Jamaican patients' understanding of diabetes mellitus

Ambulant and hospitalized patients with diabetes mellitus were interviewed by two trained interviewers to obtain information about their knowledge of the illness and the communication they had received about it. Sixty to seventy per cent of patients claimed that no explanation about the illness was given to them at the time of diagnosis. This poor communication occurred in both public and private medical services. Fifty-seven per cent of the patients' knowledge of the illness was in general poor. The hospitalized patients did learn about the illness while there, but still claimed that they learnt nothing. These data are examined in the context of the nature of the doctor-patient communication style and effect. Jamaican diabetic patients need to be better informed about their illness; despite short patient-physician contact time, an effort to explain the nature of the illness at the time of diagnosis would be worthwhile. This will need subsequent assessment and reinforcement by involving a team approach.(AU)

Mortality from diabetes mellitus in Jamaica

Mortality data for 8,799 Jamaican diabetics who died between 1970 and 1979 were collected by reviewing the death certificates of all Jamaicans that were recorded for that period. Diabetes was found to account for 6.5 percent of all deaths; 62 percent of these deaths occurred among females; and diabetes were found to die earlier than non-diabetics. There was also underreporting of diabetes in the official Registrar General's statistics, in that about a third of the decedents who had diabetes recorded on their death certificates were not coded as having died of diabetes, because the disease was not recorded as the underlying cause of death. Vascular disease was a prime cause of death among these diabetes. (AU)

Black West Indian and matched white diabetics in Britain compared with diabetics in Jamaica: body mass, blood pressure, and vascular disease

This study was designed to compare the prevalence of obesity, high blood pressure, diabetic vascular disease, and risk factors in Black West Indians who had emigrated to Britain (WIB) with those in Whites in England and among diabetic Jamaicans in Jamaica. Seventy-seven consecutive WIB patients were matched for age, sex, known duration of diabetes, and type of treatment of diabetes with 74 Whites from the same diabetes clinic in England. In Jamaica, a systematic random sample (95 women, 36 men) was studied. There was no difference in age at diagnosis between WIBs and Jamaicans. Effort chest pain (possible angina) was less frequent in WIBs (9 percent) or Jamaicans (3 percent) than in whites (25 percent). Cigarette smoking was more common in WIBs than in Whites but still low in Jamaicans. Body mass index was greatest in WIB women (85 percent), significantly more than in matched white (52 percent) or Jamaican women (45 percent); 40 percent of white men and WIB men were obese, significantly more than Jamaicans (15 percent obese). Systolic blood pressure was similar, but diastolic blood pressure was significantly greater in WIBs than in matched White subjects. The prevalence of casual hypertension was high (greater than 40 percent) in all groups, often despite treatment. Cataracts were significantly more frequent in WIB and Jamaican groups than in whites. Total background retinopathy after correcting for duration of diabetes did not differ between groups and there were no significant differences in other complication rates levels of HBA1 were lower in Whites than in the other groups. Regression analysis showed that systolic blood pressure was most consistently related to complications, particularly retinopathy, independent of ethnic group and duration.(ABSTRACT TRUNCATED AT 250 WORDS)(AU)

Social indicators, illness behaviour and mortality among patients with diabetes mellitus in Jamaica, West Indies

This dissertion presents the results of research which used interview techniques to obtain data that describe illness behaviour in diabetic patients who were either outpatients or hospitalized for complications of their illness. It also analyses mortality in Jamaican diabetics who died between 1970 and 1979. Quality of control of diabetes as determined by testing of urine or blood was a major dependent variable against which illness behaviour was evaluated. In general it was poor and this was associated with use of some bush teas. Positive attitudes towards compliance with the therapeutic regime and increased age were associated with better control. Knowledge of the illness, educational or socio-economic status had no effect on control. The appreciation of communicated information bore no relation to educational or socio-economic status. The most important finding was that only after experiencing a medical crisis did patients alter their perception of the seriousness of the illness to the extent that their compliance improved. Fear of the illness and its complications and financial difficulties were important factors affecting compliance. Mortality data from 8,799 diabetics showed that they accounted for 6.5 percent of all deaths in the 10 year period, with females having a higher risk of dying from diabetes than males. Life table analyses of data for 1977 showed that female and male diabetics had death rates of 79.36 and 45.56 per 100,000 stationary population respectively. Thus, the findings of this research quantify the magnitude of the problem of diabetes and show that the major determinant of illness behaviour in diabetes is the perceived susceptibility to and fear of the complications of the illness and consequent medical crises. (AU)

