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Background 25 hydroxyvitamin D [25(OH)D] and serum calcium have been associated with incident prostate cancer (PCa). However, there is limited data on whether these metabolites predict survival in men of African descent, a population disproportionately affected by PCa. We studied the relationship of 25(OH)D at PCa diagnosis with all-cause and cancer-specific mortality among Jamaican men and examined whether serum calcium modified any associations. Methods Serum 25(OH)D from 152 Jamaican men with incident PCa within the Prostate Cancer Risk Evaluation (PROSCARE) study were re-evaluated approximately 11 years after enrollment. 25(OH)D analyses were stratified using the using Holick criteria. PCa-specific and all-cause mortality were examined in Kaplan–Meier survival curves and Cox regression models adjusted for age, body mass index (BMI), smoking and Gleason score. Restricted cubic splines evaluated nonlinear associations. Serum calcium was assessed as an effect modifier of the association between 25(OH)D and mortality. Results Of cases with available 25(OH)D, 64 men with PCa survived, 38 deaths were PCa specific and 36 died of other causes. At baseline, 9.9% of cases were vitamin D deficient and 61.2% were vitamin D sufficient. Compared to 25(OH)D sufficient men, those with 25(OH)D

The Ja-Kids Longitudinal Study (JA-Kids) aims to improve the health and development of Jamaican children by identifying social, demographic, environmental and clinical factors that help or hinder these processes. As clinical indicators relied on maternal reporting, we aim to evaluate the quality of the self-reported data. Women were recruited across Jamaica during pregnancy or at delivery from July 1–30 September 2011. Indicators were compared between women recruited while pregnant and at delivery to understand possible differences between the sub-populations. Variables reported more than once between pregnancy and delivery were assessed to evaluate level of agreement (reliability). Clinical indicators from the literature were contrasted with study findings to determine how maternal reporting align with published prevalence (validity). Intra-class correlation and the kappa (κ) statistic were used to assess reliability while chi-squared, Fisher's-exact or students-t were used to compare differences over time; p values ≤0.05 were considered statistically significant. Women recruited during pregnancy (n = 3970) were younger, less parous and possibly more socially disadvantaged than those recruited at delivery (n = 5803). Socio-demographic and selected clinical indicators showed good to moderate (0.421 < κ < 0.681) reporting consistency between pregnancy and delivery for previous C-section (κ = 0.681), pre-existing diabetes mellitus (κ = 0.616) and prior twin gestations (0.580). Most conditions however showed only fair agreement (0.21 < κ < 0.40) including previous gestational hypertension (κ = 0.387), asthma (κ = 0.365), premature rupture of membranes (κ = 0.324), eclampsia (κ = 0.257) and essential hypertension (κ = 0.213). Infectious conditions had poor reliability. Prevalence rates for most conditions, except sickle cell disease, were lower than the published literature. Complications and outcomes which were well defined for women were better reported than those requiring clinical judgment (e.g. prior C-section versus specific hypertensive disorders of pregnancy). NCDs with only episodic acute effects were not well reported, e.g. asthma, hypertension and sickle cell disease. Maternal reporting of pregnancy complications needs to be interpreted with caution. [ABSTRACT FROM AUTHOR]

