Epidemiology of haemophilus influenzae invasive disease in Jamaica, 1990-1993

Haemophilus influenzae (H influenzae) invasive disease was studied retrospectively over a four-year period in children admitted to the Bustamante Hospital for Children in Kingston, Jamaica. A total of 86cases were identified. The mean estimated annual incidence of H influenzae invasive disease in Kingston and St. Andrew was 39 per 100,000 children under 5 years of age. The majority (77percent) of cases were in the under 2-year age group. A distinct seasonal pattern was noted, with a significantly higher proportion of patients (57-73percent) presenting in the cooler months. Meningitis was the most common clinical diagnosis, accounting for 76percent of the cases. Poor outcome was demonstrated in 21.5percent of patients with meningitis. Sensitivity testing of H influenzae isolates revealed a resistance rate of 26percent for ampicillin and 7percent for chloramphenicol. The epidemiological findings in this study provide reasonable guidelines for empiric antibiotic therapy and also support the need to seriously consider vaccine prophylaxis in Jamaican children.(Au)

Breast-feeding and weight change in newborns in Jamaica

This study was conducted to examine weight change of breast-fed infants during the first week and through the first 24 days of life, and to evaluate the effect of breast-feeding factors and maternal characteristics on early weight change in infants. The weights of 21 infants were recorded on day 1 (day of birth), and on days 3, 7, 10, 17, and 24, and the data analysed to evaluate weight change over the period. Multiple regression analysis was used to assess whether birth weight as well as maternal and breast-feeding factors were significant predictors of weight on day 24. Nineteen of the 21 infants gained weight between days 1 and 3, and 20 infants gained weight between days 3 and 7. All infants gained weight over the 24-day period and their weights at day 7 and day 24 were significantly different (P <0.05 and P <0.01, respectively) from their birth weights. Multiple linear regression analysis showed that significant (P < 0.01) predictors of weight gain by day 24 included birth weight, mother's educational level, whether the baby cried before feeding, and length of feeding time periods. This is the first study of weight change in the early days and weeks of life of exclusively breast-fed newborn infants in Jamaica. The infants showed significant weight gain during the study period and weight gain was affected by certain maternal and breast-feeding factors. (AU)

Jamaica's measles elimination experience

OBJECTIVES: This article describes the effort to eliminate measles from Jamaica and its impact on measles incidence. METHODS: In addition to routine measles vaccination, the Jamaican Ministry of Health implemented a strategy of a 1-time only catch-up vaccination campaign, conducted in 1991, and periodic follow-up campaigns, the first of which occurred in 1995. RESULTS: Since 1991, despite careful surveillance, no serologically confirmed indigenous cases of measles have occurred in Jamaica. CONCLUSIONS: Measles virus circulation has been interrupted in Jamaica. The Jamaican experience provides further evidence that global measles eradicaion is achievable.(AU)

Jamaica's measles elimination experience

OBJECTIVES: This article describes the effort to eliminate measles from Jamaica and its impact on measles incidence. METHODS: In addition to routine measles vaccination, the Jamaican Ministry of Health implemented a strategy of a 1-time-only catch-up vaccination campaign, conducted in 1991, and periodic follow-up campaigns, the first of which occurred in 1995. RESULTS: Since 1991, despite careful surveillance, no serologically confirmed indigenous cases of measles have occurred in Jamaica. The Jamaican experience provides further evidence that global measles eradication is achievable (Au)

The epidemiology of Haemophilus influenzae invasive disease n the Kingston and St. Andrew Region, Jamaica - abstract

Haemophilus influenzae invasive disease was studied retrospectively over a four year period in children admitted to the Bustamante Hospital for Children in Kingston, Jamaica. A total of 86 cases wwere identified. The estimated annual incidence of H. influenzae invasive disease in Kingston and St Andrew ranged from 39 to 45 per 100,000 children <5 years of age. The majority (77 percent ) of cases were in the < 2 year age group. A distinct seasonal pattern was noted, with a significantly higher proportion of patients (57 - 73 percent ) presenting in the cooler months. Similar seasonal variations have been described in the literature. Meningitis was the most clinical diagnosis, accounting for 76 percent of the cases. Poor outcome was demonstrated in 21.5 percent of patients with meningitis. Sensitivity testing of Haemophilus isolates revealed a resistance rate oof 26 percent for ampicillin and 7 percent for chloramphenicol. The epidemiological findings in this study do not differ significantly from those described in the literature for many developed countries. (AU)

Registration of births, stillbirths and infant deaths in Jamaica

BACKGROUND: Vital statistics underestimate the prevalence of perinatal and infant deaths. This is particularly significant when these parameters affect eligibility for international assistance for newly merging nations. OBJECTIVE: To determine the level of registration of livebirths, stillbirths and infant deaths in Jamaica. METHODOLOGY: Births, stillbirths and neonatal deaths identified during a cross-sectional study (1986): and infant death identified in six parishes (1993) were matched to vital registration documents filed with the Registrar General. RESULTS: While 94 percent of livebirths were registered by one year of age (1986), only 13 percent of stillbirths (1986) and 25 percent of infant deaths (1993) were registered. Post neonatal deaths were more likely to be registered than early neonatal deaths. Frequently the birth was not registered when the infant died. Birth registration rates were highest in parishes with high rates of hospital deliveries (rs=0.97, P<0.001) where institutions notify the registrar of each birth. Hospital deaths, however, were less likely to be registered than community deaths as registrars are not automatically notified of these deaths. CONCLUSIONS: To improve vital registration, institutions should become registration centres for all vital events occurring there (births, stillbirths, deaths). Recommendations aimed at modernizing the vital registration system in Jamaica and other developing countries are also made(AU)

Infant mortality rate in Jamaica, 1993 - abstract

In recent years, accurate estimates of the infant mortality rate in Jamaica have not been available. Official vital statistics gave a rate of 13.1 per 1000 live births in 1990 but this is known to be an underestimate because of gross under-registration of infant deaths. In 1993, a study was undertaken to determine infant mortality rates in Jamaica. Six parishes (Hanover, ST. James, Trelawny, Portland, Clarendon and St. Catherine) were chosen to provide sufficient spread over the island and a reasonable urban/rural distribution. The first three listed parishes had also been studied in 1990 by /Desai et al. A similar methodology was employed in which births and deaths for the six parishes were tracked from all hospitals islandwide, from community reports, from reports from the police stations and from the vital registration office, for the calender year 1993. The infant mortality rate for the six parishes ranged from 9.0 per 1000 in Portland to a high of 37.1 per 1000 in Trelawny with a mean of 24.0 per 1000 for the six parishes. Using data on infant mortality rates for the six parishes and for Jamaica between 1951 and 1980 the correlation was calculated and a national estimate of infant mortality rate of 24.4 per 1000 (95 percent C.I., 23.1 - 26.0 per 1000 compared with 27.0 per 1000 in 1980, suggesting little change over the fourteen-year period. Of the deaths 68.5 percent occurred during the neonatal period. Under-registration of infant deaths was extensive - 75 percent. The mean age of registered infant deaths was 3.9 (ñ3.9) months compared with 0.9 (ñ2.2) months for the unregistered deaths (p<0.0001), showing that under-registration is greatest among early infant deaths. Only 13 percent of hospital deaths were registered. The study recommended that there is an urgent need to improve the quality of health care during the neonatal period; reasons for the wide differences in the infant mortality rates of Portland and Trelawny should be explored; and procedures for ensuring registration of hospital deaths must be developed and implemented (AU)