An investigation of child mortality in Kingston and St. Andrew, Jamaica - abstract

This study was carried out as one of the thirteen field projects in the Inter-American Investigation of Mortality in Childhood, which was sponsored by PAHO/WHO. The objective of the study was to investigate causes of death in infancy and early childhood, taking into account nutritional, sociological and other environmental factors. This preliminary report is for the year 1969. An attempt was made to get complete data on all deaths of children under five years of age in the parishes of Kingston and St. Andrew, Jamaica - an area with total mean population of 547,500 in 1969. The investigation was carried out through interviews in homes, hospitals and clinics and with physicians so as to obtain complete records of the fatal illness, results of laboratory and other examinations and autopsy findings. The study area was sub-divided into urban and rural. The total number of deaths under five years of age for the year was 906, 835 of which were from the urban area. The demographic (provisional) of the Registrar General for 1969 reported 803 infant deaths, thus giving an infant mortality rate of 35.4, while the study had 763 infant deaths with an infant mortality rate of 33.8. There were 836 deaths (92 percent) under two years of age, with 469 (51.6 percent) in the neonatal period and 294 (32.5 percent) in the post neonatal period. In 1-4 years age group, 73 deaths occurred among the one-year olds and this represents 52.5 percent of deaths in this age group. Thus there were four times as many deaths in the post-neonatal period as there were in the second year of life and those in the second year of life were more than half of those deaths occurring in the 1-4 year old group. The geographic distribution was analysed according to postal zones for the urban area. Out of 835 urban deaths occurring in 21 postal zones, 445 (53.2 percent) occurred in zones 0, 11, 12 and 13 which accounted individually for the highest numbers of death. Hence establishing priorities in developing a maternal and child health programme to improve health services and reduce child mortality, emphasis must necessarily be given to children under two years old, and special attention to certain geographic areas (AU)

Growth, gross motor and language development in Jamaican infants - abstract

A longitudinal study of the growth and development of 300 Kingston infants was carried out from birth to one year of life. The infants were of predominantly Negro extraction and most came from working-class families. The study shows that the children are smaller at birth than North American norms. By the age of three months their weights are in excess. This excess last until six months, following which they are consistently below the North American Normals, but above a series reported from West Africa. Changes in heights are very much less marked, while the head circumference shows insignificant differences. Some items from the Gesell Schedules of gross motor and language behaviour were evaluated throughout the year. They were found to be accelerated over the normal white child of the Gesell Development Schedules. Children of low birthweight were significantly slower than the remaining children in attaining several items but were equal to the normal white child of the Gesell Schedules. Sex and socio economic class made no difference to the age of walking, though high weight at 12 months had a beneficial effect. The effect of race could not be assessed due to the absence of a control white population. The study group is being kept under observation (AU)

A four year developmental survey of Jamaican children: preliminary report - abstract

A continuing assessment of 300 children born by consecutive deliveries between March 7 and May 7, 1967, in the University Hospital, Kingston. Jamaica, is being carried out by the Department of Paediatrics of the University of the West Indies. Children who were one year of age in March 1968, in addition, to a physical examination, were given a developmental assessment. An attempt was also made to assess the structure of the home from which these children came and to determine if possible the effect environment had on the development of these children. Of these a random sample of 66 children were selected for the initial survey. The racial composition of the group was predominantly African, 62, mixed African and Indian or Chinese 3, Indian 1. The marital composition of the group was - single 46 percent, married 31 percent common-law union 24 percent. The general social structure of the group was lower class or lower middle class. Very few of the children had any gross physical abnormalities and the general physical examination did not suggest a gross nutritional defect. The assessment in the first year was based on the Gesell scales. In the second year on the Gesell with a few items added from the Binet. The assessment of the child was carried out in a very flexible manner. Special allowances were made where it was felt that the answer, while not acceptable in the standard test, was reasonable for the Jamaican culture. Many questions had to be rephrased in order that they could be understood by children. It was felt that some modifications were necessary in order to obtain a reasonable evaluation of the development of the children. Had this not been done, motivation or cultural factors would have further lowered the results of the assessment. Children whose assessment was difficult or where the examiner felt the assessment was inaccurate were brought back on another day for a reassessment. The assessment of the environment of these children included the physical structure of the home, the parental structure, the educational level of the adults, degree of involvement of the adults with the child and the amount of time spent with the child. The following were the average ratings in development quotations of the children at the various age levels: Gross Motor - 1-year 112, 2-year 112, 3-year 107, Fine Motor - 1-year 106, 2-year 108, 3-year 97, Adoptive - 1-year 102, 2-year 104, 3-year 92, Language - 1-year 106, 2-year 100, 3-year 91, Personal-Social - 1-year 102, 2-year 100, and 3-year 110. In the third year a comparison was made between the children living in those homes which provided the best overall environment. The children in the best homes had an adaptive rating of 98 and a language rating of 97 compared to the children living in the poorest homes who had an adaptive rating of 87 and a language rating of 83 (AU)

