Tracing Jamaican community childhood cohorts: influences of growth from 0 to 5 years on height, weight and blood pressure of adults aged 35+ years

OBJECTIVE: To investigate the early postnatal growth-chronic disease hypothesis, we decided to trace two total community cohorts of Jamaican children (Studies A & B). DESIGN AND METHODS: Prenatal and postnatal under-nutrition were widespread in the Caribbean in the early-mid 20th century. Current rates of some chronic diseases (high blood pressure (BP), diabetes) may reflect recent lifestyle and body mass index (BMI) changes, superimposed on these early constraints on childhood growth. Study A comprised children born between 1962 and 1963 and their recalled birth weight, weight at 1 month and height from 3 months were noted and other details were measured 1-3 monthly for 5 years, with re-measures at age 10-11 years (n=177). In study B (n=417), similar parameters were noted for all children <5 years, until 5 years of age. If traced, we took lifestyle enquiries, standardised measures of current height, weight, BP and fasting blood glucose. RESULTS: In Study A, 130 children (73 percent) were traced: 35 had migrated overseas (26 with whereabouts known), 3 died, 5 were ill/pregnant, leaving 87 available and known locally. Of 65 invited, 61 (28 men, 33 women) were seen. Of 205 initially sampled in Study B, 24 had migrated, 5 died, and 2 were ill so that 174 (85 percent) were still known locally but not yet followed. Study A: Univariate correlations between growth in height from 3 months to 5 years and current systolic BP (SBP) of adults aged 35+ years were inverse, at -0.21. Adjusted for current BMI, these changed to -0.25; further adjusting for initial 3-month height reduced the co-relation to -0.17 (p<0.02). Earlier height increments (to 2, 3 or 4 years) were more weakly inversely related to adult SBP, as was growth in weight, univariate -0.10, and after adjusting for current BMI and weight, -0.15 (p<0.05). Adjusted correlations with diastolic BP were prominent (-0.37) from 3 months to 4 years but not up to 5 years. Height and weight had tracked markedly from 0 to 5 years, those who grew the least having higher adult BP. CONCLUSION: Tracing adult cohorts from these earlier childhood studies in modern Jamaica is practical, worthwhile sample sizes can be achieved (>70 percent) and from this previously relatively undernourished community, those who grew least from 0 to 5 years had higher BP, even after accounting for initial size.(Au)

Alternative medicine: old ideas with new interests?

The use of complementary or alternative medicine has greatly increased in developed countries during th last few years. In such countries, laws have been passed and regulations made to protect both the public and practitioners. There are a growing number of research units in universities, journals, and associations of practitioners of complementary medicine. In Jamaica, too, there is increasing recognition, if not acceptance, of the popular interest in complementary medicine. In preparation for the next century we will need to address some of the legal, educational and scientific issues raised.(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).

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)

Changes in material resource levels in Jamaica's primary health care services between 1984 and 1991/1992

Jamaica's primary health-care services have been in a process of development since the 1970s. In 1984, a large management study collected data on levels of material resources (basic facilities, utilities, furniture, equipment and supplies items). Since 1984, serious staff shortages have affected the services, and there have been economic constraints, as well as a major huuricane. In order to measure changes over subsequent years, data on material resources weere again collected in 1991/1992, using the same sample of 65 types 2 and 3 health centres as in 1984. Data were collected by interview with health centre staff. Results, whilst showing various changes item-by-item, showed constancy or minor improvements overall in levels of resources. Type 2 health centres continued to have lower resource levels than type 3s, even though the methodology allowed for their different needs where appropriate. Staff members' opinions of condition and adequacy of resources had become more positive than before. It was concluded that, in terms of material resources, activities within the primary health-care sector have offset the adverse effects of the macro-environmental conditions affecting the health centres. This method of material resource monitoring has implications for quality assessment of health facilities in primary health-care.

