUSION: Based on these findings, it would appear that the decontamination and education projects done in 1994 were mostly successful in achieving their objectives. Entrepreneurial initiatives were not sustained.(Au)

Domestic and School Violence Among High School Students in Jamaica

This study determined the prevalence of domestic and school violence among high school students in Jamaica. A self-report questionnaire was administered to 3,124 students (1,468 boys and 1,657 girls) from 34 randomly selected high schools in 13 of the 14 parishes in Jamaica. There were 1,590 tenth graders (mean age 16 years) and 1,534 eleventh graders (mean age 17 years). One thousand six hundred and seventeen students were from rural and 1,507 from urban communities and 1,642 and 1,482 were children of professionals and nonprofessionals, respectively. The results revealed that 78.5 percent of the students had witnessed violence in their communities, 60.8 percent in their schools, and 44.7 percent in their homes. Twenty-nine percent of the students had caused injury to persons. Several weapons and techniques were used by the students during violent acts and these included the use of hands or feet 59.8 percent, nasty words 59.1 percent, kicks and punches 54.5 percent, blunt objects 26.5 percent, knives 18.4 percent, ice picks 9.3 percent, machetes 8.9 percent, scissors 8.5 percent, forks 7.5 percent, guns 6.9 percent, other weapons (e.g. bottles, dividers) 6.7 percent, acids 5.5 percent, and alkalis 4.9 percent. Significantly higher numbers of boys, 10th graders, and urban students indicated that they used more of the 14 weapons than girls, 11th graders and rural students, respectively. Effective programmes are urgently need to address the high rate of violence recorded in this study among high school youths in Jamaica.(Au)

Microbial quality of water in rural communities of Trinidad

A cross-sectional study was conducted in four rural communities of northeastern Trinidad to determine the microbial quality of water supply to households and that quality's relationship to source and storage device. Of the 167 household water samples tested, total coliforms were detected in 132 of the samples (79.0 percent), fecal coliforms in 102 (61.1 percent), and E. coli in 111 (66.5 percent). There were significant differences among the towns in the proportions of the samples contaminated with coliforms (P <0.001) and E. coli (P <0.001). Of 253 strains of E. coli studied, 4 (1.6 percent) were mucoid, 9 (3.6 percent) were hemolytic, and 37 (14.6 percent) were nonsorbitol fermenters. Of 69 isolates of E. coli tested, 10 (14.5 percent) were verocytotoxigenic. Twenty-eight (14.0 percent) of 200 E. coli isolates tested belonged to enteropathogenic serogroups. Standpipe, the most common water source, was utilized by 57 (34.1 percent) of the 167 households. Treated water (pipeborne in homes, standpipes, or truckborne) was supplied to 119 households (71.3 percent) while 48 households (28.7 percent) used water from untreated sources (rain, river/stream, or well) as their primary water supply. The type of household storage device was associated with coliform contamination. Water stored in drums, barrels, or buckets was more likely to harbor fecal coliforms (74.2 percent of supplies) than was water stored in tanks (53.3 percent of samples), even after controlling for water source (P=0.04). Compared with water from other sources, water piped into homes was significantly less likely to be contaminated with total coliforms (56.9 percent versus 88.8 percent, P <0.001) and fecal coliforms (41.2 percent versus 69.8 percent, P <0.01), even when the type of storage device was taken into account. However, fecal contamination was not associated with whether the water came from a treated or untreated source. We concluded that the drinking water in rural communities in Trinidad was grossly unfit for human consumption, due both to contamination of various water sources and during household water storage (AU)

Geographical variations in AIDS knowledge and attitude among adolescent girls of Jamaica

This article examines geographical differences in AIDS knowledge and attitudes. Data from a survey of 900 adolescent girls in the Caribbean nation of Jamaica indicate significant differences across geography in AIDS knowledge and attitude. Adolescent girls in more central areas have access to different and more sources of information than those in more remote areas. They are also more likely to know persons with AIDS, be more knowledgeable about the clinical manifestations of AIDS, and be more realistic in assessing their susceptibility of HIV. The implications of geographical differences for AIDS education efforts are discussed.(Au)

Jamaican symmetry project: long-term study of fluctuating asymmetry in rural Jamaican children