Social indicators, illness behaviour and mortality among patients with diabetes mellitus in Jamaica, West Indies

This dissertion presents the results of research which used interview techniques to obtain data that describe illness behaviour in diabetic patients who were either outpatients or hospitalized for complications of their illness. It also analyses mortality in Jamaican diabetics who died between 1970 and 1979. Quality of control of diabetes as determined by testing of urine or blood was a major dependent variable against which illness behaviour was evaluated. In general it was poor and this was associated with use of some bush teas. Positive attitudes towards compliance with the therapeutic regime and increased age were associated with better control. Knowledge of the illness, educational or socio-economic status had no effect on control. The appreciation of communicated information bore no relation to educational or socio-economic status. The most important finding was that only after experiencing a medical crisis did patients alter their perception of the seriousness of the illness to the extent that their compliance improved. Fear of the illness and its complications and financial difficulties were important factors affecting compliance. Mortality data from 8,799 diabetics showed that they accounted for 6.5 percent of all deaths in the 10 year period, with females having a higher risk of dying from diabetes than males. Life table analyses of data for 1977 showed that female and male diabetics had death rates of 79.36 and 45.56 per 100,000 stationary population respectively. Thus, the findings of this research quantify the magnitude of the problem of diabetes and show that the major determinant of illness behaviour in diabetes is the perceived susceptibility to and fear of the complications of the illness and consequent medical crises.

Illness behaviour in patients with diabetes mellitus admitted to the University Hospital of the West Indies - abstract

We studied in all 105 patients with diabetes mellitus (DM) (48 M 57 F-aged 22 - 81 years) admitted over 6 months, the circumstances contributing to admission, patients,illness perception and behaviour, doctor-patient interaction and compliance. Thirteen new patients were admitted for stabilization, 71 old patients for complications and 21 for non-diabetes related problems. Twenty old patients were admitted for stabilization and 15 for severe infections. Lack of perception of the seriousness of DM was the main contributor to poor control and admission, followed by delay in seeking attention, changes in routine and financial problems. Diabetes was not taken seriously, at the onset, by 1/3 of patients irrespective of educational and social status: this changed only after a medical crisis or complications. Delay in seeking attention was up to 4 years. More males than females discovered their DM during routine check-up or admission for reasons unrelated to DM: delay in seeking attention was more common in females. Diagnosis was made by the first doctor in 75 percent of patients. One third of the patients used informal medication such as bush teas. Patients' understanding of DM was low at onset regardless of the type of medical personnel seen. Only 36 percent of patients had a full explanation of the treatment regime at the onset. Doctor/patient communication was poor; 23 percent gained no knowledge of the DM while in hospital; 63 percent appreciated the seriousness of DM only after admission; only 27 percent gained knowledge about diet and 16 percent knowledge about other medical mangement. Financial problems contributed to poor dietary practices in 65 percent of patients while 30 percent could not maintain the prescribed regime mainly because they ran out of medication. In 65 percent compliance was motivated by fear or the present experiences. Medical consultation after discharge motivated by fear or the present experiences. Medical consultation after discharge motivated only 12 patients. This study shows the negative effect of some social factors on diabetes control: there is a need for continous reinforcement for self-management of the condition in Jamaica (AU)

Sexual development and fertility of Jamaican female patients with homozygous sickle cell disease

