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Title: The influence of early sexual debut and sexual violence on adolescent pregnancy: a matched case-control study in Jamaica.
Author: Baumgartner JN; Geary CW; Tucker H; Wedderburn M
Source: International Perspectives on Sexual and Reproductive Health. 2009 Mar;35(1):21-28.
Abstract: The authors conducted structured interviews with 15- to 17-year-old females-250 who were currently pregnant and 500 sexually experienced, but never-pregnant, neighborhood-matched controls. Bivariate and multivariate analyses were used to examine associations between adolescent pregnancy and early sexual debut, sexual coercion or violence, and sexual risk-taking behaviors. Greater proportions of pregnant youth than of their never-pregnant peers reported having had first sex by age 14 (54% vs. 41%), a first sexual partner who was five or more years older (33% vs. 20%), or multiple partners (63% vs. 50%). A greater proportion of never-pregnant youth had used contraceptives at first sex (88% vs. 80%). Almost half (49%) of all young women reported ever having experienced sexual coercion or violence. Compared with controls, pregnant youth had greater odds of having had an older partner at first sex and believing contraception is a woman's responsibility (odds ratios, 1.3 and 2.1, respectively), and had lower odds of ever having experienced sexual violence and thinking that it is important to protect oneself against pregnancy (0.5 and 0.2, respectively). An interaction between early sexual debut and multiple partners was found. Having had multiple partners was associated with pregnancy only for youth with early sexual debut. Encouraging adolescents to delay sexual debut and reduce their number of sexual partners may help prevent unintended pregnancies. Experiences of sexual coercion and violence were common among both groups, highlighting the need to address gender-based violence at the community level.
Language: English
Keywords:
JAMAICA | RESEARCH REPORT | CASE STUDIES | ADOLESCENTS, FEMALE | ADOLESCENT PREGNANCY | SEXUAL ABUSE | Caribbean | Americas | Developing Countries | Studies | Research Methodology | Adolescents | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Reproductive Behavior | Fertility | Population Dynamics | Crime | Social Problems | Sociocultural Factors
Document Number: 315213

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Peer Reviewed

Title: One versus multiple packs for women starting oral contraceptive pills: a comparison of two distribution regimens.
Author: Chin-Quee D; Otterness C; Wedderburn M; McDonald O; Janowitz B
Source: Contraception. 2009 May;79(5):369-74.
Abstract: BACKGROUND: Despite World Health Organization and International Planned Parenthood Federation recommendations to provide multiple pill cycles to new users, many programs in developing countries still give only one pill cycle to new acceptors. STUDY DESIGN: To compare provision of a single versus multiple packs of pills, new pill users in 20 matched public sector clinics in Jamaica were assigned to one of two pill regimens in which they received either one (then subsequently three) or four pill cycles at method initiation. The primary outcome was the proportion of women who used pills beyond 4 months. RESULTS: Among 655 women, those receiving one cycle of pills at initiation, followed by counseling and a three-pack resupply, were no more likely to be using pills after 4 months than women who received four packs at initiation (odds ratio=1.33; 95% confidence interval=0.88-2.0). In both pill regimen groups, returning late to the clinic for resupply was a problem. However, more women in the 1+3-pack regimen group returned late to study clinics to obtain their fifth cycle of pills than their counterparts in the 4-pack regimen group (53% vs. 28%). CONCLUSION: Our findings support the recommendation that pill users should be given more than one cycle to start, because an extra visit for resupply contributes to clinic and provider costs. Moreover, providing more pill cycles at initiation would decrease the likelihood that women experience a gap in pill use between cycles.
Language: English
Keywords:
JAMAICA | RESEARCH REPORT | CONTRACEPTIVE PREVALENCE SURVEYS | COMPARATIVE STUDIES | WOMEN IN DEVELOPMENT | CONTRACEPTIVE DISTRIBUTION | PACKAGING | ORAL CONTRACEPTIVES | TIME FACTORS | COUNSELING | USER COMPLIANCE | CONTRACEPTIVE PREVALENCE | CONTRACEPTION CONTINUATION | Caribbean | Americas | Developing Countries | Family Planning Surveys | Family Planning | Studies | Research Methodology | Economic Development | Economic Factors | Distributional Activities | Program Activities | Programs | Organization and Administration | Marketing | Contraceptive Methods | Contraception | Population Dynamics | Demographic Factors | Population | Clinic Activities | Behavior | Contraceptive Usage
Document Number: 330940

3.
Peer Reviewed

Title: Descriptive epidemiology of mortality and morbidity of health-indicator diseases in hospitalized children from western Jamaica.
Author: McCarthy JE; Evans-Gilbert T
Source: American Journal of Tropical Medicine and Hygiene. 2009 Apr;80(4):596-600.
Abstract: The objectives of our study were to describe the epidemiology of child-health indicator diseases in western Jamaica, examine differences in indicator diseases between sex and age, and generate hypotheses about causes of disease burden. International Classification of Disease, 10th Revision, coded discharge diagnoses were collected from consecutive admissions for 2003-2005 from a public tertiary care hospital. Mortality data were not coded. Perinatal disease was the most common cause of mortality, with hyaline membrane disease the primary cause. Younger children, particularly males, are disproportionately affected by all indicator diseases (P < 0.001) and more likely to die from acute respiratory tract infections and infectious diseases (P < 0.05). Sickle cell disease was the fourth most common diagnosis. Children in western Jamaica are most affected by diseases of prematurity. These children experience disease burden similar to that of children in other developing countries, but fewer neonatal sepsis and insect-borne infections, and more hematologic illness.
Language: English
Keywords:
JAMAICA | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | EVALUATION INDEXES | CLASSIFICATION | CHILDREN | INFANT | PREVALENCE | HEALTH STATUS INDEXES | CHILD HEALTH | CHILD MORTALITY | CAUSES OF DEATH | SEX FACTORS | RESPIRATORY INFECTIONS | Caribbean | Americas | Developing Countries | Research Methodology | Quantitative Evaluation | Evaluation | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Measurement | Health | Mortality | Population Dynamics | Infections | Diseases
Document Number: 331278

