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)

Proportion of time used productively by staff in Jamaica's primary health-care services - abstract

The primary health-care system in Jamaica offers extensive preventive and curative services to the public through a system of health centres, ranging from small centres with basic services to large centres with more sophiticated services. At a time of severe constraints in terms of financial and human resources, it is important to have a management system which will make the best use of these resources. The present survey was undertaken as part of a management exercise initiated by the Ministry of Health, Jamaica. The aim of the study was to describe what proportion of their working day was spent productively by various categories of personnel. A random sample of 96 was taken from approximately 400 health centres in Jamaica. At each health centre selected, 1 of each type of staff category was randomly chosen and observed during 1 day. About 500 days' observations were so made. The most being done by the staff member was recorded and classified as 'productive', 'other essential' or 'unproductive'. It was found that productive time ranged from over 60 percent to under 40 percent according to category of worker. It varied very little between large and small health centres. It has been proposed that 25 percent unproductive time would be suitable norm. The results therefore indicate that there is much scope for improvement of time and staff management in the primary in the primary health care services. At present, based on findings report here and on a model developed in a collaborative project, a new system of scheduling of clinics and of staff allocation to these clinics is being tried in two districts in Western Jamaica, the results of which will be available soon (AU)

Some haematological investigations on infants from Kingston, Jamaica - abstract

A longitudinal study of health and growth of 270 Kingston infants was carried out from birth to 1-year of age. The infants were all born at University Hospital and were from predominantly lower socio-economic backgrounds. Haemoglobin levels were estimated 7 times during the year, mean corpuscular haemoglobin concentration 3 times, and serum iron levels and haemoglobin electro-phoresis once when the infants were 10 months old. The stool of approximately 50 percent of the infants was examined for parasites at 10 months of age. The incidence of abnormal haemoglobins was 39 (14.4 percent). 4 infants had haemoglobin SS and their health and progress is reported. Data for children with haemoglobin AS appeared to be similar to that for children with haemoglobin AA. The 33 infants with birth weights below 2.5 kgm had lower mean levels for haemoglobin, serum iron and percentage saturation of transferrin than infants with birth weigh over 2.5 kgm. The following results refer to 220 singleton infants with birth weights over 2.5 kgm. and with Hb AA or AS. The mean Hg levels from 3 months of age were lower than normal values reported from developed countries. The incidence of Hb level below 10 gms. per 100 ml. varied from 20 to 50 percent between 3 and 12 months of age. Mean values for serum irons, the percentage saturation of transferrin and the mean corpuscular haemoglobin concentration were all lower than normal and were all significantly correlated with Hb levels at 10 months of age. Several factors were examined for an association with Hb level. Hb changed with age with a steep fall from birth to 3 months of age and a slight dip at 8 months of age. Males had lower Hb levels than females. Infants with birth weights between 2.5 and 3 kgm. had lower Hb levels at 3 months of age. The prevalence of parasites was 11 percent, comprising 8 percent Giardia lamblia, 2 percent Ascaris lumbricoides and 1 percent Trichuris trichiura. No hookworm was found. Possible explanations for the high incidence of anaemia are discussed (AU)

Increase in size of Jamaican school children in recent years

Standards for height and weight of Jamaican children aged 6-12 years based on measurements of 11,552 boys and girls attending 34 schools in rural and urban districts are presented. Comparisons with other studies showed that full growth potential was not being reached, but the long-term effects of this slower growth upon health are not known. Children from the city, plains and coast were larger than those from the hills. Mean heights and weights were greater than those found in surveys of the same schools, using identical techniques, about 12 years earlier (AU)

Assessment of the role of a general clinic of a health centre in a rural Jamaican community

A health centre served a defined and censussed rural community. Patients' attendances at the general clinic are expressed as attendance rates for each age/sex group in the community. The diseases most commonly diagnosed in each group of patients and the patients' use of other health services are described (AU)

Proportion of time used productively by staff in Jamaica's primary health care service

The primary health care system in Jamaica offers extensive preventive and curative services to the public through a system of health centres, ranging from small centres with basic services to large centres with more sophiscated services. At a time of severe constraints in terms of financial and human resources, it is important to have a management system which will make the best use of these resources. The present survey was undertaken as part of management exercise initiated by the Minsitry of Health, Jamaica. The aim of the study was to describe what proportion of the working day was spent productively by various categories of personnel. A sample of 96 health centres was taken from 375 providing services in Jamaica. At each health centre selected, 1 of each type of staff category was randomly chosen and observed during 1 day, and 504 days' observations were so made. The work being done by the staff member was recorded and was classified as `productive', `other essential' or `unproductive'. It was found that productive time ranged from over 60 percent to under 40 percent, according to category of worker. It varied very little between large and small health centres. The results indicate that there is much scope for improvement of time and staff management in primary health care services. At present, based on findings reported here and on a model developed in a collaborative project, a new system of scheduling of clinics and of staff allocation to these clinics is being planned in two districts in Western Jamaica (AU)

Ethnic differences in growth potential of children of African, Indian, Chinese and European origin