Childhood tetanus in Jamaica

A series of 50 cases of tetanus in children is presented. Symptomatology is discussed. Treatment schedule involving careful nursing, tetanus antitoxin, and sedation with phenobarbitone and chlorpromazine is described. Tube feeding and tracheostomy were required in some severe cases but intermittent positive pressure respiration was not required. The overall mortality of the 50 patients was 2 percent. Although the care of tetanus in Intensive Care Units has resulted in a considerable reduction in mortality, it is still possible to look after patients with tetanus in countries where such facilities are not available (AU)

Beta-thalassaemia Hb E disease

B-thalassaemia Hb E disease occurring in a young Indian girl in Jamaica is described. Three years after splenectomy there is sustained clinical improvement and blood transfusions have not been necessary. The indications for splenectomy are discussed in relation to the pathology of the anaemia as revealed by radio-isotope studies of blood volume and red cell survival (AU)

A note on infant feeding in Kingston

A longitudinal study of 300 infants from birth to a year was conducted. The age various foods are introduced into the diet and poor standard of food preparation are described. The brands of milk being given are listed and the percentage of infants receiving proprietary jars of baby food and subsidized milk is also recorded (AU)

Familial and recurrent veno-occlusive disease of liver in Jamaican children (abstract only)

The case histories of four children in a family of seven are presented. The eldest of the four, a girl, presented in 1961 at age 4 1/2 years with evidence of liver disease and portal hypertension. A liver biopsy was not performed. This child died in 1964 of hepatorenal failure and unfortunately permission for autopsy was refused. The second affected child, a boy, presented at age 2 years with hepatosplenomegaly and jaundice and a needle biopsy of his liver revealed a histological picture consistent with post V.O.D. cirrhosis. He has remained fairly well since, although signs of cirrhosis persist. In June 1966 two female siblings age 1 year and 2 years respectively, presented at the same time with acute abdominal swelling. Liver biopsies confirmed the clinical diagnosis of acute V.O.D. and their subsequent progress is briefly reviewed. The case history of a boy who has had two proven episodes of acute V.O.D. is presented. This child was first admitted in January 1958 at age 1 year and five months, with acute abdominal swelling. A liver biopsy revealed histological evidence of acute V.O.D. His clinical condition settled and repeat biopsy in March 1958 showed no residual liver disease. He remained well after this until he had an episode of obstructive jaundice in 1960 which subsided spontaneously. In 1965 he was readmitted with a history of acute abdominal swelling and after two months during which time his ascites gradually subsided, a liver biopsy was performed and this showed subacute V.O.D. A final biopsy was done in September 1966 and this showed only minimal increase of fibrous tissue. A brief note on the aetiology of V.O.D. is submitted(AU)

Forty-four cases of tetanus

A series of 44 children with Tetanus is presented. 1 child had local Tetanus, 26 were cases of moderate severity and 17 were severe. Most were secondary to injury to the feet. Treatment was with careful nursing, Phenobarbitone and Chlorpromazine in a general ward. Tube feeding and trachemostomy were carried out in some severe cases but IPPR was not required. 1 fatality occurred during the series(AU)

Acute rheumatism in Jamaican children

One hundred consecutive admissions between 1952-1960 to the University College Hospital of the West Indies of children with acute rheumatism are analysed. The condition is severe with a mortality rate of 21 per cent and cardiac morbidity rate of 24 per cent. Early diagnosis and bed rest combined with maintenance penicillin to prevent recurrence are most important aspects of treatment. The introduction of maintenance benzathine penicillin by monthly injections in 1957 has resulted in an improvement in the results (AU)

The changing pattern of pediatrics in Jamaica

An analysis was presented of 1,890 children admitted to U.W.I. in the years 1955-58, and 2,550 admitted from 1959-1962. The proportion of children under 2 has increased from 58 percent to 68 percent - due mainly to an increased number of babies with gastroenteritis (over 50 percent of admission in 1962). The mortality of gastroenteritis has declined from 22 percent to 4 percent mainly due to improvements in treatment. While the incidence of malnutrition has declined steadily since 1959, it remains the second most common cause of admission. Respiratory infections were common in both infants and older children. Acute purulent meningitis was common in infants (with a mortality rate of 20 percent). There has been a dramatic decline in the incidence of acute V.O.D. of the liver. Rheumatic fever remained common in older children and there was a marked increase in the incidence o f diphtheria, tetanus, and typhoid. Tuberculosis and congenital syphilis were infrequently seen and malaria had apparently disappeared. Diabetes and congenital hypertrophic pyloric stenosis were uncommon while coeliac disease and fibrocystic disease of the pancreas had not yet been seen (AU)

Electrolyte and acid-base disturbances occurring in infantile gastro-enteritis in Jamaica

A preliminary investigation of electrolyte and acid-base disturbances occurring in infantile gastroenteritis in Jamaica is presented. As associated malnutrition was common it is felt the clinical assessment of dehydration remains more relible than laboratory methods in such cases. True hypertonicity was rare and so was hypocalcemia. Hypopotassemia was common but never associated with paralytic illness. A low serum magnesium level was common but usually asymptomatic. In four instances however, it apparently produced serious symptoms with potentially fatal possibilities. We therefore feel that magnesium supplements should be given along with potassium and other electrolytes in the crystalloid replacement therapy of such cases (AU)