Caring for the chronically III elderly in Trinidad: the informal situation

This paper comments on research data, from a survey, which sought to determine the health and social circumstances of persons in Trinidad who were providing informal care for the chronically ill elderly during the period, March to August 1998. The research also sought to ascertain the main concerns of the caregivers in their caregiving role. One hundred caregivers in North, Central and South Trinidad were chosen using a convenience sampling method. Caregivers selected had to be at least eighteen years old and residing in their own homes or in the home of the cared. The caregivers ranged in age from 20-89 years. Eighty two percent of the caregivers were females. Wives, daughters and daughters-in-laws were the main caregivers. Daughters-in-laws were especially instrumental in providing informal care in Indo-Trinidadians households, being 28 percent of caregivers in those households compared to 4 percent for daughters-in-laws in Afro-Trinidadian households. Fifty percent of the caregivers reported their health to be good. The main health conditions reported by the others were hypertension (14 percent), diabetes mellitus (9 percent) and arthritis (18 percent). The main concern which the caregivers reported was stress (50 percent). The study revealed that caregiving was perceived by mot of these caregivers to be extremely stressful. Daughters, daughters-in-law and wives bore the greatest burden of care and desired greater assistance from family members and friends. The paper make reference to a government programme which trains young adults to work with the chronically ill elderly, in their own home. It make a case for the greater use of such young persons in order to relieve relatives of some of the burden of care.(Au)

Domestic violence: family problem and public health concern

OBJECTIVES: To determine the attitude towards, experiences of, and reasons given for domestic violence by a sampled population in Trinidad and the proportion of the abused that had interacted with the health services in relation to their domestic violence experience. DESIGN AND METHODS: Two hundred adults, > or = 18 years were selected from two communities, namely Barataria and Enterprise, using a stratified random cluster sampling technique. One hundred persons were interviewed in each community using 105 structured and open-ended questions. RESULTS: There were approximately equal numbers of persons of African and Indian descent and their ages ranged from 18 to 64 years. Twenty-seven percent of the sample had lived in homes in which there was domestic abuse in their childhood. Thirty-one persons (16 percent) experienced domestic violence in adulthood and most (77 percent) were women. First hand experience of domestic violence in adulthood by the 3 ethnic groups was not statistically significant (p=0.2257). Some of the abused were physically injured and needed to be treated by health professionals but approximately 40 percent did not discuss the true cause of their injuries. CONCLUSION: The issue of secrecy tends to shroud the problem of domestic violence. More studies need to be done on the subject to identify definitively the risks factors for domestic violence especially against women.(Au)

Dengue in Trinidad: a survey of knowledge, attitudes, practices and beliefs in two communities in Trinidad, West Indies

This study was conducted to test the Health Belief Model as it relates to dengue fever in two urban communities, namely Curepe and Woodbrook, Trinidad using a knowledge, attitude, practices and beliefs questionnaire and entomological investigations. The knowledge of dengue symptomatology, its prevention and control suggested a high level of awareness about dengue and its aetiological agents among residents of both commuities, but the connection between the vector Aedes aegypti (L.) and dengue fever transmission was poorly understood. The major determinants for cues to action were demographics, prevention of water treatment and garbage collection and disposal. Data from the present study gave clear indications of the need for health education programs, defining what garbage is and the further studies using the transtheoretical model of change (Prochaska Model). With these tools a holistic approach to vector control using community participation, health education and conventional vector control strategies may be adopted for the prevention and control of dengue and its vector. Ae. aegypti, on a sustained basis in Trinidad and, possibly, the Caribbean region.(AU)

Women's health: hormone replacement therapy - what women know and do about it

The aims of the study reported on in this paper were to determine the health status of a group of Trinidadian women age 40-64 years; to ascertain how informed they were about the "change of life", and determine the sources from which they had received their information. The study also sought to discover what women knew about hormone replacement therapy(HRT) and what had been their personal experience of it. Data for this study were obtained through self administered questionnaires to fifty (50) women. The women were chosen, half from a working class community and the others from a middle class commumnity in urban Trinidad. The women were chosen by simple quota sampling which sought to select women in the age group 40-64. The questionnaires were self administered. Additional data were gathered from discussions held in three focus groups, with approximately ten women in each group. Discussions were also held with two physicians and two pharmaceutical representatives to attempt to gain information on the role of professionals like themselves in the promotion of HRT in Trinidad. The research showed the majority of the women reporting themselves to be in good health. In relation to hormone replacement therapy, the middle-class women were significantly more informed than were the working-class. The women's knowledge of HRT though was not reflected in their patterns of usage (AU)