Abstract Plain English summary The World Health Organization (WHO) provides a framework (ICD-MM) to classify pregnancy-related deaths systematically, which enables global comparison among countries. We compared the classification of pregnancy-related deaths in Suriname by the attending physician and by the national maternal death review (MDR) committee and among the MDR committees of Suriname, Jamaica and the Netherlands. There were 89 possible pregnancy-related deaths in Suriname between 2010 and 2014. Nearly half (47%) were classified differently by the Surinamese MDR committee as compared to the classification of the attending physicians. All three MDR committees agreed that 18% (n = 16/89) of the cases were no maternal deaths. Out of the remaining 73 cases, there was disagreement regarding whether 15% (n = 11) were maternal deaths. The Surinamese and Jamaican MDR committees achieved greater consensus in classification than the Surinamese and the Netherlands MDR committees. The Netherlands MDR committee classified more deaths as unspecified than Surinamese and the Jamaican MDR committees. Underlying causes that achieved a high level of agreement among the three committees were abortive outcomes and obstetric hemorrhage, while little agreement was reported for unspecified and other direct causes. The issues encountered during maternal death classification using the ICD-MM guidelines included classification of suicide during early pregnancy; when to assume pregnancy without objective evidence; how to count maternal deaths occurring outside the country of residence; the relevance of direct or indirect cause attribution; and how to select the underlying cause when direct and indirect conditions or multiple comorbidities co-occur. Addressing these classification barriers in future revisions of the ICD-MM guidelines could enhance the feasibility of maternal death classification and facilitate global comparison. Background Insight into the underlying causes of pregnancy-related deaths is essential to develop policies to avert preventable deaths. The WHO International Classification of Diseases-Maternal Mortality (ICD-MM) guidelines provide a framework to standardize maternal death classifications and enable comparison in and among countries over time. However, despite the implementation of these guidelines, differences in classification remain. We evaluated consensus on maternal death classification using the ICD-MM guidelines. Methods The classification of pregnancy-related deaths in Suriname during 2010–2014 was compared in the country (between the attending physician and the national maternal death review (MDR) committee), and among the MDR committees from Suriname, Jamaica and the Netherlands. All reviewers applied the ICD-MM guidelines. The inter-rater reliability (Fleiss kappa [κ]) was used to measure agreement. Results Out of the 89 cases certified by attending physicians, 47% (n = 42) were classified differently by the Surinamese MDR committee. The three MDR committees agreed that 18% (n = 16/89) of these cases were no maternal deaths, and, therefore, excluded from further analyses. However, opinions differed whether 15% (n = 11) of the remaining 73 cases were maternal deaths. The MDR committees achieved moderate agreement classifying the deaths into type (direct, indirect and unspecified) (κ = 0.53) and underlying cause group (κ = 0.52). The Netherlands MDR committee classified more maternal deaths as unspecified (19%), than the Jamaican (7%) and Surinamese (4%) committees did. The mutual agreement between the Surinamese and Jamaican MDR committees (κ = 0.69 vs κ = 0.63) was better than between the Surinamese and the Netherlands MDR committees (κ = 0.48 vs κ = 0.49) for classification into type and underlying cause group, respectively. Agreement on the underlying cause category was excellent for abortive outcomes (κ = 0.85) and obstetric hemorrhage (κ = 0.74) and fair for unspecified (κ = 0.29) and other direct causes (κ = 0.32). Conclusions Maternal death classification differs in Suriname and among MDR committees from different countries, despite using the ICD-MM guidelines on similar cases. Specific challenges in applying these guidelines included attribution of underlying cause when comorbidities occurred, the inclusion of deaths from suicides, and maternal deaths that occurred outside the country of residence.

Abstract Background The World Health Organization’s definition of maternal morbidity refers to “a negative impact on the woman’s wellbeing and/or functioning”. Many studies have documented the, mostly negative, effects of maternal ill-health on functioning. Although conceptually important, measurement of functioning remains underdeveloped, and the best way to measure functioning in pregnant and postpartum populations is unknown. Methods A cross-sectional study among women presenting for antenatal (N = 750) and postpartum (N = 740) care in Jamaica, Kenya and Malawi took place in 2015–2016. Functioning was measured through the World Health Organization Disability Assessment Schedule (WHODAS-12). Data on health conditions and socio-demographic characteristics were collected through structured interview, medical record review, and clinical examination. This paper presents descriptive data on the distribution of functioning status among pregnant and postpartum women and examines the relationship between functioning and health conditions. Results Women attending antenatal care had a lower level of functioning than those attending postpartum care. Women with a health condition or associated demographic risk factor were more likely to have a lower level of functioning than those with no health condition. However, the absolute difference in functioning scores typically remained modest. Conclusions Functioning is an important concept which integrates a woman-centered approach to examining how a health condition affects her life, and ultimately her return to functioning after delivery. However, the WHODAS-12 may not be the optimal tool for use in this population and additional components to capture pregnancy-specific issues may be needed. Challenges remain in how to integrate functioning outcomes into routine maternal healthcare at-scale and across diverse settings.