Fluctuating asymmetry, small deviations from perfect bilateral symmetry, is negatively correlated with health and positively correlated with sexual selection in human adults, but the accumulation, persistence, and fitness implications of asymmetries during childhood are largely unknown. Here, we introduce the Jamaican Symmetry Project, a long-term study of fluctuating asymmetry and its physical and behavioral correlates in rural Jamaican children. The project is based on an initial sample of 285 children (156 boys and 129 girls), aged 5 to 11 years. We describe the design of the project and the methodology of measuring 10 paired morphometric traits. All traits except hand width showed fluctuating asymmetry. Fluctuating asymmetries of the legs tended to be related and were less than half as great as fluctuating asymmetries of the arms and ears. Therefore the legs may show high developmental stability resulting from selection for mechanical efficiency. A fluctuating asymmetry composite score revealed that boys have significantly lower fluctuating asymmetry than girls and that this effect resides mainly in the elbows. There were significant positive relationships between composite fluctuating asymmetry and age, height, and weight, but multiple regression analyses showed that age was negatively related to fluctuating asymmetry, whereas body size was positively correlated. These findings are compared with results from recent English studies (Au)

Knowledge, attitudes and practices of parents in a rural community with regard to the distribution of contraceptives to sexually active children under 16 years

Parents play a vital role in the lives of their children because they transmit and interpret acceptable cultural behaviour and help to mold the personality of their children. The study was designed to assess knowledge, attitude and practices of parents with regard to early sexual debut and distribution of contraceptives to sexually active children under 16 years. It was carried out on 75 parents in a rural district in Westmoreland. Two streets in the district were randomly selected and all parents with children aged 10-15 years were interviewed. Personal interviews were conducted by the researcher using pre-coded questionnaires. The result showed that while the majority of parents were knowledgeable about sexual activities in children, less than half knew about sexual activities in their children. They strongly disliked the practice of early sexual activities in children. Parental consent for contraceptive was not the preferred practice as the majority of parents expressed that they would not give consent for their children to access contraceptives but it must be made available so that children can access it when all else fail. Parents prefer to talk to and to counsel their sexually active children instead of offering contraceptives. The majority indicated that they are fulfilling their role as sexuality educators for their children.(Au)

Evaluation of school feeding programs: some Jamaican examples

It is hypothesized that giving children a daily breakfast at school may improve their scholastic achievement through several mechanisms: increasing the time spent in school, improving certain cognitive functions and attention to tasks, and, perhaps indirectly, improving nutritional status. Two Jamaican studies showed that providing breakfast to students at school improved some cognitive functions, particularly in undernourished children. However, changes in classroom behavior varied depending on the quality of ths school. Children in better-organised schools concentrated on tasks for longer periods and made fewer undesirable movements, whereas in poorly organized schools the children's behavior deteriorated. Studies to date have provided insufficient evidence to determine whether children's long-term scholastic achievement is imporved by eating breakfast daily. Well-designed, randomized, controlled. long-term trials are essential for determining public policy on the implementation of schools feeding programme(AU)

Factors affecting the time at which pregnant women first attend antenatal clinic in an urban and a rural community in Jamaica

Maternal and child health services have been priority in Jamaica for at least seven decades. Studies have shown that early access to antenatal care by pregnant women will impact positively on the outcome of the pregnancy. This survey was carried out to identify factors affecting the time pregnant women first attend antenatal clinics, and the relationship that these factors have with variables such as aged, union status and level of education. The sample of 145 was selected from pregnant women attending one rural and one urban health centre. The results revealed 54 percent of women surveyed attended antenatal clinic with the first 15 weeks of pregnancy. Age and level of education were not important determinants of time of first clinic attendance. The realization of the value of antenatal care per se, that is the minimizing of risk to the pregnant mother and foetus seemed the most important factor which influenced early antenatal clinic attendance. Facilitating factors for early attendance is included shorter waiting hours, location of the health centre, the cost of the services and convenient clinic hours based on the individual's work schedule.(AU)

Nutrition, anaemia, geohelminth infection and school achievement in rural Jamaican primary school children

