Cerebral palsy and developmental intellectual disability in children younger than 5 years: Findings from the GBD-WHO Rehabilitation Database 2019.

Objective: Children with developmental disabilities are associated with a high risk of poor school enrollment and educational attainment without timely and appropriate support. Epidemiological data on cerebral palsy and associated comorbidities required for policy intervention in global health are lacking. This paper set out to report the best available evidence on the global and regional prevalence of cerebral palsy (CP) and developmental intellectual disability and the associated "years lived with disability" (YLDs) among children under 5 years of age in 2019. Methods: We analyzed the collaborative 2019 Rehabilitation Database of the Global Burden of Disease (GBD) Study and World Health Organization for neurological and mental disorders available for 204 countries and territories. Point prevalence and YLDs with 95% uncertainty intervals (UI) are presented. Results: Globally, 8.1 million (7.1-9.2) or 1.2% of children under 5 years are estimated to have CP with 16.1 million (11.5-21.0) or 2.4% having intellectual disability. Over 98% resided in low-income and middle-income countries (LMICs). CP and intellectual disability accounted for 6.5% and 4.5% of the aggregate YLDs from all causes of adverse health outcomes respectively. African Region recorded the highest prevalence of CP (1.6%) while South-East Asia Region had the highest prevalence of intellectual disability. The top 10 countries accounted for 57.2% of the global prevalence of CP and 62.0% of the global prevalence of intellectual disability. Conclusion: Based on this Database, CP and intellectual disability are highly prevalent and associated with substantial YLDs among children under 5 years worldwide. Universal early detection and support services are warranted, particularly in LMICs to optimize school readiness for these children toward inclusive education as envisioned by the United Nations' Sustainable Development Goals.

Global Burden of Childhood Epilepsy, Intellectual Disability, and Sensory Impairments.

BACKGROUND: Estimates of children and adolescents with disabilities worldwide are needed to inform global intervention under the disability-inclusive provisions of the Sustainable Development Goals. We sought to update the most widely reported estimate of 93 million children <15 years with disabilities from the Global Burden of Disease Study 2004. METHODS: We analyzed Global Burden of Disease Study 2017 data on the prevalence of childhood epilepsy, intellectual disability, and vision or hearing loss and on years lived with disability (YLD) derived from systematic reviews, health surveys, hospital and claims databases, cohort studies, and disease-specific registries. Point estimates of the prevalence and YLD and the 95% uncertainty intervals (UIs) around the estimates were assessed. RESULTS: Globally, 291.2 million (11.2%) of the 2.6 billion children and adolescents (95% UI: 249.9-335.4 million) were estimated to have 1 of the 4 specified disabilities in 2017. The prevalence of these disabilities increased with age from 6.1% among children aged <1 year to 13.9% among adolescents aged 15 to 19 years. A total of 275.2 million (94.5%) lived in low- and middle-income countries, predominantly in South Asia and sub-Saharan Africa. The top 10 countries accounted for 62.3% of all children and adolescents with disabilities. These disabilities accounted for 28.9 million YLD or 19.9% of the overall 145.3 million (95% UI: 106.9-189.7) YLD from all causes among children and adolescents. CONCLUSIONS: The number of children and adolescents with these 4 disabilities is far higher than the 2004 estimate, increases from infancy to adolescence, and accounts for a substantial proportion of all-cause YLD.

Factors associated with elevated blood pressure or hypertension in Afro-Caribbean youth: a cross-sectional study.

