An assessment of the nutritional status of UWI (Mona) students: anthropometry - abstract

The weight and height of 703 students at the University of the West Indies, Mona, Jamaica, were measured. This number represents 26 percent of the under-26-year-old student population. The Quetelet Index, also known as the body mass index, (Wt. Ht(to -2 power), Kg.m(to -2 power) was used to classify students as underweight, 'normal' or overweight. Thirty-eight per cent of the students were found to be underweight, 55 percent were 'normal' and 7 percent overweight. There were more underweight females than males, with the converse in the "normal" category. The sexes were evenly distributed in the overweight class. An increase in weight and height was observed for Jamaican students compared with young Jamaicans measured in 1959. However, comparison between countries of origin of the students showed that the Jamaicans had the highest percentage of underweight, and the least 'normal' weight students. Financial constraints, lack of nutrition knowledge and poor dietary practices are possible reasons for the high percentage of underweight students. It is suggested that more detailed dietary and biochemical investigation should be undertaken (AU)

An evaluation of the maternal health services in Cornwall County, Jamaica - abstract

The Primary Health Care (PHC) programme was started in Cornwall County, Jamaica, in 1976. The aim of this study was to evaluate the effectiveness of the maternal health component of the Primary Health Care Services in the parishes of St. James and Trelawny. Certain key maternal health indicators were used for the evaluation. Information was collected from 720 maternal health record cards of pregnant women attending clinics in St. James and Trelawny from 14 Type 1 health centres in both parishes. The results showed that maternal health coverage increased from 59 percent to 67 percent from 1974 to 1980, while the percentage of pregnant women who made 5 or more antenatal visits increased from 10 percent to 33 percent during the same period. The percentage of pregnant women who visited the antenatal clinic in the first trimester also increased from 17 percent to 63 percent from 1975 to 1980. In general, there was an increase in the process activities at the antenatal clinics. However, the study also revealed that VDRL results were returned late in the parish of Trelawny and less than half of the pregnant women in both parishes had haemoglobin tests done. In addition, the pregnant women were not weighed at all at antenatal visits during pregnancy. In general, the maternal health targets set in 1976 were only partially met. Shortage of staff, equipment, supplies and the unsatisfactory facilities of the health centres may have contributed to the failure to meet targets. On the whole, the parish of St. James performed better than Trelawny. Primary health care services can contribute to the improvement of health status of pregnant women. However, the establishment of adequate support services is crucial in any primary health care programme (AU)

Dietary patterns with respect to iron intake in the Turks and Caicos Islands - abstract

Cohen et al (1974) found a high prevalence of anaemia amongst 0-13 year-old children in the Turks and Caicos Islands. There was a marked inter-island variation with 69 percent of 5-year-old children on Middle Caicos and 28 percent on Grand Turk being anaemic. They ascribed this anaemia as probably being due to iron deficiency. A food frequency questionnaire was designed and weighted so that household iron consumption could be computed as a score. The method was pretested and the score calibrated against 24-hr recalls for three days in 10 individuals: a correlation coefficient of r=0.93 was obtained between the two methods. The questionnaire was administered to the female household head of 144 households on Grand Turk (48), Provodentiales (46) and Middle Caicos (50), selected at random from the register of voters. The foods consumed formed a series of Guttman scales for each of the eight food groups. Chicken, fish, rice, bread and evaporated milk were most frequently consumed. The dietaries were very restricted on each island, with Middle Caicos only having eight major items consumed more than three times per week, by more than 25 percent of households. The households were divided into low, medium and high iron intake categories based on iron scores which correspond to ó7.5, 7.6 to 12.9 and o13mg Fe/d. Grand Turk and Provodentiales were similar with 1 percent of families in the low iron group and 76 percent in the high group. In contrast, 20 percent of families in Middle Caicos were in the low, and only 44 percent in the high iron intake group. The iron equivalent of the overall scores for the three islands were 15.2ñ2.1, 14.6ñ1.7 and 11.8ñ2.7mg/d respectively. The mean RDA for iron for this population's age/sex structure is 10.1 mg/d. When the contributions to the total iron intake from each food group were calculated, Middle Caicos households had significantly lower intakes in each category. These data add support to the hypothesis that dietary iron deficiency is responsible for the high prevalence of anaemia in the Turks & Caicos Islands. Bread and rice were consumed more than 3 times weekly by 98 and 93 percent of households on each island: these were the only items which would be suitable for iron fortification. As the flour and rice are entirely imported from the U.S.A., in relatively small quantities (total population 7,700), it is probably more cost-effective to distribute prophylactic iron supplements than to fortify a dietary constituent (AU)

