Norman Waldron

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

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

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

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

Prevalence of Self-reported Urinary Incontinence in Community-dwelling Older Adults of Westmoreland, Jamaica

INTRODUCTION Urinary incontinence is a disorder of considerable significance in older adults. It causes distress and morbidity, yet its true prevalence in the community is likely underestimated, because stigma and other factors may cause underreporting. WHO has developed a 10-minute screening tool to help primary healthcare providers recognize and manage the most common geriatric conditions: falls, memory loss, depression and urinary incontinence. OBJECTIVE Determine prevalence of urinary incontinence in adults aged ≥60 years in Westmoreland Parish, Jamaica; examine some of the associated risk factors; estimate how much urinary incontinence goes unreported and explore related barriers. METHODS A cross-sectional study in April 2014 of 454 older adults was conducted in 12 community clusters in Westmoreland. Data collection was done using an interviewer-administered questionnaire. Data were analyzed using SPSS version 17. Chi-square and Fisher exact tests were used to assess significance of associations between dependent and independent variables. RESULTS The majority (241/454, 53.1%) of respondents were men aged 60–95 years (median age 69 years; interquartile range: 64–77). Prevalence of urinary incontinence was 10.6% (48/453). Statistically significant associations were found between urinary incontinence and hypertension, diabetes mellitus, prostate problems and arthritis, but not with kidney problems, stroke or parity. Among respondents with urinary incontinence, 30.2% had not reported the condition to their doctor (13/43 who answered this question). Reasons cited for nonreporting included belief that urinary incontinence is normal with aging (9 respondents), not being bothered by urinary incontinence (7), inability to pay for treatment (6), feeling ashamed to report the condition (4), not knowing the appropriate doctor to see (2) and lack of awareness of available treatment options (1). Among respondents who had unreported urinary incontinence, 10 indicated a preference for physician-initiated (as opposed to self-initiated) discussion of urinary incontinence. CONCLUSION The substantial prevalence of urinary incontinence and high rate of nonreporting (almost one in three) underscore the need for systematic screening of older adults by doctors, especially at the primary care level, for early detection and appropriate urinary incontinence management.

Cardio-Vascular Disease and Cancer A Dichotomy in Utilization of Clinical Preventive Services by Older Adults in a Developing Country

Objective: To report the level of utilization of clinical preventive services by older adults in Jamaica and to identify independent factors associated with utilization. Method: A nationally representative, community-based survey of 2,943 older adults was undertaken. Utilization frequency for six preventive, cardiovascular or cancer-related services was calculated. Logistic regression models were used to determine the independent factors associated with each service. Results: A dichotomy in annual utilization rates exists with cardiovascular services having much higher uptake than those for cancer (83.1% for blood pressure, 76.7% blood glucose, 68.1% cholesterol, 35.1% prostate, 11.3% mammograms, and 9.6% papanicolaou smears). Age, source of routine care, and having a chronic disease were most frequently associated with uptake. Discussion: Education of providers and patients on the need for utilizing preventive services in older adults is important. Improved access to services in the public sector may also help increase uptake of services.

Alcohol use, depression, and life satisfaction among older persons in Jamaica

BACKGROUND We aimed to determine the prevalence of alcohol use among older Jamaicans as well as to explore among this population the relationships between alcohol use and: age, sex, depressive symptoms, and life satisfaction. Although the nature of these relationships among the proposed study population were uncertain, in other settings alcohol use has tended to decline with increasing age, occur more commonly among men than women, and show non-linear relationships with depressive symptoms and life satisfaction. METHODS Data gathered by two-stage cluster sampling for a nationally representative health and lifestyle survey of 2,943 community-dwelling older Jamaicans, aged 60 to 103 years, were subjected to secondary analysis using the Students t-test and χ 2 test as appropriate. RESULTS Current alcohol use was reported by 21.4% of the participants. It steadily declined with age and was six times more prevalent among men (37.6%) than women (6.2%). These findings were statistically significant as were associations of current alcohol use with comparatively lower levels of depressive symptoms. Current alcohol use was also more prevalent among persons who were either highly satisfied or highly dissatisfied with their lives, compared to others who had levels of life satisfaction between these two extremes. CONCLUSIONS Current alcohol use among older Jamaicans occurs primarily among men, declines with increasing age, and is associated with a relatively low likelihood of depression. It is also associated with very high and very low levels of life satisfaction.

Falls Among Community-Dwelling Older Adults in Jamaica

The objective of this study is to estimate the prevalence of and risk factors for falling among community-dwelling older adults in Jamaica. A two-stage cluster sample design was used to recruit a nationally representative sample of 2,943 older adults. The fall prevalence in the past 6 months was 21.7%. In univariate analysis, a significantly greater proportion of women, the increasingly old, rural residents, persons with vision problems (including cataracts), and those with key chronic conditions reported falling in this period compared with those without these respective attributes (p < .05). The majority of falls reported have occurred in the home (54.3%), and restriction of activities due to fear of falling was reported by 34.6% of respondents. Logistic regression found sex, area of residence, eyesight problems, cataracts, high blood pressure, and depression to be independent risk factors for falling. The falls in older adults represent a major public health issue. Identification of modifiable risk factors in developing countries such as Jamaica may help in the development of appropriate strategies to reduce fall risk.