BACKGROUND: Although several studies have identified risk factors for high blood pressure (BP), data from Afro-Caribbean populations are limited. Additionally, less is known about how putative risk factors operate in young adults and how social factors influence the risk of high BP. In this study, we estimated the relative risk for elevated BP or hypertension (EBP/HTN), defined as BP ≥ 120/80 mmHg, among young adults with putative cardiovascular disease (CVD) risk factors in Jamaica and evaluated whether relative risks differed by sex. METHODS: Data from 898 young adults, 18-20 years old, were analysed. BP was measured with a mercury sphygmomanometer after participants had been seated for 5 min. Anthropometric measurements were obtained, and glucose, lipids and insulin measured from a fasting venous blood sample. Data on socioeconomic status (SES) were obtained via questionnaire. CVD risk factor status was defined using standard cut-points or the upper quintile of the distribution where the numbers meeting standard cut-points were small. Relative risks were estimated using odds ratios (OR) from logistic regression models. RESULTS: Prevalence of EBP/HTN was 30% among males and 13% among females (p < 0.001 for sex difference). There was evidence for sex interaction in the relationship between EBP/HTN and some of risk factors (obesity and household possessions), therefore we report sex-specific analyses. In multivariable logistic regression models, factors independently associated with EBP/HTN among men were obesity (OR 8.48, 95% CI [2.64-27.2], p < 0.001), and high glucose (OR 2.01, CI [1.20-3.37], p = 0.008), while high HOMA-IR did not achieve statistical significance (OR 2.08, CI [0.94-4.58], p = 0.069). In similar models for women, high triglycerides (OR 1.98, CI [1.03-3.81], p = 0.040) and high HOMA-IR (OR 2.07, CI [1.03-4.12], p = 0.039) were positively associated with EBP/HTN. Lower SES was also associated with higher odds for EBP/HTN (OR 4.63, CI [1.31-16.4], p = 0.017, for moderate vs. high household possessions; OR 2.61, CI [0.70-9.77], p = 0.154 for low vs. high household possessions). Alcohol consumption was associated with lower odds of EBP/HTN among females only; OR 0.41 (CI [0.18-0.90], p = 0.026) for drinking <1 time per week vs. never drinkers, and OR 0.28 (CI [0.11-0.76], p = 0.012) for drinking ≥3 times per week vs. never drinkers. Physical activity was inversely associated with EBP/HTN in both males and females. CONCLUSION: Factors associated with EBP/HTN among Jamaican young adults include obesity, high glucose, high triglycerides and high HOMA-IR, with some significant differences by sex. Among women lower SES was positively associated with EBP/HTN, while moderate alcohol consumption was associated lower odds of EBP/HTN.

Dimensionality and psychometric invariance of the Youth Self-Report Form of the Child Behavior Checklist in cross-national settings.

The Youth Self-Report Form's (YSR's) factor model was derived from traditional exploratory factor analytical procedures. Assuming appropriate model specification, psychometrically invariant items, and that its items provide useful psychometric information across nations omitted from its normative samples, the YSR is widely used in cross-national studies of nonreferred children. Item response theory analytical procedures reveal (a) 2 dimensions partly overlapping with the YSR's Internalizing and Externalizing second-order factors; (b) variance (i.e., differential item functioning) in how well a few items discriminate for nonreferred children across two nations; and (c) variance in estimating severity levels in children with identical psychopathological severity cross-nationally. Addressing psychometric variance, limiting redundancy, and matching children's psychopathological severity levels with items measuring this severity might promote more accurate and economical assessment.

Is it prudent to administer all items for each Child Behavior Checklist cross-informant syndrome? Evaluating the psychometric properties of the Youth Self-Report dimensions with confirmatory factor analysis and item response theory.

Through surveying of children in 10 nations with parent, teacher, and Youth Self-Report (YSR) forms of the Child Behavior Checklist (CBCL), cross-informant syndromes (CISs) were derived and cross-validated by sample-dependent methodology. Generalizing CBCL syndromes and norms to nations excluded from its normative sample is problematic. This study used confirmatory factor analyses (CFAs) to test factor model fit for CISs on the YSR responses of 625 Jamaican children ages 11 to 18 years. Item response theory (IRT), a sample-independent methodology, was used to estimate the psychometric properties of individual items on each dimension. CFAs indicated poor to moderate model-to-data fit. Across all syndromes, IRT analyses revealed that more than 3/4 of the cross-informant items yielded little information. Eliminating such items could be cost effective in terms of administration time yet improve the measures discrimination across syndrome severity levels.

The status of early identification and early intervention in autism spectrum disorders in lower- and middle-income countries.

