Jamaican youth health status 2005 / Nivel de salud de la juventud jamaicana en el 2005

The purpose of this survey is to determine health-seeking behaviour, nutritional status and lifestyles of adolescents aged 10-15 years. A random sample of 3003 (1 422 males and 1 581 females) school-children, aged 10-15 years, was studied in a cross-sectional, interviewer-administered school-based survey conducted in all school types islandwide in a nationally representative sample of Jamaican children currently attending school. Some 3003 youths, 1422 males and 1581 females were interviewed. Males and females had similar healthcare-seeking behaviour but fewer students attending schools in rural areas reported having their eyes or hearing checked, or had seen a dentist than those attending urban schools. Some twelve per cent of adolescents were overweight/ obese. More females than males and more urban than rural students were overweight or obese. More boys (86.3%) were physically active in the last week than girls (75%). Physical activity peaked at age 13 years and was lowest at ages 11 and 14-15 years. Some 13% of adolescents 10-15 years old reported having had sexual intercourse, with boys being four times as likely as girls to report sexual activity (OR- 4.97; C.I. - 3.82, 6.47). The median age of sexual debut was 15.43 years for boys and over 15 years for girls. One-third of adolescents drank alcohol and 3% smoked marijuana in the past year. More boys than girls used drugs (p < 0.01). Some 14% of adolescents felt lonely, sad or wanted to cry most of the time/always. One-tenth seriously considered suicide. This study concluded that most adolescents attending primary and secondary schools in Jamaica were not involved in risky behaviour. However, it reveals some critical areas of concern with regard to nutritional status and physical activity, emotional well-being, drug use and sexual activity.

El propósito de este estudio es determinar el comportamiento de búsqueda de la salud, el nivel nutricional, y los estilos de vida de adolescentes de 10-15 años. Una muestra aleatoria de 3003 (1422 varones y 1581 hembras) escolares de 10-15 años de edad, fue sometida a una encuesta transversal aplicada por el entrevistador. La encuesta con sede en la escuela, fue conducida en todos los tipos de escuela a lo largo de la isla en una muestra nacionalmente representativa de niños y niñas jamaicanos que asisten a la escuela actualmente. Se entrevistaron unos 3003 jóvenes, 1422 varones y 1581 hembras. Los varones y las hembras tenían comportamientos de búsqueda de la salud similares pero el número de estudiantes que reportó haber tenido chequeos de la vista o de la audición, o haber visto a un dentista, fue menor entre aquellos que asistían a las escuelas en áreas rurales que entre los que asistían a escuelas urbanas. Alrededor del doce por ciento de los adolescentes eran obesos o estaban pasados de peso. Más hembras que varones y más estudiantes urbanos que rurales estaba pasados de peso o eran obesos. Más muchachos (86.3%) que muchachas (75%) estaban físicamente activos en la última semana. La actividad física alcanzó su punto máximo en la edad 13 años y el más bajo en las edades 11 y 14-15 años. Alrededor de 13% de adolescentes de 10-15 años reportaron haber tenido relaciones sexuales, siendo el caso que la tendencia a reportar actividad sexual fue cuatro veces mayor en los muchachos que en las muchachas (OR- 4.97; C.I. - 3.82, 6.47). La edad promedio de la iniciación sexual fue de 15.43 años para los muchachos y mayor de 15 años para las muchachas. Un tercio de los adolescentes bebió alcohol y un 3% fumó marihuana el año pasado. Más muchachos que las muchachas consumían drogas (p < 0.01). Alrededor del 14% de los adolescentes se sentían solos, tristes o sentían deseos de llorar la mayor parte del tiempo/siempre. La décima parte de ellos consideró seriamente la posibilidad de suicidio. Este estudio concluyó que la mayoría de los adolescentes que asisten a las escuelas primarias y secundarias en Jamaica no estuvieron involucrados en conductas de riesgo. Sin embargo, se ponen de manifiesto algunas áreas críticas de preocupación con respecto al nivel nutricional y la actividad física, el bienestar emocional, el uso de drogas y la actividad sexual.

