Classifying maternal deaths in Suriname using WHO ICD-MM: different interpretation by Physicians, National and International Maternal Death Review Committees.

The World Health Organization (WHO) provides a framework (ICD-MM) to classify pregnancy-related deaths systematically, which enables global comparison among countries. We compared the classification of pregnancy-related deaths in Suriname by the attending physician and by the national maternal death review (MDR) committee and among the MDR committees of Suriname, Jamaica and the Netherlands. There were 89 possible pregnancy-related deaths in Suriname between 2010 and 2014. Nearly half (47%) were classified differently by the Surinamese MDR committee as compared to the classification of the attending physicians. All three MDR committees agreed that 18% (n = 16/89) of the cases were no maternal deaths. Out of the remaining 73 cases, there was disagreement regarding whether 15% (n = 11) were maternal deaths. The Surinamese and Jamaican MDR committees achieved greater consensus in classification than the Surinamese and the Netherlands MDR committees. The Netherlands MDR committee classified more deaths as unspecified than Surinamese and the Jamaican MDR committees. Underlying causes that achieved a high level of agreement among the three committees were abortive outcomes and obstetric hemorrhage, while little agreement was reported for unspecified and other direct causes. The issues encountered during maternal death classification using the ICD-MM guidelines included classification of suicide during early pregnancy; when to assume pregnancy without objective evidence; how to count maternal deaths occurring outside the country of residence; the relevance of direct or indirect cause attribution; and how to select the underlying cause when direct and indirect conditions or multiple comorbidities co-occur. Addressing these classification barriers in future revisions of the ICD-MM guidelines could enhance the feasibility of maternal death classification and facilitate global comparison. BACKGROUND: Insight into the underlying causes of pregnancy-related deaths is essential to develop policies to avert preventable deaths. The WHO International Classification of Diseases-Maternal Mortality (ICD-MM) guidelines provide a framework to standardize maternal death classifications and enable comparison in and among countries over time. However, despite the implementation of these guidelines, differences in classification remain. We evaluated consensus on maternal death classification using the ICD-MM guidelines. METHODS: The classification of pregnancy-related deaths in Suriname during 2010-2014 was compared in the country (between the attending physician and the national maternal death review (MDR) committee), and among the MDR committees from Suriname, Jamaica and the Netherlands. All reviewers applied the ICD-MM guidelines. The inter-rater reliability (Fleiss kappa [κ]) was used to measure agreement. RESULTS: Out of the 89 cases certified by attending physicians, 47% (n = 42) were classified differently by the Surinamese MDR committee. The three MDR committees agreed that 18% (n = 16/89) of these cases were no maternal deaths, and, therefore, excluded from further analyses. However, opinions differed whether 15% (n = 11) of the remaining 73 cases were maternal deaths. The MDR committees achieved moderate agreement classifying the deaths into type (direct, indirect and unspecified) (κ = 0.53) and underlying cause group (κ = 0.52). The Netherlands MDR committee classified more maternal deaths as unspecified (19%), than the Jamaican (7%) and Surinamese (4%) committees did. The mutual agreement between the Surinamese and Jamaican MDR committees (κ = 0.69 vs κ = 0.63) was better than between the Surinamese and the Netherlands MDR committees (κ = 0.48 vs κ = 0.49) for classification into type and underlying cause group, respectively. Agreement on the underlying cause category was excellent for abortive outcomes (κ = 0.85) and obstetric hemorrhage (κ = 0.74) and fair for unspecified (κ = 0.29) and other direct causes (κ = 0.32). CONCLUSIONS: Maternal death classification differs in Suriname and among MDR committees from different countries, despite using the ICD-MM guidelines on similar cases. Specific challenges in applying these guidelines included attribution of underlying cause when comorbidities occurred, the inclusion of deaths from suicides, and maternal deaths that occurred outside the country of residence.

Central adiposity at diagnosis may reduce prostate cancer-specific mortality in African-Caribbean men with prostate cancer: 10-year follow-up of participants in a case-control study.

