Vitals: A quarterly report of the Ministry of Health, Jamaica 2017

This quarterly report integrates a special feature on surgeries in public hospitals and presents comparative data for January to March 2016 and 2017. It also looks at utilization data for health facilities and health centres, notifiable diseases and health sector complaints for the period.

Workplace violence against medical staff in public primary healthcare facilities in Barbados

OBJECTIVE: To determine the prevalence of physical and psychological violence amongst the medical staff in the eight public polyclinics of Barbados. DESIGN AND METHODS: A cross sectional study was conducted utilising a modified version of the standard Workplace Violence Questionnaire by the World Health Organisation, designed to assess the prevalence, types and features of workplace violence. All nursing and physician staff on duty at the island’s eight polyclinics during the study period (June-July 2014) were invited to participate. Statistical analysis was performed using Epi info 7. RESULTS: Of the 102 respondents (72% response rate), a total of 63% (95% CI 53.0%-72.4%) of nursing and physician staff at the polyclinics in Barbados reported having suffered at least one incident of violence in the past 12 months. Verbal abuse was the most frequent (60%; 95% CI 50.1%- 69.7%). The one-year prevalence rates of physical violence, bullying, sexual harassment, and racial harassment were 2.9%, 18.8%, 6.9% and 2.9%, respectively. Logistic regression showed that females were more likely to experience verbal abuse than males (OR=11; 95% CI 2.8-43.1) and nurses more likely than physicians (OR=1.9; 95% CI 1.1-4.7). The client accounted for 64% of the incidents. CONCLUSIONS: More than half of all staff surveyed reported experiencing some type of violence in the past year, female gender being a significant predictor of abuse. This initial process of characterising the extent and type of violence present, can serve as a foundation for further qualitative research exploring reasons for violence experienced.

Vector control services: malaria supply chain management in facilities standard operations manual

Use of malaria medicines is essential and critical in our response to the malaria situation in Guyana. It is part of the final link between patients and health services. Availability of malaria medicines and diagnostic supplies can only be realized by improving the opportunity to manage these commodities in an efficient manner. For these reasons, this manual will address all aspects of the pharmaceutical management cycle. The manual provides basic information for the successful operation of the supply chain for Malaria Medicines and Supplies. The intention is to use this manual for training and orientation of health workers in best practices of the drug management cycle, in pursuit of securing performance improvements to the malaria program.

The History Of Health and Healthcare in Trinidad And Tobago 1938-1962

The dissertation explores the evolution of the Trinidadian and Tobagonian health system from 1939, the beginning of the Second World War, so pivotal to the country's development, to the year of independence from British rule, 1962. It focuses specifically on how the expansion has been facilitated and hindered by colonial forces and has influenced the movement towards independence. This work assesses specifically the changes in morbidity, medical facilities and personnel while examining the relationship of traditionalism and modernity and the external, socio-economic and political influences to ascertain the catalysts and consequences of change in health in Trinidad and Tobago. It establishes the period as the most progressive in health and health care but spotlights the issues of underdevelopment as part of a greater colonial legacy of conformity and resistance. It looks closely at the issue of decolonisation and its role as a catalyst in development in health and medical care, but also as a perpetuating force of dependence, a direct contradiction of this principle. This work establishes the experiences in this sector as a microcosm of the colony's overall state as it evolved from colonialism to independence. The history of health in the Caribbean has been explored mainly as a facet of other prominent historical periods, such as enslavement, or topics, such as economic history. This dissertation establishes the history of health and medicine in the West Indies, and specifically in Trinidad and Tobago, as a significant subject in its own right, providing concrete evidence of its impact in shaping the society and reflecting the challenges and triumphs of a country in transition.

