Use of food expenditure data to estimate household nutrient accessibility.

The nutritional status of at-risk groups is usually monitored using health statistics. This approach has limitations as individuals are identified only after they have been afflicted by morbidity. In Jamaica, national surveys are carried out in which expenditure data on all consumption items are collected. We used these data to monitor food accessibility in at-risk groups. The identification of decreases in accessibility levels relative to requirements would enable timely intervention before there is a deterioration in nutritional status. We analysed the data from the survey of 3861 households conducted by Statistical and Planning Institutes of Jamaica in 1989. Using the food expenditure data, per capita energy and protein accessibility levels were determined. The mean energy and protein accessibility levels for the sample were 2170 Cals and 64 g, respectively. The results showed that the per capita accessibility levels of 20% and 9% of the households were less than half of requirements for energy and protein, respectively. The situation was worse in rural areas than in urban centres. However, the accessibility levels may have been underestimated as the data did not include meals bought and consumed away from the home, which may be significant to some households. We believe that the use of data from these surveys is a cost-effective way to monitor nutrient accessibility in Jamaica.

Evaluation of a gastric delivery system for iron supplementation in pregnancy.

The present investigation was undertaken to assess the efficacy of oral iron supplementation during pregnancy by using a gastric delivery system (GDS). Three hundred seventy-six pregnant women between 16 and 35 y of age and 14 and 22 wk gestation were selected if mild anemia was present (hemoglobin concentration 80-110 g/L). The participants were randomly assigned to one of three study groups given no iron, two FeSO4 tablets (100 mg Fe) daily, or one GDS capsule (50 mg Fe) daily. Blood was obtained initially and after 6 and 12 wk for measurement of red blood cell and iron indexes, including serum transferrin receptor. There was a significant and comparable improvement in hematologic and iron-status measurements in the two groups of women given iron whereas iron deficiency evolved in women given no iron supplement. We conclude that by eliminating gastrointestinal side effects and reducing the administration frequency of an iron supplement to once daily, a GDS offers significant advantages for iron supplementation of pregnant women.

Diabetes mellitus and public health in Guadeloupe.

Diabetes mellitus is now among the ten leading causes of death in the Caribbean. Studies of the prevalence of dysglycaemic disorders and risk factors for diabetes are necessary in order to design and implement tailored prevention programmes. The present study is of a representative sample of the adult population in Guadeloupe. The estimated prevalence of diabetes is 5.8% in adults, and that of impaired glucose tolerance is 7.4%. The percentage of insulin-treated patients is low, 14% of diabetics. The principal risk factors of diabetes, as classically recognised, are shown to operate. At the individual level, the presence of a diabetic parent is a greater relative risk factor than obesity. However, considering the large percentage of persons who are obese, obesity seems to be the principal factor at which a primary prevention programme at the community level should be aimed, in order to limit the incidence of hyperglycaemic states.

Diabetes mellitus and public health in Guadeloupe

Diabetes mellitus is now among the ten leading causes of death in the Caribbean. Studies of the prevalence of dysglycaemic disorder and risk factors for diabetes are necessary in order to design and implement tailored prevention programmes. The present study is of a representative sample of the adult population in Guadeloupe. The estimated prevalence of diabetes is 5.8% in adults, and that of impaired glucose tolerance is 7.4%. The percentage of insulin-treated patients is low, 14% of diabetics. The principal risk factors of diabetes,as classically recognised, are shown to operate. At the individual level, the presence of a diabetic parent is greater relative risk factor than obesity. However, considering the large percentage of persons who are obese, obesity seems to be the principal factor at which a primary prevention programme at the community level should be aimed, in order to limit the incidence of hyperglycaemic states

Anaemia in antenatals in the Turks & Caicos Islands

Anaemia in the Turks & Caicos Islands was studied by examining all antenatal records for a four-year period from 1981 to 1984. If the World Health Organization (WHO) standards were used, 60-70 per cent of the antenatals were classified as anaemic over the four-year period. The per cent of antenatals with haemoglobin levels below 9.0 gm/dl varied from 7 to 9 per cent. There was a statistical difference between the four years of data from the Turks & Caicos Islands and the haemoglobin levels of the University Hospital of the West Indies antenatals

Haemoglobin levels in West Indian antenatals

Studies conducted in the English-speaking Caribbean have shown that anaemia is a public health problem in pregnancy. However, these studies have been questioned because the World Health Organization (WHO) haemoglobin criteria, which are based on studies of North American and European women, may not apply to Caribbean women. Antenatal clinic records were studied at the University Hospital of the West Indies (UHWI), Kingston, Jamaica. Over half of the antenatal women were between the ages of 21 and 27 years. Modal parity was 1 (41%) followed by a parity of 2 (31%). Median value for gestation was 13 weeks. The mean haemoglobin level was 12.4 ñ 1.5 gm/dl (median = 12.6). Twenty-one antenatal women (3.9%) had haemoglobin levels below 11 gm/dl and only 4 (0.6%) had haemoglobin levels below 10 gm/dl. The mean haemoglobin at the UHWI was 1.9 gm/dl higher than that of 159 patients from Antigua. However, the Antiguans were an average of 6 weeks further advanced in pregnancy. In Montserrat, the mean of 138 antenatal haemoglobin levels was 2.4 gm/dl lower than the UHWI mean/ these patients were also about 6 weeks further advanced in pregnancy. This study suggests that, given the right environment, the antenatal women in Montserrat and Antigua, who are of roughly the same ethnic origin as those from Jamaica, could achieve the same haemoglobin levels as those of pregnant women attending the antenatal clinic at the UHWI, Kingston, Jamaica

Duplicate prescriptions: an aid to research and review.

We describe a method of studying patterns of prescribing and related morbidity in general practice. Prescribing data were automatically duplicated onto a ;no-carbon-required' prescription-pad. Additional information about diagnosis and indications for each drug, an indication of whether the drug was newly prescribed or a repeat, and a patient identification code were entered onto the bottom copy. A computer was used to process the data, which were gathered over a period of seven months.The method offers an efficient means of collecting data which can be applied by individuals or groups of doctors to improve patient care and help achieve rational prescribing.

Prescribing in general practice and the provision of drug information.

Duplicate prescriptions were used to monitor patient prescribing and morbidity data for 20 Tayside general practitioners during a two-year study. Each participant took part in two periods of active monitoring separated by a three-month gap. Prescribing statistics collected during the first period of monitoring formed the basis of drug information which was circulated to participants shortly after the start of the second period. Some of this information was purely statistical; other information included comments as well as statistics. Subsequent monitoring assessed any changes in prescribing. The results indicate that drug information of this kind can influence general practitioner prescribing but that there were no differences in response to information which was purely statistical and information which included comments.