Child abuse: a common problem in Curaçao?

OBJECTIVE: To assess the prevalence of child abuse among high school students in Curacao. METHODS: A questionnaire survey among high school students up to 17 years of age was conducted. The questionnaire was based on existing literature and validated questionnaires. The questionnaire used was analysed and adapted to the situation in Curaçao by a panel of experts on child abuse. The primary objective was to gain insight into the incidence, prevalence and various forms of child abuse among students in Curaçao. Five forms of child abuse are distinguished in the literature: physical abuse, emotional abuse, sexual abuse, neglect and exploitation. Furthermore, the degree of confidence of the students in general practitioners (GPs) as care providers in the field of child abuse was explored. RESULTS: Questionnaires from 545 of the 628 respondents were included. In total, 43% of the respondents had ever-experienced an event which could be defined as (a form of) child abuse. More than one-third of the respondents reporting child abuse ever had an experience that could be interpreted as physical abuse. More than 15% of the respondents reporting child abuse had experienced sexual abuse. Girls experienced significantly more sexual abuse than boys. Emotional abuse in the last year was experienced by 3% of the respondents. One per cent of the respondents ever-experienced neglect. According to most respondents, GPs were not seen as care providers in cases of child abuse; they believed that GPs were mainly to be consulted for illnesses or physical symptoms and not for forms of child abuse. CONCLUSION: The prevalence of ever-having-experienced a form of child abuse is estimated at 431 per 1000 students. Child abuse, particularly physical abuse, is common in Curaçao, and is probably comparable to other surrounding countries. General practitioners were not seen as care providers in identifying and reporting cases of child abuse according to most respondents.

Contraception and induced abortion in the West Indies: a review.

BACKGROUND: Most islands in the West Indies do not have liberal laws on abortion, nor laws on pregnancy prevention programmes (contraception). We present results of a literature review about the attitude of healthcare providers and women toward (emergency) contraception and induced abortion, prevalence, methods and juridical aspects of induced abortion and prevention policies. METHODS: Articles were obtained from PubMed, EMBASE, MEDLINE, PsychlNFO and Soclndex (1999 to 2010) using as keywords contraception, induced abortion, termination of pregnancy, medical abortion and West Indies. RESULTS: Thirty-seven articles met the inclusion criteria: 18 on contraception, 17 on induced abortion and two on both subjects. Main results indicated that healthcare providers' knowledge of emergency contraception was low. Studies showed a poor knowledge of contraception, but counselling increased its effective use. Exact numbers about prevalence of abortion were not found. The total annual number of abortions in the West Indies is estimated at 300 000; one in four pregnancies ends in an abortion. The use of misoprostol diminished the complications of unsafe abortions. Legislation of abortion varies widely in the different islands in the West Indies: Cuba, Puerto Rico, Martinique, Guadeloupe and St Martin have legal abortions. Barbados was the first English-speaking island with liberal legislation on abortion. All other islands have restrictive laws. CONCLUSION: Despite high estimated numbers of abortion, research on prevalence of abortion is missing. Studies showed a poor knowledge of contraception and low use among adolescents. Most West Indian islands have restrictive laws on abortion.

Medical abortion in primary care: pitfalls and benefits.

We describe five pitfalls of medical abortion: ectopic pregnancy not terminated after misoprostol, but without negative side-effects; long-term vaginal blood loss with suspicious retained products which disappeared spontaneously; a patient with uterus myomatatosus with severe pain and retained products in the uterus; repetition of misoprostol because of retained products in the uterus after two weeks and an allergic reaction to methotrexate. Despite these pitfalls, there are enough benefits to consider medical abortion with methotrexate and misoprostol as a safe method with a high success rate of more than 91% and a good alternative for surgical abortion. An invasive procedure is not necessary, there are no long-term complications and it can be performed at an earlier stage, which makes it more acceptable in society. In Curaçao, where abortion is legally restricted, medical abortion is performed with methotrexate and misoprostol. In countries where abortion is legal, mifepristone and misoprostol are the first choice.

[Good results of early medicinal pregnancy termination in a general practice on Curaçao]. / Goede uitkomsten van vroege medicamenteuze zwangerschapsafbreking in een huisartspraktijk op Curaçao.

OBJECTIVE: To evaluate the results of early medicinal pregnancy termination. DESIGN: Prospective, non-blinded, clinical study. METHOD: Between 2001 and 2005, 371 women presented to a medium-sized solo general practice in the centre of Willemstad, Curaçao, to request termination of an undesired pregnancy. Ofthese women, 74 first indicated a preference for abortion via curettage, and the remaining 297 chose to be treated medicinally. In the first trimester of the pregnancy, they were given methotrexate i.m. and misoprostol vaginally 3-5 days later, or only misoprostol vaginally when methotrexate was unavailable. The result was evaluated by abdominal echography two days after the treatment. RESULTS: The result of the medicinal pregnancy termination could be determined in 271 of the 297 women. In 219 (81%) of these, the pregnancy had been terminated after a single treatment, and in 29 (11%) success was achieved after a second vaginal administration of misoprostol. The total success rate of the medicinal pregnancy termination was 92% (248/271). Curettage was required in 23 women (8%) after the medicinal treatment had failed. There was no significant difference in success rate between treatment with the methotrexate-misoprostol combination and treatment with misoprostol alone. CONCLUSION: Medicinal pregnancy termination with methotrexate and misoprostol, or with misoprostol alone, was a safe method with a relatively small risk of an ongoing pregnancy. It was a good alternative for surgical abortion.

Health status of shut-ins in the Marigot Health District, Commonwealth of Dominica.

In the Commonwealth of Dominica, the health and disability status of 108 people who, for various reasons, are confined to their homes--the so-called "shut-ins"--were studied. Eighty per cent of them were over 65 years of age and 10% were children. Most shut-ins were independent in self-care but dependent in general activities. Their overall health was poor. Twenty-one suffered from diseases of the musculo-skeletal system c.q. osteoarthritis, 13 from blindness of various origins, 13 from neurological diseases, 13 from CVA, psychosis or dementia and 13 from different other diseases. One-third suffered from more than one disease. A special programme would be required to optimize the home-care for the shut-ins and to encourage them to become more active.

Health status of shut-ins in the Marigot Health District, Commonwealth of Dominica

In the Commonwealth of Dominica, the health and disability status of 108 people who, fo various reasons, are confined to their homes -- the so-called "shut-ins" -- were studied. Eighty per cent of them were over 65 years of age and 10//were children. Most shut-ins were independent in self-care but dependent in general activities. Their overall health was poor. Twenty-one suffered from diseases of the musculo-skeletal system c.q. osteoarthritis. 13 from blindness of various origins, 13 from neurological diseases, 13 from CVA, psychosis or dementia and 13 from different other diseases. One-third suffered from more than one disease. A special programme would be required to optimize the home-care for the shut-ins and to encourage them to become more active