Title: Maternal mortality in patients admitted to an intensive care unit in Jamaica.
Author: Scarlett M; Isaacs MA; Fredrick-Johnston S; Kulkarni S; McCaw-Binns A
Source: International Journal of Gynaecology and Obstetrics. 2009 May;105(2):169-70.
Abstract: A retrospective review was conducted of severe acute maternal morbidity (SAMM) admissions to the intensive care unit (ICU) at the University Hospital of the West Indies (UHWI), Jamaica, between January 2001 and December 2006. UHWI has 550 beds and is one of three tertiary care referral centers on the island; it has two 8-bed ICUs. A total of 57 women with SAMM were admitted to the ICU over the study period, representing 2.8% of ICU admissions and 0.4% of total maternal admissions to the hospital. The mean age of the women was 30 years (range, 26-36 years) and the mean duration of stay in the ICU was 6 days (range, 1-35 days). The most common diagnoses were hypertensive disorders of pregnancy, sickle cell disease, and hemorrhagic disorders (Table 1). The cause of the admission in 32 (56.1%) patients was a direct obstetric cause, while for 25 (43.8%) patients the cause was non-obstetric. Only 2 patients with viable pregnancies had inadequate prenatal care. Twenty-five women were admitted after cesarean delivery, 11 after vaginal delivery, 6 following laparotomy, and 6 after induced abortion.
Language: English
Keywords:
JAMAICA | RESEARCH REPORT | RETROSPECTIVE STUDIES | CLIENTS | PREGNANCY COMPLICATIONS | MATERNAL MORTALITY | MORBIDITY | HOSPITALS | CAUSES OF DEATH | OBSTETRICS | Caribbean | Americas | Developing Countries | Studies | Research Methodology | Program Activities | Programs | Organization and Administration | Diseases | Mortality | Population Dynamics | Demographic Factors | Population | Health Facilities | Delivery of Health Care | Health | Medicine | Health Services
Document Number: 341380

Title: Jamaican guidelines for comprehensive sexuality education. Pre-school through age 24. First edition.
Author: Jamaica Task Force Committee for Comprehensive Sexuality Education
Source: St. Ann, Jamaica, FAMPLAN, 2008. 130 p.
Abstract: This resource for students from kindergarten through age 24, was developed through a process of consensus by a diverse National Task Force and Advisory Council of Jamaican experts representing the fields of sexuality education, youth development, sexual and reproductive health and rights, family planning, HIV and AIDS, gender, media, healthcare, and education, and is meant to improve comprehensive sexuality education for young people in Jamaica. These Guidelines will assist professionals in Jamaica by providing a broad range of sexuality education information for them to share at educational facilities, and community-based, non-governmental, and faith-based organizations that work with youth, in and out of schools, who are living in rural and urban communities. While this document is tailored to suit the needs in Jamaica, it offers a usable framework that can translate into many contexts and cultures. We hope that it also proves valuable to other countries, particularly in the Caribbean region.
Language: English
Keywords:
JAMAICA | RECOMMENDATIONS | EVALUATION | POLICYMAKERS | SEX EDUCATION | SEXUALITY | INTERPERSONAL RELATIONS | SEX BEHAVIOR | SAFER SEX | SEXUALLY TRANSMITTED DISEASE PREVENTION | CULTURE | CURRICULUM | PROGRAM DESIGN | HIV PREVENTION | HOTLINES | Caribbean | Americas | Developing Countries | Administrative Personnel | Organization and Administration | Education | Personality | Psychological Factors | Behavior | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Diseases | Sociocultural Factors | Programs | HIV Infections | Viral Diseases | Information
Document Number: 325224

7.
Title: Integrating research into policy and programmes. Examples from the Jamaican experience.
Author: Ashley DE; McCaw-Binns A
Source: West Indian Medical Journal. 2008 Dec;57(6):555-61.
Abstract: Research into selected health problems across the life cycle are discussed with respect to the application and impact of the findings on policy, programme development and health outcomes. Special emphasis is placed on health research that focussed on the perinatal period, the young child and adolescent, the epidemics of chronic diseases and violence and the linkage between health and tourism. The lessons learnt over more than two decades of practice in the field of public health from conducting research aimed at developing an indigenous evidence base for policies and programmes in Jamaica are summarized.
Language: English
Keywords:
JAMAICA | RESEARCH REPORT | YOUTH | CHILDREN | DISEASES | RISK BEHAVIOR | PUBLIC HEALTH | FAMILY LIFE CYCLE | POLICY | RESEARCH AND DEVELOPMENT | Caribbean | Americas | Developing Countries | Age Factors | Population Characteristics | Demographic Factors | Population | Behavior | Health | Family Research | Family and Household | Sociocultural Factors | Political Factors | Technology | Economic Factors
Document Number: 342424

8.
Title: A comprehensive response to the HIV/AIDS epidemic in Jamaica: a review of the past 20 years.
Author: Figueroa JP; Duncan J; Byfield L; Harvey K; Gebre Y; Hylton-Kong T; Hamer F; Williams E; Carrington D; Brathwaite AR
Source: West Indian Medical Journal. 2008 Dec;57(6):562-76.
Abstract: Jamaica has a well-established, comprehensive National Human Immunodeficiency Virus (HIV) programme that has slowed the HIV epidemic and mitigated its impact. Adult HIV prevalence has been stable at approximately 1.5% since 1996. HIV rates are high among those most at risk such as sex-workers (9%) and men who have sex with men [MSM] (31.8%). Risk behaviour among adults with AIDS includes multiple sexual partners (80%), a history of a sexually transmitted infection [STI] (51.1%), commercial sex (23.9%) and crack/cocaine (8.0%). Approximately 20% of all reported AIDS cases, mainly women, give no history of any of the usual risk factors for HIV infection. The national programme is based in the Ministry of Health. Since 1988, Jamaica has had a national plan to guide its HIV response. A National AIDS Committee was established in 1988 to lead the multi-sectoral response. Prevention approaches have included information, education and communication campaigns, condom promotion, sexually transmitted infections (STI) control, targeted interventions, cultural approaches, outreach and peer education, workplace programmes and HIV counselling and testing. Concerted efforts have been made to reduce HIV stigma and discrimination. Antiretroviral therapy (ARV) was introduced for prevention of mother-to-child transmission in 2001 and a public access treatment programme introduced in 2004. A national HIV/AIDS Policy was adopted unanimously in parliament in 2005. The National Strategic plan 2007-2012 commits Jamaica to achieving universal access to HIVprevention, treatment and care. Awareness of HIV and how to prevent it is near universal though belief in myths remains strong. The condom market has increased from approximately 2.5 million in 1985 to 12 million in 2006 while condom use has grown significantly with nearly 75% of men and 65% of women reporting condom use at last sex with a non-regular partner The proportion of women 15-24 years reporting ever having a HIV test increased from 29.8% in 2004 to 48.9% in 2008. HIV transmission from mother-to-child has declined from 25% prior to 2000 to less than 8% in 2007. As of September 2008, 4450 persons or an estimated 68.5% of persons with advanced HIV and AIDS have been placed on ARV treatment resulting in a significant decline in mortality and morbidity due to HIV
Language: English
Keywords:
JAMAICA | RESEARCH REPORT | PREVALENCE | ADULTS | RISK BEHAVIOR | MEN HAVING SEX WITH MEN | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | HIV PREVENTION | HIV TESTING | MORBIDITY | MORTALITY | ANTIRETROVIRAL THERAPY | ANTIRETROVIRAL DRUGS | AWARENESS | TREATMENT | PROGRAM EVALUATION | Caribbean | Americas | Developing Countries | Measurement | Research Methodology | Age Factors | Population Characteristics | Demographic Factors | Population | Behavior | Sex Behavior | Disease Transmission Control | Prevention and Control | Diseases | HIV Infections | Viral Diseases | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Population Dynamics | HIV | Knowledge | Sociocultural Factors | Programs | Organization and Administration
Document Number: 342423

