Western Jamaica Research Articles

Factors affecting infant feeding choices with a focus on barriers to exclusive breastfeeding in Western Jamaica: a qualitative study

BackgroundDespite the many benefits of exclusive breastfeeding to infants and mothers, only 33% of Jamaican infants are exclusively breastfed up to the recommend six months. This study was conducted to identify factors affecting mothers’ feeding choices focusing on barriers to exclusive breastfeeding of infants six weeks to less than six months old.MethodsA qualitative study consisting of four focus group discussion sessions was conducted among 22 mothers attending postnatal clinics in western Jamaica from May to August 2016. The transcripts were coded by three independent coders and content analysis conducted to generate themes.ResultsFour themes were identified namely, perceived advantages of breastfeeding centered mainly on the benefits of breastfeeding for the infant and mother, perceived barriers of breastfeeding highlighting physical pain and fatigue, supplementing culturally acceptable complementary foods and herbal remedies, and cultural norms including perception of how breastfeeding affects a woman’s body, societal sources of breastfeeding information, satiation of infants, and family and other support. Mothers overwhelmingly agreed that breastfeeding was inexpensive, allowed them to bond with their infants and was good for the overall health and intellectual development of the infants. They identified painful nipples, engorged breasts, lack of sleep, physical exhaustion and pressure to return to work as barriers to breastfeeding. Mothers named a number of complementary foods, such as pumpkin, carrots, potato, banana, and chocho (Chayote), that were culturally accepted for feeding infants in Jamaica and discussed herbs that were considered to aid in infants’ nutrition and overall health. Other cultural factors that were noted to influence exclusive breastfeeding were mothers feeling that breastfeeding would help their bodies, especially their bellies, go back to their pre-maternity figure, sources of breastfeeding information in the society including the internet, belief that breast milk alone does not satisfy babies, and family and other support.ConclusionMothers in this study identified unique challenges to exclusive breastfeeding that if addressed, would help to increase exclusive breastfeeding so that the World Health Organization’s exclusive breastfeeding recommendations can be achieved.

Prevalence and predictors of cigarette smoking among people with HIV in Western Jamaica

ABSTRACT With highly active antiretroviral therapy, HIV infection has become a treatable chronic disease. However, modifiable risk factors such as cigarette smoking continue to impact the morbidity and mortality of people with HIV (PWH). We assessed the prevalence and factors associated with cigarette smoking and motivation to quit among PWH in Western Jamaica. A cross-sectional study was conducted in which 392 adults seeking HIV care at health facilities in Western Jamaica completed an interviewer-administered questionnaire. Current smoking prevalence among participants was 17.4%. Current smoking was significantly associated with being male (OR = 2.99), non-Christian/non-Rastafarian (OR = 2.34), living or working with another smoker (aOR =1.86), being moderate to severely depressed (OR = 3.24), having an alcohol drinking problem (OR = 1.84), and never being asked by a healthcare provider if they smoked (OR = 3.24). Among the PWH who currently smoke, 36.7% are moderately to highly dependent on nicotine. One-third of people who smoke (33.8%) started smoking for the first time after HIV diagnosis, while 66.2% initiated smoking before; 88% were willing to quit smoking. These findings provide baseline information for designing and implementing a comprehensive smoking cessation program that considers the needs of PWH in Jamaica, with the potential of becoming a replicable model for other HIV-specialized healthcare settings in the Caribbean.

Knowledge, attitudes, and practices of Jamaican healthcare workers on nosocomial infection control.

The emergence of deadly infections such as methicillin-resistant Staphylococcus aureus and COVID-19 (SARS-CoV-2) highlights the need for effective infection control (IC) procedures in healthcare facilities. The aim of the study was to assess the knowledge, attitudes, and practices (KAP) of healthcare workers (HCWs) on IC procedures. A cross-sectional survey was conducted among HCWs in western Jamaica from May to August 2015. A questionnaire based on the Jamaican Health Facilities Infection and Control Policies and Procedures Manual was used to collect data on staff training in IC, and their KAP of IC. Summary statistics, ANOVA, and multiple linear regression were applied for data analyses. Among 227 participants, the mean knowledge scores were statistically higher among the younger HCWs, Physicians/Nurses, and those in clinical units. Older HCWs, non-physicians/nurses, non-clinical unit workers, HCWs at Western Regional Hospital A, and those who received ongoing IC training scored higher on attitude. The practice scores were significantly correlated with the attitude scores but not the knowledge scores. The attitude score was a significant predictor for IC practices. Six knowledge and three attitude variables were significant predictors of IC practices that the Western Regional Health Authority Officials can use to implement measures to improve IC practices among HCWs.

