ABSTRACT

Over the last six decades, comprehensive national health surveys have become important datagathering mechanisms to inform countries on their health status and provide information for health policy and programme planning. Developing countries have only recently begun such surveys and Jamaica has been at the forefront of this effort. Jamaica's Reproductive Health Surveys and programme response to their findings have resulted in an almost 50% reduction in fertility rates over three decades as well as a 40% reduction in unmet contraceptive needs and a 40% reduction in unplanned pregnancies over the last two decades. The Jamaica Health and Lifestyle Surveys have served to reinforce the major burden that non-communicable diseases place on the society and the extent to which these are driven by unhealthy lifestyles. These surveys have shown that obesity, hypertension, diabetes and dyslipidaemia affect approximately 50%, 25%, 10% and 10% of the adult population, respectively. These surveys have documented low rates of treatment and control for these chronic non-communicable diseases despite two major policy initiatives, the National Programme for the Promotion of Healthy Lifestyles and the creation of the National Health Fund which subsidizes healthcare provision for chronic diseases. In order to maximize the uptake of the findings of future surveys into effective health policy, there will need to be effective collaborations between academia, policy-makers, regional and international health agencies, non-government organizations and civil society. Such collaborations should take into account the social, political and economic issues, thus ensuring a more comprehensive approach to health policy and result in improvement of the nation's health status and by extension national development.

BackgroundFaster growth velocity during childhood may increase blood pressure (BP) in adults, but there are little data from African-origin populations. We evaluated the effect of postnatal linear growth (increase in height) and change in body mass index (BMI) from birth to adolescence on systolic and diastolic blood pressure (SBP and DBP) in Afro-Caribbean youth.MethodsWe used data from the Vulnerable Windows Birth Cohort Study in Jamaica. Children were followed from birth, with periodic anthropometric measurements. BP measurements started at age 1-year and every six months thereafter. Analyses used BP measurements (mmHg) from age 15-21 years. Linear growth and change in BMI measurements were calculated for: early infancy (0-6 months), late infancy (6 months - 2 years), early childhood (2-8 years), and later childhood (8-15 years). Conditional analyses were used to compute growth rates (as z-scores). Linear mixed models were used to estimate the effect of growth rates on BP.ResultsAnalyses included 365 individuals (162 males, 203 females) with mean age 16.7 years. In multivariable models, after adjustment for age, sex, birth length, gestational age and BMI at age 15 years, faster linear growth for early infancy (β=1.06, p=0.010) was significantly associated with higher SBP. For change in BMI, after adjustment for age, sex, gestational age, height and SES at birth, significant associations of higher SBP were seen for greater increase in BMI in late infancy (β=1.41, p=0.001), early childhood (β=1.22, p=0.001) and later childhood (β=0.74, p=0.035). Faster post-natal linear growth had no significant associations with DBP, but greater increase in BMI for each of the late infancy to late childhood periods was significantly associated with higher DBP. When both growth rates were modeled together, rate of change of BMI and faster linear growth in early infancy retained significance for SBP, but only change in BMI retained significance for DBP.ConclusionFaster linear growth and greater rate of increase in BMI were associated with higher SBP and DBP in Afro-Caribbean youth, but the BMI effect was stronger.