PURPOSE: General and central adiposity are associated with the risk of developing prostate cancer (PCa), but the role of these exposures on PCa survival among men of African ancestry are less studied. This study aimed to investigate the association of anthropometry at diagnosis with all-cause and PCa-specific mortality and evaluate whether androgen deprivation therapy (ADT) modulated this risk. METHODS: Associations between body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR) at diagnosis and mortality were examined in 242 men with newly diagnosed PCa enrolled between 2005 and 2007 and re-evaluated 10.9 years later. Multi-variable Cox proportional hazard models were used to examine associations of body size variables (using standard WHO cut-points and as continuous variables) with mortality, adjusted for sociodemographic characteristics, Gleason score, smoking, diabetes, primary treatment, and ADT therapy. RESULTS: A total of 139 deaths (all-cause mortality 6.98/100 person-years) occurred (PCa-specific deaths, 56; other causes, 66; causes unknown, 17). In multi-variable analysis BMI, WC and WHR categories at diagnosis were not associated with all-cause mortality even after adjusting for ADT. While WHR (but not BMI or WC) when included as a continuous variable predicted lower PCa-specific mortality (multi-variable adjusted WHR per 0.1 difference: HR, 0.50; 95%CI 0.28, 0.93), the effect disappeared with ADT covariance and excluding deaths within the first 2 years. CONCLUSION: Our study suggests that central adiposity as measured by WHR may improve long-term survival among men of African ancestry. Metabolic studies to understand the mechanism for this association are needed.

Vital registration and under-reporting of maternal mortality in Jamaica.

OBJECTIVE: To identify why vital registration under-reports maternal deaths in Jamaica. METHODS: A cross-sectional study was undertaken to identify all maternal deaths (during pregnancy or ≤42 days after pregnancy ended) occurring in 2008. Data sources included vital registration, hospital records, forensic pathology records, and an independent maternal mortality surveillance system. Potential cases were cross-referenced to registered live births and stillbirths, and hospital records to confirm pregnancy status, when the pregnancy ended, and registration. Medical certificates were inspected for certification, transcription, and coding errors. Maternal mortality ratios (MMRs) for registered and/or unregistered deaths were calculated. RESULTS: Of 50 maternal deaths identified, 10 (20%) were unregistered. Eight unregistered deaths were coroners' cases. Among 40 registered deaths, pregnancy was undocumented in 4 (10%). Among the other 36, 24 (67%) had been misclassified (59% direct and 89% indirect deaths). Therefore, only 12 (30%) registered maternal deaths had been coded as maternal deaths, yielding an MMR of 28.3 per 100 000 live births (95% confidence interval [CI] 12.3-48.3), which was 76% lower than the actual MMR of 117.8 (95% CI 85.2-150.4). CONCLUSION: Under-reporting of maternal deaths in Jamaica in 2008 was attributable to delayed registration of coroners' cases and misclassification. Timely registration of coroners' cases and training of nosologists to recognize and code maternal deaths is needed.

Excess risk of maternal death from sickle cell disease in Jamaica: 1998-2007.

BACKGROUND: Decreases in direct maternal deaths in Jamaica have been negated by growing indirect deaths. With sickle cell disease (SCD) a consistent underlying cause, we describe the epidemiology of maternal deaths in this population. METHODS: Demographic, service delivery and cause specific mortality rates were compared among women with (n = 42) and without SCD (n = 376), and between SCD women who died in 1998-2002 and 2003-7. RESULTS: Women with SCD had fewer viable pregnancies (p: 0.02) despite greater access to high risk antenatal care (p: 0.001), and more often died in an intensive care unit (p: 0.002). In the most recent period (2003-7) SCD women achieved more pregnancies (median 2 vs. 3; p: 0.009), made more antenatal visits (mean 3.3 vs. 7.3; p: 0.01) and were more often admitted antenatally (p:<0.0001). The maternal mortality ratio for SCD decedents was 7-11 times higher than the general population, with 41% of deaths attributable to their disorder. Cause specific mortality was higher for cardiovascular complications, gestational hypertension and haemorrhage. Respiratory failure was the leading immediate cause of death. CONCLUSIONS: Women with SCD experience a significant excess risk of dying in pregnancy and childbirth [MMR: (SCD) 719/100,000, (non SCD) 78/100,000]. MDG5 cannot be realised without improving care for women with SCD. Tertiary services (e.g. ventilator support) are needed at regional centres to improve outcomes in this and other high risk populations. Universal SCD screening in pregnancy in populations of African and Mediterranean descent is needed as are guidelines for managing SCD pregnancies and educating families with SCD.