Changes in material resource levels in Jamaica's primary health care services between 1984 and 1991/1992

Jamaica's primary health-care services have been in a process of development since the 1970s. In 1984, a large management study collected data on levels of material resources (basic facilities, utilities, furniture, equipment and supplies items). Since 1984, serious staff shortages have affected the services, and there have been economic constraints, as well as a major hurricane. In order to measure changes over subsequent years, data on material resources were again collected in 1991/1992, using the same sample of 65 types 2 and 3 health centres as in 1984. Data were collected by interview with health centre staff. Results, whilst showing various changes item-by-item, showed constancy or minor improvements overall in levels of resources. Type 2 health centres continued to have lower resource levels than type 3s, even though the methodology allowed for their different needs where appropriate. Staff members' opinions of condition and adequacy of resources had become more positive than before. It was concluded that, in terms of material resources, activities within the primary health-care sector have offset the adverse effects of the macro-environmental conditions affecting the health centres. This method of material resource monitoring has implications for quality assessment of health facilities in primary health-care (AU)

Changes in material resource levels in Jamaica's primary health care services between 1984 and 1992 - abstract

Jamaica's primary health care services have been in a process of development since the 1970s. In 1984, a large management study collected data on levels of material resources (basic facilities, utilities, furniture, equipment and supplies items). Since 1984, serious staff shortages have affected the services and there have been economic constraints, as well as a major hurricane. In order to measure changes over subsequent years, data on material resources were again collected in 1991/92, using the same sample of 65 type 2 and 3 health centres as in 1984. Data were collected by interview with health centre staff. Results, whilst showing various changes item-by-item, showed constancy or minor improvements in the global (mean) levels of resources. Type 2 health centres continued to have lower resource levels than type 3s. Staff members' opinions of condition and adequacy of resources had become more positive. It was concluded that, in terms of material resourcs, activities within the primary health care sector have offset the adverse effects of the macro-environmental conditions affecting the health centres (AU)

Screening for childhood disabilities in Jamaica: the use of ten question screen in Clarendon - abstract

No screening test for childhood disability in Jamaica has previously been formally evaluated. The present report describes the validity of the Ten Question Screen (TQ) used by community workers in Jamaican component of the International Epidemiology Study of Childhood Disability, done in the parish of Clarendon. It was previously reported by this study that approximately nine per cent of children aged 2-9 years had mild, moderate or severe disabilities (one or more of: motor, visual, hearing speech or cognitive disabilities, or fits). In Clarendon, 5,461 children were screened, using the TQ and a sub-sample of 993 was subsequently assessed by a doctor and a psychologist for the presence of disabilities. The TQ proved to be an acceptable, reliable instrument and was relatively quick and easy to administer. Sensitivity was 41 percent overall, and 64 percent for moderate/severe disability. Specificity was high, at 87 percent and 86 percent, respectively. Due to the low prevalence, the false-positive rates were high, 75 percent and 90 percent, respectively. False-negative rates varied from 2 to 12 percent in the different age/sex groups, with overall rates of 6 percent for all disabilities, combined and 1 percent in serious disabilities. The lack of sensitivity was mainly due to failure to identify disabilities , especially mild cognitive disabilities, in older boys. The unacceptably high rate of false positives on the screening test indicates the need for a second level of screening to decrease the false-positive rates (increase the positive predictive value) of the test. The reasons for the high rate of false-positive results in using the Ten Question Screen and the possibility of reducing thisby using probes and an additional questionnaire were also investigated. In the 522 false-positive cases, analyses were performed of concordance of responses for three different categories of interviewer, of other disabilities not among the ones being detected, impairments, handicaps and the possibility of the parent being excessively worried about the child's health. The use of probes in TQ positive cases and the Activities of Daily Living Questionnaire (ADLQ) were tested to determine whether false positives could be reduced. Forty-four per cent of respondents in false-positive cases changed their response from positive to the community worker to negative to the doctor. Forty-eight per cent of false-positive cases had other disabilities or impairments and 4 percent had developmental handicaps. Worry was slightly more common among mothers of false-positive cases. Use of the probes and ADLQ reduced the false-positive rate (AU)

The prevalence of childhood disability and related medical diagnosis in Clarendon Jamaica