Title: Early sexual debut, sexual violence, and sexual risk-taking among pregnant adolescents and their peers in Jamaica and Uganda.
Author: Geary CW; Baumgartner JN; Tucker HT; Johnson L; Wedderburn M
Source: Research Triangle Park, North Carolina, Family Health International [FHI], YouthNet, 2008. 40 p. (Youth Research Working Paper No. 8FHI Working Paper Series No. WP08-01USAID Cooperative Agreement No. GPH-A-00-01-00013-00USAID Cooperative Agreement No. GPO-A-00-05-00022-00)
Abstract: Unintended adolescent pregnancy is a global public health problem. Some studies have found early sexual debut and experiences of sexual coercion / violence to be related to each other as well as more directly related to adolescent pregnancy. The purpose of this project was to identify risk factors for adolescent pregnancy in order to inform culturally appropriate programs that aim to prevent unintended adolescent pregnancy. This study had two phases of research. The first phase was formative research to identify contextual factors and circumstances that influence pregnancy among young adolescents (15-17 years old) in Jamaica and Uganda. Factors of particular interest included influences on early sexual debut, reports of sexual coercion / violence along a continuum of experiences, and participants' perceptions and reports of their own sexual risk-taking behavior. The second research phase was a quantitative case-control study conducted in Jamaica that measured the relationships between sexual debut, sexual coercion / violence, and sexual risk-taking among pregnant adolescents and their never pregnant, but sexually active peers. (Excerpt)
Language: English
Keywords:
JAMAICA | UGANDA | RESEARCH REPORT | FOCUS GROUPS | CONTROL GROUPS | ADOLESCENTS, FEMALE | PEER GROUPS | ADOLESCENT PREGNANCY | PREGNANCY, UNPLANNED | FIRST INTERCOURSE | RAPE | VIOLENCE AGAINST WOMEN | Caribbean | Americas | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Data Collection | Research Methodology | Adolescents | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Knowledge Sources | Communication | Reproductive Behavior | Fertility | Population Dynamics | Sex Behavior | Behavior | Crime | Social Problems | Sociocultural Factors | Domestic Violence
Document Number: 331614

10.

Title: The prevalence of other sexually transmitted infections in confirmed HIV cases at a referral clinic in Jamaica.
Author: Hutton-Rose N; Blythe C; Ogbonna C; McGrowder D
Source: Journal of the Royal Society of Health. 2008 Sep;128(5):242-7.
Abstract: Jamaica has the second highest number of acquired immunodeficiency syndrome (AIDS) cases and deaths in the Caribbean and a significant number of human immunodeficiency virus (HIV) infected individuals have a concomitant sexually transmitted infection (STI). The study determined the prevalence of non-ulcerative and ulcerative STIs and their association with sexual risky behaviour in a sample of HIV seropositive men and women. This study was conducted at the Comprehensive Health Centre in Jamaica, a sexually transmitted infection referral centre. The sample comprised 138 men and 132 women age 15-49 years, of average 29.5 years. The study was retrospective, from 2000 to 2002, and sample collection was randomized. The sexual behaviours of the subjects were assessed from the case records. In the 270 HIV diagnosed cases examined, the prevalence of STIs was 51.1% in men and 48.9% in women, with 85.4% having one or more STIs with an average of four STIs per patient. There was a total occurrence of 744 STIs with non-gonococcal urethritis (19.4%), gonorrhoea (17.2%), candidiasis (13.4%), trichomonas (12.4%), genital ulcer (10.4%) and syphilis (7.3%) the most common in HIV infected men and women. The presence of STI was associated with continued practice of risky sexual behaviour. The age group most implicated was the 30-34 year old, and 73.1% of the HIV infected patients had multiple sexual partners with only 16.4% reporting frequent condom use. The study demonstrates that there is a high prevalence of non-ulcerative and to a lesser extent ulcerative STIs in HIV infected patients in Jamaica. There are significant associations between STIs and continued high risk sexual practices in HIV infected men and women. The findings support the need for implementation of effective diagnosis and treatment strategies coupled with education about safe-sex practices in HIV prevention and STI control programmes.
Language: English
Keywords:
JAMAICA | RESEARCH REPORT | PREVALENCE | MULTIPLE PARTNERS | AIDS | SEXUALLY TRANSMITTED DISEASES | SYPHILIS | GONORRHEA | TRICHOMONIASIS | CANDIDIASIS | SEX BEHAVIOR | RISK BEHAVIOR | DEATH RATE | Developing Countries | Caribbean | Americas | Measurement | Research Methodology | Sexual Partners | Behavior | HIV Infections | Viral Diseases | Diseases | Reproductive Tract Infections | Infections | Bacterial and Fungal Diseases | Mortality | Population Dynamics | Demographic Factors | Population
Document Number: 328677

11.

Title: Protein metabolism in severe childhood malnutrition.
Author: Jahoor F; Badaloo A; Reid M; Forrester T
Source: Annals of Tropical Paediatrics. 2008 Jun;28(2):87-101.
Abstract: The major clinical syndromes of severe childhood malnutrition (SCM) are marasmus (nonoedematous SCM), kwashiorkor and marasmic-kwashiorkor (oedematous SCM). Whereas treatment of marasmus is straightforward and the associated mortality is low, kwashiorkor and marasmic-kwashiorkor are difficult to treat and have high morbidity and mortality rates. Despite extensive research, the pathogenic factors which cause a child to develop the oedematous instead of the non-oedematous form of SCM in response to food deprivation are still not clear. Over the years, two attractive hypotheses have been put forward. The first proposed that a dysadaptation in protein metabolism was involved and the second proposed that free radical damage of cellular membranes might be involved. To address aspects of these hypotheses, in this article we have reviewed work done by our group and by others on protein metabolism and pro-oxidant/anti-oxidant homeostasis in children with the oedematous and nonoedematous syndromes of SCM. Asignificant finding is that when there is chronic food deprivation children with non-oedematous SCM can maintain body protein breakdown at the same rate as when they are well nourished, but children with oedematous SCM cannot. The slower protein breakdown rate of children with oedematous SCM reduces the supply of most amino acids, resulting in decreased availability for the synthesis of plasma proteins involved in nutrient transport and the acute phase response to infection. Another consistent finding is that children with oedematous SCM have oxidative stress as there is evidence of oxidant-induced cellular damage and impaired synthesis of the primary cellular anti-oxidant glutathione. (author's)
Language: English
Keywords:
JAMAICA | RESEARCH REPORT | CHILD | MALNUTRITION | SIGNS AND SYMPTOMS | PROTEINS | METABOLIC EFFECTS | IMMUNE SYSTEM | MORTALITY | Caribbean | Americas | Developing Countries | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Nutrition Disorders | Diseases | Physiology | Biology | Population Dynamics
Document Number: 327219

12.

