Growth, morbidity, and mortality in a cohort of Jamaican adolescents with homozygous sickle cell disease

A cohort of 36 males and 46 females with homozygous sickle cell (SS) disease, aged 12 to 17 years, were followed for periods of 4 to 7 years or until their 21st birthday. Comparing SS disease to standards, growth continued for longer, resulting in greater median heights by 18 years, and median weights were less at all ages. Menarche was delayed. There were 50 hospital admissions for conditions related to SS disease, in a total of 453 observation years, an average annual incidence of 11 percent. The majority were for painful crises (48 percent) smd acute pulmonary episodes (28 percent). Leg ulceration lasting longer than 3 months was present at an average annual prevalence rate of 16 percent, and duration was significantly greater in patients of lower socioeconomic groups. Two deaths occurred compared with 0.441 expected from Jamaican life tables. The natural history of SS disease in this group of Jamaican adolescents was generally mild, over half having no hospital admissions and three-quarters being without chronic leg ulceration during the period of the study (AU)

A serological evaluation of an immunization programme in Salt Cay, Turks and Caicos Islands

A serological survey in Salt Cay, Turks and Caicos Islands, British West Indies, suggested that immunization against poliomyelitis carried out since 1971 had been unexpectedly ineffective. Immunity as judged by antitoxin levels was satisfactory for tetanus but poor for diptheria. The value of serological studies in the evaluation of immunization programmes is demonstrated. Effective evaluation of a vaccination programme must involve accurate vaccination records and continuous surveillance of disease incidence, cold chain adequacy, and vaccine delivery to susceptible groups (AU)

Body habitus of Jamaican adults with sickle-cell haemoglobin C (SC)disease

Anthropometric measurements were made in 52 adults with SC disease and compared with those on controls. Weight and interacromial diameter were significantly less in males but no other parameters differed from controls. In contrast to SS disease, SC disease does not appear to affect body habitus(AU)

Tercentenary of the first English book on tropical medicine, by Thomas Trapham of Jamaica

Between 11 and 12 o'clock in the morning of 7 June 1692 occurred one of the most famous earthquakes in history, and the town of Port Royal in the island of Jamaica, described by writers of the time as the "Babylon of the Caribbean" and "the wickedest and richest city in the New World," slid into the sea. A contempory pamphlet described the disaster and illustrated it with a crude woodcut, showing that "Dr Trapham, a Physcian in this Place was Miraculously saved, by hanging the Hands upon the Rack of a Chimney and one of his children hanging about his Neck, were both saved by a Boat; but his Wife and the rest of his Children and Family were lost." (AU)

A review of epidemiological research in rural Jamaican community, 1959-1975

Epidemiology research carried out between 1959 and 1976 in a rural community in Jamaica is summarized. The prevalence of many chronic conditions was established by cross-sectional investigations. The importance of hypertension and diabetes mellitus as a cause of mortality was demonstrated in follow-up studies. Factors influencing child growth and school achievement were investigated (AU)

Heights and weights of West Indian children with the sickle cell trait

No consistent differences were found in mean heights and weights of 170 schoolchildren aged 6-12 years with the sickle cell trait and 1247 schoolchildren with normal haemoglobin living in Dominica and Jamaica. (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)

The metacarpal index in Jamaican children and adults

The metacarpal index was measured in radiographs of the hands of 615 male and 667 female Jamaicans aged over two years. The index increased with age from two years to adulthood, and was greater in females than in males, and greater in the left hand than the right hand. Means and standard derivations of the index for the left hand are presented as standards. An index of 9.6 for males and 10.1 for females over the age of 13 years is suggested as the upper limit of normal (three standards derivations above the mean). These standards are higher than those previously reported, and are probably applicable to other black populations outside Jamaica (AU)

Treponemal serological tests in Jamaican school children, 1976

Sera from 899 children aged 6-14 years attending schools in rural St. Andrew and St. Mary in Jamaica were examined by the VDRL test and, if reactive or weakly reactive, by the FTA-ABS test. Fourteen sera were weakly reactive and, of these, 5 were positive in the FTA-ABS test. The cause of these reactive tests was not determined. The proportion of children in St. Mary who were weakly reactive in the VDRL test was 0.1 percent compared to 27.6 percent weakly reactive and reactive children in 1963, 13 years earlier, which suggests that yaws transmission has become rare in St. Mary and, by inference, probably elsewhere in Jamaica. The mistaken diagnosis of syphilis by sero-reactivity which was, in fact, due to yaws contracted in childhood used to be a major problem. With the disappearance of childhood yaws, the value of reactive treponemal tests as evidence of syphilitic infection should be of increasing significance (AU)

Some non-infective diseases endemic in the West Indies

The West Indies, and associated parts of the Caribbean area, are extremely diverse and afford interesting examples for the study of geographical medicine. Short accounts are given of some conditions whose aetiologies have been relatively recently clarified, including vomiting sickness of Jamaica, veno-occlusive disease of Jamaica, blackfat pulmonary fibrosis of Guyana, and epidemic acute glomerulonephritis of Trinidad. The aetiology of tropical sprue, which is common in Puerto Rico and absent from Jamaica remains to be explained although a hypothesis has been put forward. Further work is needed to establish the geographical distribution of idiopathic cardiomegaly and the spinal neuropathies and associated syndromes of retrebublar neuritis and sensorineural deafness before their aetiologies can be understood (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)

Lung function of healthy boys and girls in Jamaica in relation to ethnic composition, test exercise performance, and habitual physical activity

The relationships of forced expiratory volume and forced vital capacity of height, age, sex, area of residence, and ethnic composition were assessed in 622 children in Jamaica. Rural children in hill-farming communities were judged to have a higher habitual physical activity than urban children. Allowing for differences in body size, forced vital capacity averaged 3 percent greater in rural children than in urban children, 7 percent less in girls than in boys, and 16 percent greater in children of European origin than in children of African descent. Lung volumes, indices of gas transfer, and sub-maximal-exercise responses were measured in a subgroup of 108 children of African descent believed to be of common genetic stock. Total lung capacity and vital capacity averaged respectively 6 percent greater and 7 percent greater in rural than in urban children of equal height but residual volume and transfer factor did not differ significantly between localities. Rural children had a lower average cardiac and respiratory components of the oxygen transport system, consonant with the demand for muscular work. Increased habitual physical capacity, total lung capacity, and transfer factor (AU)