Always inadequate: the history of hospital services in Trinidad and Tobago [abstract]

Health related issues have played a critical role in Caribbean history. From the time of the earliest European presence, disease posed a serious challenge to life in the region. Matters worsened with the introduction of large numbers of Africans and Asians into the colonies, for the disease environment became more complicated. Western medicine was unprepared to deal with the situation. There was a lack of knowledge among the European population of many of the diseases. Thus, the provision of health care institutions was always high on the agenda of the European colonizers. However, the provision of these services was affected by a number of factors, not the least of which was the perception that some races were less vulnerable to disease than others. The result is that services provided were able to satisfy existing demand. This paper examines the health care facilities that were provided by the population of Trinidad and Tobago since 1900. The paper begins with an outline of earliest institutions and a discussion of the philosophy which guide their operations. The discourse then turns to the emergence of modern hospital institutions in the colony and the history of these institutions since 1900. The paper argues that in the development of hospital services there is a history of overwhelming demand which was never satisfied. The paper argues further that the underlying philosophy of the hospital institutions never really changed and that is the basic reason for the inadequacy of these services which remains a feature of the history of the hospitals of Trinidad and Tobago. (AU)

An investigation into the methods of disposal of certain types of biohazard materials at some hospitals and medical laboratories

Biomedical waste represents a small proportion of the total volume of waste generated by health care facilities. Such waste requires proper handling and disposal because of enviromental, aesthetic, and occupational concerns, as well as risks to human health. Improper management of infectious medical waste can trigger notable adverse public health impact. This study focuses on how body parts, limbs and blood are disposed of in Kingston, St. Andrew and St. Catherine and how this differs from the standards set in the "Guidelines for the Management of Biomedical Waste in Canada". It was conducted using the entire population (18) of medical laboratories in the selected parishes along with the entire six public hospitals also located there. Permission was granted for four hospitals and sixteen laboratories. At each hospital the head of maintenace (HOM) and a the maintenance worker that does the actual disposal of body parts and limbs were interviewed separately. At each medical laboratory the chief medical technologist and the laboratory attendant were also interviewed separately. A different questionnaire was prepared for each group. During the interviews the data was filled in by the sole investigator. 79 percent of medical laboratory formulated their own policy and procedures and the other followed the CAREC guidelines. 67 percent of the hospitals also formunlated their own policies and procedures. Incineration was the main method (75 percent)practised by hospitals for the disposal of body parts and limbs. 50 percent of the lab attendants dispose of the blood by incineration, 44 percent by pouring it down the sink after decontaminating it with either bleach or autoclaving and the other 6 percent by burial. The above results are acceptable according to the gold standards. Despite the fair results of the study, the government needs to formulate policies to structure the management of medical waste. This policy process should start by developing a Procedure Manual. Adherence will then need to be monitored by the relevant authority (AU)

Integrated primary mental health care

Mental health is increasingly being recognised as contributing significantly to the burden of disease, particularly now that the indicators have shifted from measures of mortality to measures of morbidity. Psychiatric morbidity in the community, based on community surveys, is estimated at 20 to 30 percent of the population. Increasingly, patients needing health services prefer to be in a general health care setting than in specialized centres. Internationally and regionally, the general policy has been to move toward the development of comprehensive mental health programmes integrated within primary health care. This integration may be structural (use of shared facilities), administrative (shared administrative resources) or functional (complete integration of clinical services, with staff jointly responsible for patient welfare). This paper examines how this integration can be achieved, and the potential role of the Department of Community Health and Psychiatry, University of the West Indies in advancing this integrative process through research and training.(AU)

Impact of Hurricane Luis on the health services of Antigua and Barbuda

Antigua and Barbuda, located in the Caribbean, was one of the countries most affected by Hurricane Luis in 1995. Electricity, water supply and health facilities were disrupted for several weeks. Inadequate criteria at the design stages, unsound structual design, and lack of maintenance of building components, are some of the reasons that damage was so severe. The main hospitals and 6 health facilities were destroyed and flooded and most of the medical staff had to cope with their own damaged houses. Although the knowledge and materials are available to reduce the losses caused by hurricanes, building codes are not reinforced by laws and preventive maintenance to protect health care facilities from natural hazard damage is not usually budgeted for. The additional cost of making a single or two-storey health facility almost invulnerable to future catastrophe in a hurricane is only 2 percent in initial capital cost and becomes negligible when spread over the life of a building. The effort of UN International Decades for Natural Disasters (IDNDR) directed towards disaster mitigation should be increased over the remainder of the decade to ensure that standards are respected and building codes are mandatory.(AU)

Use of disinfectants and antiseptics in Jamaican health care institutions - a knowledge, attitudes, beliefs and practices study - abstract