Sociodemographic characteristics, attitudes, and knowledge associated with previous screening for cervical cancer among women in western Jamaica

BackgroundAbout 90% of new cervical cancer cases and deaths worldwide in 2020 occurred in low- and middle-income countries. This can be attributed to the low rates of cervical cancer screening in these countries. This study was conducted to identify factors associated with lack of cervical cancer screening among women in western Jamaica with the aim to increase screening and decrease cervical cancer risk.MethodsThis cross-sectional study assessed associations between previous Pap testing or lack of testing in five years or more, sociodemographic characteristics, attitudes, and knowledge of cervical cancer among women recruited from clinics and community events in the four parishes of western Jamaica. Analyses included chi-square tests, Fisher’s exact tests, and logistic regression.ResultsOf the 223 women included in the study, 109 (48.9%) reported Pap testing five years or more previous to the study. In the multivariate analysis, women from St. James (Odds Ratio [OR]: 3.35, 95% Confidence Interval [CI]: 1.12–9.99), Trelawny (OR: 5.34, 95% CI: 1.23–23.25), and Westmoreland (OR: 3.70, 95% CI: 1.10–12.50) had increased odds of having had Pap test screening compared to women from Hanover. Women ≥ 50 years of age compared to women 18–29 years of age (OR: 6.17, 95% CI: 1.76–21.54), and employed compared to unemployed women (OR: 2.44, 95% CI: 1.15–5.20) had increased odds of Pap test screening. Similarly, women with one (OR: 4.15, 95% CI: 1.06–16.22) or two or more children (OR: 8.43, 95% CI: 2.24–31.63) compared to women with no children had higher odds of screening. Women who were aware, compared to women who were unaware, of the purpose of Pap tests had increased odds of screening (OR: 3.90, 95% CI: 1.55–9.82). Lastly, women who believed Pap tests were painful compared to women who did not, had decreased odds of having had a Pap test (OR: 0.33, 95% CI: 0.16–0.71).ConclusionsUptake of Pap tests among the women was suboptimal and varied among parishes. Young women and women without children were less likely to have ever been screened. Increased education of the purpose of Pap tests to treat pre-cancer to prevent cancer and minimization of the notion that Pap tests are painful could promote screening among women in this population.

Newborn screening for abnormal haemoglobins in Jamaica: Practical issues in an island programme.

To report the diagnostic challenges of newborn screening for abnormal haemoglobins. Cord blood samples from 13 hospitals in southwest Jamaica taken in 2008-2019. Blood spots, collected from the umbilical cord, were analysed by high pressure liquid chromatography (HPLC) to reveal phenotypes for HbSS and HbCC, but genotype confirmation may require parental studies or gene sequencing. Such cases that were successfully traced were analysed in this follow-up study. HPLC screening of 121,306 samples detected HbAS in 11,846 (9.8%), HbAC in 4508 (3.7%) and other electrophoretic abnormalities in 1090 babies. Among 101 previously unconfirmed cases, 34/90 (38%) with HPLC evidence of a HbSS phenotype had other genotypes, and 7/11 (64%) with a HbCC phenotype had other genotypes. Syndromes from the interaction of β thalassaemia occurred in 112 babies (85 with HbS, 27 with HbC) and of genes for hereditary persistence of fetal haemoglobin (HPFH) in 18 (12 with HbS, 6 with HbC). Variants other than HbS and HbC occurred in 270 babies, 16 in combination with either HbS or HbC, and 254 as traits. Most variants are benign even when inherited with HbS, although HbO Arab, HbD Punjab, or Hb Lepore Washington, which occurred in 6 cases, may cause sickle cell disease. Genes for β thalassaemia and HPFH are common in western Jamaica and when associated with HbS may present diagnostic challenges in newborns, as HbF and HbA2 have not reached diagnostic levels. Family and DNA studies may be necessary for genotype confirmation.

