Asthma and allergies in Jamaican children aged 2-17 years: a cross-sectional prevalence survey.

OBJECTIVE: To determine the prevalence and severity of asthma and allergies as well as risk factors for asthma among Jamaican children aged 2-17 years. DESIGN: A cross-sectional, community-based prevalence survey using the International Study of Asthma and Allergies in Childhood questionnaire. The authors selected a representative sample of 2017 children using stratified, multistage cluster sampling design using enumeration districts as primary sampling units. SETTING: Jamaica, a Caribbean island with a total population of approximately 2.6 million, geographically divided into 14 parishes. PARTICIPANTS: Children aged 2-17 years, who were resident in private households. Institutionalised children such as those in boarding schools and hospitals were excluded from the survey. PRIMARY AND SECONDARY OUTCOME MEASURES: The prevalence and severity of asthma and allergy symptoms, doctor-diagnosed asthma and risk factors for asthma. RESULTS: Almost a fifth (19.6%) of Jamaican children aged 2-17 years had current wheeze, while 16.7% had self-reported doctor-diagnosed asthma. Both were more common among males than among females. The prevalence of rhinitis, hay fever and eczema among children was 24.5%, 25% and 17.3%, respectively. Current wheeze was more common among children with rhinitis in the last 12 months (44.3% vs 12.6%, p<0.001), hay fever (36.8% vs 13.8%, p<0.001) and eczema (34.1% vs 16.4%, p<0.001). Independent risk factors for current wheeze (ORs, 95% CI) were chest infections in the first year of life 4.83 (3.00 to 7.77), parental asthma 4.19 (2.8 to 6.08), rhinitis in the last 12 months 6.92 (5.16 to 9.29), hay fever 4.82 (3.62 to 6.41), moulds in the home 2.25 (1.16 to 4.45), cat in the home 2.44 (1.66 to 3.58) and dog in the home 1.81 (1.18 to 2.78). CONCLUSIONS: The prevalence of asthma and allergies in Jamaican children is high. Significant risk factors for asthma include chest infections in the first year of life, a history of asthma in the family, allergies, moulds and pets in the home.

The Jamaica asthma and allergies national prevalence survey: rationale and methods.

BACKGROUND: Asthma is a significant public health problem in the Caribbean. Prevalence surveys using standardized measures of asthma provide valid prevalence estimates to facilitate regional and international comparisons and monitoring of trends. This paper describes methods used in the Jamaica Asthma and Allergies National Prevalence Survey, challenges associated with this survey and strategies used to overcome these challenges. METHODS/DESIGN: An island wide, cross-sectional, community-based survey of asthma, asthma symptoms and allergies was done among adults and children using the European Community Respiratory Health Survey Questionnaire for adults and the International Study of Asthma and Allergies in Children. Stratified multi-stage cluster sampling was used to select 2, 163 adults aged 18 years and older and 2, 017 children aged 2-17 years for the survey. The Kish selection table was used to select one adult and one child per household. Data analysis accounted for sampling design and prevalence estimates were weighted to produce national estimates. DISCUSSION: The Jamaica Asthma and Allergies National Prevalence Survey is the first population- based survey in the Caribbean to determine the prevalence of asthma and allergies both in adults and children using standardized methods. With response rates exceeding 80% in both groups, this approach facilitated cost-effective gathering of high quality asthma prevalence data that will facilitate international and regional comparison and monitoring of asthma prevalence trends. Another unique feature of this study was the partnership with the Ministry of Health in Jamaica, which ensured the collection of data relevant for decision-making to facilitate the uptake of research evidence. The findings of this study will provide important data on the burden of asthma and allergies in Jamaica and contribute to evidence-informed planning of comprehensive asthma management and education programs.

