Unravelling Delay in Care for Sexually Transmitted Infections-Related Symptoms in a Developing Country Setting (Jamaica).

BACKGROUND: Sexually transmitted infections (STIs) and STI treatment remain a challenge in public health. There is little understanding of related factors influencing health seeking behaviour and delay of care among clinic attendees in Jamaica. AIM: To determine socio-demographic profile of clinic attendees with STI and identify factors associated with delay in seeking care for STI-related symptoms. METHODS: A cross-sectional study was done. 201 adult patients presenting with STI symptoms from four health centres in Kingston and St Andrew were selected. A 24-item interviewer-assisted questionnaire was used to obtain data on socio-demographic characteristics, patients' symptoms and duration, previous STIs, knowledge of complications and seriousness of STIs, and factors influencing decision to seek medical care. RESULTS: Almost 75% delayed seeking care for STIs. Recurrent STIs was identified in 41% of patients. 'Could not find time' was the most commonly reported reason for delay in seeking care (36%). Females were 3.4 times more likely to delay seeking care for STI symptoms than males (OR 3.42, 95% CI: 1.73-6.73). Those with primary level education and below were 5 times more likely to delay seeking care for STI symptoms than those with at least secondary level education (OR 5.05, 95% CI: 1.09-23.46). Participants viewed staff as confidential (68%) and 65% thought health-care workers spent adequate time during consultations. CONCLUSION: Lower education level and the female gender are associated with delay in seeking care for STI-related symptoms. These factors should be considered when developing interventions to reduce delay in care for STI-related symptoms.

Taxi drivers and COVID-19 in Jamaica: Occupationally related income decline and health behaviour.

Income and employment are recognised as social determinants of health. Occupationally related exposures and working conditions impact health behaviours. Taxi drivers have been recognised as an occupationally COVID-19 at-risk group. COVID-19 threatens their lives and livelihoods. This study describes self-reported income changes attributed to the COVID-19 pandemic among taxi drivers. Associations between percentage change in income and reported prevention practices were ascertained. In May 2020, a cross-sectional study was done among 282 taxi drivers in the Kingston and St. Andrew Metropolitan Area in Jamaica. Multi-stage sampling was used to select taxi driver from seven hubs. Data collection utilised a 28-item questionnaire. Self-reported income before and during the COVID-19 pandemic was ascertained and correlations between relative changes in income and COVID-19 prevention practices were assessed. The median pre-COVID-19 monthly income was USD 1,428.57 (IQR = 1,467.26), about USD 51/day. Median monthly income since the COVID-19 outbreak was USD 500 (IQR = 472.37), about USD 18/day, representing a 65% reduction in income. There was a statistically significant association between the relative change in income and the practice of wearing mask while transporting passengers. Generally, as the relative change (decline) in income increased, reported compliance with mask wearing decreased (Spearman's rho = -0.15, p = 0.02). Taxi drivers have experienced marked decline in income due to the COVID-19 pandemic, with implications for health practices and the maintenance of desired health behaviours. Authorities should be cognisant of the economic impact and COVID-related consequences in the taxi industry, as they seek to develop COVID-19 occupationally related prevention and control programmes.

COVID-19 related risk perception among taxi operators in Kingston and St. Andrew, Jamaica.

BACKGROUND: In the Caribbean, all countries have confirmed COVID-19 cases. Considering the high infectivity of the virus, no preexisting immunity to the virus and an associated modest reproductive rate (R0), the high density of persons utilizing public transport is of immense public health concern. Public transport systems may facilitate and accelerate the transmission of the disease. AIM: The aim of this study was to assess the COVID-19 related risk perceptions among taxi drivers by virtue of their occupation and the implications for health promotion interventions. METHODS: A cross-sectional study was conducted in May 2020 among 282 taxi drivers in the Kingston and St. Andrew (KSA) metropolitan region in Jamaica. A 28-item anonymized self-administered questionnaire was used to collect data which was subsequently analyzed using SPSS version 20. A risk score was generated and the Mann-Whitney U and Kruskal Wallis tests were used to determine differences in the mean ranks for risk perception score as applicable. A 5% alpha level was utilized in determining statistical significance. RESULTS: Risk perception scores ranged from 10 to 21 with a median of 17 (IQR 3.25) and there was no statistically significant difference in the median risk perception score by socio-demographic variables. There was however, a statistically significant positive correlation (Spearman's rho = 0.238, p=<0.001) between risk perception and knowledge. Approximately, 86% of respondents reported that they obtained COVID-19-related information from news reports (traditional media). CONCLUSION: Taxi drivers perceive themselves to be at occupationally related risk of COVID-19. Therefore, greater understanding of this issue is paramount as it can aid in the crafting of initiatives that may enhance personal safety of both taxi drivers and commuters.

Caregivers of Older Persons in Jamaica: Characteristics, Burden, and Associated Factors.