The Significance of Information Literacy Instruction for Teachers in Training at the Sam Sharpe Teachers’ College, Jamaica

This paper employs a quasi-experimental approach to explore the impact of Information Literacy Instruction (ILI) on year one teachers in training at the Sam Sharpe Teachers’ College in Western Jamaica. It examines how ILI aids in the development of information literate (IL) student teachers. The research is guided by the Big6 Skills developed by Mike Eisenberg and Bob Berkowitz. The pre-test results show a general deficiency in IL skills, while the results of the post-test suggest that after a period of ILI, the IL competencies of the student teachers improved—especially in terms of their research skills and information seeking and evaluation abilities. This emphasizes the importance of ILI in the academic environment. A notable recommendation is that ILI for tertiary level students be taught by ILI trained and competent instructors. This research will add to the growing body of literature addressing the relevance of ILI in teacher training institutions, especially in the Caribbean region.

"It's Not Good to Be Sick and Have the Child": Perspectives on Pregnancy After HIV-Positive Diagnosis Among Women in Western Jamaica.

PurposeTo identify factors associated with reproductive decision-making for women living with HIV in Western Jamaica, to assess their confidence in anti-retroviral therapy to reduce the chances of mother to child transmission of HIV, and to better understand the experience of stigmatization surrounding becoming pregnant after HIV diagnosis.Participants and MethodsTwo focus groups were conducted among women living with HIV in the four parishes of Western Jamaica in 2011. A trained moderator conducted the focus groups along with two student notetakers. Qualitative coding and content analysis were used to identify common themes and exemplary quotations characterizing those themes.ResultsParticipants agree that adherence to antiretroviral therapy as prescribed by a physician facilitates better health and longevity; however, they were conflicted on the efficacy of the therapy to prevent mother to child transmission of the virus. Participants report that becoming pregnant after HIV diagnosis continues to be highly stigmatized. Among participants, fear of MTCT and concern that their children will be mistreated are the primary drivers of reproductive decision-making.ConclusionDespite advances in HIV treatment and assisted technologies to prevent MTCT, participants show skepticism that ARV medication is effective at preventing MTCT. Stigma and discriminatory behavior by community members and health-care professionals continue to shape reproductive decision-making for the women who participated in this study. More informed counseling that includes education on recent advancements in HIV treatment and its efficacy at preventing MTCT should be more widely available to pregnant women. To reduce stigma and discriminatory behavior, this education should extend to the larger community.

Rudist bivalves (Hippuritoidea) from the Clifton Limestone (Lower Campanian) of western Jamaica and a reassessment of the genus Vaccinites in the Americas

The lower Campanian (Upper Cretaceous) Clifton Limestone of Jamaica yields three species of hippuritid bivalve: Barrettia ruseae CHUBB, Whitfieldiella luceae sp. nov. and Vaccinites vermunti MAC GILLAVRY, and the plagioptychid: Plagioptychus sp. The hippuritids are described in detail using statistics. Barrettia ruseae is demonstrated to be a more primitive species of Barrettia than B. monilifera WOODWARD or B. multilirata WHITFIELD, and the species Whitfieldiella luceae is shown to be a more primitive species of Whitfieldiella than W. gigas CHUBB. The specimens of Vaccinites from the Clifton Limestone are compared with populations of Vaccinites from elsewhere in the Americas, and five species (probably representing a single evolutionary lineage) are recognized: V. alencasteri sp. nov. (?late Turonian-?Coniacian), V. martini MAC GILLAVRY (probably early to mid Santonian), V. macgillavryi PALMER (probably mid to late Santonian), V. vermunti MAC GILLAVRY (earliest Campanian), and V. temazcali sp. nov. (late early Campanian). The Vaccinites species can be distinguished using statistical techniques. The ages of the Clifton Limestone and the five Vaccinites species are reviewed. This research demonstrates the value of using hippuritids for biostratigraphy in the Upper Cretaceous of the Americas.

The use of complementary and alternative medicine among hypertensive and type 2 diabetic patients in Western Jamaica: A mixed methods study.