Women's health: hormone replacement therapy - what women know and do about it

The aims of the study reported on in this paper were to determine the health status of a group of Trinidadian women age 40-64 years; to ascertain how informed they were about the "change of life", and determine the sources from which they had received their information. The study also sought to discover what women knew about hormone replacement therapy(HRT) and what had been their personal experience of it. Data for this study were obtained through self administered questionnaires to fifty (50) women. The women were chosen, half from a working class community and the others from a middle class commumnity in urban Trinidad. The women were chosen by simple quota sampling which sought to select women in the age group 40-64. The questionnaires were self administered. Additional data were gathered from discussions held in three focus groups, with approximately ten women in each group. Discussions were also held with two physicians and two pharmaceutical representatives to attempt to gain information on the role of professionals like themselves in the promotion of HRT in Trinidad. The research showed the majority of the women reporting themselves to be in good health. In relation to hormone replacement therapy, the middle-class women were significantly more informed than were the working-class. The women's knowledge of HRT though was not reflected in their patterns of usage

Transformations in maternity services in Jamaica

Analysis of the current organization and delivery of maternity care in Jamaica profits not only from an assessment of recent health issues but from considerations of the development of maternity services over the past century. Historical analysis indicates that a critical element in public health policy has been the effort to enclourage use of biomedical obstretrical care and to eliminate the lay midwife. However, while women increasingly patronize hospitals, the delivery of services has deteriorated, resulting in widespread client dissatisfaction. Economic contigencies have contributed to the decline in maternity services, but health personnel manifest the ideology prevalent throughout the colonial era equating social irresponsibility with health complications. The cultural construction of illegitimacy and maternity is shown to be a dimension of class relations having an impact on health policy throughout Jamaica's history (AU)

Transformations in maternity services in Jamaica

Analysis of the current organization and delivery of maternity care in Jamaica profits not only from an assessment of recent health issues but from considerations of the development of maternity services over the past century. Historical analysis indicates that a critical element in public health policy has been the effort to encourage use of biomedical obstetrical care and to eliminate the lay midwife. However, while women increasingly patronize hospitals, the delivery of services has deteriorated, resulting in widespread client dissatisfaction. Economic contingencies have contributed to the decline in maternity services, but health personnel manifest the ideology prevalent throughout the colonial era equating social irresponsibility with health complications. The cultural construction of illegitimacy and maternity is shown to be a dimension of class relations having an impact on health policy throughout Jamaica's history (AU)

Factors influencing prenatal care among low income Jamaican women

Factors affecting women's attendance at prenatal care at the Victoria Jubilee Hospital (VJH) in Kingston, Jamaica were examined by surveying 125 prenatal clients, 50 women from surrounding communities, 50 postnatal clinic patients, and senior and ward nursing staff. Structured and open questionnaires were used. The women averaged 23.9 years old, 42.3 percent had primary education, and 30 percent were single. 20.8 percent began prenatal care at 7-9 months gestation; 49.6 percent at 4-6 months. Some of the reasons women gave for beginning late were: unaware they should go earlier: had already gone in prior pregnancies; had no child care. Prenatal clinic appoinments begin at 8 am, 7 am for 1st booking, and take all day. Contrary to expectation, multiparas were more likely to go for prenatal care frequently, and they often explained why with reference to specific interventions such as monitoring of fetal position. 20 percent or the multiparas had histories of complicated pregnancies. Nulliparas tended to begin care earlier in pregnancy than did multiparas. Women did not generally appreciate the need for either early or regular attendance at prenatal clinic. Some unexpected findings in the open interviews were that women were unconcerned about the hospital requirement that they donate a pint of blood, none complained about the $50 booking fee, only 7.4 percent had more than 3 "baby-fathers," most did receive financial support from the fathers, and 75 percent remarked positively about hospital care despite the fact that nursing and midwife staff were so overworked that 20 percent delivered themselves without any assistance. The issue of policy on booking for prenatal care and delivery and the chronic shortage and its effect on equitable patient care were discussed.(AU)

Good managers for good health services

This article outlines progress in the preparation of nurses, doctors and other professionals for managerial roles in the health services of several Caribbean countries. It is expected that there will be solid gains in effectiveness and efficiency during the next few years as the new managers' influence is felt and that the prospects for primary care and health for all will consequently be enhanced. (AU)

Buenos administradores para buenos servicios de salud

This article outlines progress in the preparation of nurses, doctors and other professionals for managerial roles in the health services of several Caribbean countries. It is expected that there will be solid gains in effectiveness and efficiency during the next few years as the new managers' influence is felt and that the prospects for primary care and health for all will consequently be enhanced

Learning health management by doing it

The course leading to a diploma in health management which was introduced at the University of the West Indies in 1984 contains a large practical element. This article explains how the students tackled their field assignments and draws attention to the benefits gained and the difficulties encountered

Learning health management by doing it

The course leading to a diploma in health management which was introduced at the University of the West Indies in 1984 contains a large practical element. This article explains how the students tackled their field assignments and draws attention to the benefits gained and the difficulties encountered (AU)