OBJECTIVE: The objective of this study was to determine and characterize caregiver burden among caregivers of community-dwelling older persons in Jamaica. METHOD: A nationally representative cross-sectional study was done among persons providing noninstitutional care for a single person (≥60 years). The Zarit Burden Interview (ZBI) and a structured questionnaire were administered to 180 caregivers from four geographic health regions. RESULTS: The ZBI scores ranged from 0 to 56 (median = 15). Independently associated factors were relationship to care recipient and age. Children/grandchildren had higher caregiver burden scores than formally employed caregivers (odds ratio = 2.9: 95% confidence interval: [1.02, 8.34]). Compared with caregivers 35 to 44 years, those aged 45 to 65 were almost 5 times more likely to report higher caregiver burden scores. CONCLUSION: Caregiver burden as identified by the ZBI was low. Age (45-65 years) and being the child/grandchild of the care recipient were independently associated with greater caregiver burden. Interventions to address caregiver burden must embrace strategies that recognize that these factors.

Socio-demographic, Health and Functional Status Correlates of Caregiver Burden Among Care Recipients Age 60 Years and Older in Jamaica.

The provision of care to older persons can impose significant burden on those providing care, burdens influenced by care recipient characteristic, caregiver attributes and availability of social support. This paper focuses on identifying relationships between caregiver burden and the socio-demographic, health and functional status attributes of care recipients age 60 years and older in Jamaica. A nationally representative cross-sectional study was done among persons providing non-institutional care for a single person 60 years and older. Data were obtained from a total of 180 caregivers from the four geographic health regions of Jamaica using the Zarit Burden Interview and a 44-question structured questionnaire. Associations between caregiver burden and socio-demographic, health and functional status of care recipients were examined and logistic regression applied to ascertain independent predictors of caregiver burden. The results revealed statistically significant relationships between caregiver burden and care recipients' receipt of conditional cash transfer grants and the ability to toilet independently. In multivariate analysis, ability to toilet remained a significant predictor of caregiver burden-Caregivers who had care recipients who were able to toilet independently were 71% less likely to have mild to severe caregiver burden compared to those who had care recipients that were not able to toilet (OR 0.29; 95% CI 0.14-0.57). Families, health care providers, social workers, state actors and caregivers should take this into account as they develop strategies to mitigate associated caregiver burden.

Zarit burden interview among caregivers of community-dwelling older adults in a caribbean setting (Jamaica): Reliability and factor structure.

The Zarit Burden Interview has been the most popularly used tool for measuring caregiver burden and with the 60 years and over population in Jamaica and developing countries expected to increase, caregiver burden and its assessment assume increased importance. Establishing the reliability and underlying factor structure of instruments such as the ZBI is critical. This study sought to determine the reliability of the Zarit Burden Interview and to assess its underlying factor structure. The ZBI was administered to 180 caregivers of community dwelling older persons in Jamaica in a nationally representative sample across four geographic health regions in 2016. The factor structure was identified using exploratory factor analysis (EFA) with Varimax rotation. Cronbach's alpha was used to assess internal consistency/reliability of the instrument. The internal consistency/reliability of the ZBI instrument was high (Cronbach's α = 0.859) and the corrected item-total correlations ranged from 0.134 to 0.730. The ZBI mean score was found to be 16.92 ± 12.04. EFA produced a six-factor model comprised of 19 items which explained 48.97% of total variance, and was subsequently reduced to four (37.27% of total variance) via the use of parallel analysis and scrutiny of confidence intervals. The four factors identified were 'personal strain', 'social relations disruption', 'resource strain/imbalance' and 'role intensity'. The ZBI-22 tool is a reliable instrument for evaluating caregiver burden among community dwelling older persons in Jamaica. A four factor model has emerged providing greater insights on the underlying constructs of the ZBI, the most widely used caregiver burden assessment tool.

Breast Cancer in Jamaica: Trends From 2010 to 2014-Is Mortality Increasing?

PURPOSE: This study sought to provide a detailed analysis of breast cancer-specific mortality in Jamaica on the basis of reported deaths between 2010 and 2014. METHODS: A cross-sectional study was done to analyze breast cancer-specific mortality data from the Registrar General's Department, the statutory body responsible for registering all deaths across Jamaica. RESULTS: A total of 1,634 breast cancer-related deaths were documented among Jamaican women between 2010 and 2014, which accounted for 24% of all female cancer deaths. The age-standardized breast cancer mortality rate increased from 21.8 per 100,000 in 2010 to 28 per 100,000 in 2014 for the total female population. The overall difference in breast cancer mortality rates between the 2014 and 2010 rates was not statistically significant (P = .114). Analysis of the year-by-year trend reflected by the annual percentage of change did show, however, a statistically significant increasing trend in breast cancer mortality (P = .028). Mortality rates varied by age, with statistically significant annual increases observed in the 35-44-, 65-74-, and ≥ 75-year age groups (P = .04, .03, and .01, respectively). CONCLUSION: Breast cancer remains the leading cause of death among Jamaican women. Despite global advances in breast cancer screening and management, breast cancer remains a major public health challenge and represents a public health priority in Jamaica. The increasing breast cancer-specific mortality in Jamaica over the 5-year period contrasts with decreasing mortality rates among US women with breast cancer. This study highlights the critical need to address the implementation of a national organized breast cancer screening program in Jamaica and to focus future research efforts on the biology of breast cancer, especially among young Jamaican women.