Community surveys of infants and children of African, Indian, Chinese and European origin in Guyana and Jamaica have been reviewed in order to compare the infleunce of ethnic origin and environmental, including nutrition, on anthropometric measurements used to assess nutritional status. Mean heights and weights of African and European were greater than those of Indian and Chinese children. African had greater weight for height and greater arm circumferences but smaller triceps skinfolds than Indian children. These differences, which cannot be disregarded when assessing nutritional status by anthropometric measurements. Specific adjustments of international standards of height and weight are proposed in order to make them more appropriate for Indian and Chinese children. (Summary)

Blood-pressure and mortality in a rural Jamaican community

1065 men and women aged 35-64 years living in rural Jamaica were first examined in 1962-1963, re-examined 5 and 10 years later, and followed-up until 1976. Overall mortality in 13 years, taking into account blood-pressures at all 3 surveys, showed that mortality was significantly increased only at pressures above 180 mm Hg systolic or 110 mm Hg diastolic. It was estimated that without this degree of hypertension the total number of deaths between the ages of 45 and 69 years would have been reduced by about 17 percent. Unlike other reports, mortality showed no significant association with lower levels of blood-pressure and mortality cannot be assumed to be identical in populations with different profiles of cardiovascular pathology (AU)

Mortality and morbidity in Jamaican adults with sickle-cell trait and with normal haemoglobin followed up for twelve years

An epidemiological survey of adults aged 35-64 years living in a rural area of Jamaica was started in 1962-63 and continued until 1975. Information was available on 856 subjects with AA and 119 subjects with AS h‘moglobin genotypes. The mortality-rates over 12 or 13 years and the number of clinic attendances in 10 years did not differ significantly between subjects with AA and those with AS h‘moglobin. The patterns of disease as well as the life expectancy of the two groups appeared to be the same.(Summary)

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)

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)

Indices to measure material resources in Jamaica's health centres - abstract

Jamaica's primary health care system was developed and implemented in the 1970's. Many new health centres were built and many equipped according to defined standards. Resources became more scarce in the 1980s. As part of a management study, instruments were devised to measure 'Facilities and Utilities', Equipment and Furniture', 'Condition of Equipment' and 'Drugs and Supplies' proved too complex to handle in practice and had a low completion rate. The other three instruments proved feasible. Indices such as these could be used to monitor changing levels of resources of make comparisons of any kind. The low levels of the indices were in accordance with the low levels of resources known to exists (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)

Approach to assessment of risk factors in mild hypertension

Criteria are urgently needed for the early detection of subjects with only mildly raised blood pressure who may be at high risk of developing the complications of hypertension. As a step towards the establishment of such criteria we have examined the association of certain possible "risk" factors-namely, x-ray evidence of cardaic enlargement, high serum cholesterol levels, effort pain, E.C.G. abnormalities, and high systolic blood pressure-with fatal or morbid endpoints in a five-year follow-up study of subjects whose diastolic pressure had been found initially to be between 95 and 114 mm Hg. The index group consisted of 22 patients in whom these endpoints occured. They comprised death from cardiovascular disease, clinical or E.C.G. deterioration, and either an increase in diastolic pressure of at at least 10 mm Hg or a diastolic pressure of 115mm Hg or both. The control group consisted of 22 subjects chosen at random from other respondents with the same range of diastolic pressures and the same age and sex distribution. "Any two or more" of the possible risk factors examined were found to occur significantly more often in the index group than in the controls, suggesting a possible approach to the early detection of high-risk subjects. The value of long-term studies along these lines and the urgent need for them are emphasised (Summary)

Heights, weights, and skeletal age of Jamaican adolescents with sickle cell anaemia

Weights, heights, and skeletal age, assessed from hand radiographs, were recorded in a cross-sectional study of 99 Jamaicans with sickle cell anaemia aged between 12 and 21 years. Compared with controls, weight and skeletal age were less at all ages. The data suggested that the average height of younger patients was less but that of older patients was at least as great as that of controls (AU)

A five-year study of infant growth in rural Jamaica

Growth patterns observed in a cohort of 229 children followed from birth to 5 years of age, are described cross-sectionally and longitudinally. The children were probably representative of those in other parts of rural Jamaica and the results, though not showing ideal growth, could be used as reference standards for similar communities. About half the children failed to make any net any net weight gain during at least one 6-month period, and 13 (6 percent) had no net weight gain for a whole year or more. The limited usefulness of good or poor weight increments as guides to long-term progress is discussed (Summary)

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)

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)

Socio-economic and cultural influences on child growth in rural Jamaica

A semi-longitudinal study of growth in children up to 5 years of age in a rural Jamaican community is described. One of its aims was to investigate the relationship between growth and factors in the social environment such as family structure, parental characteristics, housing and income. A strong relationship between growth and socio-economic variables was found. This apparently masked whatever effects the quality of care or separation from the parents may have upon child growth. (Summary)

Jamaica: the social background of malnutrition

A study is described in which anthropometric measurements were made on a cohort of infants born in a rural area in Jamaica, and repeated at frequent intervals since birth. Growth, by the standards of infants in industrial countries, is much retarded from three months of age till about two years of age; by eighteen months of age less than 20 percent of children have attained their expected weight for age, or their expected weight for height. Comparisons were made of the social backgrounds of children whose quarterly weight increments were above the 90th and below the 10th percentiles. The findings confirm the influence of factors associated with poverty and rapid reproduction and suggest that unstable parental relationships may be a major cause of infant malnutrition in Jamaica. (Summary)