An analysis of pathological causes of death in 417 children under two years of age in Kingston and St. Andrew Jamaica over a two-year period between 1968 and 1970 - abstract

An analysis has been made of the causes of death of 417 children on whom autopsies were done as part of the PAHO/WHO Inter-American Investigation of Mortality in Childhood. Only adequately documented autopsies are included. Sixty-three of the deaths occurred in the first 24 hours, 80 in the next 6 days and 50 between 7 and 27 days. There were 87 deaths between 28 days and six months of age. The remaining 137 deaths occurred between 6 months and two years. The cases dying under 7 days are not representative of the KSAC Area as the majority of deaths occurring in the Victoria Jubilee Hospital are not included. Infections accounted for 56 percent of the deaths in the age group 7-27 days. Congenital malformations were responible for 38 percent of the deaths in this age group. Of those dying under two years of age, there were four main causes: gastroenteritis in 34 percent, pneumonia in 16 percent and malnutrition in 10 percent and congenital malformations in 18.5 percent. Infections are major causes of mortality in 43.4 percent of all autopsied cases under 2 years of age (AU)

An investigation of child mortality in Kingston and St. Andrew, Jamaica - abstract

This study was carried out as one of the thirteen field projects in the Inter-American Investigation of Mortality in Childhood, which was sponsored by PAHO/WHO. The objective of the study was to investigate causes of death in infancy and early childhood, taking into account nutritional, sociological and other environmental factors. This preliminary report is for the year 1969. An attempt was made to get complete data on all deaths of children under five years of age in the parishes of Kingston and St. Andrew, Jamaica - an area with total mean population of 547,500 in 1969. The investigation was carried out through interviews in homes, hospitals and clinics and with physicians so as to obtain complete records of the fatal illness, results of laboratory and other examinations and autopsy findings. The study area was sub-divided into urban and rural. The total number of deaths under five years of age for the year was 906, 835 of which were from the urban area. The demographic (provisional) of the Registrar General for 1969 reported 803 infant deaths, thus giving an infant mortality rate of 35.4, while the study had 763 infant deaths with an infant mortality rate of 33.8. There were 836 deaths (92 percent) under two years of age, with 469 (51.6 percent) in the neonatal period and 294 (32.5 percent) in the post neonatal period. In 1-4 years age group, 73 deaths occurred among the one-year olds and this represents 52.5 percent of deaths in this age group. Thus there were four times as many deaths in the post-neonatal period as there were in the second year of life and those in the second year of life were more than half of those deaths occurring in the 1-4 year old group. The geographic distribution was analysed according to postal zones for the urban area. Out of 835 urban deaths occurring in 21 postal zones, 445 (53.2 percent) occurred in zones 0, 11, 12 and 13 which accounted individually for the highest numbers of death. Hence establishing priorities in developing a maternal and child health programme to improve health services and reduce child mortality, emphasis must necessarily be given to children under two years old, and special attention to certain geographic areas (AU)

The status of maternal and child health services for Jamaica with particular reference to the metropolitan parishes of Kingston and St. Andrew

Jamaica is a small developing country with a low gross national domestic product. Nevertheless, it is advocated that resources be allocated to maternal and child Health services because children are the future of the nation; women and children form a considerable portion of the population; many causes of illness in women and children are preventable; and maternal and child health services form a good vehicle for education of the family for healthful living. Maternal mortality data are used as the main indices of maternal health. Maternal mortality rates are falling, but are still higher than in certain countries of Latin America and in the developed countries. Haemorrhage has replaced toxaemia as the main cause of maternal mortality, but toxaemia is still important. Significant contributions to maternal mortality are made by abortion and sepsis. Maternal mortality is less where there is antenatal care. Anaemia in pregnancy is very prevalent as are positive reactions to serological tests of syphilis. Infant mortality rates have fallen progressively. Death rates in the second year of life and in the 1 - 4 year age group have also fallen but are still many times the equivalent rates in the United Kingdom. Data for the first year of the Inter-American Investigation of Childhood Mortality are presented. The true death rates in the under 5 age group are higher than officially reported because of under registration of deaths. Nutritional deficiency as underlying or associated cause contributes to 31.7 percent of all deaths under 5 years of age (excluding neonatal deaths) and is most marked in the postnatal period. Diarrhoeal disease is also an important cause of death. Nutritional deficiency as judged by weight for age is present in over 40 percent of children under five years. Jamaica spends 8 percent of its annual budget on Health, but per capita expenditure is low. There are only 710 doctors with very few obstetricians and paediatricians. 34.5 percent of the births in 1970 were attended by unqualified attendants, and the resources at the main maternity hospital are severely taxed. There are also shortaged of Paediatric beds. Only two-thirds of the established posts for public health nurses are filled. The main problems in maternal and child health are discussed and it is recommended that greater emphasis be given to maternal and child health, that maternal and child health units be established in the Ministry of Health and large Health Departments and that family planning services be integrated with maternal and child health services. Maternal mortality review committees should be established and the statistical services should be improved (Summary)