Development of primary health care in Jamaica

The development of primary health care in Jamaica is explored, tracing its early roots to the abolition of the slave trade, the collapse of estate-based services after emancipation and the subsequent establishment of the Island Medical Services in 1875. Most developments in the health sector occurred after World War I in response to the high infectious disease mortality rates. The Rockefeller Foundation was asked to assist with the control of hookworm, tuberculosis, malaria and yaws. Its recommendation led to the growth of public health programmes (eg environmental health, public health nursing, community midwifery) alongside community-based curative services run by hospitals. The most significant period of development occurred in the 1970s when the various vertical programmes were integrated into the current primary care system. Jamaica was integral in the development of the World Health Organization's Alma Ata Declaration on Primary Health Care, tabling the "Jamaican Perspective on Primary Health Care" which set out its goal that all citizens should be within 10 miles walking distance of a primary health care facility. At the close of the twentieth century, the health reform process led to the development of regional health authorities aimed at integrating the management of primary and secondary care under four Regional Boards of Health. This has led to a change in the role of the central Ministry of Health to one of policy-making, health promotion, setting standards, monitoring and evaluation of the quality of health care. (AU)

Oral health status of 12 year old children in St. Lucia and its association with oral health knowledge, attitudes and practices

OBJECTIVE: This study was carried out in St. Lucia, one of the islands of the eastern Caribbean. The island's population of 150,000 persons is relatively young, with 45 percent under the age of twenty years. The study sought to determine the oral health status of 12-year-old children and its association with oral health knowledge, attitudes and practices. METHODS: A cross-sectional survey was undertaken. Four schools (two rural and two urban) were randomly selected from 14 schools in the north of the island. Simple random sampling was used to select 97 students aged 12 years (15 percent of the school population). Trained dental personnel performed a dental examination and recorded the students' decayed, missing or filled teeth (DMFT) status. The principal investigator (SA) administered a structured questionnaire as well as performed the oral examinations. World Health Organization (WHO) guidelines for DMFT surveys were adhered to. The data were collected in July 2000 and analysed using SPSS, version 9. RESULTS: The DMFT level of the students was 2.0, which by WHO standards is low. This compares quite favourably with a 1997 study when the DMFT level identified in an island-wide study was 6.0. It should be noted, however, that 65.3 percent of children had 1 to 7 decayed teeth, 8.2 percent had 1 to 4 missing teeth, with only 9.2 percent have 1 to 2 filled teeth, indicating the need for access to routine dental examination and treatment. Knowledge and practice levels were generally good, which may explain the low DMFT level. CONCLUSION: Dental health education is currently integrated into the school curriculum and is provided by teachers. This would seem to be an effective avenue for dental health education. However, it needs to be supported by increased access to rutine examination and treatment by dental health personnel. Proper planning or oral health education programmes that include oral health education and behaviour modification, along with public health measures such as salt fluoridation, would contribute to further reducing the incidence of oral diseases. (Au)

Health research in the Commonwealth Caribbean

Health research and the dissemination of its findings are important to healthcare development. It is therefore useful to monitor the productivity of scientists and to examine the difficulties which affect their ability to conduct and publish research findings. This study aimed to examine these factors in six Caribbean countries. Health researchers published two or more papers in referred professional journals between 1987 and 1990 were interviewed to determine area of research, number of publications an research constraints. In those four years, 427 first authored article were published by those interviewed. University of the West Indies (UWI) researchers in the three campus territories published most of the articles, with little research being done in noncampus territories. Of seven priority areas defined by Caribbean Health Ministers, most researches were interested in chronic diseases, maternal and child health, followed by nutrition and the acquired immunodeficiency syndrome (AIDS). There was not much research on human resource development and strengthening of health care systems. Major constraints to research were lack of resources including funding, time, staff and equipment. Despite this, only 54 percent had applied for funding. There were few posts for research at the UWI. Notwithstanding these constraints, researchers were conducting several projects simultaneously and were involved with more projects that would be expected from the number of publications. Many expressed the need for experienced advice and assistance in writing protocols and analysing data. At the UWI it might be helpful to appoint a senior person or group in each department with specific responsibility for promoting research.(AU)

Informing maternal and child health (MCH) policy through research

Maternal and Child Health (MCH) policy over the past two decades has been strongly influenced by research. The paper presents examples of some of the research undertaken and its significant influence in shaping health service delivery. Research in child health has focussed on oral rehydration therapy, immunization and perinatal morbidity and mortality. On the maternal side, morbidity and mortality have been examined with particular focus on problems which contribute to maternal and perinatal morbidity and mortality. Policies arising out of the outcome of these studies have influenced organization of service delivery, information system development, manpower development and deployment, maternal education, surveillance/auditing, quality of care, design of physical facilites and selection of equipment. The results of these studies have also led to the identification of areas requiring further study and testing of intervention to correct the deficiencies identified. These studies demonstrate that research can and does influence health policy, and has impacted positively on the quality and cost of care provided through our health services.(AU)