Peer Reviewed

Title: Are published standards for haematological indices in pregnancy applicable across populations: An evaluation in healthy pregnant Jamaican women.
Author: James TR; Reid HL; Mullings AM
Source: BMC Pregnancy and Childbirth. 2008;8:8.
Abstract: The haematological profile of the pregnant woman has an impact on the outcome of the pregnancy. Published guidelines indicate acceptable levels for haematological indices in pregnancy but they are population specific. Indicators of haemoglobin concentration are the most commonly utilized of the indices. These published international norms are used across populations, however, there is no evidence confirming their applicability to a population such as the Jamaican pregnant woman. This study was therefore undertaken with the intent of documenting the haematological profile of pregnant primigravid Jamaican women and comparing these to the established norms to determine whether the norms apply or whether there was a need to establish local norms. This was a longitudinal study done on a cohort of 157 healthy primigravid women ages 15 to 25 and without anaemia, and who were recruited from the antenatal clinic of the University Hospital of the West Indies, Kingston, Jamaica. The haemoglobin concentration, packed cell volume, mean cell volume, mean cell haemoglobin, mean cell haemoglobin concentration, white blood cell count, red blood cell count and platelet count were measured on samples of blood obtained from each consenting participant during each of the three trimesters. The results were analysed using SPSS for windows (Version 11) and the data expressed as means plus or minus S.D. Means were compared using the student's paired t-test. Comparison was then made with the international norms as recommended by the United States Center for Disease Control (1989). Ethical approval for this study was obtained from the University Hospital of the West Indies/University of the West Indies Ethics Committee. The results showed changes by trimester in all measured variables. For most of the indices the changes achieved levels of significance across trimesters. These changes were however in keeping with the expected physiological response in pregnancy and the values were similar to the published international norms.The findings suggest that the international norms for haematological indices in pregnancy are applicable across populations and to the pregnant Jamaican primigravid woman. This finding may be reassuring to others with a similar population and stage of development as Jamaica. (author's)
Language: English
Keywords:
JAMAICA | RESEARCH REPORT | LONGITUDINAL STUDIES | PREGNANT WOMEN | PRIMIPARITY | HEMATOLOGICAL EFFECTS | PREGNANCY, FIRST TRIMESTER | PREGNANCY, SECOND TRIMESTER | PREGNANCY, THIRD TRIMESTER | PREGNANCY OUTCOMES | Caribbean | Americas | Developing Countries | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Parity | Fertility Measurements | Fertility | Population Dynamics | Hemic System | Physiology | Biology | Pregnancy | Reproduction
Document Number: 325075

13.

Title: HIV morbidity and mortality in Jamaica: Analysis of national surveillance data, 1993 -- 2005.
Author: Losina E; Figueroa P; Duncan J; Divi N; Wolf LL
Source: International Journal of Infectious Diseases. 2008 Mar;12(2):132-138.
Abstract: Pre-antiretroviral therapy (ART) HIV-related survival and timing of HIV identification have not been reported from the Caribbean. Using Jamaican national surveillance data, we estimated overall, AIDS-free, and AIDS survival, identified factors influencing HIV-related mortality, and examined factors associated with late HIV/AIDS identification. The Jamaican HIV/AIDS tracking system (HATS) national surveillance data included timing of first positive HIV test, stage at identification, date of AIDS diagnosis, and death. We estimated overall and AIDS-free survival by initial stage, using a proportional hazard model to identify factors associated with worse survival, and logistic regression to examine factors related to later case identification. Of 10 674 reported HIV cases, 48% were asymptomatic, 14% symptomatic, and 38% first reported with AIDS. Five-year AIDS-free survival was 77% for asymptomatic persons and 63% for symptomatic. Median survival after AIDS diagnosis was 1.02 years. Age, number of opportunistic diseases, and initial stage were strongly associated with mortality. Older age, drug use, and sex with a commercial sex worker were associated with later identification. In the pre-ART era, over one-third of HIV-infected persons in Jamaica were first identified with advanced disease. This highlights the need for earlier diagnosis as ART programs roll out in the Caribbean. (author's)
Language: English
Keywords:
JAMAICA | RESEARCH REPORT | SURVEYS | HIV | EPIDEMIOLOGY | MORBIDITY | MORTALITY | MORTALITY DETERMINANTS | RISK BEHAVIOR | ANTIRETROVIRAL THERAPY | EXAMINATIONS AND DIAGNOSES | Caribbean | Americas | Developing Countries | Sampling Studies | Studies | Research Methodology | HIV Infections | Viral Diseases | Diseases | Public Health | Health | Population Dynamics | Demographic Factors | Population | Behavior | Medical Procedures | Medicine | Health Services | Delivery of Health Care
Document Number: 325009

14.
Title: Can research accelerate progress toward millennium development goal 5 (maternal health) in Jamaica?
Author: McCaw-Binns A
Source: West Indian Medical Journal. 2008 Dec;57(6):549-54.
Abstract: The Ministry of Health and the University of the West Indies have collaborated over 25 years to develop the evidence base to improve maternal health. The experience is reviewed as a model to accelerate Jamaica's progress toward achieving the Millennium Development Goals (MDGs). The process included measuring the disease burden due to maternal morbidity and mortality; developing and field testing interventions to manage the leading problems, national scale-up, monitoring and evaluation. This began with developing clinical guidelines to manage the hypertensive disorders of pregnancy while establishing high risk (referral) antenatal clinics, expansion and upgrading of referral facilities, and audits to identify barriers to quality healthcare, including establishing maternal mortality surveillance. As we succeed, research funds have become scarce, limiting support to postgraduate students, a reliable, cost effective resource pool capable of undertaking the research needed to provide the evidence base to influence public policy more widely. A locally financed resource pool is needed to support fellowships for graduate students to accelerate their training and availability to contribute to national development. The model from Thailand is put forward for consideration. The operations research model for maternal health can be transferred to other MDG objectives. As Jamaica pursues its goal of developed nation status, and international grant financing shrinks, local civil society will need to fill the vacancy and invest in the most abundant natural resource, young people.
Language: English
Keywords:
JAMAICA | THAILAND | RESEARCH REPORT | OPERATIONS RESEARCH | GOALS | YOUTH | MATERNAL HEALTH | ANTENATAL CARE | HYPERTENSION | TRAINING ACTIVITIES | TESTING | INTERVENTIONS | RESEARCH AND DEVELOPMENT | Caribbean | Americas | Developing Countries | Asia, Southeastern | Asia | Research Methodology | Program Evaluation | Programs | Organization and Administration | Planning | Age Factors | Population Characteristics | Demographic Factors | Population | Health | Maternal Health Services | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Vascular Diseases | Diseases | Training Programs | Education | Measurement | Technology | Economic Factors
Document Number: 342425

15.

