Emergence of zika virus epidemic and the national response in Jamaica

BACKGROUND: Jamaica, along with the Americas, experienced major epidemics of arboviral diseases transmitted by the Aedes aegypti mosquito in recent years. These include dengue fever in 2012, Chikungunya fever in 2014 and Zika virus infection (ZIKV) in 2016. We present the emergence of the ZIKV epidemic in Jamaica and outline the national response. METHODS: The Ministry of Health's preparedness included: heightened surveillance, clinical management guidance, vector control and management, laboratory capacity strengthening, training and staffing, risk communication and public education, social mobilization, inter-sectoral collaboration, resource mobilization and international cooperation. RESULTS: The first case of ZIKV was confirmed on January 29, 2016 with date of onset of January 17, 2016. From January 3 to July 30, 2016 (Epidemiological Week (EW) 1-30), 4648 cases of ZIKV were recorded (4576 suspected, 72 laboratory-confirmed). Leading symptoms were similar among suspected and confirmed cases: rash (71% and 88%), fever (65% and 53%) and joint pains (47% and 38%). There were 17 suspected cases of Guillain Barre syndrome; 383 were reported in pregnant women, with no reports of microcephaly to date. Zika and dengue viruses were circulating predominantly in 2016. At EW30, 1744 cases of dengue were recorded (1661 suspected and 83 confirmed). Dengue serotypes 3 and 4 were circulating with 121 reports of dengue haemorrhagic fever...(AU) CONCLUSION:The possibility exists for endemicity of ZIKV similar to dengue and chikungunya in Jamaica. A ZIKV vaccine, similar to the dengue and chikungunya vaccines, is needed to be fast-tracked into clinical trials to mitigate the effects of this disease.

Chikungunya in Jamaica: Public health effects and clinical features in children / Chikungunya en Jamaica ­ Efectos en la Salud Pública y Características Clínicas en Niños

Chikungunya virus (CHIKV) entered the Caribbean for the first time in 2013 and Jamaica experienced its maiden epidemic with Chikungunya Fever in 2014. We aimed to describe the public health effects and describe the clinical features in children and adolescents in Jamaica. METHODS: This study reviewed the public health effects of the illness in Jamaica by reviewing available data sources and the clinical features in 210 children and adolescents meeting the case definition at two hospitals, Bustamante Hospital for Children and University Hospital of the West Indies between August 23 and October 31, 2014 by chart review. Descriptive analyses and comparisons between groups using the Mann-Whitney U test were performed with SPSS version 22. RESULTS: The majority of households were affected by the illness which caused widespread absenteeism from school and work, loss of productivity and economic losses estimated at 60 billion dollars. The health sector was impacted by increased numbers seen in clinics and emergency departments, increased need for bed space and pharmaceuticals. Ninety-nine per cent of the children were febrile with a median maximal temperature of 102.4 F. Ninety-three per cent had household contacts of 0­20 persons. In addition to fever, maculopapular rash and joint pains, infants six months and younger presented with irritability and groaning (p = 0.00) and those between six months and six years presented with febrile seizures (p = 0.00). Neurologic involvement was noted in 24%. Apart from anaemia, few had other laboratory derangements. Few had severe organ dysfunction and there were no deaths. CONCLUSION: The Chikungunya Fever epidemic had significant public health and economic impact in Jamaica. In children, there were characteristic presentations in neonates and young infants and in children six months to six years. Neurologic involvement was common but other organ dysfunction was rare. These findings underscore the need to prevent further epidemics and the quest for a vaccine.(AU)