Forty years: an introduction to the development of a Caribbean public health

The development of public health and primary care in Jamaica is examined with particular reference to the historical events which paved the way for their development: notably, the collaborative work undertaken by the Rockefeller Foundation (Commissions on hookworm, tuberculosis, malaria, yams); recommendations of the Moyne Commission (leading to the establishment of the West Indies School of Public Health); and the Irvine Commission which recommended the establishment of the University College of the West Indies. A confluence of political, social and international activity in the 1970s proved catalytic in the development of the current ethos of primary health care, and the Department of Social and Preventive Medicine was instrumental in the training of the most innovative addition to the primary care health team, the community health aide. Undergraduate and postgraduate training programmes of the Department are highlighted as it celebrates its fortieth anniversary.(AU)

Evaluation of high risk antenatal clinics: Jamaica

The aim of this study was to determine whether high risk antenatal clinics are providing services to patients needing them most in a timely way. Of particular interest was to determine the prevalence of high risk women using the clinics; how efficiently patients were been seen, once referred; what were the reasons for referral and subsequent diagnosis and what measures were taken regarding continued care for the patients. A structured questionnaire was administered to a systematic sample of patients attending the clinics by a nurse/midwife. A minimum sample of 100 interviews per site was administered. Due to the length of the questionnaire, only eight to ten interviews could be completed in an eight hour day; thus samples were selected to enable interviewers to manage this number of patients on a given day.(AU)

Maternal lifestyle and pregnancy outcome in Jamaica: the effects of cigarette and marijuana smoking, alcohol use and sexual activity

Cigarette smoking, marijuana and alcohol use, and coital activity have been investigated for effect on foetal birth weight and gestation chiefly in developed countries. Apart from the relationship between cigarette smoking and heavy alcohol intake and growth retardation, the evidence for poor birth outcome is controversial. Little is known of the effect of these lifestyle factors in developing countries where poor pregnancy outcome is common. Using data from a population based perinatal study in Jamaica, the effect of lifestyle factors was ivestigated in 8486 babies. Data collected by midwives at birth included the date of the last menstrual period, socio-demographic characteristics and frequency of tobacco, marijuana and alcohol use during pregnancy, as well as coital frequency at quickening and at delivery. Babies were weighed and measured. Live birth outcomes investigated were low birth weight, preterm birth and growth retardation, with population rates of 10.1 percent, 8.7 percent and 9.7 percent, respectively. Data were processed using SPSS and BMDP statistical packages. The prevalence of cigarette, marijuana and alcohol use was 7.0 percent, 2.1 percent and 16.4 percent respectively. 74 percent and 27 percent of women were having sexual intercourse at quickening and in the week prior to delivery, respectively. Apart from coital frequency at quickening, life style factors were strongly associated with each other. All life style factors were associated with social class. On univate analysis, significant associations were found between cigarette smoking and low birth weight (p,0.04) and growth retardation ,0.05). Association between marijuana use and low birth weight and between alcohol use and lower incidence of preterm birth failed to reach significance (p=0.05, p=0.16). When stratified by frequency of use, there was a significant trend in both cases (p<0.05, p<0.04). After controlling for socio-demographic characteristics and other life style factors, associations were maintained between cigarette smoking and low birth weight. Foetal effects of maternal cigarette smoking are present even in al low prevalence country. The effect of marijuana use is less conclusive, but the data suggest that this activity may be detrimental to the foetus. (Au)

Anticardiolipin antibodies in women with thromboembolic disorders and in primiparae

Our aims were to determine if the presence of anticardiolipin antibodies (aCL) is an independent risk factor for venous thromboembolism (VTE), myocardial infarction (MI) and stroke (CVA) and to estimate the prevalence of aCL among primiparae and its influence on pregnancy outcome. aCL antibody concentration and isotype were measured using an anticardiolipin ELISA. 50 cases of VTE, CVA and MI along with 149 age-matched controls were recruited from a hospital based case control study. Ages ranged from 15 to 49 years. 1,212 primiparae with uncomplicated pregnancies were recruited from clinics in Kingston and St. Andrew. aCL antibodies were present in 16/50 (32 percent) of CVA, VTE and MI cases and in 23/149 (15.4 percent) of the controls (X = 6.5, p = 0.0107). The estimated relative risk for VTE, CVA and MI associated with aCL antibodies is 2.58 (OR = 2.58; 95 percent CI 1.15-5.77). Among the primiparae 137/807 (16.9 percent) were aCL positive. The impact of aCL antibody presence on pregnancy outcomes has not yet been assessed. aCL antibodies confer a significant risk of VTE, CVA, and MI among women 15-49 years old.(AU)