There is limited information on autism spectrum disorders from lower- and middle-income countries (LMIC). This paper reviews the status of early identification and early intervention for autism spectrum disorders in response to the article by Camarata (2014) . The PubMed database was searched to identify relevant epidemiological studies from LMIC. Seven studies from five countries were identified: Colombia, India, Jamaica, Jordan, and Mexico. The mean age of parental concern, at 21-24 months, and mean age of diagnosis, at 45-57 months, were similar in LMIC, but later than in high-income countries. Both country groups reported language disorder to be the symptom of initial concern. Similarities in biological aspects of the disorders were noted across LMIC and high-income countries. Comparable ages of identification and diagnosis across vastly different LMIC suggest limited resources to be the underlying contributory factor. Recommendations for improving early identification and intervention made by researchers in the LMIC are reported.

High-Sensitivity C-Reactive Protein is Related to Central Obesity and the Number of Metabolic Syndrome Components in Jamaican Young Adults.

BACKGROUND: High-sensitivity C-reactive protein (hsCRP) has been shown to predict cardiovascular disease (CVD) endpoints and is associated with CVD risk factors and the metabolic syndrome. This study evaluated the association between hsCRP and CVD risk factors among Afro-Caribbean young adults in Jamaica. METHODS: We conducted a cross-sectional analysis of data from the Jamaica 1986 Birth Cohort Study. Data were collected between 2005 and 2007 when participants were 18-20 years old. All participants completed an interviewer administered questionnaire and had anthropometric and blood pressure (BP) measurements performed. Fasting blood samples were collected for measurement of glucose, lipids, and hsCRP. Logistic regression models were used to identify factors independently associated with high hsCRP. RESULTS: Analyses included 342 men and 404 women with mean age 18.8 ± 0.6 years. Approximately 15% of the participants had high risk hsCRP (>3 mg/L), with a higher prevalence among women (20 vs. 9%; p < 0.001). The prevalence of elevated hsCRP increased with body mass index category, high waist circumference (WC), high triglycerides, low high density lipoprotein, and lower parental education among women, but only for high WC and lower parental education among men. In logistic regression models controlling for sex and parental education, high WC was associated with significantly higher odds of high hsCRP (OR 7.8, 95% CI 4.8-12.9, p < 0.001). In a similar model, high hsCRP was also associated with the number of metabolic syndrome components. Compared to participants with no metabolic syndrome component, having one metabolic syndrome component was associated with a twofold higher odds of high hsCRP (OR 2.2, 95% CI 1.3-3.8, p = 0.005), while having three components was associated with a 14-fold higher odds of high hsCRP (OR 13.5, 95% CI 2.4-76.0, p < 0.001). CONCLUSION: High hsCRP is common among Jamaican young adults and is strongly associated with central obesity and the number of metabolic syndrome components.

Appropriate waist circumference cut points for identifying insulin resistance in black youth: a cross sectional analysis of the 1986 Jamaica birth cohort.

BACKGROUND: While the International Diabetes Federation (IDF) has ethnic specific waist circumference (WC) cut-points for the metabolic syndrome for Asian populations it is not known whether the cut-points for black populations should differ from those for European populations. We examined the validity of IDF WC cut points for identifying insulin resistance (IR), the underlying cause of the metabolic syndrome, in predominantly black, young Jamaican adults. METHODS: Participants from a 1986 birth cohort were evaluated between 2005 and 2007 when they were 18-20 years old. Trained observers took anthropometric measurements and collected a fasting blood sample. IR was assessed using the homeostasis model assessment computer programme (HOMA-IR). Sex specific quartiles for IR were generated using HOMA-IR values and participants in the highest quartile were classified as "insulin resistant". Receiver operator characteristic (ROC) curves were used to estimate the best WC to identify insulin resistance. The sensitivity and specificity of these values were compared with the IDF recommended WC cut-points. RESULTS: Data from 707 participants (315 males; 392females) were analysed. In both sexes those with IR were more obese, had higher mean systolic blood pressure, glucose and triglycerides and lower mean HDL cholesterol. The WC was a good predictor of IR with an ROC area under the curve (95% CI) of 0.71(0.64,0.79) for men and 0.72(0.65,0.79) for women. Using the Youden Index (J) the best WC cut point for identifying IR in male participants was 82 cm (sensitivity 45%, specificity 93%, J 0.38) while the standard cut point of 94 cm had a sensitivity of 14% and specificity of 98% (J 0.12). In the female participants 82 cm was also a good cut point for identifying IR (sensitivity 52%, specificity 87%, J 0.39) and was similar to the standard IDF 80 cm cut point (sensitivity 53%, specificity 82%, J 0.35). CONCLUSIONS: The WC that identified IR in young black men is lower than the IDF recommended WC cut point. Sex differences in WC cut points for identifying IR were less marked in this population than in other ethnic groups.