Antibacterial effects of Carica papaya on common wound organisms [abstract]

OBJECTIVE: The objective was to investigate the antibacterial activity of the crude Carica papaya preparations as used by nurses, on gram negative and gram positive organisms; to determine which part and stage of maturity of the fruit yielded the best antibacterial activity, and determine the effects of storage conditions on the observed activity. METHODS: The pathogens commonly found in human wounds were obtained from the Microbiology Department, University of the West Indies, Biochemistry Section, The University of the West Indies and the Jamaican Bureau of Standards. Cultures were routinely maintained in nutrient agar slants at 4§c. Extracts were obtained by separately grinding fractions of the epicarp, endocarp and seeds of the immature, mature and ripe Carica papaya fruit and filtering them through guaze. Sensitivity tests were conducted by adding 0.06 ml. of agar wells (6 mm diameter) prepared from 20 ml agar seeded with 10 cells/ml suspension of one of the eight organisms per plate. The inoculated plates were allowed to equilibrate at 4§c for one hour then incubated at 37§c for 24 hours, after which zones of inhibition were measured in millimeters. Antibacterial activity was expressed in terms of the radius of the zone of inhibition calculated as the difference in radius of the observed zones and the edge of the agar wells. Daily sensitivity tests were carried out on extracts stored at 5§c, 25§c and 35§c for 7 days. RESULTS: The seed extracts from all three stages of the fruit showed an average order of inhibition in the following order: B cereus> E coli> S faecalis> S aureus> P vulgaris> and X flexneri. There was no significant difference in bacterial sensitivity between the immature, mature and ripe fruits tested. The epicarp and endocarp did not produce any inhibition zone in any of the three stages of the fruit tested. There was a gradual reduction in antibiotic activity with increasing storage item. Also, a fall-off of activity was found to be more drastic at higher temperatures. CONCLUSION: The findings show that crude extracts of Carica papaya seed have antibacterial activity that inhibits the growth of both gram positive (B cereus, S aureus and S faecalis) and gram negative (E coli, P vulgaris and S flexneri) organisms. Observed activity was dependent on stage of maturity but tended to decrease with duration and conditions of storage. No antibacterial activity was observed from the epicarp and the endocarp of the fruit. (AU)

Knowledge, attitude and practice among women actively seeking abortion services at a public health facility in Kingston Metropolitan area, January to March 1996

The knowledge, attitudes and practices of 95 women actively seeking aortion services at a public health facility in the Kingston Metropolitan Area were studied over a six week period. In the study 38 percent of the respondents were under and 62 percent were above age twenty years. Although their educational level was fairly high, their unemployment rate was equally high. Respondents displayed a mixture of positive and negative attitude towards pregnancy and abortion. The level of contraceptive use both by respondents and partners was very low, immediately prior to the pregnancy. Respondents sought abortions for economic reasons mainly. Sixty two (65 percent) respondents wanted abortion to be made available on demand. There is need for a definite policy to be formulated towards legislation of abortion. Public education also needs to be strengthened in family planning and family life education with special emphasis on adolescents. (AU)

The Jamaica asthma and allergies national prevalence survey: rationale and methods

BACKGROUND: Asthma is a significant public health problem in the Caribbean. Prevalence surveys using standardized measures of asthma provide valid prevalence estimates to facilitate regional and international comparisons and monitoring of trends. This paper describes methods used in the Jamaica Asthma and Allergies National Prevalence Survey, challenges associated with this survey and strategies used to overcome these challenges. METHODS/DESIGN: An island wide, cross-sectional, community-based survey of asthma, asthma symptoms and allergies was done among adults and children using the European Community Respiratory Health Survey Questionnaire for adults and the International Study of Asthma and Allergies in Children. Stratified multi-stage cluster sampling was used to select 2, 163 adults aged 18 years and older and 2, 017 children aged 2-17 years for the survey. The Kish selection table was used to select one adult and one child per household. Data analysis accounted for sampling design and prevalence estimates were weighted to produce national estimates.DISCUSSION: The Jamaica Asthma and Allergies National Prevalence Survey is the first population- based survey in the Caribbean to determine the prevalence of asthma and allergies both in adults and children using standardized methods. With response rates exceeding 80% in both groups, this approach facilitated cost-effective gathering of high quality asthma prevalence data that will facilitate international and regional comparison and monitoring of asthma prevalence trends. Another unique feature of this study was the partnership with the Ministry of Health in Jamaica, which ensured the collection of data relevant for decision-making to facilitate the uptake of research evidence. The findings of this study will provide important data on the burden of asthma and allergies in Jamaica and contribute to evidence-informed planning of comprehensive asthma management and education programs.