A concept of Caribbean fatherhood

OBJECTIVE: To investigate the manner in which Jamaican men view themselves and their relationships with women and their role in family life as partners and fathers. METHODS: A two-stage stratified random sample was used to select men aged 15-40 years in three parishes, Kingston, St.Andrew and Hanover. Enumeration districts and dwellings were selected in the first and second stages, respectively. In selected dwellings, all males 15-40 years were identified among the eligible males who had fathered at least one child. From these, one respondent was randomly selected. A questionnaire was administered to the sample yield of 714. Focus group discussions were held with a subset of the sample. Eight focus groups were held, four each in rural and urban areas among men 15-24 years, and similarly among men 25-40 years. RESULTS: The majority (64 percent) of the men who currently either in visiting or common-law unions and 23 percent had formed these unions between the ages of 15 and 19 years. Most (58 percent) had spent one to six years in their current union, of which the largest group (26 percent) spent one and a half to three years. Just over two-thirds of the children were born in current unions and those born outside of the current union were born in visiting unions (41 percent). Approximately 44 percent of the respondents' children were not living with them; 80 percent were living with their mothers. Respondents (87 percent) reported that they were involved in their children's lives. Major involvement was the provision of food (52 percent), clothes (51 percent) and health care (51 percent). The main obstacle identified for male participation in parenting was their marginal economic status. Significant relationships (p<0.1) were: the increase in the fathering role with age; fathers who were not household heads were less involved in their children's lives, especially when a step-father was present and the economic contribution of fathers was strongly related to their economic status. Contact between parents was significantly influenced by the age of both the father and the children. CONCLUSIONS: The findings indicate that fatherhood is hinged in the ability of the men to make economic and material contributions to their family. In general, men wanted a better life for their children but faced real constraints. Poverty was the major factor preventing men from performing the role they consider central to their concept of fatherhood. (AU)

High prevalence of genital Chlamydia trachomatis infection in women presenting in different clinical settings in Jamaica: implications for control strategies

OBJECTIVE: To determine the prevalence of genital Chlamydia trachomatis infection and risk factors in women attending family planning, gynaecology, and sexually transmitted disease (STD) clinics in Jamaica. METHODS: Endocervical specimens from 645 women including 238 family planning, 170 gynaecology, and 237 STD clinic attendees were examined for C trachomatis using a direct fluorescence assay (DFA) and culture. Investigations were carried out for the presence of other STD pathogens and demographic, behavioural, historical, and clinical data recorded for each participant. RESULTS: The prevalence of C trachomatis infection was 35 percent, 47 percent, and 55 percent in family planning, gynaecology, and STD clinic clients, respectively. The performance of the DFA was comparable to that of culture in screening for C trachomatis. Logistic regression analysis revealed that the independent risk factors for C trachomatis were non-barrier contraceptive methods in family planning clients (OR = 2.1; 95 percent confidence interval (CI) = 1.2 - 3.9; p= 0.0110), cervical ectopy in gynaecology clients (OR = 3.9; 95 percent CI = 1.4 - 10.6; p= 0.0076) and concomitant Trichomonas vaginalis infection in STD clients (OR = 3.5; 95 percent CI = 1.8 - 6.8; p = 0.003). Age, number of sex partners, and reason for visit were not identified as risk factors for C trachomatis infection. CONCLUSIONS: Consistently high prevalence if C trachomatis infection occurs in Jamaican women. Universal screening or presumptive treatment should be evaluated as prevention and control measures for C trachomatis infection in this population where all women appear to be at risk. (AU)

Correlation between histopathology evaluation by curettage and diagnostic hysteroscopy in patients with abnormal uterine bleeding

Diagnostic hysteroscopy was performed on a total of 54 patients with abnormal uterine bleeding, comprising 42 premenopausal and 12 postmenopausal patients. The commonest finding on hysteroscopy in the premenopausal patients was submucous fibroid accounting for 28.6 percent of cases, while endometrial polyp was the commonest finding in postmenopausal patients constituting 33.3 percent of cases. After excluding submucous fibroids, the concordance rate between hysteroscopy and histopathology was found to be 74 percent, even in the absence of targeted biopsy, thus confirming is diagnostic accuracy. A sensitivity of 87 percent and a specificity of 85 percent were obtained.(AU)

