Maung Aung

Factors affecting uptake of cervical cancer screening among clinic attendees in trelawny, Jamaica

BACKGROUND Use of the Pap test has resulted in a decline in cervical cancer mortality in developed countries. Yet, despite established cervical cancer screening programs, a significant portion of Jamaican women are not undergoing screening for cervical cancer. This study was carried out to identify factors that affect Jamaican womens decisions to screen for cervical cancer. METHODS A population survey was administered to 367 clinic-attending women 25 to 54 years of age in the Parish of Trelawny from May to July of 2005. An interviewer-administered questionnaire assessed the womens knowledge, attitudes, and practices regarding cervical cancer and cervical cancer screening. RESULTS Overall, 11% of the women had never had a Pap smear and only 38% had a Pap test within the last year. Annual visits to a health provider have a strong influence on womens decisions to regularly screen for cervical cancer. Provider recommendation also positively affected initial receipt of a Pap smear as well as continued regular screening. CONCLUSIONS Programs that promote annual health checkups, encourage consistent provider recommendations, and emphasize screening as a preventive measure might positively influence womens decisions to screen for cervical cancer.

Risk factors for clinical leptospirosis from Western Jamaica.

A retrospective, matched case-control study was conducted in Jamaicas Western Regional Health Authority (WRHA). Forty-three individuals developing clinical leptospirosis between January 2005 and December 2007 (i.e., cases) were age and neighborhood matched to 89 controls. Odds ratios (OR) and associated 95% confidence intervals (CIs) and the relative excess risk due to interaction (RERI) were calculated. Cases had increased odds of contact with rodents OR 3.52, goats OR 3.38, and being engaged in outdoor labor OR 5.30. Knowledge of leptospirosis and indoor work was protective, OR 0.39 and OR 0.16, respectively. Positive RERI values were noted for joint exposure to rodents and goats (RERI 5.54), outdoor labor and goats (RERI 6.97), and outdoor labor and rodents (RERI 30.59). Our results suggest a synergistic effect of occupational and environmental exposures on clinical human leptospirosis from the WRHA. Knowledge of the disease and its risk factors allows for protection from the disease.

Factors associated with the acceptability of male circumcision among men in Jamaica.

Objectives To determine the prevalence of male circumcision (MC) among men in the western region of Jamaica, and to identify factors associated with acceptability of MC for self, infants (<1 year) and older sons (1-17 years). Methods A cross-sectional, interviewer-administered questionnaire survey of 549 men aged 19-54 years was conducted in the western region of Jamaica. The survey included questions about the acceptance of MC for self, infants, and sons before and after an information session about the benefits of MC in preventing HIV/STI transmission. Logistic regression models were used to identify factors that were associated with acceptability of MC. Adjusted odds ratios (AOR) and 95% confidence intervals (CI) were calculated from the models. Results Fourteen percent of the men reported that they were circumcised. In the multivariable model, which adjusted for age, education, religion and income, there were increased odds of accepting MC for infants/sons among uncircumcised men who accepted MC for self (AOR=8.1; 95% CI = 4.1-15.9), believed they would experience more pleasure during sex if circumcised (AOR=4.0; 95% CI = 2.0-8.2), and reported having no concerns regarding MC (AOR=3.0; 95% CI = 1.8-4.8). Similarly, uncircumcised men who reported no concerns about MC or who believed that they would experience more pleasure during sex if circumcised were more likely to accept MC for self. Conclusion Providing men with information about MC increased acceptance of MC for self, infants (<17 years) and sons (1-17 years). Since targeted education on the benefits of male circumcision for prevention of HIV/STI can be effective in increasing acceptability of MC, health professionals should be trained, and willing to discuss MC with men in healthcare facilities and in the community.

Gender norms and sexual behaviours among men in western Jamaica

UNLABELLED Objectives Gender norms, especially among men, can reduce the effectiveness of HIV prevention programs. We sought to assess the association between attitudes towards gender norms and risky sexual behaviours, and identify sociodemographic factors that predict gender-inequitable and masculinity norms among men in western Jamaica. METHODS A cross-sectional, survey of 549 men aged 19-54 years was conducted. Attitudes towards gender norms were measured using the Gender Equitable Men and Macho scales. Logistic regression and general linear models were used to assess associations between gender norms and multiple sexual partners, and to identify the associated sociodemographic factors. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) are presented. RESULTS Fifty-four percent of the participants (mean age=32.4 years) reported multiple sex partners and 22% reported unprotected sex with non-regular partner in the past 12 months. Men with moderate (AOR=2.2; 95% CI=1.4-3.3) and high (AOR=4.2; 95% CI=2.0-8.5) support for inequitable gender norms, and moderate (AOR=1.7; 95% CI=1.1-2.7) and high (AOR=2.5; 95% CI=1.5-4.3) support for masculinity norms were more likely to report multiple sex partners. Similarly, men with moderate (AOR=2.4; 95% CI=1.3-4.3) and high (AOR=2.5; 95% CI=1.2-5.2) support for inequitable gender norms were more likely to report unprotected sex with a nonregular partner. CONCLUSION A high proportion of Jamaican men engage in risky sexual behaviours. These results highlight the need for behaviour change interventions addressing gender norms targeting Jamaican men.

