Growth monitoring: the role of community health volunteers

A community volunteer programme was initiated in rural Jamaica in May 1990. The main aim of the programme was to monitor the growth of children less than 36 months of age through community health volunteers (CHVs) and improve their nutritional status. At the end of the second year the programme was evaluated to determine effectiveness. The results of the evaluation indicated that almost all (95.6 percent) of the children were covered by the CHVs. In addition the participation rate was high (78.5 percent). However, only 50 percent of the children were adequately covered. Nonetheless, 81 percent of them gained adequate weight. Indeed, malnutrition levels declined by 34.5 percent. The annual cost per child per year for the total programme was fairly moderate (US$14.5) with growth monitoring accounting for nearly half (42.7). The results suggest that CHVs can play an important role in primary health care programmes in developing countries(AU)

Development of a questionnaire for assessing the school environment

This article describes the development of a school environment questionnaire to assess student's perception of their school environment. The dimensions and internal consistency reliability were examined ulitlzing various statistical methods - factor analysis and alpha coefficient. The sample consisted of 705 students from two high schools with ages ranging from ten to nineteen years. Results showed that the students perceived their school as having various aspects, rather than a global point of view. Factor analysis identified seven dimensions in the school environment: external characteristics of the environment, aesthetic and functional elements of the classroom, students' bathroom, the canteen and staffroom, the aesthetic and functional elements of the school as a whole and sanitation. Overall the internal reliability of the factors was high. Implications for school health programs are addressed. (au)

Risk factors associated with malnutrition in rural Jamaica

Risk factors associated with malnutrition were examined in Jamaica. Socio-economic data were obtained on 63 well-nourished and 14 malnourished children. Risk factors associated with malnutrition were birth weight less than 2.5kg (P < 0.01), maternal age equal to or greater than 25 years (P < 0.05) and landlessness (P < 0.05). Intervention aimed at reducing these factors can go a long way in reducing the malnutrition problem in developing countries (AU)

Rapid rural appraisal: its role in health planning in developing countries

There is an urgent need for a quick inexpensive and reliable method for identifying groups and individuals most in need of primary health care. The Rapid Rural Appraisal (RRA) is the most appropriate approach. It is a method by which resources can be quickly deployed to alleviate the problems of the poor. If properly used it can play a major role in identifying community health needs thereby aiding the health planning process and improving the health of the people. Nevertheless, RRA techniques should not be regarded as separate and apart from other research methodologies but complementary to them (AU)

Risk factors associated with the typhoid outbreak in Westmoreland, Jamaica in 1990 - abstract

The first wave of the typhoid epidemic started in July 1990, followed by a second wave in September 1990. One hundred and forty-five cases in the latter were studied to determine the risk factors associated with transmission of the Salmonella typhi in the three affected areas in Westmoreland. This was a case control study in which 145 cases were compared with 154 matched controls. The same questionnaire was administered to both groups. The mean age of the cases was similar to that of the controls (13.1 ñ 9.1 SD vs 13.2 ñ 7.9 SD). Sex distribution of the cases and controls was also similar (females: 44.8 percent vs 46.8 percent; males: 55.2 percent vs 53.2 percent). More than half of the cases (58.6 percent) and controls (64.9 percent were students). The purchase of two or more food items from vendors (odds ratio 2.5), piped water into the home (odds ratio 2.4), preparing food for the household (odds ratio 2.4) and the eating of ice-cream (odds ratio 2.2) were all associated with risk of typhoid fever. The results of the case control study were consistent with the possible spread of typhoid through the purchase of food items or ice-cream from vendors or through the piped water system but none of these associations could be established as causative factors on the basis of the case control study alone. Public health measures including health education were directed at controlling all possible modes of transmission of the typhoid epidemic (AU)

Is breastfeeding on the decline: the need to reinforce existing policies

The advantages of breast feeding are many. There is now strong scientific evidence indicating that breastfeeding plays an important role in preventing breast cancer, and in avoiding a further pregnancy in the first six months after delivery. Furthermore, the human immune virus has been isolated in breast milk. Recent evidence has emerged, however, which indicates that breeastfeeding is declining in developing countries. This is related to a variety of factors such as the introduction of modern technology, inappropriate advertising and promotion of infant formulae and lack of adequate social support systems. There is also scientific evidence which shows that the combined oral contraceptive pill significantly decreases milk output. In the light of this trend of declining breastfeeding, and new information pertaining to breastfeeding, there is urgent need for policy-makers in developing countries critically to examine their breastfeeding policies. This will provide them with an oppertunity to update these policies and at the same time develop strategies to promote breastfeeding and reverse the negative trends. (AU)