In a population-based survey in a defined area in the parish of Clarendon, Jamaica, the prevalence of six types of childhood disabilities was sought. All children aged 2-9 years who screened positive for disability, with 8 per cent of children screening negative (out of a total of 5,468 children), were assessed by a physician and a psychologist. Disabilities were categorised by types and levels of severity. The estimated prevalence rate for all types and levels of disabilities was 93.9 per 1,000 children and for serious disability was 24.9 per 1,000. The rates for specific disabilities showed wide variation (cognitive, 81/1,000; speech, 14/1,000; visual, 11/1,000; hearing, 9/1,000; motor, 4/1,000; seizure, 2/1000). Of the disabled children, 70 per cent had only one disability, 23 per cent had two and 6 per cent had three or four disabilities. If disability is to be seen as a major outcome of a range of interacting factors, then these prevalence rates, taken with the specific aetiologies, would provide a framework for planning preventive and rehabilitative interventions. (AU)

Service needs of children with disabilities in Jamaica

We investigated the service needs of children attending a medical assessment as part of a two stage survey of 2 to 9-year-old children in mid and south Clarendon, Jamaica. Parents were asked about symptoms relating to six different disabilities: visual, hearing, speech, motor, cognitive and fits. Following medical and psychological assessment, a diagnosis of mild, moderate, severe or no disability was made. For children with disabilities, the frequencies of five possible types of intervention recommended by the physician were analysed and related to the prevalence of the six disabilities in the parish. To estimate the needs of the Jamaican child population the figures were extrapolated based on an estimate of 1 million children under the age of 15 years. These needs were then compared with places in existing services. Of the disabled children, 62 percent needed special education, 29.5 percent needed community-based services, 21 percent needed spectacles, 21 percent needed specialist referral, and 6 percent required medical treatment. Although the vast majority of these needs are not met, many more could be met in the community if existing health and education personnel are trained in basic techniques of screening and assessment. (AU)

Identification of childhood disability in Jamaica: the ten question screen

This is the first in a series of papers that report the testing of two instruments for the identification and assessment of childhood disability by community workers (CWs) in Third World countries. It is part of the International Epidemiological Study on Childhood Disability. The Ten Question Screen (TQ) was used as the main instrument to identify disability in a two stage population-based survey of 5478 children aged 2-9 years in Clarendon, Jamaica. In the second stage, TQ positive and 8 percent of the screen negative controls were professionally assessed by a doctor and a psychologist using standard criteria on the main classification system of the ICIDH. Sensitivity of the TQ as a whole varies in different strata of the group and amongst different disabilities, from perfect in girls under 6 years, fits and motor disabilities and for serious disability in all groups except boys over 5 years with a cognitive disability. Specificity was good but the false positive rate was unacceptably high at 74 percent. It was concluded, firstly, that the validation of a simple questionnaire of perceptions of behaviour against objective measurments of impairments was perhaps not fair to the TQ. In spite of this, the TQ would be a very useful instrument in collection disability data for identifying people in need of rehabilitation help, if a way of reducing false positive could be found. (AU)

Service needs of disabled children in Jamaica - abstract

Parents of children presenting for a medical assessment as part of a two-stage survey of 2 to 9-year-old children in mid and south Clarendon were asked about symptoms relating to six different disabilities: visual, hearing, speech, motor, cognitive and fits and whether they had sought treatment for these symptoms. Their responses were compared with those who were diagnosed as disabled by the professional team. The frequencies of five possible types of intervention for children with disabilities recommended by the physician were analysed and related to the estimated prevalence of the six disabilities in the parish, to estimate the needs of Jamaican children for the various types of services. These were then compared with existing services. For all disabilities, except fits, the percentage of children that received treatment for symptoms was low, ranging from 5 percent for cognitive to 33 percent for motor symptoms. For children found to be disabled, the rates were a little higher except for treatment of fits which was 87 percent and cognitive disability at 5.6 percent. Awareness of the disability was also poor in cognitive, visual and speech disabilities. Fifty-six percent of disabled children needed special education, 29.5 percent needed community-based services, 21 percent needed spectacles, 21 percent needed specialist referral and 6 percent required medical treatment. The vast majority of the estimated needs for Jamaica as a whole are unmet (AU)

A comparison of efficacy of the key informant and community survey methods in the identification of childhood disabilities in Jamaica