Peer Reviewed

Title: Cervical dysplasia and cancer: Use of hormonal contraceptives in Jamaican women.
Author: McFarlane-Anderson N; Bazuaye PE; Jackson MD; Smikle M; Fletcher HM
Source: BMC Women's Health. 2008 May 30;8:9.
Abstract: This study was conducted to determine whether use of hormonal contraceptives is associated with cervical dysplasia and cancer in a population where there is widespread use of hormonal contraception and the rates of cervical cancer remain high at 27.5/100,000. A case-control study was conducted among women visiting the colposcopy and gynaelogical clinics at a tertiary referral hospital. Two hundred and thirty six cases CIN I (72), II (59), III (54), cancer (51) and 102 controls, consented and were interviewed on use of contraceptives using a structured questionnaire. Logistic regression was used to determine odds ratios (ORs) and 95% confidence intervals (CIs) associated with use of hormonal contraception in cases and controls and in low and high risk cases. Recruitment was carried out from 2001 -2002. Contraceptives used were: oral contraceptives - 35%, injections (depot medroxy progesterone acetate (Depo-provera) -10%, Intrauterine devices - 2%, combinations of these and tubal ligation - 30%. 23% reported use of 'other' methods, barrier contraceptives or no form of contraception. Barrier contraceptive use was not significantly different between cases and controls. Current and / or past exposure to hormonal contraceptives (HC) by use of the pill or injection, alone or in combination with other methods was significantly higher in the cases. In multivariate analysis with age and number of sexual partners as co-variates, use of hormonal contraception was associated both with disease, [OR, 1.92 (CI 1.11, 3.34; p = 0.02] and severity of the disease [OR, 2.22 (CI 1.05, 4.66) p = 0.036]. When parity and alcohol consumption were added to the model, hormonal contraception was no longer significant. The significant association with high risk disease was retained when the model was controlled for age and number of sexual partners. Depo-provera use (with age and number of sexual partners as covariates) was also associated with disease [OR, 2.43 (CI 1.39, 4.57), p = 0.006] and severity of disease [OR 2.51 (1.11, 5.64) p = 0.027]. With parity and alcohol added to this model, depo-provera use retained significance. Exposure to HC greater than 4years conferred more risk for disease and severity of disease. Hormonal contraception did confer some risk of dysplasia and women using HC should therefore be encouraged to do regular Pap smear screening. (author's)
Language: English
Keywords:
JAMAICA | RESEARCH REPORT | CASE CONTROL STUDIES | WOMEN | CONTRACEPTIVE AGENTS, ESTROGEN | CONTRACEPTIVE AGENTS, PROGESTIN | ORAL CONTRACEPTIVES | INJECTABLES | CERVICAL EFFECTS | CERVICAL CANCER | HPV | PAP SMEAR | Caribbean | Americas | Developing Countries | Studies | Research Methodology | Demographic Factors | Population | Contraceptive Agents, Female | Contraceptive Agents | Contraception | Family Planning | Contraceptive Methods | Cervix | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Cancer | Neoplasms | Diseases | Viral Diseases | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 326992

16.
Title: Comprehensive longitudinal studies of child health, development and behaviour in Jamaica: findings and policy impact.
Author: Samms-Vaughan M
Source: West Indian Medical Journal. 2008 Dec;57(6):639-44.
Abstract: BACKGROUND: Birth cohort and other longitudinal studies of children's health, development and behaviour have provided important information on child and adult outcomes. This has allowed evidence based policy and programme development targeted at issues specific to countries. Few studies have been conducted in developing countries. This paper reports on the findings and policy implications of two comprehensive longitudinal studies in Jamaica. METHOD: The findings of the Jamaican Birth Cohort Studies, conducted between 1986 and 2003, and the Profiles Project, a longitudinal study commencing in 1999 when children were six years, were reviewed. Recommendations from the studies and their impact on policy and programme development for Jamaican children were identified. RESULTS: Policy and programme impact were identified in areas of child poverty intervention, parenting, social activities, violence and aggression, health and nutrition, screening and early intervention, setting of standards for early childhood institutions, gender early childhood indicators and education and training. Policy and programme impact were national, regional and international. CONCLUSION: Comprehensive longitudinal studies of children in developing countries, though costly, provide wide-ranging and important information for policy and programme development.
Language: English
Keywords:
JAMAICA | RESEARCH REPORT | LONGITUDINAL STUDIES | COHORT ANALYSIS | CHILD HEALTH | POVERTY | VIOLENCE | HEALTH | NUTRITION | SCREENING | INTERVENTIONS | Caribbean | Americas | Developing Countries | Studies | Research Methodology | Socioeconomic Factors | Economic Factors | Behavior | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Programs | Organization and Administration
Document Number: 342422

17.
Title: The prevalence of mucocutaneous disorders among HIV-positive patients attending an out-patient clinic in Kingston, Jamaica.
Author: Thompson DS; Bain B; East-Innis A
Source: West Indian Medical Journal. 2008 Jan;57(1):54-7.
Abstract: OBJECTIVES: Skin disorders are thought to occur frequently in persons with HIV/AIDS. To our knowledge, there are no studies in the literature reporting on the spectrum and prevalence of skin disorders in HIV-positive patients in the Caribbean. This study focused on the prevalence and spectrum of skin disorders seen in a population of HIV-positive patients in Jamaica. METHODS: A 5-year retrospective study was conducted by reviewing the records of patients attending a HIV out-patient clinic at the University Hospital of the West Indies in Kingston, Jamaica. RESULTS: Two hundred and eighty-six (286) patients were included in the study. Skin and mucous membrane disorders were documented in 74% of the patients in this series. Inflammatory disorders comprised the largest category of skin disorders followed by fungal infections. The most frequently diagnosed dermatological disorders were papular prurigo, oral candidiasis, dermatophyte infections, herpes simplex infections and seborrhoeic dermatitis. Kaposi's sarcoma was rare. This pattern is similar to those reported from the African continent and other tropical countries. CONCLUSIONS: Dermatological disorders contribute significantly to the morbidity of HIV-positive patients and patterns of skin disorders are similar to those seen in other tropical settings.
Language: English
Keywords:
JAMAICA | RESEARCH REPORT | PREVALENCE | PERSONS LIVING WITH HIV/AIDS | DERMATOLOGICAL EFFECTS | INFECTIONS | BACTERIAL AND FUNGAL DISEASES | Caribbean | Americas | Developing Countries | Measurement | Research Methodology | HIV Infections | Viral Diseases | Diseases | Physiology | Biology
Document Number: 342707

18.