Growth curves for normal Jamaican neonates / Curvas de crecimiento en los neonatos jamaicanos normales

The aim of this study was to provide standards for the assessment of birthweight, head circumference and crown-heel length for normal, singleton newborns of predominantly West African descent. Data were collected for 10 482 or 94of all recorded births in Jamaica during the two-month period September 1 to October 31, 1986. After editing procedures, data were available for 6178 (birthweight), 5975 (head circumference), and 5990 (crown-heel length). The data presented in tables and growth curves include birthweight, head circumference and crown-heel length for males and females separately, for gestational ages 30-43 weeks. Data sets from the University Hospital of the West Indies in 1990 and 1999 were used to explore the possibility of secular change over the period 1986-1999. In conclusion, these ethnic and gender-specific growth curves are based on the most extensive dataset currently available in Jamaica for babies of West African descent.

High risk health behaviours among adult Jamaicans / Conductas de Alto Riesgo para la Salud entre los Adultos Jamaicanos

The purpose of this study was to assess the prevalence of high risk health behaviours among adult Jamaicans aged 15-49 years in 2000, and to compare the results with the 1993 survey. A nationally representative sample of 2013 persons aged 15-74 years was surveyed in 2000 using cluster sampling in the Jamaica Healthy Lifestyle Survey (Wilks et al, unpublished). Interviewer administered questionnaires and anthropometrical measurements were done. Data for a sub-sample of adults aged 15-49 years were analyzed The sub-sample included 1401 persons (473 men and 928 women). Significantly more men (18.6) than women (4.3) reported never having had a blood pressure check (p = 0.0001). Approximately one-third of the women reported that they had never had a Pap smear (36.0) or a breast examination (31.2). Current cigarette smoking was reported in 28.6 of men and 7.7 of women (OR 3.73 CI 2.71, 5.15), while 49.0 of men and 15.0 of women ever smoked marijuana (OR 3.28 CI 2.56, 4.20). Significantly more men (28.0) than women (11.7) reported ever having a sexually transmitted disease (OR 2.93 CI 2.16, 3.97); having more than one sexual partner in the past year (49.1 vs 11.4, OR 4.31 CI 3.22, 5.76) and usually using a condom during sexual intercourse (55.3 vs 40.5, OR 1.3 CI 1.11, 1.68). Between 1993 and 2000, significant trends include: more persons reported having a blood pressure check, a reduction in multiple sexual partners, increased condom use at last sex (women), reduced crack/cocaine use (males) and increased marijuana smoking. Although there were some significant positive lifestyle trends between 1993 and 2000, high risk behaviours remain common among Jamaican adults. Comprehensive health promotion programmes are needed to address these risk behaviours

El propósito de este estudio fue evaluar la prevalencia de conductas de alto riesgo para la salud entre adultos jamaicanos comprendidos en las edades de 15 a 49 en el año 2000, y comparar los resultados con la investigación realizada en 1993. Una muestra nacional representativa de 2013 personas comprendidas en las edades de 15 a 74 años, fue sometida a investigación en el 2000, usando el muestreo por cluster del Jamaica Healthy Lifestyle Survey (Wilks et al, inédito). Se realizaron entrevistas en forma de cuestionarios, así como mediciones antropométricas. Se analizaron los datos de una sub-muestra de adultos entre edades de 15 a 49 años. La submuestra incluyó 1401 personas (473 hombres y 928 mujeres). Un número de hombres significativamente mayor (18.6%) que el de las mujeres (4.3%) reportaron no haber tenido nunca un chequeo de la presión (p = 0.0001). Aproximadamente un tercio de las mujeres reportó no haberse hecho nunca la prueba citológica (36.0%) o el examen de mamas (31.2%). El hábito actual de fumar cigarrillos fue reportado en el 28.6% de los hombres y el 7.7% de las mujeres (OR 3.73 CI 2.71, 5.15), mientras que el 49.0% de los hombres y el 15% de las mujeres nunca fumó marihuana (OR 3.28 CI 2.56, 4.20). Significativamente más hombres (28.0%) que mujeres (11.7%) reportaron no haber tenido nunca enfermedades de transmisión sexual (OR 2.93 CI 2.16, 3.97); haber tenido más de una pareja sexual en el año anterior (49.1% vs 11.4%, OR 4.31 CI 3.22, 5.76), y usar comúnmente condón durante el acto sexual (55.3% vs 40.5%, OR 1.3 CI 1.11, 1.68). Entre 1993 y 2000, las tendencias significativas incluyen lo siguiente: más personas reportaron el chequeo de la presión sanguínea, una reducción en las parejas sexuales múltiples, el aumento del uso de condones en el último acto sexual (mujeres), la reducción en el uso de crack/cocaína (hombres), y aumento en el consumo de marihuana para fumar. Aunque hubo algunas tendencias positivas significativas en cuanto al estilo de vida entre 1993 y el 2000, los comportamientos de alto riesgo siguieron siendo comunes entre los adultos jamaicanos. Se necesitan programas generales de la promoción de la salud para abordar estas conductas de alto riesgo.