Summary: Background: Sickle cell disease (SCD) affects 2.8% of Jamaican antenatal women. Between 1998–2007 their maternal mortality ratio was 7–11 times higher than women without these disorders. We aim to determine if outcomes improved between 2008 and 17 amid declining fertility and changes in referral obstetric care. Methods: Maternal deaths in Jamaica's maternal mortality surveillance database (assembled since 1998) with SCD reported as underlying or associated cause of death were compared to those without known SCD, over two decades from 1998 to 2017. Social, demographic and health service variables were analysed using SPSS and EpiInfo Open. Findings: Over the two decades from 1998 to 2017, 806 (74%) of the 1082 pregnancy-associated deaths documented by the Jamaican Ministry of Health and Wellness were maternal deaths. The maternal mortality ratio (MMR) did not statistically change over the two periods for women with (p = 0.502) and without SCD (p = 0.629). The MMR among women with and without SCD in 2008–17 was 378.1 (n = 41) and 89.2/100,000 live births (n = 336) respectively, an odds ratio of 4.24 (95% CI: 3.07–5.87). When deaths due to their blood disorders were excluded, risk remained elevated at 2.17 (95% CI: 1.36–3.32). There was an upward trend in direct deaths over the two decades (p [trend]=0.051). Interpretation: MMRs were unchanged over two decades for Jamaicans with SCD. The high contribution to maternal mortality by women with SCD may explain some of the persistently higher mortality experience of women in the African diaspora. Multi-disciplinary evidence-based strategies need to be developed and tested which improve survival for women with SCD who want to have children. Funding: No external funding was provided.

OBJECTIVE: To estimate the economic cost of Chronic Non-Communicable Diseases (CNCDs) and the portion attributable to obesity among patients in Jamaica. METHODS: The cost-of-illness approach was used to estimate the cost of care in a hospital setting in Jamaica for type 2 diabetes mellitus, hypertension, coronary heart disease, stroke, gallbladder disease, breast cancer, colon cancer, osteoarthritis, and high cholesterol. Cost and service utilization data were collected from the hospital records of all patients with these diseases who visited the University Hospital of the West Indies (UHWI) during 2006. Patients were included in the study if they were between15 and 74 years of age and if female, were not pregnant during that year. Costs were categorized as direct or indirect. Direct costs included costs for prescription drugs, consultation visits (emergency and clinic visits), hospitalizations, allied health services, diagnostic and treatment procedures. Indirect costs included costs attributed to premature mortality, disability (permanent and temporary), and absenteeism. Indirect costs were discounted at 3% rate. RESULTS: The sample consisted of 554 patients (40%) males (60%) females. The economic burden of the nine diseases was estimated at US$ 5,672,618 (males 37%; females 63%) and the portion attributable to obesity amounted to US$ 1,157,173 (males 23%; females 77%). Total direct cost was estimated at US$ 3,740,377 with female patients accounting for 69.9% of this cost. Total indirect cost was estimated at US$ 1,932,241 with female patients accounting for 50.6% of this cost. The greater cost among women was not found to be statistically significant. Overall, on a per capita basis, males and females accrued similar costs-of-illness (US$ 9,451.75 vs. US$ 10,758.18). CONCLUSIONS: In a country with per capita GDP of less than US$ 5,300, a per capita annual cost of illness of US$ 10,239 for CNCDs is excessive and has detrimental implications for the health and development of Jamaica.

Antenatal depression is associated with adverse maternal and infant well-being. However, compared to postpartum depression, it has been less frequently explored globally or in Jamaica. This study aimed to determine the prevalence of, and factors associated with, antenatal depressive symptoms among Jamaican women in order to inform policy and build interventions that could improve their management and reduce their negative consequences.This secondary analysis of data from the second Jamaican Birth Cohort Study (JA-Kids Birth Cohort) included 3,517 women enrolled during pregnancy. Information was extracted from interviewer-administered questionnaires which recorded social, demographic, medical and obstetric information during pregnancy. The Edinburgh Postnatal Depression scale (EPDS) was used to screen for depression, with scores ≥13 considered indicative of a high likelihood of depression. Bivariate analysis examined associations between depressive symptoms and: age, income, financial difficulties, perceived social support, perceived partner infidelity, previous child-bearing unions and children with the current partner. Obstetric factors were also explored and included gravidity, prior adverse pregnancy outcome and complications from previous pregnancies. Variables that predicted the likelihood of depression based on an EPDS cut score of 13 were evaluated using logistic regression.One in five participants (19.6%; 95% CI 18.3-20.9%) had a high likelihood of antenatal depression (EPDS ≥13). Significant predictors of high depressive symptom severity included four indicators of poor perceived social and partner support [ORs (95% CI) ranged from: 1.61 (1.07-2.43); p = 0.024 to 3.14(1.69-5.84); p< 0.001], perceived partner infidelity [1.86 (1.36, 2.54); p