Title: 2008 National Youth Shadow Report: Progress Made on the 2001 UNGASS Declaration of Commitment on HIV / AIDS. Jamaica.
Author: Townsend DA; Ford V
Source: New York, New York, Global Youth Action Network, Global Youth Coalition on HIV / AIDS, 2008. 13 p.
Abstract: Information gathering for this report primarily relied on secondary sources in an effort to encapsulate the existing work on HIV/AIDS service delivery. Among the methods used were reviews of official documents and published statistics; public ministry papers and documents; case studies; publications from the UN agencies such as UNAIDS, UNFPA and UNICEF. As well, we conducted interviews with Country Representatives from UNAIDS, as well as other representative of UNFPA and a senior official from the Ministry of Health. Key findings and recommendations: 1) In conjunction with young advocates, the Jamaican government should immediately develop and implement a National HIV Policy for Youth; 2) Leaders in both the public and private sector must be sensitized on issues of HIV prevention and treatment, and serve as advocates for evidence-based prevention and treatment for young people; 3) Jamaica must collect data on young people disaggregated by age and gender in order to fully understand the trends and behaviors that fuel youth vulnerability to HIV infection and to know where to best allocate resources; 4) Age-specific interventions that include life skills-based education- including HIV prevention, and sexual and reproductive health information must be incorporated into the national educational system; 5) Age-specific HIV media campaigns aimed at increasing young people's knowledge of the disease and reducing stigma should be implemented; 6) The lack of Youth- Friendly Services for young populations is a significant barrier to effective prevention and treatment; must be scaled up to ensure young people receive treatment for STIs, Voluntary Counseling and Testing, counseling on safe sex behaviors, and so on; 7) There is a heightened need for gender-sensitive and inclusive policies and programmes that target issues of sexual violence through behavior change communication; 8) Vulnerable populations such as LGBTQ individuals, IDUs and sex workers must be engaged in the collective response to HIV/AIDS; 9) Jamaica must create meaningful leadership and capacity building opportunities for young leaders who are part of the AIDS response to ensure the relevance and effectiveness of interventions targeting youth; and 10) Policies and programmes need to create a safer, more supportive environment for young people living with HIV (YPLHIV) that addresses their needs and respects their rights to lead full and healthy lives free from violence or discrimination. (excerpt)
Language: English
Keywords:
JAMAICA | RESEARCH REPORT | YOUTH | ORPHANS AND VULNERABLE CHILDREN | STREET KIDS | SEX WORKERS | MEN HAVING SEX WITH MEN | DRUG USE AND ABUSE | HIV PREVENTION | SOCIAL DISCRIMINATION | CRIME | NEEDS | HEALTH EDUCATION | INFORMATION | PROGRAM ACCESSIBILITY | Developing Countries | Caribbean | Americas | Age Factors | Population Characteristics | Demographic Factors | Population | Family and Household | Sociocultural Factors | Homeless Persons | Residence Characteristics | Population Distribution | Geographic Factors | Sex Behavior | Behavior | HIV Infections | Viral Diseases | Diseases | Social Problems | Economic Factors | Education | Program Evaluation | Programs | Organization and Administration
Document Number: 326132

19.

20.

Title: Improving the education response to HIV and AIDS: Lessons of partner efforts in coordination, harmonisation, alignment, information sharing and monitoring in Jamaica, Kenya, Thailand and Zambia.
Author: Visser-Valfrey M; Brown CR; Abagi O; Buabuttra T; Nalwamba C
Source: [Geneva, Switzerland], Joint United Nations Programme on HIV / AIDS [UNAIDS], Inter-Agency Task Team on Education, 2008 Mar. 77 p.
Abstract: This report documents the findings of a study on the quality and effectiveness of collaboration among partners involved in the HIV and AIDS response in the education sector. The study was commissioned by the United Nations Joint Programme on HIV/AIDS (UNAIDS) Inter-Agency Task Team (IATT) on Education which brings together UNAIDS Cosponsors, bilateral agencies, private donors, and civil society organizations. The purpose of this study was to document how external partners coordinate and harmonise their efforts at the country level, to identify areas of overlap and significant gaps in country responses, and to formulate recommendations for improving synergy and alignment across IATT member agencies and other actors operating at the country level. The case studies were conducted between March and May 2007 in Jamaica, Kenya, Thailand and Zambia. These countries were selected to represent geographical, epidemiological and socio-economic diversity and because significant efforts have been undertaken insupport of education sector responses to HIV and AIDS in these settings. The study was carried out by an international consultant with the support of four local consultants. In each country, an IATT member agency hosted the study, while the IATT Secretariat, with the help of a working group of IATT members, undertook the overall supervision of the study. Data for the study were collected through a comprehensive documentation review and interviews with key stakeholders from the education sector and the overall HIV and AIDS response. To ensure maximum involvement of all parties, a draft country aide memoire was produced after the field work, circulated to those consulted and finalised based on the suggestions received. While every attempt was made to ensure that a wide selection of stakeholders was consulted, the findings are limited by the short duration of time in-country. The study is not a comprehensive mapping exercise of country-level activity. Rather the findings reflect country stakeholder perspectiveson engagements, progress and on-going challenges. (author's)
Language: English
Keywords:
JAMAICA | KENYA | THAILAND | ZAMBIA | RESEARCH REPORT | EVALUATION REPORT | HIV | AIDS | EDUCATION | COORDINATION | EVALUATION | PROGRAM EFFECTIVENESS | INFORMATION DISTRIBUTION | MONITORING | Caribbean | Americas | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Asia, Southeastern | Asia | Africa, Southern | HIV Infections | Viral Diseases | Diseases | Organization and Administration | Program Evaluation | Programs | Communication
Document Number: 308672

21.

Peer Reviewed

Title: Randomized controlled trial to investigate impact of site-based safer sex programmes in Kingston, Jamaica: Trial design, methods and baseline findings.
Author: Weir SS; Figueroa JP; Byfield L; Hall A; Cummings S
Source: Tropical Medicine and International Health. 2008 Jun;13(6):801-813.
Abstract: The objective was to describe the design, methods and baseline findings of a multi-level prevention intervention to increase consistent condom use among persons at public social sites in Kingston, Jamaica, who have new or concurrent sexual partnerships. A two-arm randomized controlled trial (RCT) of 147 sites where persons meet new sex partners. Sites were identified by community informants as places where people meet new sexual partners, which include bars, street locations, bus stops, malls and others. Sites were sorted into 50 clusters based on geographic proximity and type of site and randomized to receive a multi-level site-based intervention or not. Intervention components include on-site HIV testing, condom promotion and peer education. Effectiveness of the intervention will be measured by comparing the proportion of persons with new or multiple partners in the past year who report recent inconsistent condom use at intervention vs. control sites. Baseline surveys were conducted at 66 intervention (711 men, 845 women) and 65 control sites (654 men, 738 women). Characteristics of intervention and control sites as well as the characteristics of patrons at these sites were similar. The outcome variable was balanced with approximately 30% of men and 25% of women at intervention and control sites reporting a new partner or more than one partner in the past year and recent inconsistent condom use. The baseline findings confirm that the population is an appropriate target group for HIV prevention and that randomization will provide the means to estimate programme effectiveness. (author's)
Language: English
Keywords:
JAMAICA | RESEARCH REPORT | CLINICAL TRIALS | INTERVENTIONS | SAFER SEX | CONDOM USE | SEX BEHAVIOR | HIV PREVENTION | SOCIAL BEHAVIOR | SEXUAL PARTNERS | MULTIPLE PARTNERS | Caribbean | Americas | Developing Countries | Clinical Research | Research Methodology | Programs | Organization and Administration | Behavior | Risk Reduction Behavior | HIV Infections | Viral Diseases | Diseases
Document Number: 326867