Antecedentes: El virus de Chikungunya (CHIKV) entró en el Caribe por primera vez en 2013, y Jamaica experimentó su primera epidemia de fiebre de Chikungunya en 2014. Nos propusimos como objetivo describir sus efectos en la salud pública y describir sus características clínicas en niños y adolescentes en Jamaica. Métodos: Este estudio examinó los efectos de la enfermedad en la salud pública en Jamaica. El examen se realizó mediante la revisión de fuentes de datos disponibles y las características clínicas en 210 niños y adolescentes que cumplían con la definición del caso en dos hospitales ­ Hospital Pediátrico Bustamante y el Hospital Universitario de West Indies ­ entre el 23 de agosto y 31 de octubre de 201, según las historias clínicas. Se realizaron análisis descriptivos y comparaciones entre los grupos usando la prueba U de Mann-Whitney y la versión 22 de SPSS Resultados: La mayoría de los hogares fueron afectados por la enfermedad, que causó un ausentismo generalizado en escuelas y trabajos, pérdida de productividad, y pérdidas económicas estimadas en 60 billones de dólares. El sector de la salud fue afectado por un aumento del número de personas atendidas en clínicas y departamentos de urgencias, y una mayor necesidad de camas en los hospitales y productos farmacéuticos. Noventa y nueve por ciento de los niños presentaron un estado febril con una temperatura mediana máxima de 102.4 F. Un noventa y tres por ciento tuvo contactos domésticos de personas de 0­20. Además de fiebre, erupciones maculopapulares y dolores en las articulaciones, los niños de seis meses o menos edad, presentaron irritabilidad y quejidos (p = 0.00), y aquellos entre seis meses y seis años de edad presentaron convulsiones febriles (p = 0.00). Se observó compromiso neurológico en el 24%. Aparte de anemia, algunos tenían otros trastornos de laboratorio. Otros presentaban una disfunción orgánica severa y no hubo muertes. Conclusión: La epidemia de fiebre de Chikungunya tuvo un impacto significativo tanto en la salud pública como en la economía de Jamaica. Los niños presentaron manifestaciones características, observadas tanto en recién nacidos y bebés pequeños como en niños de seis meses a seis años. El compromiso neurológico fue común, pero cualquiera otra disfunción orgánica fue rara. Estos hallazgos subrayan la necesidad de hacer más por evitar las epidemias y buscar la solución de una vacuna.(AU)

COVID-19 Stressors among Dental Academics at UWI­A Caribbean Perspective

COVID-19 is a pandemic that has a ected health care personnel worldwide. Dentists have a high risk of contracting COVID-19 given the face-to-face contact required in daily interactions with their patients. This study aimed to determine the stressors experienced by academic dentists due to the COVID-19 situation in Trinidad and Jamaica. All academic staff at the University of the West Indies (UWI) dental schools (St. Augustine and Mona campuses) were invited to complete a self-reported questionnaire, which was conducted for one month from May to June 2020. Thirty-two dental academics responded and the response rate was 61.54%. More than a third (34.4%) were in the 25­35 age group, 71.9% were females. The most common speciality (20.7%) was restorative dentistry. Just over one-third (38.7%) had been in academia for 5­10 years. Most (40.6%) were apprehensive about infecting their family. When the locus of control was determined, just over half (53.1%) felt they were in control of protecting themselves while 34.4% felt that external factors controlled their lives. The findings suggest that academic sta at UWI dental schools (Trinidad and Jamaica) were stressed by the COVID-19 situation. The vast majority were worried about infecting their families.

Cadmium in Jamaican bush teas

Samples of Jamaican plants used as bush teas were collected from households in high soil-cadmium (Cd)areas of central Jamaica and analysed by graphite furnace atomic absorption spectrophotometry for totalcadmium and for cadmium extractable with a hot water brew as prepared for human consumption to determinetheir contribution to dietary cadmium exposure. The concentrations ranged from < 0.03 to 6.85ìg/g for total Cd, between 1 and 15% of which was extracted with a hot water brew. One cup (200 ml)of the teas examined was found to contain < 0.04–1.18 ìg of Cd and would contribute 0.1 – 0.3 ìg of Cdto a person’s dietary intake. This is significantly below the provisional tolerable weekly intake (PTWI)of 7 ìg Cd/kg body weight established by theWorld Health Organization (WHO). While this suggests thatbush tea consumption does not contribute significantly to the PTWI, some of the teas examined exceed theWHO recommendation of less than 0.3 mg/kg Cd for medicinal plants.

The efficacy of premarin versus ketoconazole on prostate-specific antigen responses in castrate-resistant prostate cancer in Jamaica