An evaluation of the child health services in Cornwall County, Jamaica

In 1976 a special pilot program was initiated in Cornwall County, Jamaica, with World Bank assistance. This program sought to enhance primary health care services, primarily through training and decentralization. The study reported here, conducted in January-June 1980, was designed to gauge that program's effect on the health of children under two years of age. For this purpose, two Cornwall County parishes (St. James and Trelawny) were selected, and within each the "pilot" district where the program had been implemented was studied along with a "non-pilot" district. The study itself was based on the records of 323 children attending the smallest and simplest class of health care center within the areas covered, together with health worker responses to a questionnaire and data on supplies provided to the centers. The study results suggest that certain features of infant and young child health services in the study parishes improved between 1976 and 1980. Specifically, health service coverage appears to have increased; the average number of routine clinic visits per child rose; and the prevalence of malnutrition seems to have diminished. On the other hand, immunization coverage was still low, and the study findings incicate no major increase in average birth-weights. Regarding the "pilot" versus "non pilot" districts, the former fared somewhat better than the latter in terms of the average number of clinic visits per child, immunization coverage, low-weight births, nutritional status, and health services coverage, although in many cases the differences observed were fairly modest (AU)

Relations entre diarrhee a rotavirus et contenu energetique de l'alimentation dans un groupe d'enfants jamaicains d'age prescolaire: une etude prospective / Relations between rotavirus diarrhea and food energy content in a group of Jamaican children of pre-school age: a prospective study

The cancerous role of frequent infections, particularly intestinal ones, on the growth of the child, has already been noted by several authors. Therefore, with acute diarrhea, the convergence of factors as varied as anorexia, accrued loss of nutrients, or familiar dietary habits all alter the nutritional state of the child. On the other hand, it seems that the part played by each one of these factors varies according to the type of diarrhea. Therefore, it has been suggested that with acute rotavirus diarrhea, refusal of food was responsible for the reduction of food consumption, rather than dietary "taboos", and children who were breastfed had a higher energy consumption level then those who were not breastfed. Therefore, the objective of this work is to study the relations between energy consumption in Jamaican preschoolers and the presence of rotavirus diarrhea.(AU)

Improving child health and development through school children spreading the concept in Jamaica - abstract

In the Caribbean there is a need to find innovative low-cost approaches to improve the health and development of young children. One such approach is using primary school children to reach the families. In a pilot project in 1979, we taught rural school children development concepts. Following that experience, we extended the curriculum to focus on the total child and to include health, hygiene and nutrition, and identified primary school level as being the most appropriate. In 1982, in collaboration with the Ministries of Health and education, we extended the project to seven primary schools, and no longer taught children ourselves but trained the teachers to do so. Our aims were to improve the knowledge, skills and child-rearing practices of teachers, guardians and school children, and develop better parents for the future. Our long-term goal was to integrate the curriculum into that of the Ministry of Education, and to improve the health and development of pre-school children. Two weekly workshops were held with the teachers where the curriculum was explained. The subject was taught one period a week for a school year. The curriculum was explained. The subject was taught one period a week for a school year. The curriculum was action-oriented with songs, pictures and role-playing. In order to evaluate the project, five project classes (333 school children) were selected, and two control classes (N = 161) from similar schools in the same parish. The teachers (Index N = 14, Control N = 28), school children and a random sample of guardians (Index N = 90, Control N = 47) were evaluated by test or questionnaire. Analysis shows marked and statistically significant improvement in the school children and teachers' knowledge and attitudes to all topics taught. Most of the guardians reported that messages had been delivered to them and, in some topics, they themselves showed improvement. They also reported significant improvement in the children's practices at home. The findings suggest that using schools for health and education of the community is an effective and efficient approach. It is also probable that these children will be better parents in the future. This approach to integrating health and education is in keeping with the basic concepts of Primary Health Care, and could be useful in other Caribbean countries (AU)