Little has been published concerning choices and use of disinfectants and antiseptics in Caribbean health care institutions. This paper reports some findings from a cross-sectional study of knowledge, attitudes, beliefs and patterns of use concerning those chemicals. The study was carried out among 176 distributors or users from 12 public health care institutions in the cities and major rural towns of Jamaica. Most respondents acknowledged no distinction between the terms "disinfectant" and "antiseptic". Pharmacies gave the most accurate definitions. Fifteen per cent of all respondents failed to give any definition. In general, female respondents were better informed than males. Bleach, "Savlon" (R) and phenolics were the most commonly used disinfectants, while alcohol was seldom acknowledged for this purpose. Disinfectants were supplied sometimes as concentrates and sometimes in diluted form; they were not always stored appropriately and were often over- or under-diluted. Few respondents knew the recommended strengths for effective disinfection and chemosterilization. Concerning disinfectants, a small number of ancillary workers and registered nurses listed "smell" as their most important characteristic. Some persons believed that all disinfectants are safe and effective for all purposes. When supplies were short, inappropriate substitution occurred in 37 percent of cases. Policy guidelines for cleaning and disinfection are urgently needed in Jamaican health institutions. Education of health workers should stress appropriate selection, storage, and monitoring of the use of disinfectants and antiseptics. Pre-employment and in-service training of workers in infection control, including disinfectant use, is highly recommended (AU)

Health and socioeconomic status in St. Lucia

This dissertation examines the relationship between health status and socioeconomic status in St. Lucia. Data for the study were collected during a nationwide survey carried out in St Lucia in 1990. Using bivarite and multivariate analyses, the pattern of relationship between health and socioeconomic status was examined and defined. The analyses showed that there was a persistent pattern in the relationship between health and socioeconomic status generally, the higher the socioeconomic status of an individual, the better the health status. Recognizing that the link between health and socioeconomic status is the access to health facilities, the accessibility and utilization of the private and public health facilities by the various socioeconomic groups are also examined. The study reveals that the disadvantaged socioeconomic groups generally have more diabilities, possess less access to better quality care and utilize the public health care facilities more than the other socioeconomic groups. The study ends with some guidelines for future research in the Caribbean. (AU)

Analysis of admissions to a district primary care hospital in Dominica - abstract

As part of a series of studies on the Primary Health Care Services in the Marigot Health District, the medical records of the Marigot Hospital, a 23-bed primary care hospital were analyzed for patterns of morbidity and specific qualities of a primary care hospital, using the International Classification of Primary Care. From 1st October, 1991 to 30th September, 1992, a total of 608 admissions was registered, spending a total of 3328 nights. Duration of admission ranged from 1 to 105 days, with a mean of 5.5 and a median of 2 days. The average daily bed occupancy rate was 9.1. Nearly all admissions were ad hoc, mostly through the casualty department. The most frequent diagnoses on admission were mainly medical: hypertension, diabetes mellitus, asthma, seizure disorders and infectious diseases of skin, gastro-intestinal tract and respiratory system. The elderly population was admitted mainly for diabetes mellitus, hypertension and cellulitis, and stayed relatively long, whereas admissions for febrile diseases, respiratory tract infections and gastroenteritis were of short duration. The main concurrent diagnoses were diabetes mellitus and hypertension. Surgical and gynaecological cases are generally directly referred to the central Princess Margaret Hospital. Eight terminally ill patients spent on average of 32 days in the hospital. It is concluded that (district) primary care hosptials have distinctive qualities; at relatively low cost adequate care for most common medical and paediatric conditions, terminal care and post-operative care and rehabilitation can be provided. Primary care hospitals could be used more efficiently with improving liaising between primary and secondary levels of care and a more detailed definition of the position of primary care hospitals within the health care services (AU)

The quality of services offered at primary health care centres in Jamaica - abstract

It is imperative to assess the quality of services, especially prior to making any major organizational changes. Such assessments furnish a strong platform for planning. The objectives of this study were to identify the factors that would influence the degree of customer satisfaction. A survey was carried out over a ten-day period on a sample of 261 patients selected from seven primary health care centres within the parishes of Kingston and St. Andrew. The results revealed that three-quarters of the users of health centres lived within a radius of five miles. In addition, three-quarters of the respondents were knowledgeable about the type of health services available to them. Within this group, there were 79 percent of women respondents as compared to 65 percent of male respondents (p<0.05). Seventy percent of respondents had a positive attitude towards the fee-payment for services. The younger age group had a more positive attitude towards fee-payment than older respondents (p<0.001). Respondents with relatively high education levels also had more positive attitudes towards fee-payment than less educated respondents (p<0.01). Approximately 50 percent of the respondents reported being satisfied with the interpersonal relationship with doctors and nurses, while only 20 percent expressed satisfaction for the relationship with their pharmacists. Three-quarters of the respondents expressed their dissatisfaction with the physical facilities at the health centres. A high proportion (92 percent) of the clientele was dissatisfied with the health care delivery process. The health care receivers were moderately satisfied with the health services offered to them (AU)