An investigation of child mortality in Kingston and St. Andrew, Jamaica: Preliminary review for 1969

It has been shown that mortality in childhood in Jamaica is declining rapidly in all parts of the island. Regional differences however are still found with higher rates in the Western parishes. This paper describes a preliminary review of deaths of children under five years of age in the corprate area of Kingston & St. Andrew, Jamaica, for the year 1969. Between the ages of six month and two years, gastro-enteritis and malnutrition still account for a high proportion of deaths. Children whose mothers lack antenatal care and whose mothers were very young, were at a greater risk of dying in the neonatal period. There was also a relative preponderance of deaths among children in a well defined geographic area of a lower socio-economic status. Prematurity and obstetrical complications were the chief causes of deaths in the neonatal period. There were also 12 deaths from gastro-enteritis and 8 from tetanus in this period, and 22 from diphtheria and whooping cough in the postneonatal and early childhood periods. Hence in establishing priorities in developing and improving a maternal and child health programme, emphasis must necessarily be given to children under two years of age and special attention to certain geographic areas. It is hoped that this report help to point out needs for preventive programmes and for other uses of the results in health planning. This preliminary analysis has been done in order to obtain some early information that would be useful to the Ministry of Health, Jamaica. (SUMMARY)

Inter-American investigation of mortality in childhood: 1968-1970 organization and some preliminary results - abstract

The Inter-American Investigation of Mortality in Childhood was inaugurated by PAHO/WHO in 1967 following a successful inter-American study of adult urban mortality. The study, an exercise in international and interdisciplinary co-operation, is being conducted in fifteen centres in the Western hemisphere, including Kingston and St. Andrew, Jamaica, and is being coordinated by the Health Statistics Department of PAHO/WHO under Dr. Ruth Puffer. A team including physicians, social workers, nurses, and a medical statistician is studying the deaths of all children under five years in the Kingston and St. Andrew area during the years 1968-1970. To enable valid conclusion to be drawn, similar data on social, economic and environmental factors are being collected for a representative sample of living children from the same area and in the same age group. The aim of the study is to elucidate the various factors contributing to death so as to make more accurate data available for those responsible planning the health services and for appropriate preventive measures. Preliminary analysis of the first year's data on approximately 1,000 deaths has shown that the principal underlying causes of death in the age group studied are perinatal causes (38 percent), gastroenteritis (18.4 percent) congenital anomalies (7.9 percent), respiratory tract infections (7.3 percent), malnutrition (7.1 percent), and accidents (3.4 percent) AU

Report on 151 childhood malignancies observed in Jamaica

During a 10-year period 1958-67, 151 tumors were noted in children under 15 years of age in Jamaica. This comprised 2.9 percent of all malignant tumors observed. Leukemia was the most common form of cancer. The incidence of retinoblastomas was high and surpassed incidences of neuroblastomas and of Wilms' tumors. Kaposi's sarcoma was not observed, and hepatocellular carcinoma was extremely rare. The tumor incidence pattern in Jamaica therefore largely resembles that in the United States and in Western Europe. It contrasts significantly with that in Uganda and in Western Nigeria. This merits attention, since over 90 percent of the Jamaican population is either pure Negro or of predominantly Negro descent as a result of importation from West Africa in former days. (Summary)