Gender-specific birthweight for gestational age charts for the island of Jamaica - abstract

Previous authors have shown that when population-based surveys of the birthweight of newborns by gestational age are conducted with limited control of data collection, the birthweight of pre-term infants shows a bimodal distribution. This was also found during the 1986 Jamaican Perinatal Mortality and Morbidity Surveys, when birthweights were collected on some 10,000 live births occurring in Jamaica over a two-month period. A combination of statistical methods was used to overcome the inherent inaccuracies occurring during large surveys. First, for pre-term births the two normal distributions for birthweights by gestational age were determined for each gender, using moment estimators. The normal distribution with the lower mean birthweight was accepted as correct, that with the higher mean birthweights representing either inaccuracies of measurement or of documentation of the last menstrual period. Mean birthweights for gestational ages 26 to 44 weeks were then fitted to the best curve by regrssion analysis. In this way, gender-specific birthweight for gestational age charts for Jamaica were produced. The charts produced by applying statistical methods to population-based data were comparable to those obtained under more carefully controlled situations (AU)

Maternal stress associated with raising autistic children in Jamaica

OBJECTIVE: Our objective was to determine the level of stress associated with raising an autistic child in Jamaica, a developing nation with fewer available resources for affected families. METHODS: Fifty-two autistic children were identified through medical records of hospitals and private paediatricians, and from registers of special schools. Mothers completed the Parental Stress Index (PSI), the Brief Symptom Inventory (BSI) (a measure of mental health status), and a socioeconomic questionnaire. The PSI identified stress in two major domains, the Parent and Child Domains. It also included a life event stress scale. The severity of autism was assessed by using the Childhood Autism Rating Scale. Results were compared with national sample of healthy children, in which similar parent questionnaires had been completed. SPSS software version 7.5 was used for data analysis and a "p" value less than 0.05 was considered significant. The sample of autistic children consisted of 41 males (78.8 percent) and 11 females (21.2 percent) with a mean (ñ standard deviation) age of 6.5ñ3.7 years. The control group consisted of 72 males (50.3 percent) and 71 females (49.7 percent) with a mean/SD age of 6.0ñ0.4 years. RESULTS: Both study and control groups had similar Parent Domain scores, but parents of autistic children had significantly higher scores in the Child Domain (p<0.001). Mothers of non-autistic children obtained significantly higher scores in somatization, (p<0.001), depression (p<0.05), hostility (p<0.05) and paranoia (p<0.001) using the BSI Crowding (p<0.05), maternal level of education (p<0.05), and occupation (p<0.01) were significantly associated with stress in the control group, but not in the study group. The severity of autistic features (p<0.001) significantly contributed to stress associated with raising autistic children. Factors that did not significantly contribute to stress in either group included: socio-economic status, age and gender of the child, and stressful life events. CONCLUSIONS: Mothers of autistic children experienced significantly higher levels of stress than did mothers of non-autistic children. Parental stress was directly attributed to dificulties of the child (Child Domain), but not to parenting inadequacy (Parent domain). With autism on the increase, public services aimed at assissting parents by providing respite care and/or training in behaviour management will need to be developed. (AU)

Vision screening in Jamaican children

OBJECTIVE: To determine the prevalence of vision impairment in Jamaican pre-school children. METHODS: A national sample of Jamaican children at the end of the pre-school years was identified using the quarterly Jamaican Labour Force Survey. Each year, this survey identifies 500 pre-school children (1 percent of the national population) using a two-stage stratified random sampling process based on electoral divisions. Over two successive years, a 1 percent and a 0.5 percent sample of children were identified (n=750). A total of 302 children had their distance and near visual acuity assessed. Information on socio-economic status and the parental perception of children's vision was obtained by parental interview. RESULTS: 10.4 Percent of the children were identified as being in need of further ophthalmological referral using the American Academy Screening Guidelines. 4.1 percent of the children were diagnosed as having "low vision" according to the World Health Organization classification. 45.8 percent of the children were unable to identify letters and required lap-card use for evaluation of vision. No gender or socioeconomic differences were identified between those children requiring further ophthalmological assessment and those who did not (p<0.05). Parental perception of children's visual impairment was shown to be an unsatisfactory tool to assist in determining children at high risk for vision impairment. CONCLUSION: Based on the rates of children requiring further ophthalmological evaluation and the rates of low vision identified in this study, the abscence of identifiable risk factors and the inaccuracy of parental perception, all Jamaican pre-school children should be offered vision screening. The inability to identify letters demands that screening programmes must have facilities available for using lap-cards. (AU)