Drug prescribing for diabetes mellitus in primary care: a comparison of public and private practice in three Caribbean countries - abstract

Examining the appropriateness of drug prescribing for people with diabetes mellitus in Caribbean countries is important because of the high cost of drug treatment, the potential for improved control of the disease and the possibility of reducing adverse side effects of treatment. This study examined patterns of drug prescribing for diabetes mellitus in public and private sector primary care settings in three Caribbean countries. The sample included 690 patients in Barbados (BDS, 24 percent private), 791 in Trinidad and Tobago (TT, 13 percent private) and 180 in Tortola (BVI, 31 percent private). Patients treated in public health care facilities were prescribed significantly more drugs than those treated in private practice. Few patients had diabetes mellitus managed by diet alone (8 percent public, 15 percent private). Metformin was rarely used as single agent therapy (3 percent public, 6 percent private). Most patients were treated with sulfonylurea drugs alone or in combination with metformin (75 percent public, 67 percent). The proportion of sulfonylurea prescriptions for chlorpropamide varied (Public: BVI 80 percent, TT 60 percent, BDS 10 percent; Private: BVI 41 percent, TT 28 percent, BDS 7 percent) as did prescriptions for gliclazide and glipizide (Public: BDS 41 percent, BVI 3 percent, TT 1 percent; Private: BVI 51 percent, BDS 46 percent, TT 19 percent). A high proportion of patients were treated for hypertension (public 49 percent, private 40 percent). In private practice, ACE inhibitors and diuretics were the most frequently prescribed drugs. In the public sector, Brinderin accounted for 53 percent of prescriptions in TT while thiazides, methyldopa, betablockers and ACE inhibitors were the most frequently prescribed drugs in BDS and BVI. These variations in prescribing practice among countries of the region suggest that factors other than patients' needs or the cost effectiveness of treatment are important in determining prescribing practices. Individual countries should examine how efficiency and effectiveness of drug use could be improved (AU)

Inventory management and forecasting methods in the parish of St. Catherine, Jamaica

This study was carried out among different categories of government health professionals who are responsible for the forecasting of supplies to perform their duties. The study investigated some basic aspects of inventory management and forecasting practices. Fifteen public health nurses, 13 staff nurses, 8 pharmacists, 6 dentist and 5 supplies officers from 2 hospitals, 26 health centres and 12 satellite clinics answered a slf administered questionnaire. The results indicate that there are various inventory management and forecasting practices among those health workers. Knowledge and formal training in inventory management was low for some professionals. There was a lack of involvement in the budgetary process for the supplies. Taking into account the findings of this study, it is suggested that there is a need for the improvement of the inventory management and forcasting system including the revision of the VEN/drug list and to encourage the health professionals to adhere to the VEN/drug list (AU)

Changes in material resource levels in Jamaica's primary health care services between 1984 and 1991/1992

Jamaica's primary health-care services have been in a process of development since the 1970s. In 1984, a large management study collected data on levels of material resources (basic facilities, utilities, furniture, equipment and supplies items). Since 1984, serious staff shortages have affected the services, and there have been economic constraints, as well as a major hurricane. In order to measure changes over subsequent years, data on material resources were again collected in 1991/1992, using the same sample of 65 types 2 and 3 health centres as in 1984. Data were collected by interview with health centre staff. Results, whilst showing various changes item-by-item, showed constancy or minor improvements overall in levels of resources. Type 2 health centres continued to have lower resource levels than type 3s, even though the methodology allowed for their different needs where appropriate. Staff members' opinions of condition and adequacy of resources had become more positive than before. It was concluded that, in terms of material resources, activities within the primary health-care sector have offset the adverse effects of the macro-environmental conditions affecting the health centres. This method of material resource monitoring has implications for quality assessment of health facilities in primary health-care (AU)