OBJECTIVES: Premarin and ketoconazole are affordable secondary hormonal options available for castrate-resistant prostate cancer (CRPC) in Jamaica. The aim of this study was to compare the relative efficacy of both drugs to decrease prostate-specific antigen (PSA) in CRPC in a population of patients of predominantly African escent. SUBJECTS AND METHODS: This study retrospectively identified patients with CRPC that presented to the University Hospital of the West Indies (January 1, 2009-December 31, 2013) and patients from a private urology clinic (November 2, 2005-June 3, 2015). The primary endpoint was to identify the proportion of patients with a decline of ¡Ý 50% in PSA level after treatment. The relative efficacy was assessed by the time to progression (TTP), an increase in PSA of 25% above nadir with PSA progression defined by Prostate Cancer Clinical Trials Working Group2 criteria. RESULTS: Thirty-five patients diagnosed with CRPC were identified; 32 initially treated with premarin and three with ketoconazole. Nine of the patients initially on premarin were crossed over to the ketoconazole treatment roup, bringing to twelve the patients treated with ketoconazole. Decline in PSA of ¡Ý 50% was observed in 43.8% (14 of32) and 25% (3 of 12) of patients on premarin and ketoconazole, respectively. The median (95% CI) TTP for patients treated with premarin was 24.00 (19.28, 28.724)months and ketoconazole was 13.54 (1.66, 25.41) months with no statistically significant difference between the groups (p = 0.107; log rank test). CONCLUSION: The study did not identify differences in the relative efficacy between premarin and ketoconazole in treating patients with CRPC.

Analysing the HIV care cascade: a site-level examination of viral load suppression in Kingston, Jamaica

OBJECTIVE: To analyse the HIV care cascade at the site level at the University Hospital of the West Indies,Kingston, Jamaica. SUBJECTS AND METHODS: This was a retrospective analysis of the national HIV treatment database for all entries between the years 2010 and 2013 identifying the key stepsin the HIV care cascade with an increased focus on parameters influencing viral load suppression. Proportions by classic cascade denominator and new denominators were calculated. Equality of proportions, with corresponding p-values and confidence intervals, was used to assess cascade step differences. RESULTS: Total enrolment in the clinic increased over the period (from 1206 to 1472 patients), as did number of patients receiving antiretroviral therapy [ART] (from 879to 1199). Using the classic denominator approach, significant increases were seen for patients on ART (8.4%,95% CI 0.053, 0.127) and significant declines were seen in viral load samples collected (-5.1%, 95% CI -0.099,-0.001) and viral load results returned (-12.1%, 95% CI-0.164, -0.056). No significant changes were identified in patients engaged in care (p = 0.885) or viral load suppression(p = 0.124). New denominator analysis showed significant changes in patients on ART engaged in care,-9.4% (95% CI -0.116, -0.072), as well as viral load suppression for patients on ART, 7.9% (95% CI 0.009,0.148). CONCLUSIONS: Site-level data can increase the detail included in the HIV care cascade and avoid limitations of the classic cascade. Site-level analysis can provide greater insight into the factors affecting patient outcomes and furnish the required data

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

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

Risk factors for postpartum depression among women attending postnatal clinics in Kingston, Jamaica

OBJECTIVES: To measure the prevalence of postpartum depression among women attending postnatal clinics in Kingston, Jamaica, and to determine the risk factors associated with the occurrence of postpartum depression in this population. SUBJECTS AND METHODS: This study was cross-sectional, and surveyed 132 women. The survey was conducted among postnatal women who attended the postnatal clinic at the Victoria Jubilee Hospital (VJH), the University Hospital of West Indies and several government health centres in Kingston during the months of July–September 2015. The survey instrument was a field tested interviewer-assisted questionnaire to which the Edinburgh Postnatal Depression Scale was incorporated to indicate the presence of depressive symptoms among the respondents. RESULTS: The prevalence of postpartum depression among the women in this study is estimated to be 47.7%. Mothers who had a life event with a significant negative impact were 2.7 times more likely to have postpartum depressive symptoms than those who did not (OR = 2.7; 95% CI 1.02,7.17; p = 0.046), and mothers who were unemployed were 60% more likely to develop postpartum depressive symptoms than those who were employed (OR = 1.60; 95% CI1.17, 2.18; p = 0.003).CONCLUSION: The prevalence of postpartum depressive symptoms in the Jamaican population of postpartum women in this study is higher than previous estimates andhigher than the World Health Organization estimates(2015). Studies should be undertaken with larger sample sizes to unearth further risk factors that may predispose women to postpartum depressive symptoms in Jamaica.