An evaluation of child health services in Cornwall County, Jamaica - abstract

The Primary Health Care (P.H.C) programme was started in Cornwall County, Jamaica, in 1976. The aim of this study was to evaluate the effectiveness of the child health component of the P.H.C. services in the parishes of St. James and Trelawny. Certain key child health indicators were used for the evaluation. Information was collected from 323 child health record card of children attending clinics in St. James and Trelawny (24 months of age at time of study) from 14 Type 1 health centres in both parishes. The results showed that coverage of children under 2 years increased from 33 percent to 50 percent from 1974 to 1980, while the average number of clinic visits per child increased from 2 to 5 during the same period. The results also indicated that the prevalence of malnutrition had fallen from 8 percent to 4 percent between 1975 and 1980. However, immunization coverage for diphtheria, pertussis, tetanus and poliomyelitis was low. Generally, the child health targets set in 1976 were only partially met. Shortage of staff, equipment, supplies and unsatisfactory facilities at the health centres may have contributed to the failure to meet the targets. On the whole, the parish of St. James performed better than Trelawny, whereas the pilot districts performed better than the non-pilot districts. Primary health care services can contribute to the improvement of health status of children. However, the establishment of adequate support services is crucial in any primary health care programme (AU)

Rural development projects and nutritional status of preschool children in Haiti - abstract

In order to assess the effect of agricultural development on nutrition, a survey was conducted in the Plaine of Gonaives (Haiti) where a land irrigation project had been implemented two years previously. The economy of the region is essentially based on agriculture. Drought is the major problem so that the traditional land irrigation system covers only 25 percent of needs. The main objective of the project was directed towards the exploitation of the water table in order to drain water to arable lands, as well as to improve agricultural extension services and export crop production. The Nutrition survey was conducted in October, 1981, and a sample of 108 children, aged 1 to 60 months, were selected from 2 villages which were similar in their ecosystem and social structure and were located inside and outside of the project area respectively. It was found that the agricultural yield per hectare was 5 times higher in the project area than in the control area. No difference was found in nutritional status between areas, assessed either by anthropometric indices or by incidence of stunting and wasting. The following table shows the percentage of malnourished children in each category expressed as per cent of the total (n): AREA: Project - Normal 84.3, Stunted 9.8, Stunted and Wasted 3.9, Wasted 2.0, N 51; AREA: Control - Normal 82.5, Stunted 12.3, Stunted and Wasted 1.8, Wasted 3.5, N 57; AREA: National Survey (1978) - Normal 68.4, Stunted 25.5, Stunted and Wasted 3.0, Wasted 3.4, N 4460. About 85 percent of children were anaemic in both areas and the mean haemoglobin concentration was similar. In children aged 4-5 years, food consumption and therefore protein and energy consumption was higher in the project area, although in both areas, energy and protein consumption were less than the recommended dietary allowance for the Caribbean. This survey shows that an exclusively economic project, even if it improves family income and subsequently food intake, does not necessarily improve nutritional status. It stresses the importance of including components that are more closely related to nutritional status, such as health and education, into a rural development project (AU)