Disparities in access to family planning in Jamaica

In order to improve the effectiveness and subtainability of the family planning programme, the National Family Planning Board has devised a strategy to shift users to longer-acting methods and increase the role of the private sector. To design interventions, a better understanding of existing services was thought to be necessary. This study examines the distribution of family planning service delivery points in Jamaica and the services offered by the public and private sectors through an examination of records and questionnaire interviews. The study found that, because of the concentration of private sector providers - the main outlets for longer-acting methods - in urban areas, rural areas had poor access to these methods. Because rural areas are not attractive to private sector providers, the public sector should recognize the need to continue to serve these areas (AU)

Disparities in access to family planning in Jamaica

In order to improve the effectiveness and subtainability of the family planning programme, the National Family Planning Board has devised a strategy to shift users to longer-acting methods and increase the role of the private sector. To design interventions, a better understanding of existing services was thought to be necessary. This study examines the distribution of family planning service delivery points in Jamaica and the services offered by the public and private sectors through an examination of records and questionnaire interviews. The study found that, because of the concentration of private sector providers - the main outlets for longer-acting methods - in urban areas, rural areas had poor access to these methods. Because rural areas are not attractive to private sector providers, the public sector should recognize the need to continue to serve these areas

Midazolam versus diazepam as premedication for gynaecologic laparoscopy done under local anaesthesia

A prospective randomised double blind trial was performed in 106 patients to compared the use of intravenous midazolam (mean dose 6.5 mg, range 4-9 mg) versus 10 mg diazepam, during gynaecologic laparoscopy under local anaesthesia. The parameters examined were: the ease of laparoscopy, patient tolerance, the amnesic effect and intra-operative blood pressure changes. Depth of sedation and recovery time were measured, using the Trieger test. The preoperative demographic variables and the operators ability to perform the procedures were similar in the two groups. The patients were more deeply sedated with the midazolam but the recovery time was similar. The patients tolerated the procedure better with midazolam with fewer of them describing the procedure as unpleasant (22 percent versus 53 percent) (P<0.01), fewer of them had whole body movement during th procedure (24.5 versus 54.5 percent) (P=0.009) and more of them had amnesia for the procedure (85 percent versus 36 percent) (P<0.0001). However mean blood pressure rose to hypertensive levels intra-operatively in the midazolam group but not in the diazepam group.(AU)

Transcervical resection of the endometrium (TCRE) using the rollerball resectoscope - abstract

Objective: To assess the efficacy of transcervical resection of the endometrium using the rollerball resectoscope in Jamaican women complaining of menorrhagia. Methods: From January 1st 1994 to December 31st 1994, 16 women underwent TCRE using a 27 fr CIRCON-ACMI uterine resectoscope with a rollerball electrode and 5 per cent dextrose/water as the irrigation medium. All patients had previous diagnostic hysteroscopy with endometrial sampling that demonstrated benign pathology. Details of operative time, fluid absorption and complications were recorded on prepared forms. Menstrual status was enquired at follow-up visits at 1, 3 and 6 months after the procedure. Results: The average operative time was 43 minutes and the average fluid absorption 308 ml. Complications included endometritis in 2 patients and one uterine perforation. Eight patients were amenorrheic at the 1st visit and remained so at 6 months, 2 women reported spotting to 3 months followed by amenorrhea. A further 3 continued to menstruate but with reduced loss. The remaining 3 were not satisfied and 2 chose hysterectomy. Conclusion: TCRE using the rollerball resectoscope can be an alternative therapy for women with menorrhagia, however, complications need to be addressed by proper patient selection, skilled training in operative hysteroscopy and a larger study population followed long term (AU)

Prevalence of antibodies to hepatitis C virus and other markers in Jamaica

Three population groups, 1500 blood donors, 513 antenatal women representing a normal population group and 250 sicklers representing a multiply transfused group were studied to determine the prevalence of hepatitis C viral (HCV) infection in Jamaica. The relationship to liver enzyme levels, hepatitis B infection, syphilis and HIV infection was also investigated. Sera were screened by enzyme-linked immunoassay (EIA) for anti-HCV C100-3 and subsequently tested by a supplementary second generation recombinant immunoblot assay (RIBA). In the blood donors, the prevalence of anti-HCV was low, 0.3 per cent - 0.4 per cent, the same level as that reported by several European countries. In the multiply transfused sicklers, the prevalence was more than seven times higher. No HCV infection was detected in the antenatal group. There was little correlation between HCV infection and surrogate markers alanine aminotransferase (ALT) and antibody to hepatitis B core antigen (anti-HBc) and no correlation with sexually transmitted diseases. (AU)