Meningitis in childhood - Bahamas 1979 - 1983

Meningitis is certaily one of the most notorious disease in infancy and childhood. While there have been numerous articles dealing with this subject in the medical literature, there has been no study of meningitis in the under 12 age group in the Bahamas. This publication presents a retrospective look at the experience at the Princess Margaret Hospital, Nassau, Bahamas 1979 -1983

Epidemiology of haemophilus influenzae invasive disease in Jamaica, 1990-1993

Haemophilus influenzae (H influenzae) invasive disease was studied retrospectively over a four-year period in children admitted to the Bustamante Hospital for Children in Kingston, Jamaica. A total of 86cases were identified. The mean estimated annual incidence of H influenzae invasive disease in Kingston and St. Andrew was 39 per 100,000 children under 5 years of age. The majority (77percent) of cases were in the under 2-year age group. A distinct seasonal pattern was noted, with a significantly higher proportion of patients (57-73percent) presenting in the cooler months. Meningitis was the most common clinical diagnosis, accounting for 76percent of the cases. Poor outcome was demonstrated in 21.5percent of patients with meningitis. Sensitivity testing of H influenzae isolates revealed a resistance rate of 26percent for ampicillin and 7percent for chloramphenicol. The epidemiological findings in this study provide reasonable guidelines for empiric antibiotic therapy and also support the need to seriously consider vaccine prophylaxis in Jamaican children.(Au)

Maternal and neonatal factors associated with poor cognitive outcomes at 11 years of age in a cohort of low birth weight infants in Jamaica

OBJECTIVE: To determine maternal and birth factors that are associated with poor cognitive outcome in a low-birth weight (LBW) cohort enrolled at birth and examined at 11 years of age. The identification of these factors will help to plan intervention strategies to improve cognitive outcomes in LBW infants. DESIGN AND METHODS: In September and October 1986, all Jamaican-born children were enrolled in the Jamaican Perinatal Mortality Survey. At that time, a Main Questionnaire, asking questions about maternal demographic, social, and medical conditions and reviewing aspects of the pregnancy, labour, and delivery, was administered. A geographical subset of children was examined for cognitive abilities at 11 years of age using the Peabody Picture Vocabulary Test and Ravens Progressive Matrices. Former LBW children were included in the testing even though they were outside of the geographical area. Of the 1569 children tested, 107 were former LBW infants. Linear regressiong models were developed associating variables from the Main Quesitionnaire with outcomes on the cognitive tests. Based on the regression models, a Nursery Checklist was developed that could be used to identify children for referral to early intervention programmes. RESULTS: Twenty-one (20 percent) of the 107 ex-LBW children performed two standard deviations below the mean of the entire cohort. Maternal and birth factors associated with poor outcome were: living in poor housing conditions, not taking prenatal iron, not working outside the home and the infant not crying at birth. The Nursery Checklist identified 90 percent of the infants with poor cognitive outcomes while only referring 56 percent of the LBW population to intervention services. CONCLUSION: The factors associated with poor cognitive outcome include two socio-economic factors, an indication of infant viability at birth, and a possible nutritional deficiency. These factors can be used to institute primary interventions to ameliorate these conditions and to identify children in need of secondary interventions in early childhood.(Au)

The epidemiology of Haemophilus influenzae invasive disease n the Kingston and St. Andrew Region, Jamaica - abstract