Energy intakes and rotavirus diarrhoea: a prospective study - abstract

Dietary information and anthropometric measurements were obtained on 6 seperate occasions during one month for each of 68 children under 5 years of age during and after recovery from rotavirus diarrhoea. The period of exclusive breastfeeding was under 3 months for 89 percent of children, 36 percent had received solids before 4 months, and 24 percent were currently receiving some breastmilk. Eighty-two per cent of mothers had observed weight loss and reduced appetitie since the onset of diarrhoea. Dietary recalls (24-hour) showed that 94 percent of children were receiving less than two-thirds of the recommended allowance for energy during the acute phase of diarrhoea, 60 percent during early convalescence and 40 percent during late convalescence (4 and 14 days after cessation of diarrhoea respectively. Intakes per kilogramme body weight were also low: PHASE - Acute diarrhoea, Early convalescence, Late convalescence; JAMAICA 43 ñ 19, 68 ñ 23, 78 ñ 22 respectively KCALS/KG/DAY, BANGLADESH (Rotavirus patients) 63, 84, 100 respectively. Bangladesh studies report higher intakes among children with non-rotavirus diarrhoeas. Healthy Jamaican children are reported to have a mean intake of 80 Kcals/kg. The average weight gain of the children was twice the expected gain. However, children with lower energy intakes during early convalescence, when 85 percent had recovered appetities, gained less than the expected weight. Breastmilk can make an important contribution to energy intake during infection. This study found that most children receiving breastmilk had better weight gains. The study underlines the need for adequate diets during and following recovery from acute diarrhoea to counteract the negative nutritional impact of the episode. Breastfeeding can help to maintain a minimum intake in the face of appetite loss (AU)

A community study of parasites, nutritional status and housing in young Jamaican children - abstract

Parasitic infections may contribute to gastoenteritis and protein-energy malnutrition (PEM) both important problems among young Caribbean children. We conducted an epidemiological study of the prevalence of parasitic infestation and its association with the environment and nutritional status of preschool age children in a poor Kingston neighbourhood. The sample comprised all the 145 children (6 -36 months old) in a defined area. There were equal numbers of boys and girls and in each of 5 age groups (6 - 11, 12 - 17, 18 -23, 24 -29, 30 -36 months). Single stool specimens were examined for helminth ova and protozoan cysts using the formolether method, with iodine staining for light microscopy. The children's weights and heights were measured and their guardians were interviewed about their housing, sanitation and social background. Thirty-four per cent of the children were infested with 1 - 5 organisms: Trichuris, 21 percent, Ascaris, 18 percent, with generally low - moderate loads (< 5,000 ova/500 mg stool). Giardia occurred in 12.6 percent with very few other protozoans (E. coli, 4.2 percent, C.mesnili, 2.1 percent and E. nana, 0.7 percent). The peak prevalence (70 percent) was among 30-36 month-olds, age being significantly positively associated with the presence of parasites (p 0.001). The infested children had significantly poorer sanitation and water facilities (p<0.05) and their parents had a lower educational level (p<0.05) than the non-infested. Sixty-one (42.9 percent) children had some degree of undernutrition with 13(9.1 percent)moderately - severly malnourished. Single stool specimens probably underestimated the true point prevalence and load of parasitic infestations. There was a significant positive association between nutritional status and the presence of parasites in this study, However, undernutrition occurred most often among young toddlers (12 - 17 months) and parasitic infestation among 30 - 36 month-olds. This suggests that parasitic infestation did not play an important role in the aetiology of PEM in this community (AU)

Response to the central and peripheral airways to cigarette smoking in humans and rats

The effect of tobacco smoke on the central and peripheral airways were assessed in humans and rats by direct and indirect methods. In both species tobacco smoke affected the central and peripheral airways. In humans there were apparent decreases in the 1-second forced expiratory volume, peak expiratory flow rate and significant increases in closing volume and closing capacity (P less than 0.001). In rats significant changes were seen in specific airway resistance from the 6th week of exposure onwards. Similarly, airway luminal diameter decreased markedly in tobacco-exposed animals to subthreshold concentrations of acetylcholine (10(-8) M). This decrease was also exposure time dependent. The increased responsiveness of the respiratory system has been attributed to inter alia: (1) increased vagal activity; (2) increased mucus production leading to decreased airway lumen; (3) mucosal swelling due to changed ionic constellation; (4) disturbance of the lungs' defense mechanism; (5) imbalance in and easy accessibility to the adrenoceptors. (AU)