The simultaneous or intermittent use of alternative treatments and prescription medications for hypertension and type 2 diabetes mellitus can have adverse health effects. To identify beliefs and practices associated with the use of alternative treatments for hypertension and type 2 diabetes mellitus among patients. A mixed-methods study including an investigator-administered survey and focus group discussion sessions using convenience sampling was conducted among patients aged ≥18 years during May to August 2018. Descriptive statistics were used to describe and compare demographic characteristics among groups of survey participants using JMP Pro 14.0. Thematic analysis was conducted to analyze the qualitative data using NVivo. Most study participants (87-90%) were on prescription medication for their condition. Of survey participants, 69% reported taking their medication as prescribed and 70% felt that prescription medicine was controlling their condition. Almost all participants (98%) reported using alternative treatments, mainly herbal medications, and 73-80% felt that herbal medicines controlled their conditions. One-third believed that herbal medicines are the most effective form of treatment and should always be used instead of prescription medication. However, most participants (85%) did not believe that prescription and herbal treatments should be used simultaneously. Most (76-90%) did not discuss herbal treatments with their healthcare providers. Four themes emerged from the focus group sessions: 1) Simultaneous use of herbal and prescription medicine was perceived to be harmful, 2) Patients did not divulge their use of herbal medicine to healthcare providers, 3) Alternative medicines were perceived to be highly effective, and 4) Religiosity and family elders played key roles in herbal use. This study provides useful insights into perceptions and use of alternative treatments by patients that can be used by healthcare providers in developing appropriate interventions to encourage proper use of prescription medicines and alternative medicines resulting in improved management of these chronic diseases.

Effectiveness of an intrauterine device informative intervention among post-natal women in Western Jamaica

IntroductionIntrauterine devices are the most effective long-acting reversible contraceptives, but in many developing countries, such as Jamaica, these devices remain underutilized.MethodsA cross-sectional informative intervention was conducted among women ≥ 18 years of age attending postnatal clinics in western Jamaica from May to August 2018. Data were collected using an investigator-administered questionnaire/pre-test followed by a 12-slide PowerPoint® presentation and a post-test.ResultsMost of the 299 women who participated were 18–29 years of age, with a mean age of 27.1 (SD ± 6.1) years. Most had their first pregnancy between ages 18 and 24 years, with mean age at first pregnancy of 20.2 (SD ± 4.0) years. Only 3.0% of participants reported current use of an intrauterine device; 3.5% reported using an intrauterine device in the past. For nearly every measure of knowledge of intrauterine devices, there was a significant change in the proportion of participants who got the correct answer from the pre-test to the post-test. The mean summed pre-test knowledge score was 9.54 (SD ± 3.46) and the post-test score was 15.23 (SD ± 1.92); the possible total score is 18. The difference between the mean scores (5.69 points) was also significant.ConclusionThe intervention resulted in significant change in knowledge of intrauterine devices among the women and cleared up many misconceptions that may have contributed to reluctance of women to use intrauterine devices. Women of reproductive age in Jamaica should be counseled on contraceptive methods including intrauterine devices so that these devices can be considered in their contraceptive choices.

Knowledge, attitudes and practices among healthcare professionals regarding complementary alternative medicine use by patients with hypertension and type 2 diabetes mellitus in Western Jamaica

ObjectivesThis study investigated the knowledge, attitudes, and practices (KAP) of healthcare professionals (HCPs) regarding CAM use for Hypertension (HTN) and Type 2 Diabetes Mellitus (T2DM) among patients in western Jamaica, and to determine HCPs’ perceptions of the need for training on CAM. DesignA cross-sectional study was conducted from May to August 2019. SettingHCPs serving patients with HTN and T2DM in chronic disease clinics in western Jamaica completed a self-administered questionnaire that provided data on their sociodemographic characteristics, training, and KAP of CAM. Main outcome measureThe data identified factors associated with discussion and recommendation of CAM to patients and personal use of CAM by HCPs. ResultsType of profession (physicians vs nurses OR = 2.17; 95 % CI = 1.07−4.42 and pharmacists vs nurses OR = 8.67; 95 % CI = 2.83−26.57) was significantly associated with discussion of CAM. Training on CAM was significantly associated with discussion (OR = 2.36; 95 % CI = 1.26−4.42), recommendation (OR = 2.72; 95 % CI = 1.36–5.42), and personal use of CAM (OR = 2.90; 95 % CI = 1.69−4.97). Dieticians and nutritionists had 4.56 higher odds of personal use of CAM (95 % CI = 1.16−17.86), and personal use of CAM was significantly associated with discussion (OR = 8.94; 95 % CI = 4.76−16.80) and recommendation (OR = 7.17; 95 % CI = 3.54–14.51) of CAM. The majority of HCPs (70–89 %) agreed that there is a need to include CAM in professional training programs. ConclusionThe results of this study can be used to guide development of programs for training HCPs on knowledge and safe use of CAM so that they can better serve their patients.