Results of a questionnaire study of 91 Jamaican patients with homozygous sickle cell (SS) disease and 59 Jamaican control subjects of similar socioeconomic status indicated a mean delay of 2.3 years in age at menarche and of 3.9 years in age at first pregnancy in SS disease. The mean interval between first sexual exposure and pregnancy was similar in the two groups. The delay in age at first pregnancy in SS disease resulted partly from the delay in puberty, but it also resulted from a further delay in first sexual exposure, with a mean interval between menarche and first sexual exposure of 2.6 and 4.4 years in control subjects and patients, respectively. Physical and social factors that related to this delay were reflected in the higher prevalence of casual unions in patients; this finding implied lesser sexual exposure. Although the similar interval between first sexual exposure and pregnancy did not suggest a lesser fertility in patients with SS disease, the number of infants born to patients with SS disease was less at all ages compared with Jamaican standards. This finding might reflect lesser fertility subsequent to the first pregnancy. (AU)

Circumstances relating to hospitalization of diabetic patients in three hospitals in Jamaica - abstract

One hundred and thirty-five diabetic patients admitted to 3 hospitals were interviewed to determine the circumstances related to hospitalization and the difficulties in compliance with the diabetic regimen. Fifty (50) patients were in the University Hospital of the West Indies 50 in Kingston Public Hospital and 35 at the Cornwall Regional Hospital. The duration of illness ranged from 2 days to 31 years, with more patients being admitted within the first 5 years of onset, and the numbers decreasing in each 5-year grouping. Non-compliance with the diabetic regimen was due mainly to difficulties in remaining on the diabetic diet (27.4 percent, financial problems (25.9 percent) and problems in obtaining medication (12.6 percent). The main factors precipitating hospitalization were the neglect of proper medication/diet (19.3 percent), ignorance (12.6 percent) and socio-economic problems (8.9 percent). Fifty-six (41.5 percent) of the patients were admitted to hospital because of poor diabetic control or direct complications of diabetes, 25 (18.5 percent) had diabetes as well as other illnesses and 54 (40 percent) of the patients were admitted primarily for reasons other than diabetes. Seventy-two (53.3 percent) patients were admitted primarily for stabilization of their diabetes but only 2 of these were new patients. 46.7 percent of the 135 patients had had previous admissions to hospital. In 51.9 percent of the 135 patients, knowledge of the disease was rated "low". 37 percent had no means of financial support while they were in hospital, 51.1 percent were supported by kinship/relatives, 17 percent by insurance/employer/pension, and 0.7 percent by the church. Thus the diabetic patients are admitted to hospital mainly for complications of their illness: half had been admitted previously and their difficulties with compliance were mainly because of problems with diet, ignorance and poverty. This study points out again the need for patient education in diabetes (AU)

Factors related to the prevalence of hyperglycaemia in Jamaica: a preliminary report

A pilot survey of 1,346 persons was undertaken to determine factors related to hyperglycaemia and its prevalence in the Jamaican population aged 15 years and over. Overweight and increasing age (over 35 years) were found to be associated with higher blood sugar levels. The diagnostic criterion for hyperglycaemia was a 2-hr + post-prandial blood glucose in excess of 169.4 mg/100 ml which value was one standard deviation higher than the mean blood sugar value in the 2-hr + post-prandial group of respondents. The prevalence rate was 6.1 (AU)

Some social factors related to control of diabetes mellitus in adult Jamaican patients

A population of 103 adult diabetic patients was interviewed at the Outpatient Clinic for diabetic patients of the University Hospital of the West Indies to examine the effects of severity of the illness and social variables, such as facilities at home

Social effects of leg ulceration in sickle cell anemia

The relationship between chronic leg ulceration and the education, employment, and familial relationships of adults with homozygous sickle cell disease was studied. There was a significant correlation between the age of onset of leg ulcer group demonstrated and educational attainment. Patients in the leg ulcer group demonstated lower educational attainment, had greater difficulty in obtaining and retaining employment, and were less likely to form maritial relationships (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)

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