Objective: To estimate the prevalence and correlates of overweight and obesity among children six to ten years old in the North-East Health Region (NEHR) of Jamaica.Methods: Weights and heights were measured in a representative sample of 5710 children between the ages of six and ten years in 34 schools between October 2008 and March 2009.Overweight and obesity were defined as body mass index (BMI) Z-score >1SD and >2SD, respectively based on the World Health Organization (WHO)-endorsed age and gender-specific growth standards for children.Point prevalence estimates of overweight and obesity were calculated.Odds ratios (OR) and 95% confidence intervals (CI) were used to estimate associations between overweight and obesity and age, gender and school location.Results: Overweight and obesity prevalence among children six to ten years old in NEHR, Jamaica, was 10.6% and 7.1%, respectively.Overweight (OR = 1.11, 95% CI: 1.04, 1.18) and obesity (OR = 1.17, 95% CI: 1.08, 1.26) prevalence increased significantly with age.Overweight (OR = 1.51, 95% CI: 1.27, 1.80) and obesity (OR = 1.36, 95% CI: 1.11, 1.67) prevalence was significantly higher among girls than boys.Children attending rural-public schools had less risk of being overweight (OR = 0.57, 95% CI: 0.46, 0.70) and obese (OR = 0.35, 95% CI: 0.28, 0.44) when compared with urban-public schools and private schools.Both overweight (OR = 2.11, 95% CI: 1.60, 2.78) and obesity (OR = 1.68, 95% CI: 1.24, 2.28) were significantly more common among children attending private schools.After adjusting for age and gender, the results still remained statistically significant.Conclusions: Overweight/obesity prevalence among children six to ten years old in NEHR of Jamaica is 17.7% with older children and girls having higher rates.Children attending urban-public and private schools have higher prevalence than those attending rural schools.Appropriately targeted interventions are needed to combat this problem.

OBJECTIVE:To evaluate the effect of a preventative intervention in Jamaican basic schools on child behaviour and parent-teacher contacts.DESIGN AND METHODS:Five basic schools in Kingston, Jamaica, were randomly assigned to an intervention (n = 3) or control (n = 2) condition. Intervention involved seven whole-day teacher workshops using the Incredible Years Teacher Training Programme supplemented by fourteen lessons on social and emotional skills in each class. Within each classroom (n = 27), children were screened for behaviour difficulties through teacher report and children with the greatest difficulties were selected for evaluation of outcomes (135 children). Teachers'reports of child behaviour using the Strengths and Difficulties Questionnaire and of the quality of teacher-parent contacts were collected at the beginning and end of the school year Multilevel regression analyses controlling for school and classroom were used to evaluate the effects of intervention on child behaviour.RESULTS:Significant benefits of intervention were found for children's conduct problems (regression coefficient (b) = -0.62, 95% confidence interval (CI): -0.01, -1.23), hyperactivity (b = -0.84, 95% CI: -1.57, -0.11) and peer problems (b = -1.24, 95% CI: -1.89, -0.59). The effect sizes were 0.26 for conduct problems, 0.36 for hyperactivity and 0.71 for peer problems. No significant benefits were found for the prosocial and emotional problems subscales. The intervention also resulted in increases in the number of positive teacher-parent contacts (p < 0.0001). No benefits were found for the number of negative teacher-parent contacts.CONCLUSION:This is a promising approach for reducing children's externalizing behaviour and peer problems and for improving the quality of teachers' contacts with parents of children with behaviour problems.