Factors associated with the use of complementary and alternative therapies among patients with hypertension and type 2 diabetes mellitus in Western Jamaica: a cross-sectional study

BackgroundThis study examined the prevalence and predictors of complementary and alternative medicine use among clinic patients with hypertension and/or type 2 diabetes mellitus in western Jamaica.MethodsA cross-sectional study using an investigator-administered questionnaire was conducted from May to August 2017. Data on sociodemographic factors, complementary and alternative medicine use, and knowledge and perceptions of complementary and alternative medicine were collected from the patients. Multivariable logistic regression analysis was used to examine associations between patient characteristics and knowledge and perceptions of complementary and alternative medicine and complementary and alternative medicine use.ResultsA total of 362 patients were invited to participate and 345 (95.3%) completed the questionnaire; 311 (90.1%) had hypertension, 130 (37.7%) had type 2 diabetes mellitus and 96 (27.8%) had both diseases. Seventy-nine percent of the participants with hypertension and 65% with type 2 diabetes mellitus reported current use of complementary and alternative medicine. Self-reported knowledge of complementary and alternative medicine (none/poor vs average/good/excellent) was significantly associated with complementary and alternative medicine use for hypertension (AOR = 0.33, 95% CI = 0.13–0.87) and type 2 diabetes mellitus (AOR = 0.06, 95% CI = 0.01–0.37). Believing that complementary and alternative medicine is a natural method for treating hypertension was significantly associated with complementary and alternative medicine use among patients with hypertension (AOR = 3.9, 95% CI = 1.26–12.00), and belief that it is acceptable to use prescription medication and complementary and alternative medicine simultaneously was significantly associated with complementary and alternative medicine use among patients with type 2 diabetes mellitus (AOR =7.19, CI = 1.34–38.52).ConclusionsParticipants’ perceptions of their knowledge and beliefs regarding complementary and alternative medicine strongly influence their use of complementary and alternative medicine. These findings can be used in designing educational interventions to promote the proper use, and mitigate detrimental effects, of complementary and alternative medicine in this population.

Cretaceous geology and tectonic assembly of Jamaica

Abstract This paper provides new data on the Cretaceous geology together with existing data to define four terranes for the Cretaceous of Jamaica. The Northeast Blue Mountain Terrane (NEBMT) contains a shallow-water pile of Campanian basaltic and andesitic lavas interbedded with shallow-water, rudist-bearing limestones. The Southeast Blue Mountain Terrane (SEBMT) contains plume-related basalts attributed to the Caribbean Large Igneous Province (CLIP) of Turonian–Coniacian age overlain by interbedded cherts, limestones and basalts with CLIP affinity of Coniacian–Campanian age; the overlying succession is provisionally attributed to the late Campanian to Maastrichtian. The Western Blue Mountain Terrane (WBMT) contains a suite of Campanian arc rocks intruded by granodiorites which have tectonic contacts with metamorphic rocks (high pressure–low temperate blueschists, amphibolites and greenschists). The Western Jamaica Terrane (WJT) contains a suite of volcanic arc rocks in the Valanginian–Hauterivian, Barremian, Turonian, Santonian to Campanian, and Maastrichtian to Paleocene. These rocks are interbedded with thick to very thick (up to several kilometres) sedimentary sequences which occur at outcrop and in hydrocarbon exploration wells. Three major unconformities are present in the WJT, at the bases of the Crofts Synthem (earliest Campanian), Kellits Synthem (late Campanian to early Maastrichtian) and Yellow Limestone (late Paleocene to early Eocene). The NEBMT and SEBMT are separated from the WBMT and WJT by a NE–SW, left-lateral transform fault that defined the edge of the Caribbean Plate from the early(?) Cretaceous to the mid Eocene and allowed the Cuban oceanic arc and eastern Jamaican terranes to be emplaced between the Americas. Metamorphism in the WBMT indicates the existence of a northeasterly dipping subduction zone which allowed the subduction of CLIP lithosphere in the Campanian. Rudist bivalves suggest an affinity between Jamaica and the Siuna (Chortis) and Guerrero (Mexico) terranes in the Lower Cretaceous, suggesting that these arcs were close together. Subsequently, the three unconformities record interactions between the Jamaican arc segment and the Chortis Block and finally the collision with the Jamaican arc segment with the Maya Block in the Paleocene. The petroleum geology of each Cretaceous terrane is reviewed in the context of source and reservoir rocks. Possible source rocks exist in the Jurassic under northern Jamaica, the Albian to Turonian interval, which is associated with oceanic anoxic events, and the Maastrichtian, which contains thin units of organic-rich shales. Reservoirs are largely confined to limestones which preserve porosity in the body chambers of rudist bivalves and which have also been locally dolomitized and fractured (increasing both porosity and permeability). Oil-associated gas seeps present at outcrop, and oil shows of Jurassic and Cretaceous age from exploration wells indicate the existence of active petroleum systems, but not necessarily of economic hydrocarbon accumulations.

