A study of local health systems in Jamaica, 1992

The study presents the state of development of local health systems in Jamaica. It defines the local health system as a parish, and reviews the national geopolitical and economic climates in which these systems have developed and which have served as frameworks for national health policies.

Human T-lymphotropic virus type I (HTLV-I) seroprevalence in Jamaica: I. demographic determinants

During 1985 and 1986, the authors measured antibodies to human T-lymphotropic virus type I (HTLV-I) in a cohort of 13,260 Jamaicans from all parts of the island who applied for food-handling licenses. HTLV-I seroprevalence was strongly age and sex dependent, rising from 1.7 percent (10-19 years) to 9.1 percent (o70 years) in men and from 1.9 percent (10-19 years) to 17.4 percent (o70 years) in women. In a logistic regression analysis, women were more likely to be seropositive than were men, and farmers, laborers, and the unemployed were more likely to be HTLV-I seropositive than were those reporting student or professional occupations. In men, African ethnicity was associated with HTLV-I seropositivity in the univariate analyssis but was not a risk factor after adjustment for age and sex. There was a trend toward higher age-stratified HTLV-I seroprevalence among younger women who reported more pregnancies, but older multigravidas had lower rates of HTLV-I seropositivity. Persons born outside Jamaica had significantly lower seroprevalence than did those born in Jamaica, but they were of slightly different ethnic and occupational compositions than those born in Jamaica. (AU)

Human T-lymphotropic virus type I (HTLV-I) seroprevalence in Jamaica - II geographic and ecological determinants

An island-wide cohort of 13,260 Jamaicans who applied for food-handling licenses during 1985 and 1986 were tested for antibodies to human T-cell lymphotropic virus type I (HTLV-I). Demographic and residence history data were linked to geographic measures of elevation, rainfall, crop-growing areas, population density, and additional measures of urbanization and correlated with HTLV-I antibody status. By logistic regression analysis (performed separately for men and women), men and women who currently resided at low elevation (ó1,000 ft (305 m)) were more likely to be HTLV-infected than were those residing at high elevation. Men, but not women, who were born in citrus-growing areas were more likely to be HTLV-I infected than were men who were born in other areas. By univariate analysis, there was a significant positive trend of increasing HTLV-I seroprevalence with increasing amount of annual rainfall associated with birthplace and primary residence areas. However, these associations did not remain in significance after adjusting for age and sex. These environmental associations raise the possibility of new modes of viral transmission or host response to infection, although they may simply be surrogates for socioeconomic status, breast-feeding habits, or sexual behaviour, which are known determinants of HTLV-I zero prevalence. (AU)

Sexual transmission of human T-lymphotropic virus type I (HTLV-I)

Human T-lymphotropic virus type I (HTLV-I), the prototype human retrovirus, has been linked epidemilogically to adult T-cell leukemia-lymphoma and to tropical spastic paraparesis. Modes of infection include mother-to-child transmission, most likely by ingestion of breast milk; parenteral transmission by blood transfusion and intravenous drug abuse; and male-to-female sexual transmission. Female-to-male transmission of HTLV-I is thought to occur only rarely, if at all. We document risk factors for male-to-female and female-to-male transmission of HTLV-I among persons in Jamaica attending clinics for sexually transmitted disease.(AU)

Future leadership in public health in the Commonwealth Caribbean, including the role of the University of the West Indies

Advances in public health in Commonwealth Caribbean over the past four decades have been well marked by the decline in communicable diseases which were among the leading causes of death. Among the advances must be included the eradication of malaria from several Commonwealth Caribbean countries. Inspite of the progress made, there are still embarrassing occasions when certain preventable diseases reach epidemic proportions. Many of the advances made were possible through dynamic leadership. There is a shortage of qualified management personnel in all branches of the health services, and this results very often in the lack of implementation of various programmes and the misuse of limited resources. To maintain and continue reasonable standards of public health, training of health personnel for future leadership is of paramount importance. The role of the University of the West Indies must of necessity be as a centre of learning and research as well as an important agent for change and development at the national and regional levels. In the final analysis, it is people who will count. Whatever successes or failures we may have will depend on people at both the provider and the consumer levels. Therefore, leaders must be committed to the overall goals of the health service and there should be an enthusiasm and excitement about aiming at, and striving for, excellence in the execution of programmes (AU)

Development of model district health teams in Grenada

Following a profile on the status and organisation of health in Grenada, a proposal is presented for a model district health team aimed at increasing access to health care and better managing health services island-wide. The proposal addresses the issues of geographical site, organisational structure, facilities, equipment, personnel, financial and other resources, and the dispensation of health care services. Evaluation mechanisms are also outlined and constraint are identified

Hospital deaths from cerebrovascular accidents: some associated factors

Mortality of 415 patients after admission to K.P.H. and U.H. during 1969-1971 with final diagnosis of CVA was examined in relation to certain factors: age onset of CVA, sex presence or absence of hypertension and/or diabetes, level of consciousness and number of CVA. It was found that age on onset, presence of hypertension and/or diabetes and level of consciousness on admission adversely affected mortality (AU)

A preliminary epidemiological investigation of cerebro-vascular diseases in Jamaica

A preliminary epidemiological study of cerebro-vascular accident was carried out. Analysis was made of the mortality data available for Jamaica for the years 1962 to 1971. Deaths from C.V.A. were shown to occur more commonly in females than males except in the under 25 years age group. An excess mortality in females seems to be in keeping with the reports in the literature which dealt with negro poulations. Mortality was closely linked with age, the age specific death rates showing an increase with increasing age in both sexes over the 10 year period. The rates within each group were equivocal over the same time period. The results of the analysis of the case histories of 415 patients and 48 interviewed patients seen at the Kingston Public Hospital and the University Hospital of the West Indies are presented. There was an excess of females - 1.5 females to 1 male. The average age - mean plus 1 standard deviation - of all these patients was 60.3ñ1.6 years. An attempt was made to determine the infleunce of increasing numbers of C.V.As and certain associated diseases - diabetes, hypertension and obesity - on survival after C.V.A. No definite conclusions could be drawn because of the small numbers involved but it would seem likely that these pre-existing diseases adversely affect the chances of survival. The level of consciousness on admission did seem to infleunce survival - the anaysis showed a high mortality rate in patients who were unconscious on admission. Because of the importance of the contribution of cerebro-vascular disease to mortality in Jamaica it is recommended that a detailed epidemiological study be done to determine the extent of morbidity caused by this disease and the presence of any causative factors which could be prevented (Summary)