Using information about elderly subjects attending government medical clinics to tailor nutrition education services to their needs

A study of the elderly was carried out in 2 Cornwall County parishes (Hanover and Westmoreland) from June to August, 1987. The health status and general situation of the elderly attending Government Medical Clinics was studied to obtain information to design nutrition education services that met their needs. Four Health Centres (two Type II and two Type III) were selected by stratified random sampling for the study. The results indicated that more elderly women (71 percent) than men (29 percent) used in primary Health Care Services. Obesity was more common among women (29 percent) than men (0 percent). More men (30 percent) were underweight than were women (9 percent). Food stamps appeared to be the most regular source of income for the elderly. Most of the elderly (92 percent) felt that they were not in good health. Although they generally had 2 to 3 meals per day, their food intake, particularly of fruits and peas, appeared to be inadequate. The results point clearly to a need to strengthen the nutrition education services offered to the elderly attending Government Medical Clinics in Cornwall County, Jamaica (AU)

Effects of the institutionalization of primary health care

This paper addresses the institutionalization of the primary health care program in Cornwall County Jamaica, supervised by the Ministry of Health. Under this program, 59 new health centers were constructed and 28 existing ones remodelled. The primary health centers were decentralized and an administrative unit of a hierarchy of health centers was established and classified as type 1 through 4. Type 1 health center was the smallest and the simplest health unit, and both type 2 and 3 health unit functioned as referral units for patients from type 1 health center. The type 4 health center had an additional administrative block for senior staff of the parish. The implications of this health system to Cornwall County in 1976 were 1) a decline in community health aides per health center, 2) additional child welfare, prenatal family planning, and medical clinics were held, 3) the number of rural families utilizing health care increased, 4) community health workers made significantly fewer home visits as a result of additional clinic units and in turn child health care declined significantly, 5) health workers carried out more curative activities and fewer preventive duties, 6) an increase in data collection through defaults in the system lead to non-utilization of the data for policy planning purposes, 7) shortage of staff to support the increased patient load and duties at health centers. Consequently, the health system could not cope with this well intentioned policy change which emphasised shifting from community outreach to health center-based activities. (AU)

Feeding practices of infants, and beliefs of mothers in Western Jamaica

An infant feeding survey was carried out in three parishes in Cornwall County, Jamaica, from March to August, 1984, in an attempt to determine the feeding practices of infants and beliefs of mothers in Western Jamaica. Forty-one enumeration districts (EDs) were randomly selected from two strata, urban and rural, in proportion to the population distribution. Six hundred and fourteen households with children under thirty-six months of age were selected from 41 EDs. The results showed that the prevalence of breastfeeding was 98 percent. Despite the high frequency of breastfeeding, infant formula was introduced very early, and only about half the mothers introduced semi-solids and solids within one month of the recommended time. The most popular foods, identified as good foods, were also popular weaning foods. It is concluded that there is need for adequate training of both primary and secondary health-care staff, and reinforcement of the effectiveness of nutrition education programmes is also important (AU)

Trend in nutritional status of children in Western Jamaica (1973-1984): the role of economic development - abstract

This paper is a retrospective review of the role economic development played in influencing the changes in nutritional status of pre-school children in the parishes of Hanover and St. James during the period 1973-1984. Malnutrition levels decreased by approximately 50 percent in both parishes during the period 1973-1975. During the period 1976 to 1978, the prevalence of malnutrition remained constant at 6 percent in Hanover. A similar trend was observed in the early 1980s. On the other hand, malnutrition levels increased fom 4.5 percent to 9.3 percent in St. James during the period 1976-1978. Malnutrition levels appeared to have remained unchanged at 8 percent in St. James in 1982 but had increased again to 10.2 percent by 1984. Economic conditions improved during the period 1973-1975 in St. James, but not in Hanover, and thereafter deteriorated. During the late 1970s food prices increased by 40 percent: this trend continued into the early 1980s. The impact of the Community Health Aide Programme. By and large, it appears that economic changes can influence changes in nutritional status of children. However, the use of a simple yet highly appropriate level of technology in primary health care programmes can also stimulate positive changes in the health status of children even in the absence of economic growth. This underscores the need to develop and strengthen community nutrition programmes within primary health (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)