Lost and linked to care: a 6-year longitudinal default tracking program of a cohort of infants exposed to HIV in Western Jamaica

ABSTRACT Evidence-based interventions are urgently needed to successfully achieve the elimination of mother to child transmission of HIV. This study aimed to evaluate the impact of a default tracking programme on the outcomes of infants exposed to HIV. We conducted a longitudinal cohort study of mothers infected with HIV. We established a default tracking programme for HIV-infected mother-infant pairs using a multidisciplinary team with clear lines of responsibilities. Infants exposed to HIV who did not return for the assessment of their infection status were defined as ‘defaulters’. The defaulters were tracked and classified as linked to care or ‘lost to follow-up’ (LTFU) if they were not re-engaged in care. Within the study cohort, we investigated LTFU at 6 weeks, 4 months, and 18 months, linkage-to-care, and laboratory outcomes. Between 2012 and 2017, there were 454 live-births, 25 transfers, 2 deaths, 8 cases of HIV infection, 136 defaulters, and 68 infants LTFU. The number of children who defaulted care reduced from 44% in 2012 to 7% in 2017 (p = 0.0001)). Infants LTFU reduced significantly from 21% to 4% (p = 0.0001). The prevalence of negative PCR1 increased significantly from 75% to 97% (p = 0.002), while that for positive PCR declined from 4% to 0%. The seroconversion rate was 1.9%. Of the 68 infants LTFU among the entire cohort, 18 (4%) were lost at 6 weeks, 14 (3%) at 4 months, and 36 (9%) at 18 months (p = 0.025). Thirty-four of the LFTU (97%) at 18 months tested negative for PCR1, and 31 (89%) tested negative for PCR 2. Three defaulters that were linked-to-care had HIV infection. Multidisciplinary service packages and the tracking of mother-infant pairs who default from care had a positive impact on reducing LTFU and increasing PCR uptake in this non-breastfeeding population.

Using the random forest algorithm to integrate hydroacoustic data with satellite images to improve the mapping of shallow nearshore benthic features in a marine protected area in Jamaica

Hydroacoustic and optical remote sensing have been commonly used to map shallow nearshore benthic features. However, the number, type, scale, and accuracy of the mapping products that can be obtained from the two sensors differ; as such, there can be limited agreement between their mapping products. These differences can be further accentuated if the hydroacoustic data are interpolated to produce a map. Interpolation introduces spatial uncertainty and reduces map accuracy. Consequently, maps generated from the two sensors may provide dissimilar spatial and temporal representations of the same benthic features. We therefore compared the performance of a random forest regression (RFr) and a universal kriging (UK) interpolation method and a post-classification enhancement that can be used to increase the accuracy and complementarity of benthic habitat maps derived from hydroacoustic data. First, we used single beam echosounder (SBES) survey bathymetry data from the Bluefields Bay marine protected area (MPA) in western Jamaica (13.82 km2 in size), to create a bathymetric surface model (BSM), from which rugosity and bathymetric position index (BPI) maps were generated. Next, the RFr was used to create submerged aquatic vegetation (SAV) percentage cover maps from the SBES SAV cover data by predicting cover at un-sampled locations. Predictors included auxiliary data such as depth, BPI, survey points coordinates and radiometrically corrected, deglinted and water column corrected image reflectance index values from each of the following: WorldView-2, Geoeye-1 and Landsat 8. Additionally, a SAV map was created using the UK. The most accurate SAV cover thresholds were identified and were used to create binary maps from the RFr and UK maps. A rugosity derived coral reef map was then added to the binary maps. The resulting benthic habitat maps had comparable accuracies and class coverage to benthic maps classified from GeoEye-1 and WorldView-2 images using pixel and object-based classifiers. However, map accuracies were calculated using a suboptimal number of reference points (<50) for two of the benthic map classes (SAV absent and coral reef). This was not considered to be problematic as the addition of the coral reef class to the binary maps resulted in a significant decrease in uncertainty (standard error and confidence interval width of the overall accuracy) and a significant increase in the user’s accuracy of the SAV absent map class. Also, the difference in uncertainty and accuracy between the map classes did not change. The methods used in this study can therefore be used to increase the accuracy (and to decrease the uncertainty) and the complementarity of maps derived from hydroacoustic data.