22.

23.

24.

Peer Reviewed

Title: An assessment of sites where persons go to meet sexual partners in St. James, Jamaica, using the PLACE method.
Author: Figueroa JP; Dolan CB; Dale D; Hileman SB; Weir S
Source: Sexually Transmitted Diseases. 2007 Jun;34(6):410-415.
Abstract: The objective of this study was to assess sexual behavior of persons at risk of HIV infection. The goal of this study was to identify sites where HIV prevention is needed. Customers at sites where persons meet new sex partners in St. James, Jamaica, were surveyed. Of 421 sites, 282 men and 200 women (random sample, 23 sites) and 320 men and 265 women (special sample, 26 sites) were interviewed. Over one fourth of men and 14% (special) and 4% (random) of women had one or more new sex partners in the last 4 weeks. Seventy-eight percent of men reported condom use at last sex with a new partner compared with 66% of women. Approximately 50% of respondents reported condom use at last sex with a regular partner. Sites at which people meet new sex partners were diverse with significant opportunities for prevention. Commercial and transactional sex are features at many sites. (author's)
Language: English
Keywords:
JAMAICA | RESEARCH REPORT | INTERVIEWS | SEXUAL PARTNERS | PERSONS LIVING WITH HIV/AIDS | MULTIPLE PARTNERS | CONDOM USE | TRANSACTIONAL SEX | HIV PREVENTION | SEX BEHAVIOR | Developing Countries | Caribbean | Americas | Data Collection | Research Methodology | Behavior | HIV Infections | Viral Diseases | Diseases | Risk Reduction Behavior
Document Number: 317220

25.

Title: Jamaican Youth Risk and Resiliency Behaviour Survey 2005. School-based survey on risk and resiliency behaviours of 10-15 year olds.
Author: Fox K; Gordon-Strachan G
Source: Chapel Hill, North Carolina, University of North Carolina at Chapel Hill, Carolina Population Center [CPC], MEASURE Evaluation, 2007 Mar. [134] p. (TR-07-58USAID Cooperative Agreement No. GPO-A-00-03-00003-00)
Abstract: The 2005 Jamaica Youth Risk and Resiliency Behaviour Survey (2005 JYRRBS) interviewed a nationally representative sample of 3003 in-school youth aged 10-15, of whom 1,422 were males and 1581 were females. The main purpose of the survey was to determine health status, nutritional habits and lifestyles of children and young teenagers aged 10-15 years in a nationally representative sample of Jamaican children currently in school and relate these to demographic and socio-economic factors. In addition, the 2005 JYRRBS included questions on risk and resiliency to determine factors which provide protection from teen pregnancy, HIV/AIDS, violence and obesity to inform programs targeted at the early adolescent period. The survey included the following modules: demographic information; the child and school; physical activity; dietary practices; medical care and perception of self; emotions and mental health; resiliency; violence and unintentional injuries; alcohol, tobacco and drug use; sexual behaviour; sources of information; anthropometry - weight, height, and waist and hip circumference; and literacy and numeracy. (excerpt)
Language: English
Keywords:
JAMAICA | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | DEMOGRAPHIC AND HEALTH SURVEYS | KAP SURVEYS | YOUTH | STUDENTS | CHILD HEALTH | ADOLESCENT HEALTH | RISK ASSESSMENT | RISK BEHAVIOR | RISK FACTORS | SOCIOECONOMIC FACTORS | NEEDS ASSESSMENT | FAMILY CHARACTERISTICS | Caribbean | Americas | Developing Countries | Research Methodology | Demographic Surveys | Population Dynamics | Demographic Factors | Population | Surveys | Sampling Studies | Studies | Age Factors | Population Characteristics | Education | Health | Evaluation | Behavior | Biology | Economic Factors | Family and Household | Sociocultural Factors
Document Number: 319743

26.

Peer Reviewed

Title: Short birth intervals and uterine cervical cancer risk in Jamaican women.
Author: Hoyo C; Yarnall KS; Fortney J
Source: International Journal of Gynecology and Obstetrics. 2007 Jul;98(1):56-57.
Abstract: High parity, common in developing countries, has been consistently associated with higher cervical cancer (CC) risk. Pregnancy-related immunosuppression has been proposed as a possible mechanism by which oncogenic human papillomavirus (HPV) can replicate. Stanczuck reported a higher risk of CC among women genetically predisposed to lower immune response. In-vitro studies also demonstrate increased transcriptional activity of HPV16/18 in a progesterone-rich environment. Indeed, a greater than 2-fold increase in CC risk was reported in women with rapid multiple births. However, this study used nulliparous women as referents, which does not allow one to distinguish the role of parity from that of birth-intervals. Birth-intervals are a modifiable risk factor of CC, 80% of which occurs in developing countries. To determine whether short birth-intervals increase CC risk, incident cases were identified through the Kingston-St. Andrews, Jamaica, Cancer Registry, and controls were identified from cytology log-books of facilities where cases were diagnosed. Response rates of cases and controls were 82% and 60%, respectively. Analyses are restricted to 183 cases and 214 controls with >/= 2 pregnancies each lasting >/= 7 months, (>/=1 birth interval). The average interval was estimated by dividing the sum of non-pregnant months by total pregnancies. We assessed factors known to be associated with CC or pregnancy for confounding and retained those that changed the OR >/= 10%. (excerpt)
Language: English
Keywords:
JAMAICA | RESEARCH REPORT | HEALTH SURVEYS | WOMEN | BIRTH INTERVALS | CERVICAL CANCER | RISK FACTORS | PARITY | HPV | Developing Countries | Caribbean | Americas | Health | Demographic Factors | Population | Fertility Measurements | Fertility | Population Dynamics | Cancer | Neoplasms | Diseases | Biology | Viral Diseases
Document Number: 317980

27.