Predictors of hospitalization and surgical intervention among patients with motorcycle injuries.

BACKGROUND: To describe the distribution of injuries, hospitalization rates by body areas injured, and surgery-requiring admissions, and to identify independent predictors of admission to a regional hospital in Jamaica. METHODS: A cross-sectional study was conducted among persons presenting to the St Ann's Bay Regional Hospital in Jamaica (2016-2018) with injuries sustained from motorcycle crashes. A census was done of patients admitted to the surgery ward from the emergency room, as well as those referred to the Orthopaedic Outpatient Department. Trained members of the orthopedic team administered a pretested questionnaire within 24 hours of presenting to the orthopedic service to elicit data on sociodemographic characteristics, motor vehicle collision circumstance and motor bike specifications, physical injuries sustained and medical management, as well as compliance with legal requirements for riding a motorcycle. Associations between variables were examined using χ2 tests and logistic regression. RESULTS: There were 155 participants in the study, and 75.3% of motorcyclists with injuries required admission. The average length of stay was approximately 10 days. Surgery was required for 71.6% of those admitted. Lower limb injuries constituted 55% of all injuries. The independent predictors for admission were alcohol use and total body areas involved. Motorcycle crash victims who used alcohol close to the time of crash were three times more likely to be admitted to hospital than those who did not consume alcohol. As the total body areas involved increased by one, there was a threefold increase in the likelihood of being admitted. Additionally, the greater the number of body areas involved, the greater was the likelihood of admission. DISCUSSION: Lower limb injuries are the most commonly reported injuries among victims of motorcycle crashes. Alcohol and total body areas involved are independent predictors of admission to hospital. In the planning of trauma delivery services, this information should be taken into account. LEVEL OF EVIDENCE: Level IV.

Helmet use among motorcycle accident victims in the north-east region of Jamaica.

Currently in Jamaica, motorcyclists account for the largest group of fatalities among all road users. Between 2016 and 2018, a cross sectional study was conducted at the Saint Ann's Bay Regional Hospital involving 155 participants. There were 98.7% males, ages ranged from 14-64 years and more than two thirds of the motorcyclists were under 40 years. Only 29.4% wore helmets, and of those motorcyclists, 52.8% indicated they were only riding for a short distance. Increasing age correlated with increased helmet compliance. Persons with motorcycles greater than 150 cubic centimetres were also more likely to wear a helmet. Interventions to promote increased helmet compliance should take these factors into account in conjunction with enhancing law enforcement.

Performance and Receiver Operating Characteristics of the Mini-Mental State Examination Instrument in Detecting Dementia in a Rapidly Aging Developing Country (Jamaica).

OBJECTIVE: To examine the performance of the Mini-Mental State Examination (MMSE) in community-dwelling older persons in a developing country (Jamaica) undergoing rapid population aging. METHODS: An embedded validity study was conducted utilizing participants from a nationally representative sample of 2782 older persons. Standardized MMSE scores were obtained for study participants. A random selection of 170 persons with MMSE scores greater than 20 and 170 persons with scores 20 or less was done. Field staff were trained to apply the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for the diagnosis of dementia. In total, 300 participants (167 participants with MMSE score of 20 or less, 133 participants with scores greater than 20) were assessed and categorized according to dementia status. Performance characteristics of the MMSE tool were determined for study participants and appropriate adjustment and analyses subsequently applied to facilitate extrapolation to the nationally representative sample. RESULTS: The mean MMSE scores for participants with score of 20 and less was 17.1 (standard deviation [SD] = 3.2) and 24.5 (SD = 2.8) for those with scores greater than 20. Dementia was identified in 34 participants. The receiver operating characteristic curve for MMSE scores in relation to dementia diagnosis had an area under the curve value of 0.935 (95% confidence interval, 0.893-0.977). The optimal MMSE cut-point was 18/19 and was consistently so regardless of age category, gender, educational level, and number of chronic illnesses. CONCLUSION: There is merit in using the MMSE examination as a screening tool for dementia in Jamaica. The findings of this study coupled with widespread use and familiarity among practitioners give credence to the MMSE as a reasonable screening tool for dementia in Jamaica-rapidly aging society.