Obesity is rising globally and is associated with increased risk of adverse pregnancy outcomes. This study aims to investigate overweight and obesity and its consequences among Jamaican women of reproductive age, particularly development of diabetes, hypertension and the risk of maternal death.A national lifestyle survey (2007/8) of 1371 women of reproductive age provided data on the prevalence of high BMI, associated risk factors and co-morbidities. A national maternal mortality surveillance database (1998-2012) of 798 maternal deaths was used to investigate maternal deaths in obese women. Chi-squared and Fisher exact tests were used.High BMI (> = 25kg/m2) occurred in 63% of women aged between 15 and 49 years. It was associated with increasing age, high gravidity and parity, and full time employment (p

Are skilled birth attendants really skilled? A measurement method, some disturbing results and a potential way forward/Les << accoucheurs/euses qualifies/es >> ont-ils/elles reellement les competences pour pratiquer des accouchements? Presentation d&apos;une methode de mesure de ces competences, de certains resultats deangeants et d&apos;une voie de progression potentielle/[??]Que tan calificados estan los asistentes de parteria calificados? Objective Delivery by a skilled birth attendant (SBA) serves as an indicator of progress towards reducing maternal mortality worldwide--the fifth Millennium Development Goal. Though WHO tracks the proportion of women delivered by SBAs, we know little about their competence to manage common life-threatening obstetric complications. We assessed SBA competence in five high maternal mortality settings as a basis for initiating quality improvement. Methods The WHO Integrated Management of Pregnancy and Childbirth (IMPAC) guidelines served as our competency standard. Evaluation included a written knowledge test, partograph (used to record all observations of a woman in labour) case studies and assessment of procedures demonstrated on anatomical models at five skills stations. We tested a purposive sample of 166 SBAs in Benin, Ecuador, Jamaica and Rwanda (Phase I). These initial results were used to refine the instruments, which were then used to evaluate 1358 SBAs throughout Nicaragua (Phase II). Findings On average, Phase I participants were correct for 56% of the knowledge questions and 48% of the skills steps. Phase II participants were correct for 62% of the knowledge questions. Their average skills scores by area were: active management of the third stage of labour--46%; manual removal of placenta--52%; bimanual uterine compression--46%; immediate newborn care--71%; and neonatal resuscitation--55%. Conclusion There is a wide gap between current evidence-based standards and provider competence to manage selected obstetric and neonatal complications. We discuss the significance of that gap, suggest approaches to close it and describe briefly current efforts to do so in Ecuador, Nicaragua and Niger. Resume Les << accoucheurs/euses qualifies/es >> ont-ils/elles reellement les competences pour pratiquer des accouchements? Presentation d&apos;une methode de mesure de ces competences, de certains resultats deangeants et d&apos;une voie de progression potentielle Objectif Le taux d&apos;accouchement par un accoucheur qualifie sert dans le monde entier d&apos;indicateur des progres realists dans la reduction de la mortalite maternelle (cinquieme objectif du Millenaire pour le deeloppement). Si l&apos;OMS suit la proportion de femmes accouchees par des accoucheurs qualifies, eile sait peu de choses sur la capacite de ces agents de sante a prendre en charge des complications obstetricales courantes potentiellement fatales. Nous avons evalue les competences de ces accoucheurs dans cinq etablissements presentant une forte mortalite maternelle, en tant que point de depart pour une amelioration de la qualite des prestations. Methodes Les directives de la Prise en charge integree de la grossesse et de l&apos;accouchement de l&apos;OMS (PCIGA) nous ont servi de norme pour l&apos;evaluation des competences. Celle-ci a ete realisee sur la base d&apos;un test de connaissances ecrit, d&apos;etudes de cas utilisant un partographe (appareil capable d&apos;enregistrer l&apos;ensemble des parametres pour une femme en travail) et de la demonstration par les participants de differentes operations sur des modeles anatomiques dans cinq postes d&apos;evaluation des competences. Nous avons teste cette evaluation sur un echantillon choisi a dessein de 166 accoucheurs qualifies du Benin, de l&apos; Equateur, de la Jamaique et du Rwanda (phase I). Les resultats initiaux obtenus ont ete utilises pour perfectionner les instruments d&apos;evaluation, qui ont ensuite ete appliques a 1358 accoucheurs qualifies dans l&apos;ensemble du Nicaragua (phase II). Resultats En moyenne, les participants a la phase I ont fourni une prestation