Invertebrate borings from the Eocene of Seven Rivers, parish of St. James, western Jamaica

The fossil biota of the Eocene Yellow Limestone Group of Jamaica is diverse in vertebrates and, particularly, invertebrates. However, its invertebrate trace fossils remain understudied. Herein, we document the borings of the Seven Rivers vertebrate site in western Jamaica. This is in the Litchfield Formation, high in the Lutetian (about mid-Middle Eocene). The suite of borings identified from this site comprises Apectoichnus longissimus (Kelly and Bromley); Entobia isp.; Oichnus simplex Bromley; and Oichnus paraboloides Bromley. Substrates infested by Entobia isp. include both molluscs and sirenian ribs. Oichnus ispp. occur only in bivalves and are mainly non-penetrative, which may be a taphonomic artifact. Tubes of the common A. longissimus are preserved free from any woody substrates, which have presumably rotted away; however, one specimen has a dark, carbonaceous external film and others have carbonized wood inclusions. The occurrence of A. longissimus in the Jamaican rock record coincides with periods of sub-aerial exposure.

β-Thalassemia Mutations in Jamaica: Geographic Variation in Small Communities

Over the last 43 years, surveys of over 200,000 subjects in Jamaica have identified β-thalassemia (β-thal) mutations. In most, these genes were detected at birth in patients with sickle cell-β-thal and so the prevalence and distribution would not be influenced by subsequent clinical course. There were two newborn populations, 100,000 deliveries in the corporate area between 1973-1981 and 84,940 in south and western Jamaica between 2008-2016. A third population, which derived from the Manchester Project in central Jamaica, screened 16,612 secondary school children, aged predominantly 15-19 years, and identified 150 students with the β-thal trait and 11 with sickle cell [Hb S (HBB: c.20A>T)]- or Hb C (HBB: c.19G>A)-β-thal. The latter patients may have been subject to symptomatic selection, but this should not have affected those with β-thal trait. Of the 24 different molecular mutations, β0-thal genes accounted for 10.0-27.0% of these groups and most common was IVS-II-849 (A>G) (HBB: c.316-2A>G). Of the β+ mutations, seven subjects had severe genes with low levels of β chain synthesis but the majority were benign mutations in the promoter region. The –29 (A>G) (HBB: c.-79A>G) mutation dominated in the newborn study in Kingston, similar to experiences in Guadeloupe and African Americans but the –88 (C>T) (HBB: c.-138C>T) mutation was more common among school students in central Jamaica. Caribbean populations are genetically heterogeneous but variations within different parts of Jamaica is of potential importance for prenatal diagnosis and genetic counseling. This information may also be useful among the large Jamaican diaspora.

Predictors of pregnancy after HIV-positive diagnosis among women in western Jamaica.

BackgroundAntiretroviral therapy has minimized mother-to-child transmission of HIV and given hope to HIV-positive women considering pregnancy. In Jamaica, 36% of HIV-positive pregnant women enrolled in a pediatric/perinatal HIV/AIDS program had repeat pregnancies.ObjectiveTo describe the epidemiology and identify factors associated with pregnancy after HIV diagnosis among HIV-positive women in Western Jamaica.MethodsA cross-sectional study was designed among HIV-positive women 18–54 years old who either had or did not have at least one pregnancy after HIV-positive diagnosis. A questionnaire was used to collect information on sociodemographic factors and health-seeking, reproductive, and sexual risk behaviors.ResultsA total of 219 HIV-positive women participated in this study. Length of time since HIV diagnosis, CD4 count, and birth-control methods used were significant predictors of pregnancy after HIV diagnosis. Women diagnosed with HIV <5 years previously had lower odds for pregnancy after HIV diagnosis (adjusted OR 0.12, 95% CI 0.02–0.84) compared to those who had been diagnosed ≥8 years previously. Women with CD4 count <350 were over six times as likely to have a pregnancy after HIV diagnosis (adjusted OR 6.94, 95% CI 1.18–40.66). The odds for pregnancy after HIV diagnosis for a woman decreased by 93% if her children shared the same father (adjusted OR 0.07, 95% CI 0.006–0.77).ConclusionThis study identified significant predictors of pregnancy after HIV diagnosis that indicate that integrative family-planning interventions with supportive reproductive counseling are likely to help HIV-positive women obtain early appropriate care and plan the pregnancies they desire.