A comparison of the efficacy of the key informant and the community survey methods for identifying children with disability was carried out in the Jamaican component of an international epidemiological study of children disability. Approximately 130 key informants were exposed to a two-day workshop giving information on sign of disability, aspects of the project, and available services. Questionnaires were given to enable the informants to refer children and they were reminded six months later. In the survey method, eight community workers completed a house-to-house survey of all families and administered the 10-question screen with probes on 5475 children, 2 to 9 years old. Seventeen referrals were made by the key informants; of these, two were found to have disabilities. Of the 821 children who tested positive on the 10-question screen on the house-to-house survey, 193 had disabilities. We concluded that the key informant method would not be a satisfactory way of identifying cases of childhood disability. (AU)

Survey of community health aides in Jamaica (1987-1988)

The community health aide (CHA) programme was initiated in 1967, and, by the early 1980s, 1,328 CHAs had been trained and over 1,100 remained in the service. The aim of the programme was to train CHAs to assist in the delivery of basic health care. During the restructuring of the health services in 1985-1986, many CHAs were made redundant. As part of a large study aimed at assessing the current status of the CHA programme, this paper reports results of interviews with 415 CHAs still in service in 1987-1988 and 134 showed that they continued to perform duties in the community and in health centres with emphasis on the maternal and child health services and the management of diabetics and hypertensives. The survey of CHAs no longer employed as such showed that the majority remained unemployed though many continued to use their skills on a voluntary basis. These CHAs felt that home visiting had been reduced and environmental health was being neglected since they left, and that problems were not being regularly reported to the professionals at the health centres. It was recommended that all CHAs be offered training in the taking of blood pressure levels and in the giving of insulin injections to diabetics. Recommendations included improved methods of selection, longer training, greated community outreach, especially to the elderly, post-training evaluation, regular assessment of the CHAs' performance, and improved upward mobility opportunities and job security (AU)

The prevalence of childhood disability in Clarendon, Jamaica - abstract

The experience of the epidemiological transition for developing countries is leading to a revision of paediatric priorities, with increasing concern for the problem of childhood disabilities. Their exists a lack of knowledge of the profile of disability occurrence in Caribbean communities. In a community-based study in the parish of Clarendon, Jamaica, done between 1986 and 1989, the prevalence of six types of childhood disabilities was sought. Within a defined area, data were collected on 5,468 children aged 2-9 years via household surveys. All children screening positive for disability, together with a sample of `normal' children, were assessed by a physician and a psychologist. Disabilities were categorised by types and levels. The prevalence rate for all types and degrees of disabilities was 93 per 1,000 children and for severe disability, 5.4 per 1,000 children. The rates for specific disabilities showed wide variation (cognitive - 81/1000, speech - 14/1000, visual - 10/1000, hearing - 9/1000, motor - 4/1000 and seizure -2.0/1000), with cognitive problems either singly or in combination accounting for a large segment of the disability profile. Seventy per cent of disabled children had only one disability, 23 per cent had two and 6 per cent had three and four. A literature review reveals no data on prevalence for the region that would make meaningful comparisons. International comparisons are difficult, due to conceptual and methodological dissimilarities. The prevalence of childhood disabilities for Clarendon suggests that this aspect of children's functioning should be given greater emphasis by planners and policy-makers. If disability is to be seen as the final outcome of a range of interacting factors, then these prevalence rates, taken with the specific aetiologies, would provide a framework for planning intervention (AU)

Material resources in Jamaica's primary health care centres

A national study of management aspects of the primary health care services in Jamaica provided data on material resources (facilities, utilities, furniture, equipment and supplies) available at health centres. It was postulated that a description of resources and of their relationship to output could be useful, and the study set out to develop composite indices to measure material resource levels. Staff at a sample of 92 health centres, in all parishes, were interviewed to provide objective statements of resources present and subjective assessments of their adequacy and condition. Results showed that certain basic material resource items were present in a relatively high proportion of health centres but others, perhaps less crucial, were scarce. The lower level health centres were less well supplied with resource items than the others, even after standardising for their different needs. The data provided evidence that output by personnel was related to level of material resource inputs. Experimenting with formulation of composite indices of material resources, considerations of sensitivity, simplicity and creditability led to the conclusion that indices based on objective statements were as appropriate as the more complicated ones based on subjective assessments. Use of indices based on objective data showed that the South-Eastern and Western health areas had higher levels of resource than the North-Eastern and Southern areas. It was concluded that composite indices based on simple statements and calculations can be useful in monitoring levels of material resources, and that material resources probably have an effect on output from health centres (AU)