Patricia Desai

Heights, weights, and skeletal age of Jamaican adolescents with sickle cell anaemia.

Weights, heights, and skeletal age, assessed from hand radiographs, were recorded in a cross-sectional study of 99 Jamaicans with sickle cell anaemia aged between 12 and 21 years. Compared with controls, weight and skeletal age were less at all ages. The data suggested that the average height of younger patients was less but that of older patients was at least as great as that of controls.

Coagulation changes during the steady state in homozygous sickle-cell disease in Jamaica

Summary. Coagulation studies were carried out in 117 Jamaicans with homo‐zygous sickle‐cell disease in the steady state, and 40 local controls. The patients had significantly higher factor‐VIII levels, higher platelet counts, lower factor‐V and plasminogen levels, shorter thrombin times and higher serum fibrinogen degradation products (FDP) than the control group. The low factor‐V and plasminogen levels, and high FDP levels, might be explained by activation of the coagulation system and continuous clot lysis even in the absence of painful crisis. The high factor‐VIII levels and short thrombin times found in these patients could not be explained.

Identification of childhood disability in Jamaica: the ten question screen.

This is the first in a series of papers that report the testing of two instruments for the identification and assessment of childhood disability by community workers (CWs) in Third World countries. It is part of the International Epidemiologic Study on Childhood Disability. The Ten Question Screen (TQ) was used as the main instrument to identify disability in a two stage population-based survey of 5478 children aged 2-9 years in Clarendon, Jamaica. In the second stage, TQ positive and 8% of the screen negative controls were professionally assessed by a doctor and a psychologist using standard criteria based on the main classification system of the ICIDH. Sensitivity of the TQ as a whole varied in different strata of the group and amongst different disabilities, from perfect in girls under 6 years, fits and motor disabilities and for serious disability in all group except boys over 5 years with cognitive disability. Specificity was good but the false positive rate was unacceptably high at 74%. It was concluded, firstly, that the validation of a simple questionnaire of perceptions of behaviour against objective measurements of impairments was perhaps not fair to the TQ. In spite of this, the TQ would be a very useful instrument in collecting disability data or for identifying people in need of rehabilitation help, if a way of reducing false positives could be found.

Mortality and morbidity in Jamaican adults with sickle-cell trait and with normal haemoglobin followed up for twelve years.

An epidemiological survey of adults aged 35--64 years living in a rural area of Jamaica was started in 1962--63 and continued until 1975. Information was available on 856 subjects with AA and 119 subjects with AS haemoglobin genotypes. The mortality-rates over 12 or 13 years and the number of clinic attendances in 10 years did not differ significantly between subjects with AA and those with AS haemoglobin. The patterns of disease as well as the life expectancy of the two groups appeared to be the same.

Categories, classes and criteria in childhood disability — experience from a survey in Jamaica

This paper reports a new classification and criteria for disabilities and handicaps used in a survey of childhood disability in Jamaica. Part of the International Classification of Impairments, Disabilities and Handicaps was used, with an alternative classification for disabilities similar to that of impairment, and with a complete set of criteria for levels of severity. For handicaps, the set proposed in the WHO manual, Training Disabled People in the Community, was used. No difficulties were encountered in the use of definitions or severity criteria. The inter-rater reliability for disability as a whole by community workers was 79% (kappa statistic 0.58), and for the physician and psychologist 90 and 100%. The handicap classification was easy to use but there was some confusion with resulting poor inter-rater reliability for some questions. This could be corrected by clarification of the meaning of the questions during training. We recommend use of this classification and criteria as being simple and realistic for surveys of childhood disability conducted by community workers.

A Comparison of Efficacy of the Key Informant and Community Survey Methods in the Identification of Childhood Disability in Jamaica

A comparison of the efficacy of the key informant and the community survey methods for identifying children with disability was carried out in the Jamaican component of an international epidemiological study of childhood disability. Approximately 130 key informants were exposed to a 2-day workshop giving information on signs of disability, aspects of the project, and available services. Questionnaires were given to enable the informants to refer children and they were reminded 6 months later. In the survey method, eight community workers completed a house-to-house survey of all families and administered the 10-question screen with probes on 5475 children, 2 to 9 years old. Seventeen referrals were made by the key informants; of these, two were found to have disabilities. Of the 821 children who tested positive on the 10-question screen in the house-to-house survey, 193 had disabilities. We concluded that the key informant method would not be a satisfactory way of identifying cases of childhood disability.

BLOOD-PRESSURE AND MORTALITY IN A RURAL JAMAICAN COMMUNITY

1065 men and women aged 35--64 years living in rural Jamaica were first examined in 1962--1963, re-examined 5 and 10 years later, and followed-up until 1976. Overall mortality in 13 years, taking into account blood-pressures at all 3 surveys, showed that mortality was significantly increased only at pressures above 180 mm Hg systolic or 110 mm Hg diastolic. It was estimated that without this degree of hypertension the total number of deaths between the ages of 45 and 69 years would have been reduced by about 17%. Unlike other reports, mortality showed no significant association with lower levels of blood-pressure; this difference may be due to a lower incidence in this community of coronary and cerebral thrombosis. The relation between blood-pressure and mortality cannot be assumed to be identical in populations with different profiles of cardiovascular pathology.

The Determinants of Irreversibly Sickled Cells in Homozygous Sickle Cell Disease

Summary. The relationship between the irreversibly sickled cell (ISC) count and other haematological parameters has been investigated. Positive correlations occurred with the MCH, MCHC, and with two expressions of intracellular Hb S content. Since the ISC has a high MCHC, the positive correlations with MCHC and with factors derived from the MCHC may be difficult to evaluate. Negative correlations occurred with total haemoglobin and Hb F. The MCHC was found to affect the relationship between HbF and ISC count, a low MCHC being associated with, and probably determining, lower ISC counts at any level of Hb F. It is proposed that a low MCHC may inhibit ISC formation and the practical implicaions of this are discussed.

A longitudinal study of child growth in a rural community in Jamaica.

A longitudinal study of the growth of a cohort of 229 infants born in a rural area in Jamaica and followed to their 4th birthdays is described, and this paper reports analyses of the anthropometric measurements. Moderate impairment of growth affected the majority of children and was most marked between the ages of 3 and 15 months. Severe impairment occurred in boys more often than girls and in this comm unity was rarely attributable to disease. The concept of weight faltering has been investigated in some detail; failure to gain weight for a period of 6 months occurred in almost half the children but was not, by itself, a useful prognostic index of malnutrition; it occurred commonly in children of above average weight whose subsequent growth was normal. The provision of intensive care at specially appointed child welfare clinics did not completely prevent the development of serious malnutrition.

Urographic findings in homozygous sickle cell disease.

A prospective study of the renal abnormalities on excretion urography in 189 patients with homozygous sickle cell disease is presented. Demonstrable abnormalities were present in 69% but there was no correlation with symptomatology. Calyceal clubbing was the most common abnormality occurring in 39% of cases and its incidence increased with age. An unexpectedly high prevalence (23%) of papillary necrosis occurred and both sinuses and cavities were demonstrated. The reasons for this high prevalence are discussed. The urographic findings did not correlate significantly with hematological features of the disease.