OBJECTIVE: To determine whether nutritional status, anaemia and geohelminth infections were related to school achievement and attendance in Jamaican children. DESIGN: A cross-sectional study using a randomly selected sample. SUBJECTS: Eight hundred children aged 9-13 years randomly selected from those enrolled in grade 5 in 16 primary schools in rural Jamaica. RESULTS: The mean height for age of the children was -0.37 z-score +/-1.0 s.d. with 4.9 percent having the heights for age < -2 s.d. of the NCHS references. Anaemia (Hb < 11 g/dl) was present in 14.7 percent of the children, 38.3 percent were infected with Trichuris trichiura and 19.4 percent with Ascaris lumbricoides. Achievement levels on the Wide Range Achievement Test were low, with children performing at grade 3 level. In multilevel analyses, controlling for socioeconomic status, children with Trichuris infections had lower achievement levels than uninfected children in spelling, reading and arithmetic (P < 0.05). Children with Ascaris infections had lower scores in spelling and reading (P < 0.05) Height for age (P < 0.01) was positively associated with performance in arithmetic. Ascaris infection (P < 0.001) and anaemia (P < 0.01) predicted poorer school attendance. CONCLUSION: Despite mild levels, undernutrition and geohelminth infections were associated with achievement, suggesting that efforts to increase school achievement levels in developing countries should include strategies to improve the health and nutritional status of children(AU)

School breakfast benefits children's nutritional status

There are very few well-designed studies in developing countries to evaluate the benefits of school feeding programmes. The aim of this study was to determine the effects of giving breakfast on rural childrens' nutritional status, breakfast history and amount of money they brought to school. We conducted a randomized controlled trial of providing breakfast to rural primary school children in grade 2 to 5 in 16 schools in Jamaica. 407 undernourished children (weight for age,-ISD NCHS references and 407 adequtely nourished children (weight for age>-ISD) matched for age gender and class were randomly assigned to either breakfast or placebo groups for one school year. Breakfast consisted of bread or spiced bun with cheese and 250 ml flavoured milk which supplied 590-720 kcal and 22.5 g protein per day. The placebo was a small piece of orange. The children heights and weight were measured before and after the intervention. Differences between categorical variables were examined by Chi-squared tests and effects of giving breakfasts were tested by multiple regression analyses. The children receiving breakfast gained significantly more in weight and body mass index (p<.001) and height (p<0.05) than those in the placebo group. Participation in the programme did not reduce the amount of money brought to school, or change their home breakfasts, suggesting no significant income transfer to the families. We subsequently trained teaches to identify undernourished children who could benefit from a school meal using a calibrated measuring stick. (AU)

Seroprevalence of hepatitis B virus among school-age children in the Stann Creek District of Belize, Central America

Adults in the Stann Creek district of Belize have a high prevalence of hepatitis B virus (HBV) infection, but the age of onset of these infections is unclear. We conducted a seroprevalence study of hepatitis B markers among Stann Creek school-age children to provide information for planning a hepatitis B vaccine program. The overall prevalence in 587 students was high for antibody to hepatitis B core antigen (anti-HBc) (43.3percent) and hepatitis B surface antigen (HBsAg) (7.7 percent). There was marked variation of anti-HBc by school and by the predominant ethnic groups attending those schools. Maya had the highest prevalence (76 percent), followed by Mestizo (50 percent), Garifuna (37 percent), and Creole (25 percent). Children less than nine years of age attending the rural primary schools (mostly Garifuna and Creole) (p< 0.05). Anti-HBc was found in 42 percent and 36 percent of students at the two high schools. Of the five schools tested, only at the urban primary school did anti-HBc positivity increase with age. Based on an analysis of the cost of serologic screening before immunization compared with mass vaccination, preimmunization serologic screening resulted in vaccine program cost savings in four of the five schools. Because most children in the rural areas contract hepatitis B before entering school, immunization against HBV should be integrated into the routine infant immunization program (AU)

Development of food frequency questionnaires in three population samples of African origin from Cameroon, Jamaica and Caribbean migrants to the UK

