Jamaica

Objective: Given interventions implemented in recent years to reduce maternal deaths, we sought to determine the incidence and causes of maternal deaths for 1998-2003. Method: Records of public hospitals and state pathologists were reviewed to identify pregnancy-related deaths within 12 months of delivery and determine their underlying causes. Results: 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. Interpretation: 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.

Twenty-five samples of Pterois volitans caught in Jamaican waters were analyzed for 25 essential, non-essential and toxic elements using Graphite Furnace Atomic Absorption Spectrophotometry (GF-AAS), Inductively Coupled Plasma Optical Emission Spectroscopy (ICP-OES) and Instrumental Neutron Activation Analysis (INAA). The mean values for calcium (355 mg/kg), copper (107 lg/kg), iron (0.81 mg/kg), potassium (3481 mg/kg), magnesium (322 mg/kg), manganese (0.04 mg/kg), selenium (0.47 mg/kg), sodium (700 mg/kg) and zinc (4.46 mg/kg) were used to estimate dietary intake. The percentage contribution to provisional tolerable weekly intake for a 70 kg male and a 65 kg female were also estimated for the toxic elements arsenic (1.28% M, 1.38% F), cadmium (0.26% M. 0.28% F), mercury (3.85% M, 4.15% F) and lead (0.17% M, 0.18% F). To further assess the risk of mercury toxicity and the role of mitigation provided by selenium, selenium-mercury molar ratios were calculated for all samples. All samples were shown to have a molar excess of selenium. In addition the suggested selenium health benefit value was calculated, and was positive for all samples. It was concluded that P. volitans appears to contribute modestly to mineral and trace element nutrition, while not being a significant contributor to dietary exposure of toxic elements.

Objective: The aim of this study was to examine the relationship between children's experiences of three different types of violence and academic achievement among primary school children in Kingston, Jamaica. Methods: A cross-sectional study of 1300 children in grade 5 [mean (S.D.) age: 11 (0.5) years] from 29 government primary schools in urban areas of Kingston and St. Andrew, Jamaica, was conducted. Academic achievement (mathematics, reading, and spelling) was assessed using the Wide Range Achievement Test. Children's experiences of three types of violence -exposure to aggression among peers at school, physical punishment at school, and exposure to community violence -were assessed by self-report using an interviewer administered questionnaire. Results: Fifty-eight percent of the children experienced moderate or high levels of all three types of violence. Boys had poorer academic achievement and experienced higher levels of aggression among peers and physical punishment at school than girls. Children's experiences of the three types of violence were independently associated with all three indices of academic achievement. There was a dose-response relationship between children's experiences of violence and academic achievement with children experiencing higher levels of violence having the poorest academic achievement and children experiencing moderate levels having poorer achievement than those experiencing little or none. Conclusions: Exposure to three different types of violence was independently associated with poor school achievement among children attending government, urban schools in Jamaica. Programs are needed in schools to reduce the levels of aggression among students and the use of physical punishment by teachers and to provide support for children exposed to community violence. Practice implications: Children in Jamaica and the wider Caribbean experience significant amounts of violence in their homes, communities, and schools. In this study, we demonstrate a dose-response relationship between primary school children's experiences of three different types of violence and their academic achievement. The study points to the need for validated violence prevention programs to be introduced in Jamaican primary schools. Such programs need to train teachers in appropriate classroom management and discipline strategies and to promote children's social and emotional competence and prevent aggression.