Knowledge, attitudes and practices of women regarding pap smears - abstract

The aims of the study were to assess women's knowledge, attitudes and practices regarding cervical cancer and screening, to see how knowledge influences attitudes and how both influence practice, and to examine certain social and demographic correlates. Between January 29, 1996 and February 29, 1996, 209 female patients, aged 19 years and over, were interviewed in the Casualty Department of the University Hospital of the West Indies. A questionnaire measuring knowledge, attitudes and practices regarding Pap smears and cervical cancer and selected characteristics of the patients and their partners were administered by a single interviewer. Quota sampling methodology was employed. Most of the respondents (98 percent) had heard about Pap smears, but the majority did not know that its main purpose is to help in the prevention of cervical cancer, as opposed to its detection. Only a majority of patients knew what the cervix is and that it is the part of the body that Pap smears are concerned with. The majority of respondents had positive attitudes with respect to cervical screening. However, having positive attitudes and possessing knowledge about Pap smears did not significantly influence compliance with screening, and apathy accounted for a significant portion of non-compliance. If a nationwide screening programme is to be successful, patient motivation and behaviour modification will need to be addressed. (AU)

International variation in the incidence of hypertension in pregnancy among primiparae: the Jamaican experience - abstract

The study was undertaken to determine the natural history of blood pressure measurements during pregnancy in a geographical population of primiparae in the Caribbean, and to compare this with similarly measured populations. It used data collected during a randomized controlled trial of low dose aspirin. Serial measurements of blood pressure, proteinuria and maternal weight were obtained at each antentalepisode and inpatient admission. The population comprised 6043 primiprae resident in the parishes of Kingston and St. Andrew, Jamaica, with singleton pregnancies and no indications for exculsion from randomization in the low dose aspirin trial. The mean systolic and diastolic blood pressure at 20 - 24 weeks gestation (105mm Hg and 63mm, respectively) was substantially lower than that found in four different population in south-east Asia or in the United Kingdom (UK). During the latter half of pregnancy, there was a rise of 4 mm Hg systolic and 5 mm Hg diastolic, substantially less than that found among primiparae in China (9mm) or the UK (9mm). There were, however, high prevalences of eclampsia and proteinuria, and maternal and perinatal mortality ascribed to maternal hypertension is substantial. Proteinuria prevalence started to increase with diastoblic blood pressures of 80 mm. In conclusion, there is evidence that definition of hypertension in pregnancy in Jamaica should involve lower levels of diastoblic blood pressure than those used in many countries. No epidemiological studies are yet available to ascertain difference between European countries or American populations. These should help formulate coherent theories as to the aetiology of the hypertensive disorders of pregnancy(AU)

Research productivity in the Caribbean

Research and the dissemination of health research findings are of importance to the Caribbean as a whole. Hence, it is necessary to monitor the productivity of scientists in the region and to examine the difficulties which affect their ability to disseminate their research findings. The aim of the present study is to examine these factors. The study group selected consisted of researchers who had produced two or more papers in refereed professional journals between 1987 and 1990. A questionnaire was administered in six Caribbean islands. Lack of resources, including funding, time, staff and equipment, were cited as major constraints to carrying out research. There were extremely few posts for research, particularly in the University of the West Indies. In spite of the constraints, researchers were active, conducting several projects at a time. Four hundred and twenty-seven first authored articles on biomedical science were published by the researchers interviewed in the four years. Researchers at the University of the West Indies published most of the articles in all three campus territories. Little research was being done in the non-campus territories. Of the priority areas, most researchers were interested in chronic diseases followed by maternal and child health. Only 54 percent of the researchers had applied for funding. In addition, they were generally involved with more research projects than would be expected from the number of their research publications. Many researchers expressed the need for experienced advice and assistance in writing protocols, reporting and analysing their data. It might be helpful to appoint a senior person or group in each department of the University of the West Indies with the specific responsibility to promote research programmes (AU)