Prevalence of antibodies to hepatitis C virus and other markers in Jamaica

Three population groups, 1500 blood donors, 513 antenatal women representing a normal population group and 250 sicklers representing a multiply transfused group were studied to determine the prevalence of hepatitis C viral (HCV) infection in Jamaica. The relationship to liver enzyme levels, hepatitis B infection, syphilis and HIV infection was also investigated. Sera were screened by enzyme-linked immunoassay (EIA) for anti-HCV C100-3 and subsequently tested by a supplementary second generation recombinant immunoblot assay (RIBA). In the blood donors, the prevalence of anti-HCV was low, 0.3 per cent - 0.4 per cent, the same level as that reported by several European countries. In the multiply transfused sicklers, the prevalence was more than seven times higher. No HCV infection was detected in the antenatal group. There was little correlation between HCV infection and surrogate markers alanine aminotransferase (ALT) and antibody to hepatitis B core antigen (anti-HBc) and no correlation with sexually transmitted diseases.

Show, no show and sterilization

The study investigates the factors involved in the decision of a sample of women to break appointments for sterilizations at the Fertility Management Unit of the University of the West Indies. A case control study involved 50 women who did not show up (no-shows) and an equal number who did show up (shows) over the same period. The no-shows had spent a shorter time in their current union than the shows, and some had no children for their partners at the time the appointments were made. Marriage was the single most important event that would encourage the no-shows to consider sterilization in the future. As long as poor women see child bearing as a precondition for financial assistance from spouses, they will hesitate to give up this capability (AU)

The effect of user fees on the utilization of family planning services: a clinical study

A new fee structure was introduced to the Advanced Training and Research in Fertility Management Unit in 1992. The study looked at the effect of the new fees on attendance and the choice of contraceptive methods through an examination of clinic records and a questionnaire survey. There was a decline in attendance of roughly 28 per cent between 1992 and 1993. The decline affected mainly new clients and those who accepted injectables. A reduction in the price of injectables is suggested since the fee for this short-term method is more in line with those charged for long-term and permanent methods. (AU)

The effect of user fees on the utilization of family planning services: a clinical study

A new fee structure was introduced to the Advanced Training and Research in Fertility Management Unit in 1992. The study looked at the effect of the new fees on attendance and the choice of contraceptive methods through an examination of clinic records and a questionnaire survey. There was a decline in attendance of roughly 28 per cent between 1992 and 1993. The decline affected mainly new clients and those who accepted injectables. A reduction in the price of injectables is suggested since the fee for this short-term method is more in line with those charged for long-term and permanent methods.

Show, no show and sterilzation

The study investigates the factors involved in the decision of a sample of women to break appointments for sterilizations at the Fertility Management Unit of the University of the West Indies. A case control study involved 50 women who did not show up (no-shows) and an equal number who did show up (shows) over the same period. The no-shows had spent a shorter time in their current union than the shows, and some had no children for their partners at the time the appointments were made. Marriage was the single most important event that would encourage the no-shows to consider sterilization in the future. As long as poor women see child bearing as a precondition for financial assistance from spouses, they will hesitate to give up this capability.