Socio-economic health disparities in tobacco smoking among Afro-Caribbean adults: Findings from the Jamaica Health and Lifestyle Survey 2007–2008

OBJECTIVES: To evaluate whether education attainment oroccupation class was associated with the prevalence of tobacco smoking among Jamaican adults. SUBJECTS AND METHODS: This study was a secondary analysis of data collected from the Jamaica Health and Lifestyle Survey 2007–2008 (JHLS-II) and included participants who were 25–74 years old. Data on current tobacco smoking, highest educational attainment and usual occupation were collected using an interviewer-administered questionnaire. Poisson regression models were used to estimate sex-specific, age-adjusted prevalence and prevalence ratios (PR). RESULTS: Analyses included 2299 participants (696 men,1603 women) with mean age of 42.9 years. Prevalence of current smoking among men and women was 25.8% and 7.8%, respectively (p < 0.001). Age-adjusted prevalence of current smoking in men was highest in the primary education group (36.5%) and lowest in the post-secondary education group (10.2%), p (trend) = 0.003. Among women, prevalence was highest among those with junior secondary education (10.2%) and lowest among those with primary education (4.7%), p (trend) = 0.014. Using post secondary education as the reference category, age adjusted PR showed statistically significant two- to three fold higher prevalence of current smoking for all the lower education groups among men. Prevalence ratios for women were lower and not statistically significant. Disparity patterns for occupation were similar, with statistically significant higher age-adjusted prevalence among men in the lower occupational categories, but not among women. CONCLUSION: There are large socio-economic disparities in tobacco smoking among men, but less so among women in Jamaica. Interventions to reduce smoking should consider these socio-economic disparities.

Dogs and goats as sentinels for environmental lead burden in Caribbean basin islands: Jamaica West Indies

Ingested/inhaled environmental lead (Pb) continues to pose a health risk to humans (children in particular) and animals. Automobile emissions from leaded gasoline combustion (less of a problem today with the phasing out of leaded gasoline), lead contaminated foods, soil and water, lead-based paints, ceramics, batteries (more frequently encountered today), and possible electronic waste, remain major sources of environmental lead. In a study carried out in Jamaica, West Indies, blood samples from dogs (n=63 at 5 locations) and goats (n=46 at 4 locations) were collected in lead-free (EDTA) tubes and analyzed by graphite furnace atomic absorption spectrometry (GFAAS) for lead. The analytical method detection limit was 0.24 μg/dl. Overall (blood lead) PbB concentrations were 2.83 ñ 2.96 μg/dl (dogs), and 1.02 ñ 0:10 μg/dl (goats). There were significant differences among locations, and. in a location of high automobile and plant foliage/grass forage density, PbB levels were 7.03 ñ 2.96 μg/dl (n=8) and 1.91 ñ 0.83 μg/d1 (n=10) in dogs and goats respectively. Although sample sizes are small the results suggest the use of dogs and goats as sentinels for evaluating environmental lead in developing countries.

Epidemiology of tetanus in Jamaica, 1993–2010

BACKGROUND: Although tetanus is still endemic in Jamaica, the epidemiologic profile has not been evaluated. METHODS: Admission registers at the main tertiary referral hospital were accessed to identify all patients diagnosed with tetanus from 1 January 1993 to 1 December 2010. RESULTS: There were 26 cases of tetanus (annual incidence of 0.57 cases per 1,000,000 population). Tetanus was more common in men (5.2:1) at a mean age of 59 ± 18.1 years. Persons in high-risk occupations (farmers, gardeners and construction workers) accounted for 52% of cases. CONCLUSION: Tetanus remains endemic in Jamaica, occurring more commonly in elderly men. Doctors should be educated about the importance of a high index of suspicion, an immunisation history and promoting booster shots in high-risk groups.

Aedes aegypti in Jamaica, West Indies: container productivity profiles to inform control strategies

OBJECTIVE: To describe the Aedes aegypti container profile in the three parishes of Portland, St. Anns and St. Catherine, Jamaica.METHOD: Traditional stegomyia and pupae per person indices.RESULTS: A total of 8855 containers were inspected. A. aegypti were breeding in 19.2% of the 4728 containers in Portland, in 6.7% of the 2639 containers in St. Ann, and in 27.2% of the 1488 containers in Tryhall Heights, St. Catherine. Container types differed between Portland (P > 0.02) on one hand and St. Ann and Tryhall Heights, St. Catherine on the other hand: there were with no vases or potted plants with water saucers in St. Ann and St. Catherine. A. aegypti were breeding in more containers in St. Catherine (38%) (38% in wet season and 21% in the dry season) than in Portland (19%) or St. Ann (6%), both of which had more containers but A. aegypti breeding in fewer: 17.7% and 11.2% in the wet and 20.4% and 3.5% in the dry seasons respectively. The daily production of adult mosquitoes in the three study sites was 1.51, 1.29 and 0.66 adult female mosquitoes per person in Portland, St. Ann and St. Catherine during the dry season and 1.12, 0.23 and 1.04 female mosquitoes per person in the wet season respectively.CONCLUSION: All three communities are at risk for dengue outbreaks and vector control should concentrate on reducing the mosquito populations from the most productive containers before a new dengue virus serotype is introduced into Jamaica.