Low dose aspirin in pregnancy are there any benefits

Although the question of major prophylactic benefits of low-dose aspirin in preventing pre-eclampsia or intrauterine growth retardation in pregnancies of mothers who had had such a history has been convincingly negated by the CLASP study, there has remained a question whether pregnancies of primiparae (the group most at risk of such outcomes) might benefit. This study was designed as a randomized controlled trial to address this possibility and other hypotheses arising from the CLASP study. The hypotheses addressed concerns whether low-dose aspirin prevented in or delayed the onset of the hypertensive disorders of pregnancy, including pre-eclampsia, and eclampsia, and whether preterm delivery or low birthweight rates were reduced. In addition, the study was designed to assess whether enrolment, early rather than late, had the most beneficial effect. In parallel, possible adverse effects on mother and infant were monitored. A total of 6275 primiparae were enrolled from 12 weeks gestation in community clinics in Kingston and St. Andrew in Jamaica; 97 percent of them were followed throughout pregnancy. There were no differences in the development of markers of hypertensive disorders, the prevalence of pre-eclampsia or eclampsia except for oedema, which was more prevalent in those on placebo. Mothers on the drug showed no differences in mean diastolic bloodpressure at any stage of pregnancy - they were not less likely to deliver preterm or have a larger foetus. They were, however, significantly more likely to suffer from bleeding disorders antenatally, intrapartum and postpartum. It is concluded that low-dose aspirin has no place in the management of normal pregnancy (AU)

Breastfeeding prevalence among six-week-old infants at the University Hospital of the West Indies, Mona, 1995

Eighty-five (85) mothers attending post-natal and well baby clinics were interviewed at six-weeks post-partum regarding breastfeeding practices of their latest child. An overall prevalence of 98.8 percent at six-weeks-of-age was seen, with an exclusive breastfeeding rate of 37.6 percent. Older maternal age and multiparity favoured exclusive breastfeeding. There was no significant association between the pattern of breastfeeding (exclusive versus partial) and employment or union status. Breastfeeding was found to favour good weight gain in normal birthweight babies. Normal birthweight babies who were exclusively breastfed had a higher mean weight gain than the exclusively breastfed low birthweight infants, who had better weight gain when partially breastfed (AU)

Breastfeeding prevalence among six-week infants at University Hospital of the West Indies

Eighty-five (85) mothers attending postnatal and well baby clinics were interviewed at six weeks post-partum regarding breastfeeding. An overall prevalence of 98.8 percent at six weeks of age was seen, with an exclusive breastfeeding rate of 37.6 percent. Older maternal age and multiparity favoured exclusive breastfeeding. There was no significant association between pattern of breastfeeding (exclusive versus partial) and employment or union status. Breastfeeding was found to favour good weight gain in normal birthweight babies. Normal birthweight babies who were exclusively breastfed had a higher mean weight gain than the exclusively breastfed low birthweight infants, who in turn had better weight gain when partially breastfed (AU)

Breastfeeding prevalence among six-week infants at University Hospital of the West Indies

Eighty-five (85) mothers attending postnatal and well baby clinics were interviewed at six weeks post-partum regarding breastfeeding. An overall prevalence of 98.8 percent at six weeks of age was seen, with an exclusive breastfeeding rate of 37.6 percent. Older maternal age and multiparity favoured exclusive breastfeeding. There was no significant association between pattern of breastfeeding (exclusive versus partial) and employment or union status. Breastfeeding was found to favour good weight gain in normal birthweight babies. Normal birthweight babies who were exclusively breastfed had a higher mean weight gain than the exclusively breastfed low birthweight infants, who in turn had better weight gain when partially breastfed

Registration of births, stillbirths and infant deaths in Jamaica

BACKGROUND: Vital statistics underestimate the prevalence of perinatal and infant deaths. This is particularly significant when these parameters affect eligibility for international assistance for newly merging nations. OBJECTIVE: To determine the level of registration of livebirths, stillbirths and infant deaths in Jamaica. METHODOLOGY: Births, stillbirths and neonatal deaths identified during a cross-sectional study (1986): and infant death identified in six parishes (1993) were matched to vital registration documents filed with the Registrar General. RESULTS: While 94 percent of livebirths were registered by one year of age (1986), only 13 percent of stillbirths (1986) and 25 percent of infant deaths (1993) were registered. Post neonatal deaths were more likely to be registered than early neonatal deaths. Frequently the birth was not registered when the infant died. Birth registration rates were highest in parishes with high rates of hospital deliveries (rs=0.97, P<0.001) where institutions notify the registrar of each birth. Hospital deaths, however, were less likely to be registered than community deaths as registrars are not automatically notified of these deaths. CONCLUSIONS: To improve vital registration, institutions should become registration centres for all vital events occurring there (births, stillbirths, deaths). Recommendations aimed at modernizing the vital registration system in Jamaica and other developing countries are also made(AU)