Psychosocial outcomes in a cohort of perinatally HIV-infected adolescents in Western Jamaica

Background: Psychosocial factors interact with adolescent development and affect the ability of HIV-infected adolescents to cope with and adhere to treatment.Aim: To evaluate psychosocial outcomes in perinatally HIV-infected adolescents (PHIVAs) in Western Jamaica after psychosocial intervention.Methods: The Bright Futures Paediatric Symptom Checklist (BF-PSC) was used for psychological screening of PHIVAs in Western Jamaica. Referred patients were evaluated using the Youth version of the Columbia Impairment Scale (CIS). Demographic, laboratory and clinical data obtained between July 2014 and June 2016 were evaluated retrospectively and outcomes were reviewed before and after psychosocial intervention.Results: Sixty PHIVAs were enrolled and 36 (60%) had a positive BF-PSC score that necessitated referral. The BF-PSC correctly identified 89% of patients with impaired psychosocial assessment by CIS scores. Referred patients were less likely to adhere to treatment, to be virologically suppressed or to have a CD4+ count of >500 cells/μl, and were more likely to be in the late teenage group or to be of orphan status. After intervention, the prevalence of viral suppression increased and median viral load decreased. A difference in mean CD4+ cell count was detected before but not after intervention in teenage and orphan groups.Conclusions: The BF-PSC identified at-risk PHIVAs with impaired psychosocial functioning. Increased vulnerability was noted in orphans and older teenagers. Psychosocial interventions (including family therapy) reduced psychosocial impairment and improved virological suppression. Mental health intervention should be instituted to facilitate improved clinical outcomes, autonomy of care and transition to adult care.

Mapping shallow nearshore benthic features in a Caribbean marine-protected area: assessing the efficacy of using different data types (hydroacoustic versus satellite images) and classification techniques

ABSTRACTVarious benthic mapping methods exist but financing and technical capacity limit the choice of technology available to developing states to aid with natural resource management. Therefore, we assessed the efficacy of using a single-beam echosounder (SBES), satellite images (GeoEye-1 and WorldView-2) and different image (pixel-based Maximum Likelihood Classifier (MLC), and an object-based image analysis (OBIA)) and hydroacoustic classification and interpolation techniques, to map nearshore benthic features at the Bluefields Bay marine protected area in western Jamaica (13.82 km2 in size). A map with three benthic classes (submerged aquatic vegetation (SAV), bare substrate, and coral reef) produced from a radiometrically corrected, deglinted and water column-corrected WorldView-2 image had a marginally higher accuracy (3%) than that of a map classified from a similarly corrected GeoEye-1 image. However, only one of the two extra WorldView-2 image bands (coastal) was used because the yellow band was completely attenuated at depths ≥3.7 m. The coral reef class was completely misclassified by the MLC and had to be contextually edited. The contextually edited MLC map had a higher overall accuracy (OA) than the OBIA map (86.7% versus 80.4%) and maps that were not contextually edited. But, the OBIA map had a higher OA than a MLC map without edits. Maps produced from the images also had a higher accuracy than the SAV map created from the acoustic data (OAs >80% and kappa >0.67 versus 76.6% and kappa = 0.32). SAV classification was comparable among the classified SBES SAV data points and all the final maps. The total area classified as SAV was marginally larger for satellite maps; however, the total area classified as bare substrate using the images was twice as large. A substrate map with three classes (silt, sand, and coral/hard bottom) produced from the SBES data using a random forest classifier and a Markov chain interpolator had a higher accuracy than a substrate map produced using a fractal dimension classifier and an indicator krig (the default choice) (72.4% versus 53.5%). The coral reef class from the SBES, OBIA, and contextually edited maps had comparable accuracies, but covered a much smaller area in the SBES maps because data points were lost during the interpolation process. The use of images was limited by turbidity levels and cloud cover and it yielded lower benthic detail. Despite these limitations, satellite image classification was the most efficacious method. If greater benthic detail is required, the SBES is more suitable or more effort is required during image classification. Also, the SBES can be operated in areas with turbid waters and greater depths. However, it could not be used in very shallow areas. Also, processing and interpolation of data points can result in a loss of resolution and introduces spatial uncertainty.