Urban Jamaican children's exposure to community violence / Niños jamaicanos en zonas urbanas expuestos a la violencia de las comunidades

Exposure to violence in childhood is associated with aggression in adulthood. The high level of community violence in Jamaica is likely to expose Jamaican children to violence. There has been no detailed study of the exposure of Jamaican children to violence in their daily lives. Some 1674 urban 11-12-year-old children, previously part of a national birth cohort study, completed a questionnaire detailing their exposure to violence as witnesses, victims and aggressors. Their parents completed a socio-economic questionnaire. Jamaican children had high levels of exposure to physical violence. A quarter of the children had witnessed severe acts of physical violence such as robbery, shooting and gang wars, a fifth had been victims of serious threats or robbery and one in every twelve had been stabbed. Children reported being least exposed to sexual violence and to being shot at. Robbery was an almost universal experience affecting children from all schools and socio-economic groups. The single commonest experience as a victim of violence was the loss of a family member or close friend to murder, affecting 36.8 of children. Children's experiences of witnessing violence occurred chiefly in their communities but their personal experiences of violence occurred at school. Boys and children attending primary school had greater exposure to violence as witnesses and victims. Socio-economic status discriminated exposure to physical violence as witnesses but not as victims. Intervention strategies to reduce children's exposure to violence should include community education on the impact of exposure to violence on children, particularly the loss of a significant person, and the development of a range of school-based violence prevention programmes

La exposición a la violencia en la niñez se halla asociada con la agresión en la edad adulta. El alto nivel de violencia comunitaria en Jamaica, tiende a exponer a los niños jamaicanos a la violencia. Hasta el momento no ha habido un estudio detallado de la exposición de los niños jamaicanos a la violencia en sus vidas diarias. Unos 1 674 niños urbanos de 11 a 12 años de edad, quienes previamente formaban parte de un estudio de cohorte de nacimientos a escala nacional, respondieron a una encuesta dando detalles de su exposición a la violencia como testigos, víctimas y agresores. Sus padres respondieron una encuesta socioeconómica. Los niños jamaicanos presentaban altos niveles de exposición a la violencia física. Una cuarta parte de los niños había sido testigo de serios actos de violencia física, tales como robo con fuerza, tiroteos y guerras entre pandillas rivales. Una quinta parte de ellos había sido víctima de serias amenazas o de robo, y uno de cada doce había sido apuñalado. Los niños informaron haber estado menos expuestos a la violencia sexual y a los disparos. El robo fue casi una experiencia universal que afectó a los niños de todas las escuelas y grupos socio-económicos. La experiencia más común en cuanto a ser víctimas de la violencia estuvo dada por la pérdida de algún miembro de la familia o algún amigo cercano por asesinado, lo cual afectó al 36.8% de los niños. Las experiencias de los niños en relación con haber sido testigos de hechos violentos, tuvieron lugar principalmente en sus comunidades, pero sus experiencias personales de violencia ocurrieron en la escuela. Los niños que asistían a la escuela primaria estuvieron más expuestos a la violencia como testigos y como víctimas. El estatus socio-económico resultó un criterio discriminante en cuanto a la exposición a la violencia física en forma de testigo, pero no como la víctima. Las estrategias de intervención para reducir este problema deben incluir la educación de la comunidad respecto al impacto de la exposición de los niños a la violencia - particularmente con respecto a la pérdida de alguna persona importante para ellos - así como el desarrollo de una serie de los programas de prevención de la violencia