Knowledge, Attitude, and Practices Regarding Vector-borne Diseases in Western Jamaica

Abstract Background Outbreaks of vector-borne diseases (VBDs) such as dengue and malaria can overwhelm health systems in resource-poor countries. Environmental management strategies that reduce or eliminate vector breeding sites combined with improved personal prevention strategies can help to significantly reduce transmission of these infections. Objective The aim of this study was to assess the knowledge, attitudes, and practices (KAPs) of residents in western Jamaica regarding control of mosquito vectors and protection from mosquito bites. Methods A cross-sectional study was conducted between May and August 2010 among patients or family members of patients waiting to be seen at hospitals in western Jamaica. Participants completed an interviewer-administered questionnaire on sociodemographic factors and KAPs regarding VBDs. KAP scores were calculated and categorized as high or low based on the number of correct or positive responses. Logistic regression analyses were conducted to identify predictors of KAP and linear regression analysis conducted to determine if knowledge and attitude scores predicted practice scores. Findings In all, 361 (85 men and 276 women) people participated in the study. Most participants (87%) scored low on knowledge and practice items (78%). Conversely, 78% scored high on attitude items. By multivariate logistic regression, housewives were 82% less likely than laborers to have high attitude scores; homeowners were 65% less likely than renters to have high attitude scores. Participants from households with 1 to 2 children were 3.4 times more likely to have high attitude scores compared with those from households with no children. Participants from households with at least 5 people were 65% less likely than those from households with fewer than 5 people to have high practice scores. By multivariable linear regression knowledge and attitude scores were significant predictors of practice score. Conclusion The study revealed poor knowledge of VBDs and poor prevention practices among participants. It identified specific groups that can be targeted with vector control and personal protection interventions to decrease transmission of the infections.

Correlates of symptoms of depression and anxiety among clinic patients in Western Jamaica

OBJECTIVES There is a paucity of studies on psychosocial disorders in clinic populations in Jamaica. Therefore, we sought to determine the prevalence and correlates of symptoms of depression and anxiety in a clinic population in western Jamaica. METHODS A total of 338 participants from four outpatient clinics of : A total of 338 participants from four outpatient clinics of the Western Regional Health Authority (WRHA) were screened for symptoms of depression and anxiety using questions from the Beck Depression Inventory-II and the Beck Anxiety Inventory. The Chi-square test was used to examine differences in symptoms of anxiety and depression by gender. Multivariate linear and logistic regression were used to examine the associations between symptoms and sociodemographic variables with significance set at p<0.05. RESULTS Approximately 30% of participants had moderate or severe depression symptoms while 18.6% had moderate or severe anxiety symptoms. Participants aged 30-39 years were more likely than older participants to have moderate or severe anxiety symptoms (odds ratio [OR]: 2.0, 95% confidence interval [CI]: 1.39, 5.56). Women reported a statistically significant higher prevalence of anxiety symptoms (10.0% vs 7.1%, p = 0.003). There was also a statistically significant difference between anxiety means by gender. Furthermore, income was found to be a significant predictor of anxiety for women only (p = 0.0113). Married persons were more likely than those who had never married to have moderate or severe anxiety symptoms (OR: 2.57, 95% CI: 1.14, 5.76). CONCLUSIONS Our findings suggest that the prevalence of depression may be higher than global estimates in similar outpatient settings. Screening and intervention efforts may need to focus on younger persons, women, and married persons.

Prostate Cancer Knowledge, Attitudes and Screening Practices among Men in Western Jamaica.

Background African-Caribbean men, particularly Jamaican men, have one of the highest incidences of prostate cancer in the world. This cross-sectional study was conducted to investigate knowledge, attitudes, practices and factors associated with prostate cancer screening among men in western Jamaica. Methods A questionnaire was administered to men 40-93 years old during May to August 2007. The outcome variable of interest was previous prostate cancer screening. Results Approximately 35% of men were previously screened for prostate cancer. Men > 70 years were 93% less likely to be screened compared to men 40-49 years (95% CI: 0.01, 0.56). Men living in the parish of Trelawny were 10.5 times more likely not to be screened compared to men in St James (95% CI: 2.33, 47.17) and manual labourers were 5.5 times less likely to have been screened than non-manual labourers (95% CI: 0.97, 31.68). Men who had not been advised to have prostate cancer screening were 92% less likely to be screened than those advised (95% CI: 0.02, 0.29), and men who were not sure of how frequently screening should be conducted were 6.1 times more likely not to be screened compared to those who knew that screening should be conducted annually (95% CI: 1.10, 33.35). Men who visit healthcare providers only when they feel sick were 6.4 times more likely not to be screened compared to men who visit annually (95% CI: 1.63, 25.41). Conclusion A substantial proportion of Jamaican men ≥ 40 years had never been screened for prostate cancer. Interventions should be instituted to make prostate cancer screening readily available and to promote active participation of men in these programmes especially men ≥ 70 years, men with less economic resources, and men who do not routinely visit a physician or health facility.