Haemophilus influenzae invasive disease was studied retrospectively over a four year period in children admitted to the Bustamante Hospital for Children in Kingston, Jamaica. A total of 86 cases wwere identified. The estimated annual incidence of H. influenzae invasive disease in Kingston and St Andrew ranged from 39 to 45 per 100,000 children <5 years of age. The majority (77 percent ) of cases were in the < 2 year age group. A distinct seasonal pattern was noted, with a significantly higher proportion of patients (57 - 73 percent ) presenting in the cooler months. Similar seasonal variations have been described in the literature. Meningitis was the most clinical diagnosis, accounting for 76 percent of the cases. Poor outcome was demonstrated in 21.5 percent of patients with meningitis. Sensitivity testing of Haemophilus isolates revealed a resistance rate oof 26 percent for ampicillin and 7 percent for chloramphenicol. The epidemiological findings in this study do not differ significantly from those described in the literature for many developed countries. (AU)

The prevalence and perception of child abuse in Jamaica

In Jamaica, reporting of child abuse is not mandatory and reported cases are typically extreme. This study was designed to determine the true prevalence, nature and perception of all forms of abuse, including events unlikely to be reported. A representative sample of 156 mothers from three Child Welfare Clinics (two public and one private) were chosen. Information was obtained by a culture specific questionnaire, requesting women to report their own experiences when under 12-years of age. Apart from demographic information, specific questions were asked to elicit events of minor and major physical abuse, emotional abuse, and neglect (physical and emotional). The questionnaire was administered by 3 interviewers with an interobserver reliability of 95 percent. Data were processed by SPSS, using Chi-squared-Mantel Haenszel and Fisher's exact test. Seventy-one point four percent (71.4 per cent) of women experienced some form of abuse with physical, emotional and sexual abuse occurring in 53 percent, 33 percent and 10 percent, respectively. Forty-seven percent (47 per cent) experienced neglect, 38 percent physical and 19 percent emotional. There was a strong association between major and minor physical abuse (p trend < 0.001). Multiple forms of abuse were common with 18 percent, 20 percent, 4 percent experiencing two, three, and four forms of abuse, respectively. No significant differences occurred in prevalence of abuse by age or site, though there were striking demographic differences among mothers. Of women identified as being abused, perception was low, ranging from 26 percent for physical abuse to 58 percent emotional abuse (p < 0.0001). In this population, child abuse in all forms was prevalent, pervasive and persistent over time. Low levels of perception suggest cultural acceptance of abuse, particularly physical abuse, the majority of which was minor. However, minor abuse predicted more severe events. Relatively low levels of emotional neglect suggest a caring population that may be amenable to intervention through education with regard to the effects of abuse and alternative methods of discipline (AU)

Epidemiology of haemophilus influenzae invasive disease in Jamaica, 1990-1993

Haemophilus influenzae (H influenzae) invasive disease was studied retrospectively over a four-year period in children admitted to the Bustamante Hospital for Children in Kingston, Jamaica. A total of 86cases were identified. The mean estimated annual incidence of H influenzae invasive disease in Kingston and St. Andrew was 39 per 100,000 children under 5 years of age. The majority (77percent) of cases were in the under 2-year age group. A distinct seasonal pattern was noted, with a significantly higher proportion of patients (57-73percent) presenting in the cooler months. Meningitis was the most common clinical diagnosis, accounting for 76percent of the cases. Poor outcome was demonstrated in 21.5percent of patients with meningitis. Sensitivity testing of H influenzae isolates revealed a resistance rate of 26percent for ampicillin and 7percent for chloramphenicol. The epidemiological findings in this study provide reasonable guidelines for empiric antibiotic therapy and also support the need to seriously consider vaccine prophylaxis in Jamaican children.

Maternal lifestyle and pregnancy outcome in Jamaica: the effects of cigarette and marijuana smoking, alcohol use and sexual activity

