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Background In 1996 a study found that approximately one in four tourists to Jamaica were affected with traveler's diarrhea (TD) during their stay. That year the Ministry of Health initiated a program for the prevention and control of TD. The aim of this ongoing program was to reduce attack rates of TD from 25% to 12% over a 5-year period by improving the environmental health and food safety standards of hotels. Methods Hotel-based surveillance procedures for TD were implemented in sentinel hotels in Negril and Montego Bay in 1996, Ocho Rios in 1997, and Kingston in 1999. A structured program provided training and technical assistance to nurses, food and beverage staff, and environmental sanitation personnel in the implementation of Hazard Analysis Critical Control Point principles for monitoring food safety standards. The impact of interventions on TD was assessed in a survey of tourists departing from the international airport in Montego Bay in 1997–1998 and from the international airport in Kingston in 1999–2000. The impact of the training and technical assistance program on food safety standards and practices was assessed in hotels in Ocho Rios as of 1998 and in Kingston from 1999. Results At the end of May 2002, TD incidence rates were 72% lower than in 1996, when the Ministry of Health initiated its program for the prevention and control of TD. Both hotel surveillance data and airport surveillance data suggest that the vast majority of travelers to Kingston and southern regions are not afflicted with TD during their stay. The training and technical assistance program improved compliance to food safety standards over time. Conclusion Interventions to prevent and control TD in visitors to Jamaica are positively associated with a reduction in TD in the visitor population and improvements in food safety standards and practices in hotels.

Although rotavirus infections are generally considered to be confined to the intestine, recent reports suggest that extraintestinal disease occurs. We studied whether rotavirus infection was associated with antigenemia during a major outbreak of gastroenteritis in the Kingston metropolitan area, during July-August 2003. Rotavirus antigen was identified in 30 of 70 acute-phase serum samples (including from 2 deceased individuals) but in only 1 of 53 control samples. Serum antigen levels were inversely associated with time since symptom onset and were directly associated with antigen levels in stool (P = .02). Serum antigen levels were significantly elevated during primary infections (acute-phase serum immunoglobulin G [IgG] titers,25), compared with those in subsequent infections (acute-phase serum IgG titers,or = 25) (P = .02). Antigenemia was common in this outbreak and might provide a mechanism to help explain rare but well-documented reports of findings of extraintestinal rotavirus. In situations in which stool samples are not readily available (i.e., patients with severe dehydration or those recently recovered or deceased), serum testing by enzyme immunoassay offers a new and practical diagnostic tool.

As part of the reproductive health quality assurance programme, the Ministry of Health sought to review maternal deaths in public hospitals. These hospitals attend 95% of institutional births and 82% of all births.Deaths among females 10-50 years in public hospitals during 1993-1995 were reviewed to identify pregnancy-related deaths. Cause of death and access to care were compared with previous studies (1981-1983 and 1986-1987 [12 months]).The maternal mortality ratio of 106.2 per 100 000 live births, was no different than the 119.7 observed in 1986-1987 and 118.6 for 1981-1983. The leading causes of death remained pre-eclampsia/eclampsia and haemorrhage. The only significant cause-specific decline occurred among deaths due to ruptured ectopic pregnancy (P = 0.012). While in 1986-1987 access to care was associated with risk of death from gestational hypertension (P = 0.02), these differences are no longer significant. Differences persist, however, for haemorrhage and all other causes, which were less likely to occur at the more skilled institutions. The region with the least obstetricians had the highest mortality ratio but the one with the most did not have the lowest ratio, indicating that quality is more important than quantity.Regional differences indicate the capacity to reduce maternal mortality by at least 50% with re-allocation of skilled personnel and improved quality. All hospitals must be able to manage haemorrhage cases as patients are unlikely to survive referral.

This article uses data from the United States, Jamaica, Malaysia, and Bangladesh to explore gender differences in adult health. The results show that women fare worse than men across a variety of self-reported health measures in all four countries studies. These health status disparities between men and women persist even after appropriate corrections are made for the impact of (a) differential mortality selection by gender and (b) sociodemographic factors. Data from Jamaica indicate that gender disparities in adult health arise early and persist throughout the life cycle, with different age profiles for different measures.The US, Jamaica, Malaysia, and Bangladesh have different levels of socioeconomic development, life styles, gender norms, and expectations. The authors use survey data on measures of general health and physical functioning by age and gender in their study of differential gender patterns in adult health and their determinants. The study found that there are significant gender differences in adult health, with women faring worse than men across a variety of measures in all four countries studied. Health status disparities between the sexes persist even after correcting for the impact of differential mortality selection by gender and sociodemographic factors such as age, education, income, and location of respondent. Biological factors, behavioral factors, and reporting biases have all been suggested as explanations for these gender differences in adult ill health. Given the consistency of the gender disparity in adult ill health across different measures and countries with different levels of education, income, life styles, and norms and expectations about behavior as illustrated in this study, however, reporting bias is most likely not a major cause of gender differentials in adult health. The fact that significant gender differentials in adult health persist despite controlling for sociodemographic characteristics points instead to the need for further research into the behavioral and biological bases of the differentials.

This paper traces the history of epidemics of poliomyelitis in Jamaica from 1954 to 1982 the Governments policies and strategies for immunization the consequences and implications for the future. The prevalence of communicable diseases in the English speaking Caribbean has declined considerably over the last 2 decades creating a false sense of security and complacency in implementing continuous preventive measures such as immunization. Poliomyelitis is 1 such case. The last case of paralytic poliomyelitis was reported in Jamaica in 1969. 12 years later the Ministry of Health announced the outbreak of poliomyelitis in the parish of St. James. The Virology Laboratory had identified the Type I virus as the causative agent. Despite all the recommendations of public health officials and an officially accepted policy on immunization full immunization coverage of children 0-4 years did not exceed 50% at any time during 1964 and 1982. The rapid dissemination of 2 doses of oral polio vaccine at 6-week intervals during the mass campaign to over 70% of the child population effectively brought the outbreak under control and limited the spread of disease. Maternal Child Health clinics and the school health program now routinely give a minimum of 3 doses of OPV to all children under 10 years of age during the next 18 months. Supportive legislation and an ongoing public education program will be required to achieve and maintain a level of 80% coverage in the child population.