Gender Norms and Family Planning Practices Among Men in Western Jamaica.

The objective of this study was to identify the association between gender norms and family planning practices among men in Western Jamaica. A cross-sectional survey of 549 men aged 19 to 54 years attending or visiting four government-operated hospitals was conducted in 2011. Logistic regression models were used to identify factors associated with taking steps to prevent unwanted pregnancy, intention to have a large family size (three or more children), and fathering children with multiple women. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were calculated from the models. Reduced odds for taking steps to prevent unwanted pregnancy among men with moderate (AOR = 0.5; 95% CI = 0.3-0.8) and high (AOR = 0.3; 95% CI = 0.1-0.6) support for inequitable gender norms was observed. Desiring large family size was associated with moderate (AOR = 2.0; 95% CI = 1.3-2.5) and high (AOR = 2.6; 95% CI = 1.5-4.3) support for macho scores. For men with two or more children (41%), there were increased odds of fathering children with multiple women among those who had moderate (AOR = 2.1; 95% CI = 1.0-4.4) and high (AOR = 2.4; 95% CI = 1.1-5.6) support for masculinity norms. Support for inequitable gender norms was associated with reduced odds of taking steps to prevent unwanted pregnancy, while support for masculinity norms was associated with desiring a large family size and fathering children with multiple women. These findings highlight the importance of including men and gender norms in family planning programs in Jamaica.

Epidemiology of Chikungunya fever outbreak in Western Jamaica during July–December 2014

Objective Our study describes the 2014 Chikungunya outbreak in Western Jamaica in terms of geographic distribution and trend of the outbreak over time, and evaluates clinical symptoms of the disease based on pre-existing conditions. Methods We conducted a retrospective, cross-sectional study of 609 clinically defined Chikungunya virus (CHIKV) fever cases that occurred in the four parishes of the Western Regional Health Authority of Jamaica from July 2014 to December 2014. Cases were not confirmed by laboratory tests but met clinical and epidemiological criteria of CHIKV fever. Results Our results show a propagated spread of CHIKV fever during the outbreak period with the peak at the end of October. Main urban cities, such as Montego Bay and Lucea, were identified as places that had high numbers of cases. Fever and arthralgia were the two most common clinical symptoms in CHIKV patients. Although a majority (80%) of infants aged <2 years had up to four symptoms (80%), the percentage of infants with higher numbers of symptoms (9–10) was higher than in older age groups. However, back pain was found to occur significantly more in older patients. Those with arthritis as a pre-existing condition were more likely to experience headache, asthenia, back pain, and periarticular edema. Conclusion These findings can help public health officials develop more effective programs to prevent the spread of CHIKV outbreaks by focusing on crowded urban cities. The findings indicate that those who are likely to develop a higher number of symptoms, such as young infants and people with pre-existing conditions, such as arthritis, should be more closely monitored to better manage the disease outcome.

Anemia in pregnancy in Western Jamaica

Background Anemia is one of the most prevalent problems in pregnancy. In 2011, 29.9% of all pregnant women in Jamaica were diagnosed with anemia. Objective The objective of this study was to determine the prevalence and predictors of anemia in pregnancy in Western Jamaica. Methods A cross-sectional study was conducted among 293 mothers attending post-natal clinics in Western Jamaica. A questionnaire was administered to the mothers, and an abstraction form was used to collect clinical data from the mothers’ records. Results The prevalence of anemia among the women was 37.6%. Younger mothers (aged 18–24 years) were more likely to be anemic compared to those ≥35 years (odds ratio [OR]: 3.44, 95% CI: 1.07–11.06). Mothers who reported not always washing their hands after using the toilet were almost 10 times more likely to be anemic (OR: 9.7, 95% CI: 1.72–54.78) compared to those who reported always washing their hands. Mothers who attended a public facility for antenatal care were 2.3 times more likely to be anemic (OR: 2.31, 95% CI: 1.03–5.18) compared to those who obtained care at a private facility, and mothers who reported being told that they were anemic by a health care provider (HCP) were almost six times more likely to be anemic compared with those who were not told (OR: 5.58, 95% CI: 1.73–17.93). Conclusion The results of the study indicate that early identification and treatment of anemia, especially among younger pregnant women, should be a priority. HCP should ensure that women understand the need to be cured of their anemia and to adhere to preventive hygienic practices.