Pulmonary function in Afro-Jamaicans: implications in screening

Pneometric parameters and closing volume were measured in 950 Afro-Jamaicans of both sexes. Prediction formulae relating each measurement to age and height were constructed. Based on these formulae it is concluded that differences in compartments of the lung exist in Afro-Jamaicans. Closing volume measurements yielded higher values for Afro-Jamaicans than is observed in white populations. It is suggested that in the absence of baseline values an erroneous diagnosis of small airway disease could result. The possibility that the observed differences may have been due to environmental rather than genetic factors is discussed. (AU)

Social environment of malnourished children compared with that of other children in Jamaica

This investigation was part of a longitudinal study of mental development of seventeen Jamaican children who were admitted to hospital with severe protein energy malnutrition. The children were compared with 20 adequately nourished children who were admitted to hospital for other reasons. Previous research had shown that, 1 month after the children left hospital, both groups had similar scores on a modified Caldwell inventory of Home Stimulation. When, in the present investigation, the inventory was repeated 24 months later, scores remained similar in both groups. When compared with data collected from a survey in a poor neighbourhood, again the scores of the neighbourhood children were similar to those of the malnourished group. The malnourished children were however living in poorer houses and had failed to catch up to the other groups in nutritional status. Comparison of these findings with those from other countries suggests that the ecology of malnutrition differs in different cultures and that Jamaican mothers of malnourished children are characterized by poverty rather than poor maternal-child relationships. It also appears that, at this age, poor levels of home stimulation were not a major factor in producing the deficit in development manifested by the malnourished group.(AU)

Bronchomotor tone in protein-energy malnutrition

The study examined the reactivity of the tracheobronchial tree of rats maintained on low protein and tryptophan-deficient diets. It was found that: (1) Rats maintained on 5 percent protein or triptophan-deficient diets showed little or no weight gain. A 15 percent protein diet was adequate for normal growth of female rats, but not of male rats. (2) Airways of malnourished rats showed significant bronchoconstriction when treated to an acetylcholine (AcCH) concentration of 10 to the 11 power M. The treshold concentration of AcCh for normal rats was 10 to the -5 M. Airways of malnourished rats were also more sensitive to cold. (3) Rehabilitation of the malnourished rats attenuated the response to AcCh. Recovery, however, was not complete. (4) Prior application of phentolamine and atropine markedly reduced the sensitivity of the airways of malnourished rats to AcCh. The results seem to indicate that O-adrenoceptors and the vagus nerve may be involved in the observed increased reactivity of airways of malnourished rats.(AU)

Tracheobronchial function in health and disease: effect of mucolytic substances

The effect of mucolytic and expectorant substances on ciliary beat frequency, mucus transport velocity and mucus production, was investigated in normal and bronchitic rats. The results showed that: (i) N-acetylcysteine and S-carboxymethylcysteine were mildly cilioexcitatory at low and ciliodepressive at higher concentrations in both normal and bronchitic rats. A similar pattern was seen in mucus transport velocity. (ii) Bisolvan enhanced all aspects of muciciliary activity in both groups of animals. Sobrepin was less effective than Bisolvan and more effective than Tachoquilin. (iii) Geleomytrol, Ozothin and prostaglandin E1 were all cilioexcitatory in rats with bronchitis. Mucus transport velocity was similarly stimulated by both Geleomyrtol and Ozothin. (iv) Ammonium chloride and potassium iodide enhanced mucociliary activity in normal and bronchitic rats. (v) All substances stimulated mucus production, however, the most potent was prostaglandins E1. The mechanisms for increased mucociliary activity involve inter alia the probable cleaving of disulphide bridges, decreased mucosal swelling, altered rheological characteristics and stimulation of adenylate cyclase (AU)