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 facilities 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.

Seroprevalence of toxoplasma gondii, rubella virus, cytomegalovirus herpes simplex virus (TORCH) and syphilis in Jamaican pregnant women

Seroprevalence of toxoplasma gondii, rubella virus, cytomegalovirus, herpes simplex virus infections (TORCH) and syphilis were determined in order to assess the immune/susceptibility status in Jamaican pregnant women in 1986. The positive rates were 57%(T. gondii), 69%(rubella), 97%(CMV), 91%(HSV), and 4.9%(syphilis), respectively. The rate of reactivity for rubella was over 50%in all parishes, the highest being 85%in St. Thomas. The seroprevalence of T. gondii was lowest in Trelawny (37.5%). There were no significant differences in seropositivity of CMV and HSV infections between women from various parishes. The importance of seroprevalence of the TORCH group of agents and syphilis on perinatal morbidity and mortality in Jamaican women is discussed, and appropriate recommendations for prevention and control of congenital infections in Jamaica are suggested.

An evaluation of the domiciliary midwifery services in Jamaica

A random sample of 78 district midwives, representing 24% of all district midwives in the government health service, were interviewed to assess their knowledge and practice of domiciliary midwifery as part of the Jamaican Perinatal Morbidity and Mortality Survey in 1986. A standard questionaire based on the WHO guidelines on appropriate technology for birth was used. Records of their two preceding home deliveries were examined and their delivery bag inspected for availability of basic supplies and equipment. A mean of 21.5 home deliveries was attended by each rural midwife in 1986 compared with 3.8 in the urban areas. Routine laboratory tests were not done on many mothers, and there were long delays in getting results. Midwives' knowledge was average overall with one-third of them showing poor knowledge of high-risk factors in infant and newborn care. Most midwives routinely shave and give enemas to mothers. Unavailability of equipment and supplies, including vitamin K and eye drops, is cimmon; 24% of midwives made no perinatal home visit in the previous month, and 80% fell short of the set norm of 5 postnatal home visits; 84% of midwives put the baby to the mother's breast within one hour of delivery. Essential supplies and lab investigations need to be provided and measures taken to improve domiciliary midwifery through a programme of continuing education and better supervision of midwives. A strategy to promote home deliveries under specified conditions needs to be considered

Polio immunization and serological status in children and adolescents in Jamaica 1985

A survey of immunization status and serological immunity to polio was carried out in 5 parishes in Jamaica in 1985. A sample of 2,506 children and adolescents aged 1 - 19 years was chosen by selecting clusters of children in enumeration districts (EDs) in each parish from the 1980 Census. Immunization status was verified by examining immunization records. Serological assay for antibodies to Polio Types 1, 2 =, and 3 was done. A positive neutralization test at dilution of 1:8 was done. A positive neutralization test at dilution of 1:8 was taken as immunity to the polio virus. Of the 1,819 children whose immunization status was confirmed, coverage with 3 or more doses of roral polio vaccine was highest in the 1 - 4 year age group with with 79.7% and lowest in the 15 - 19-year age group with 37.4%. Of the 2,506 children 81.4%, 94.7% and 72.3% were seropositive for Polio Types 1, 2 and 3 respectively. There was a significant difference in the prevalence of seropositives between individuals with and those without a history of vaccinations. No urban/rural or sex differences were noted. The study indicated a higher level of immunization status than previous surveys and a high level of serological immunity to polio