OBJECTIVES: To develop the methods for assessment of food and nutrient intake using standardized food frequency questionnaires (FFQ) in three African origin populations from Cameroon, Jamaica and Caribbean migrants to the United Kingdom. DESIGN: Cross-sectional assessment of diet from a representative sample in each site, using either a 2-day food dairy or a 24-h recall method to determine food for inclusion on the food frequency questionnaire. SETTING: A rural and urban site in Cameroon, Evodoula and Cite Verte in Yaounde, respectively; a district in Kingston, Jamaica; Afro-Caribbeans living in central Manchester, UK. SUBJECTS: Aged 25-79 years, 61 from the Cameroonian urban site, 62 from village site; 102 subjects from Jamaica (additional analysis on a subsample of 20): 29 subjects from Manchester, UK. MAIN OUTCOME MEASURES: Food contributing to nutrients in each site to allow the development of a FFQ. RESULTS: A high response rate was obtained in each site. Comparison of macronutrient intakes between the sites showed that carbohydrate was the most important contributor to energy intake in Jamaica (55 percent) and the least in the rural Cameroon. In rural Cameroon, fat (mainly palm oil) was the most important contributor to energy intake (44 percent). Manchester had the highest contribution of protein energy (17 percent). Food contributing to toal energy, protein, fat and carbohydrate were determined. In rural Cameroon, the top 10 food items contributed 66 percent of the total energy intake compared to 37 percent for the top 10 foods in Manchester. Food contributing to energy were similar in Jamaica and Manchester. Cassava contributed 40 percent of the carbohydrate intake in rural Cameroon and only 6 percent in urban Cameroon. One FFQ has been developed for use in both sites in Cameroon containing 76 food items. The FFQ for Jamaica contains 69 foods and for Manchester 108 food items. CONCLUSION: Considerable variations exist within sites (Cameroon) and between sites in foods which are important contributors to nutrient intakes. With careful exploration of eating habits it has been possible to develop standardized, but locally appropriate FFQs for use in African populations in different countries.(AU)

Predictors of all cause mortality in an island population of African descent, Tobago, West Indies, 1976-1994

The objective of this study was to evaluate the predictors of all cause mortality in a rural West Indian population. From 1976 to 1978, 92.5 percent of an adult (o 21 years) Afro-Caribbean community was examined for selected cardiovascular risk factors using a pretested questionnaire. Bloodpressure, resting ECG, fasting and 2-hour post-load blood glucose, serum uric acid and body mass index were measured. Alcohol consumption patterns were also assessed. Follow-up measurements were made over the next 18 years during return visits for medical attention and at home visits. Additional information was obtained from hospital (the only one in the island) and church records. Eighteen-year mortality studies revealed 96/482 females (19.9 percent) and 88/345 (25.5 percent) males had died. Genetic and environmental influences appear operative. Intervention to alter environmental components would reduce premature mortality (AU)

Use of food expenditure data to estimate household nutrient accessibility

The nutritional status of at-risk groups is usually monitored using health statistics. This approach has limitations as individuals are identified only after they have been afflicted by morbidity. In Jamaica, national surveys are carried out in which expenditure data on all consumption items are collected. We used these data to monitor food accessibility in at-risk groups. The identification of decreases in accessibility levels relative to requirements would enable timely intervention before there is a deterioration in nutritional status. We analysed the data from the survey of 3861 households conducted by Statistical and Planning Institutes of Jamaica in 1989. Using the food expenditure data, per capita energy and protein accessibility levels were determined. The mean energy and protein accessibility levels for the sample were 2170 Cals and 64 g, respectively. The results showed that the per capita accessibility levels of 20 percent and 9 percent of the households were less than half of requirments for energy and protein, respectively. The situation was worse in rural areas than in urban centres. However, the accessibility levels may have been underestimated as the data did not include meals bought and consumed away from the home, which may be significant to some households. We believe that the use of data from these surveys is a cost-effective way to monitor nutrient accessibility in Jamaica (AU)

Disparities in access to family planning in Jamaica

In order to improve the effectiveness and subtainability of the family planning programme, the National Family Planning Board has devised a strategy to shift users to longer-acting methods and increase the role of the private sector. To design interventions, a better understanding of existing services was thought to be necessary. This study examines the distribution of family planning service delivery points in Jamaica and the services offered by the public and private sectors through an examination of records and questionnaire interviews. The study found that, because of the concentration of private sector providers - the main outlets for longer-acting methods - in urban areas, rural areas had poor access to these methods. Because rural areas are not attractive to private sector providers, the public sector should recognize the need to continue to serve these areas (AU)