HIV-1 epidemic in the Caribbean is dominated by subtype B.

BACKGROUND: The molecular epidemiology of HIV-1 in the Caribbean has been described using partial genome sequencing; subtype B is the most common subtype in multiple countries. To expand our knowledge of this, nearly full genome amplification, sequencing and analysis was conducted. METHODOLOGY/PRINCIPAL FINDINGS: Virion RNA from sera collected in Haiti, Dominican Republic, Jamaica and Trinidad and Tobago were reverse transcribed, PCR amplified, sequenced and phylogenetically analyzed. Nearly full genomes were completed for 15 strains; partial pol was done for 67 strains. All but one of the 67 strains analyzed in pol were subtype B; the exception was a unique recombinant of subtypes B and C collected in the Dominican Republic. Of the nearly full genomes of 14 strains that were subtype B in pol, all were subtype B from one end of the genome to the other and not inter-subtype recombinants. Surprisingly, the Caribbean subtype B strains clustered significantly with each other and separate from subtype B from other parts of the pandemic. CONCLUSIONS: The more complete analysis of HIV-1 from 4 Caribbean countries confirms previous research using partial genome analysis that the predominant subtype in circulation was subtype B. The Caribbean strains are phylogenetically distinct from other subtype B strains although the biological meaning of this finding is unclear.

Informed consent from patients participating in medical education: a survey from a university hospital in Jamaica

BACKGROUND: Medical students at the University of the West Indies receive clinical training by passing through a series of hospital rotations at the University Hospital of the West Indies (UHWI). Many of these patients are unaware that medical students may be involved in their care. We performed this study to determine patient awareness and their willingness to participate in research and teaching activities. FINDINGS: All consecutive patients admitted to the UHWI between May 1, 2006 and May 29, 2006 who required elective or emergency surgical procedures were prospectively identified These patients were interviewed using a standardised pre-tested questionnaire about their knowledge and willingness to have medical students participate in the delivery of their hospital care. Data was analyzed using SPSS Version 12.0. There were 83 (39.5%) males and 127 (60.5%) females interviewed. The patients were unaware of the grade of the medical professional performing their interview/examination at admission in 157 (74.8%) cases or the grade of medical professional performing their operations in 101 (48.1%) cases. Only 14 (6.7%) patients were specifically asked to allow medical students to be present during their clinical evaluation and care. When specifically asked, 1 patient declined. Had they been asked, 196 (93.3%) patients would have voluntarily allowed medical student involvement. Only 90 (42.9%) patients were made aware that they were admitted to an academic centre with research interests. Only 6 (6.7%) patients declined. Had they been asked, 84 (93.3%) patients would be willing to participate in teaching or research projects. CONCLUSIONS: As medical educators, we are responsible to adhere to ethical and legal guidelines when we interact with patients. It is apparent that there is urgent need for policy development at the UWI to guide clinicians and students on their interactions with patients.

Extraordinary 5-year CapEx for health plan 2019-2024

The document details Capital Expenditure that the Ministry of Health will undertake in the five year period 2019-2024.

The burden of gestational diabetes mellitus in Jamaican women with a family history of autosomal dominant type 2 diabetes

OBJECTIVES: To determine if Jamaican women of African descent with a family history of early onset autosomal dominant type 2 diabetes have greater odds of developing gestational diabetes mellitus (GDM) than those without a family history of the disease. METHODS: A comparative study was conducted of two groups of pregnant Jamaican women: the first with a family history of early onset autosomal dominant type 2 diabetes; the second with no history of the disease. Incidence, odds for developing GDM, and metabolic profiles in first and second trimesters were assessed using SPSS 11.5 (SPSS Inc., Chicago, Illinois, United States). RESULTS: The incidence of GDM was 12.0 percent in women with a family history of early onset autosomal dominant type 2 diabetes and 1.5 percent in women without a family history of the disease (P < 0.05). Women with a family history were nine times more likely to develop GDM than those without a family history of diabetes (95 percent confidence interval: 5.00–16.38, P < 0.0001). CONCLUSION: Family history of early onset autosomal dominant type 2 diabetes appears to increase susceptibility to GDM in Jamaican women. Pregnant women of any age with family history of early onset autosomal type 2 diabetes should be screened for GDM.