Title: Culture-specific factors contributing to HIV risk among Jamaican adolescents.
Author: Hutchinson MK; Jemmott LS; Wood EB; Hewitt H; Kawha E
Source: Journal of the Association of Nurses in AIDS Care. 2007 Mar-Apr;18(2):35-47.
Abstract: The purpose of this article is to describe the results from an elicitation research study addressing the multisystem-level factors that contribute to HIV risk among Jamaican adolescents. Focus group and survey data were determined from parents, adolescents, and teachers in Kingston, Jamaica, from 2004 and 2005. Guided by an ecological extension of the Theory of Planned Behavior, focus groups and survey questionnaires identified cultural factors at the individual, family, and societal levels that significantly influence Jamaican adolescents' behavioral, normative, and control beliefs related to sexual behaviors that contribute to risk for HIV and other sexually transmitted infections. Although some factors were similar to those reported among adolescents living in the United States, others were culture-specific influences and beliefs that were unique to Jamaica. Results from the current study could contribute to the development of theory-based, culture-specific HIV risk-reduction interventions for use with Jamaican adolescents. (author's)
Language: English
Keywords:
JAMAICA | RESEARCH REPORT | FOCUS GROUPS | ADOLESCENTS | CULTURE | RISK FACTORS | HIV INFECTIONS | SEX BEHAVIOR | RISK BEHAVIOR | Developing Countries | Caribbean | Americas | Data Collection | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Sociocultural Factors | Biology | Viral Diseases | Diseases | Behavior
Document Number: 313361

28.

Title: Family planning and the World Bank in Jamaica.
Author: King T
Source: In: The global family planning revolution: three decades of population policies and programs, edited by Warren C. Robinson and John A. Ross. Washington, D.C., World Bank, 2007. :155-174.
Abstract: In Jamaica, as in many countries, the pioneers of family planning were men and women who sought to improve the well-being of their impoverished women compatriots, and who perhaps were also conscious of the social threats of rapid population growth. When, eventually, population control became national policy, the relationship between the initial private programs and the national effort did not always evolve smoothly, as the Jamaican experience shows (see box 10.1 for a timeline of the main events in relation to family planning in Jamaica). A related question was whether the family planning program should be a vertical one, that is, with a staff directed toward a sole objective, or whether it should be integrated within the public health service. These issues were not unique to Jamaica, but in one respect Jamaica was distinctive: it was the setting for the World Bank's first loan for family planning activities. Family planning programs entailed public expenditures that were quite different from the infrastructure investments for which almost all Bank loans had been made, and the design and appraisal of a loan for family planning that did not violate the principles that governed Bank lending at the time required a series of decisions at the highest levels of the Bank. These decisions shaped World Bank population lending for several years and subjected the Bank to a good deal of external criticism. For that reason, this chapter focuses on the process of making this loan. (excerpt)
Language: English
Keywords:
JAMAICA | HISTORICAL REVIEW | CASE STUDIES | POLICYMAKERS | FAMILY PLANNING ORGANIZATIONS | GOVERNMENT | WORLD BANK | FAMILY PLANNING POLICY | POLICY DEVELOPMENT | FAMILY PLANNING PROGRAM EVALUATION | FAMILY PLANNING PROGRAMS | PRIVATE SECTOR | POPULATION POLICY | POPULATION CONTROL | Caribbean | Americas | Developing Countries | Studies | Research Methodology | Administrative Personnel | Organization and Administration | Organizations | Political Factors | Sociocultural Factors | International Agencies | Family Planning | Social Policy | Policy | Planning | Macroeconomic Factors | Economic Factors
Document Number: 321945

29.

Peer Reviewed

Title: Epidemiologic transition in maternal mortality and morbidity: New challenges for Jamaica.
Author: McCaw-Binns A; Alexander SF; Lindo JL; Escoffery C; Spence K
Source: International Journal of Gynecology and Obstetrics. 2007 Mar;96(3):226-232.
Abstract: Given interventions implemented in recent years to reduce maternal deaths, we sought to determine the incidence and causes of maternal deaths for 1998-2003. Records of public hospitals and state pathologists were reviewed to identify pregnancy-related deaths within 12 months of delivery and determine their underlying causes. Maternal mortality declined (p = 0.023) since surveillance began in 1981-83. The fall in direct mortality (p=0.0003) included 24% fewer hypertension deaths (introduction of clinical guidelines, reorganization of antenatal services) and 36% fewer hemorrhage deaths (introduction of plasma expanders). These improvements were tempered by growing indirect mortality (p = 0.057), moving to 31% of maternal deaths from 17% in 1993-95. Declines in direct mortality may be associated with surveillance and related improvements in obstetric care. Increased indirect deaths from HIV/AIDS, cardiac disease, sickle cell disease and asthma suggests the need to improve collaboration with medical teams to implement guidelines to care for pregnant women with chronic diseases. (author's)
Language: English
Keywords:
JAMAICA | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | MOTHERS | PERSONS LIVING WITH HIV/AIDS | MATERNAL MORTALITY | MORBIDITY | OBESITY | PERINATAL MORTALITY | MORTALITY DECLINE | CAUSES OF DEATH | QUALITY OF HEALTH CARE | Developing Countries | Caribbean | Americas | Research Methodology | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | HIV Infections | Viral Diseases | Diseases | Mortality | Population Dynamics | Demographic Factors | Population | Body Weight | Physiology | Biology | Health Services Evaluation | Program Evaluation | Programs | Organization and Administration
Document Number: 312681

30.

Title: 'She sweet up the boopsy and him nuh get nuh wine'. Young women and sexual relationships in Kingston, Jamaica.
Author: Rolfe B; Hemmings J; Morris TA; Samuels-Dixon V
Source: London, England, Options, 2007 Jul. 79 p. (PEER Study)
Abstract: This report presents findings from a qualitative study into young women's sexual relationships in inner-city Kingston, Jamaica, carried out between May and June 2007. The study aimed to explore the social and economic environment in which young women's relationships take place; to identify opportunities and barriers to behaviour change; and to generate insight into condom use, HIV risk perceptions, and types of sexual relationships. After this executive summary, the implications of the findings for programmes are discussed. The detailed evidence and discussion from the PEER research is presented after this. (excerpt)
Language: English
Keywords:
JAMAICA | RESEARCH REPORT | QUALITATIVE RESEARCH | YOUTH | WOMEN | SOCIOECONOMIC FACTORS | BEHAVIOR CHANGE | CONDOM USE | HIV INFECTIONS | PERCEPTION | RISK BEHAVIOR | LIFE STYLE | SOCIOECONOMIC STATUS | Caribbean | Americas | Developing Countries | Research Methodology | Age Factors | Population Characteristics | Demographic Factors | Population | Economic Factors | Behavior | Risk Reduction Behavior | Viral Diseases | Diseases | Psychological Factors
Document Number: 320060


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