Cigarette smoking, marijuana and alcohol use, and coital activity have been investigated for effect on foetal birth weight and gestation chiefly in developed countries. Apart from the relationship between cigarette smoking and heavy alcohol intake and growth retardation, the evidence for poor birth outcome is controversial. Little is known of the effect of these lifestyle factors in developing countries where poor pregnancy outcome is common. Using data from a population based perinatal study in Jamaica, the effect of lifestyle factors was ivestigated in 8486 babies. Data collected by midwives at birth included the date of the last menstrual period, socio-demographic characteristics and frequency of tobacco, marijuana and alcohol use during pregnancy, as well as coital frequency at quickening and at delivery. Babies were weighed and measured. Live birth outcomes investigated were low birth weight, preterm birth and growth retardation, with population rates of 10.1 percent, 8.7 percent and 9.7 percent, respectively. Data were processed using SPSS and BMDP statistical packages. The prevalence of cigarette, marijuana and alcohol use was 7.0 percent, 2.1 percent and 16.4 percent respectively. 74 percent and 27 percent of women were having sexual intercourse at quickening and in the week prior to delivery, respectively. Apart from coital frequency at quickening, life style factors were strongly associated with each other. All life style factors were associated with social class. On univate analysis, significant associations were found between cigarette smoking and low birth weight (p,0.04) and growth retardation ,0.05). Association between marijuana use and low birth weight and between alcohol use and lower incidence of preterm birth failed to reach significance (p=0.05, p=0.16). When stratified by frequency of use, there was a significant trend in both cases (p<0.05, p<0.04). After controlling for socio-demographic characteristics and other life style factors, associations were maintained between cigarette smoking and low birth weight. Foetal effects of maternal cigarette smoking are present even in al low prevalence country. The effect of marijuana use is less conclusive, but the data suggest that this activity may be detrimental to the foetus. (Au)

Neonatal mortality determinants in Jamaica - abstract

The Perinatal Survey included among its objectives the quantification of the island's neonatal mortality rate, the identification of the causes of these deaths and the determination of characteristics of both mother and infant that are associated with an increased risk of death, so that intervention and reduction would be possible. Data were collected on babies born between September 1986 and August 1987 and who died in the first 28 days of life, anywhere in Jamaica. Postmortems were performed where feasible. A death questionnaire provided information on date, place and time of death, age of mother and classification of death by the Wigglesworth method. Additional social, environmental, medical, obstetric and neonatal data were included on a main questionnaire. Data from the death questionnaire were analyzed, using SPSS. There were 950 neonatal deaths identified over the 12-month period of study. The neonatal mortality was 17.9 per 1,000 live births, with the early and late neonatal mortality rates being 16.0 and 1.9 per 1,000 respectively. The major contributors to neonatal death were prematurity and perinatal asphyxia (73.5 percent). The majority of deaths (56.2 percent) occurred in the first day of life. Twins had a sevenfold greater risk of dying than singletons, with 58.6 per cent of deaths among second twins. One-third of neonatal deaths were to teenage mothers although they accounted for 26 percent of total births. Babies born to mothers under 15 years of age were four times more likely to die than infants of mothers 25 - 29 years of age. The neonatal death rate in Jamaica is high with room for improvement, particularly in the prevention of perinatal asphyxia and the early identification and management of mothers whose infants are at high risk of neonatal death (AU)

The effects of the environment on autistic spectrum disorder in Jamaica

OBJECTIVE: The prevalence of autistic disorder has been rising worldwide. This disorder is believed to have a genetic basis with an environmental trigger. The clinical presentation has features that are similar to mercury poisoning, suggesting a probable environmental trigger. This paper investigates the relationship between environmental contaminants/toxins, including mercury, and autistic disorder in Jamaica. METHODS: Autistic children were identified from public and private hospital records and from records of special schools. Fifty-eight parents of autistic children completed a questionnaire about their environment and frequency of exposure to harmful chemicals and contaminants during pregnancy and prior to diagnosis. The childhood Autism Rating Scale determined the severity of autistic disorder. The relationship between the severity of autism and different environmental factors was analyzed using the chi-squared test. RESULTS: The meanñStandard Deviation age of autistic children was 6.5ñ3.7 years. There were 79 percent male and 21 percent female. Although there were rates of autism calculated by parish, there are no known apparent links between the geographical region and severity of autism. Sixty percent of the population had changed their address since birth. No association was found between use of common household chemicals (eg bleach, disinfectant), residence close to possible environmental contaminants (eg garbage dumps, factories, bodies of water) and autism, either during pregnancy or prior to diagnosis. A single case of exposure to mercury during pregnancy associated with severe autism was identified. CONCLUSIONS: This study was unable to identify any associations between a number of environmental agents and the severity of autism. The single case of mercury exposure during pregnancy warrants further investigation of this association with a larger sample size (AU)