Internalizing stigma associated with mental illness: findings from a general population survey in Jamaica

OBJECTIVES. The culture of stigma associated with mental illness is particularly intense when persons who are normally victims of that stigmatization (mentally ill persons and their family members) themselves act negatively toward others whom they associate with mental illness. We attempt to determine the extent of this internalization and assimilation of stigmatizing attitudes, cognitions, and behaviors in persons who are at risk for such stigmatization in Jamaica. METHODS. Data from a 2006 national survey on mental health were analyzed. Demographic variables, the presence or absence of mental illness in respondents and in their family members, and responses pertaining to behaviors and attitudes toward mentally ill persons were examined. Subsamples (respondents with mental illness, respondents with a family member with mental illness, respondents with neither) were compared using the chi-square test. RESULTS. Respondents with family members with mental illness were less likely to demonstrate a number of different manifestations of stigmatization than others (P = 0.009–0.019). Respondents with mental illness showed no difference in the demonstration of a number of different manifestations of stigmatization from other respondents (P = 0.069–0.515). CONCLUSIONS. The small number of mentally ill respondents resulted in low statistical power for demonstrating differences between that subgroup and other respondents. The significantly more positive attitudes and behavior of respondents with family members with mental illness suggest that some benefit may be gained by creating more opportunities for the general public to interact with persons with mental illness.

Surgeries in public hospitals

This publication presents a special feature on surgeries performed in public hospitals for the reference period, January to March 2017. Readers will find the 22% percent reduction in live births (compared to similar period in 2016) an interesting observation, particularly when viewed against the background of the Zika outbreak and the encouragement to families to delay pregnancies.

Violence among youth in Jamaica: a growing public health risk and challenge

Although the overwhelming majority of Jamaican children and adolescents are well adjusted, a substantial group exhibits high levels of maladjustment and deficient functioning (1). A perfunctory review of Jamaican newspapers and television talk-shows reveals that violence, particularly violence perpetrated by youths, is of major concern in every sector of Jamaican society. Although aggressive and violent behaviors are not new in Jamaica, the recent escalation of criminal violence among the adolescent population has become a major public policy issue and a serious public health problem. Violent activities have become more vicious and the perpetrators more ruthless than what the typical Jamaican over 40 years of age is used to (M. Jones, Social Scientist, personal communication, 8 March 2006). The purpose of this article is to review the relevant literature, describe the existing knowledge regarding aggression and violence among children and youth in the Jamaican context, and evaluate the plausibility of popular assumptions regarding the correlates of aggressive and violent outcomes in Jamaican children and youth. This article assesses the relationship between ecological processes and youth outcomes in Jamaica and is organized in the following manner: the first section addresses the incidence of violence and its impact on society; the next section focuses on the overall conceptual framework and its usefulness in assessing child outcomes in the Jamaican context. Pursuant to that, the individual attributes of violent outcomes are addressed, as well as two levels of the ecological environment: the proximal (near) environment and the distal (far) environment. In the proximal context, the issue of parental involvement is addressed as two separate issues: father absence and mother absence. This is because a substantial number of Jamaican children, historically, have not had "involved" fathers ... final section summarizes, discusses implications for policy decision making

The church's response to sexual reproductive health issues among youths: Jamaica's experience

This study evaluated the response of religious denominations to sexual reproductive health issues among youths using a close-ended, structured, 32-item questionnaire and an interview. The majority (71% men, 71% women) of the respondents attended church regularly; were unmarried (92% men, 83% women); were sexually active (71% men, 45% women); used drugs (65% men, 62% women). The majority of the respondents (46% men, 63% women) were reprimanded and/or ostracized by the Church. The findings suggest that issues encompassing sexuality and drugs among youth do not resonate well with the conventional religious practice of the Church, hence a significant incidence of ostracism and the likelihood of premarital sex and drug use.