correcte pour 56% des questions de connaissances et pour 48% des etapes de competences. Les participants a la phase II ont repondu correctement a 62% des questions de connaissances. En moyenne, leurs resultats en matiere de competences se repartissaient par domaines comme suit. Prise en charge active du troisieme stade du travail : 46%, retrait manuel du placenta : 52%, compression uterine a deux mains :46%, soins immediats au nouveau-ne :71% et reanimation neonatale :55%. Conclusion II existe un large ecart entre les exigences de la norme actuelle reposant sur une base factuelle et la capacite des prestateurs a prendre en charge certaines complications obstetricales et neonatales. Nous examinons l&apos;importance de cet ecart, proposons des approches pour le combler et decrivons brievement les efforts entrepris dans cette voie en Equateur, au Nicaragua et au Niger. Resumen [??]Que tan calificados estan los asistentes de parteria calificados? Un metodo de medicion, algunos resultados preocupantes y un posible paso adelante Objetivo La atencion del parto por personal de salud calificado es un indicador que valora el progreso realizado para reducir la mortalidad materna a nivel mundial, y que se ve reflejado en el quinto Objetivo de Desarrollo del Milenio. Aunque la OMS sigue de cerca la proporcion de mujeres que dan a luz atendidas por un personal calificado, es poco lo que sabemos sobre su competencia para manejar complicaciones obstetricas comunes potencialmente mortales. Evaluamos la competencia del personal calificado en cinco entornos de alta mortalidad materna como punto de partida para empezar a mejorar la calidad de la asistencia. Metodos El grado de competencia se determino empleando como referencia la guia de la OMS, Manejo integrado del embarazo y el parto (IMPAC). La evaluacion incluyo un examen escrito sobre los conocimientos en la materia, estudios de casos del partograma (registro de variables durante la vigilancia del trabajo de parto) y una evaluacion de la practica demostrada con modelos anatomicos en cinco tipos de aptitudes. Se analizo una muestra intencionada de 166 asistentes calificados en Benin, el Ecuador, Jamaica y Ruanda (fase I). Con esos resultados iniciales se refinaron los instrumentos, que volvieron a ser utilizados para evaluar a 1358 personal calificado a traves de Nicaragua (fase II). Resultados En promedio, los participantes en la fase I contestaron correctamente el 56% de las preguntas sobre los conocimientos teoricos. Asi mismo, desempenaron correctamente el 48% de los pasos de las pruebas practicas. Los participantes en la fase II respondieron correctamente al 62% de las preguntas teoricas. Sus puntuaciones promedias por area de practica fueron las siguientes: manejo activo del tercer periodo del parto, 46%; extraccion manual de la placenta, 52%; compresion uterina bimanual, 46%; atencion inmediata al recien nacido, 71%; y reanimacion neonatal, 55%. Conclusion Existe una brecha importante entre las normas actuales basadas en la evidencia y las aptitudes del personal para manejar determinadas complicaciones obstetricas y neonatales.Tras analizar las implicaciones de esta brecha, se propone medidas para corregirlo y se describe brevemente las actividades que actualmente se lleva a cabo con ese fin en el Ecuador, Nicaragua y el Niger. [TEXT NOT REPRODUCIBLE IN ASCII.], Introduction Background Each year obstetric complications kill over 500 000 women worldwide. (1,2) Skilled attendance during labour, delivery and in the early postpartum period could prevent many of these deaths, [...]

BackgroundDecreases in direct maternal deaths in Jamaica have been negated by growing indirect deaths. With sickle cell disease (SCD) a consistent underlying cause, we describe the epidemiology of maternal deaths in this population.MethodsDemographic, service delivery and cause specific mortality rates were compared among women with (n = 42) and without SCD (n = 376), and between SCD women who died in 1998-2002 and 2003-7.ResultsWomen with SCD had fewer viable pregnancies (p: 0.02) despite greater access to high risk antenatal care (p: 0.001), and more often died in an intensive care unit (p: 0.002). In the most recent period (2003-7) SCD women achieved more pregnancies (median 2 vs. 3; p: 0.009), made more antenatal visits (mean 3.3 vs. 7.3; p: 0.01) and were more often admitted antenatally (p:ConclusionsWomen with SCD experience a significant excess risk of dying in pregnancy and childbirth [MMR: (SCD) 719/100,000, (non SCD) 78/100,000]. MDG5 cannot be realised without improving care for women with SCD. Tertiary services (e.g. ventilator support) are needed at regional centres to improve outcomes in this and other high risk populations. Universal SCD screening in pregnancy in populations of African and Mediterranean descent is needed as are guidelines for managing SCD pregnancies and educating families with SCD.