Prevalence of antibodies to hepatitis C virus and other markers in Jamaica - abstract

Three population groups, 1500 blood donors, 513 antenatal women representing a normal population group and 250 sicklers representing a multiply transfused group, were studied to determine the prevalence of Hepatitis C Viral (HCV) infection in Jamaica. The relationship to liver enzyme levels, hepatitis B infection, syphilis and HIV infection was also investigated. Sera were screened by EIA for anti-HCV C100-3 and subsequently tested by a supplementary second generation recombinant immunoblot assay (RIBA). In the blood donors, the prevalence of anti-HCV was low, 0.3 percent - 0.4 percent, the same level as that reported by several European countries. In the multiply transfused sicklers, the prevalence was more than seven times higher. No HCV infection was detected in the antenatal group. There was little correlation between HCV infection and surrogate markers alanine transferase (ALT) and antibody to hepatitis B core antigen (anti-HBc) and no correlation with sexually transmitted diseases (AU)

Hysteroscopic assessment of abnormal uterine bleeding in users of the intrauterine contraceptive device

Sixty users of the IUD who complained of abnormal menstural blood loss were evaluated by hysteroscopy, and the findings were compared with a matched group who had this investigation for "missing strings". Submucous fibroids and endometritis were more frequent in the study group whereas malposition of the IUD was commoner in the controls (p<0.05) (AU)

Hysteroscopic assessment of abnormal uterine bleeding in users of the intrauterine contraceptive device

Sixty users of the IUD who complained of abnormal menstural blood loss were evaluated by hysteroscopy, and the findings were compared with a matched group who had this investigation for "missing strings". Submucous fibroids and endometritis were more frequentl in the study group whereas malposition of the IUD was commoner in the controls (p<0.05).

Large loop excision of the transformation zone (LLETZ) an alternative treatment for cervical intraepithelial neoplasia

The technique of large loop excision of the transformation zone (LLETZ) as an alternative to destructive/ablative method of treatment of cervical intraepithelial neoplasia (CIN) such as cryotherapy, laser vaporization and cone biopsy of uterine cerix is assessed. Forty-five patients underwent this procedure for either diagnostic or therapeutic reasons. It was well-tolerated, and minor bleeding occurred in 4.4 per cent of patients. The quality of the histological specimen was excellent in all cases, only two showing evidence of charring artefacts. In 11 patients (24.4 per cent), a more serious lesion was detected than that found at punch biopsy of the cervix. This method offers a cheaper and more effective alternative to laser vaporization and combines the benefits of the gold standard cone biopsy of the cervix with that of local ablative techniques. (AU)

Large loop excision of the transformation zone (LLETZ) an alternative treatment for cervical intraepithelial neoplasia

The technique of large loop excision of the transformation zone (LLETZ) as an alternative to destructive/ablative method of treatment of cervical intraepithelial neoplasia (CIN) such as cryotherapy, laser vaporization and cone biopsy of uterine cerix is assessed. Forty-five patients underwent this procedure for either diagnostic or therapeutic reasons. It was well-tolerated, and minor bleeding occurred in 4.4 per cent of patients. The quality of the histological specimen was excellent in all cases, only two showing evidence of charring artefacts. In 11 patients (24.4 per cent ), a more serious lesion was detected than that found at punch biopsy of the cervix. This method offers a cheaper and more effective alternative to laser vaporization and combines the benefits of the gold standard cone biopsy of the cervix with that of local ablative techniques.

Chlamydial infections in selected populations in Jamaica

The importance of Chlamydia trachomatis as a cause of genital tract infection in Caribbean countries is largely unknown. Two hundred and sixteen cervical and urethral specimens were collected from patients with cervicitis and urethritis attending a Sexually Transmitted Diseases (STD) Clinic, a Gynaecology Clinic and a Family Planing Clinic in Kingston. Specimens were tested for chlamydiae by direct immunofluorescence and cell culture methods. They were also investigated for N. gonorrhoeae infections. Seventy-two of 138 patients (52.2 percent) at the STD Clinic were positive for chlamydiae; 28 of 50 ((56.0 percent ) from the Gynaecology Clinic and 11 of 28 (39.3 percent) from the Family Planning Clinic were positive. The prevalence of C. trachomatis (52.3 percent) was higher than that of N. gonorrhoeae (11.1 percent) in all groups. The results indicate that C. trachomatis is a common cause of genital tract infections in Jamaica(AU)

Diagnostic hysteroscopy

Diagnostic hysteroscopy was performed on 100 patients. The most frequent indication was abnormal uterine bleeding. In premenopausal women, submucous fibroids were the main findings and in postmenopausal women, 59 per cent had an atrophic endometrium. Precise localization of the missing intrauterine contraceptive devices was achieved in all cases. Hysteroscopy improved diagnostic accuracy and reduced the need for blind curretage. (AU)