BACKGROUND School-based interventions involving teacher and/or child training have been shown to benefit teacher practices and to prevent conduct problems and improve children's social and emotional competence in developed countries; however, we are aware of no reports from a developing country. We conducted a pilot study of the Incredible Years Teacher Training programme and a curriculum unit on social and emotional skills based on concepts and activities drawn from the Incredible Years Dina Dinosaur Classroom Curriculum to determine if this approach is appropriate for use with Jamaican pre-school teachers and children. METHODS Five pre-schools in Kingston, Jamaica were randomly assigned to an intervention (3 pre-schools with 15 classrooms) or control (2 pre-schools with 12 classrooms) condition. Intervention involved seven whole-day teacher workshops using the Incredible Years Teacher Training programme supplemented by 14 child lessons in each class. The project was evaluated through structured observations of four categories of teacher behaviour and four observer ratings: two rating scales of child behaviour and two rating scales of classroom atmosphere. RESULTS Significant intervention benefits were found to teachers' behaviour with increased positive behaviour [b = 7.9; 95% confidence interval (CI): 3.5, 12.3], reduced negative behaviour (b =-3.5; 95% CI: -6.6, -0.2) and increases in the extent to which teachers promoted children's social and emotional skills (b = 46.4; 95% CI: 11.0, 81.7). The number of teacher commands was not significantly reduced (b =-2.71; 95% CI: -6.01, 0.59). Significant intervention benefits were found to ratings of child behaviour with an increase in children's appropriate behaviour (b = 5.7, 95% CI: 1.0, 10.8) and in children's interest and enthusiasm (b = 7.2, 95% CI: 0.9, 13.5). Intervention also benefited classroom atmosphere with increases in opportunities provided for children to share and help each other (b = 1.3, 95% CI: 0.5, 2.1) and in teacher warmth (b = 1.3, 95% CI: 0.9, 1.8). CONCLUSION This is a promising approach for improving the emotional climate of Jamaican pre-school classrooms and for improving child behaviour and participation.

Aim: To determine the effect of early childhood stimulation with undernourished children and their mothers on maternal depression.Methods: Mothers of 139 undernourished children (weight for age <= -1.5 z-scores) aged 9 - 30 months were recruited from 18 government health centres in the parishes of Kingston, St Andrew, and St Catherine, Jamaica. They received weekly home visits by community health aides for one year. Mothers were shown play activities to do with their child using home made materials, and parenting issues were discussed. Frequency of maternal depressive symptoms was assessed by questionnaire. Child development was also measured.Results: Mothers in the intervention group reported a significant reduction in the frequency of depressive symptoms (b = -0.98; 95% CI -1.53 to -0.41). The change was equivalent to 0.43 SD. The number of home visits achieved ranged from 5 to 48. Mothers receiving >= 40 visits and mothers receiving 25 - 39 visits benefited significantly from the intervention ( b = -1.84, 95% CI -2.97 to -0.72, and b = -1.06, 95% CI -2.02 to -0.11, respectively) while mothers receiving < 25 visits did not benefit. At follow up, maternal depression was significantly negatively correlated with children's developmental quotient for boys only.Conclusions: A home visiting intervention with mothers of undernourished children, with a primary aim of improving child development, had significant benefits for maternal depression. Higher levels of maternal depression were associated with poorer developmental levels for boys only.

Objectives To assess the feasibility of integrating early psychosocial stimulation into primary care for undernourished children and to determine the effect on children's development and mothers' knowledge and practices of childrearing.Design Cluster randomised controlled trial.Setting 18 clinics in three Jamaican parishes.Participants 139 undernourished children aged 9 to 30 months and their mothers enrolled in intervention or control clinics.Interventions Weekly home visits by community health aides for one year in addition to usual duties. Parenting issues were discussed with die mothers and play activities were demonstrated with the children using homemade materials.Main outcome measures Children's scores on the Griffiths mental development scales and mothers' knowledge and practices of childrearing.Results Children from the intervention group showed significant improvements in development: developmental quotient, 7.8 points (95% confidence interval 4.5 to 11.1); hearing and speech, 10.7 points (5.9 to 15.4); hand and eye coordination, 6.8 points (3.4 to 10.1); and performance subscale, 11.0 points (5.6 to 16.4). No improvements were shown on the locomotor subscale. The mothers from the intervention group showed improved knowledge and practices of childrearing. Change in body mass index and height independently affected change in development.Conclusion Integrating parenting skills and early psychosocial stimulation for undernourished children into primary care was feasible and effective in improving the children's development and mothers' knowledge and practices of childrearing.

Objective : To compare mothers of undernourished children with mothers of adequately nourished children on maternal depression, parenting self-esteem, social support and exposure to stressors and to determine if these variables are independently related to undernutrition and stimulation provided in the home after controlling for socio-economic status. Design : A case control study. Setting : Children and their mothers were recruited from 18 government health centres in the Kingston, St Andrew and St Catherine parishes of Jamaica. Subjects : One hundred and thirty-nine mothers of undernourished children (WAZ≤−1.5 z scores) aged 9 – 30 months and 71 mothers of adequately nourished children (WAZ > −1 z scores) matched for sex and age group were enrolled into the study. Results : Mothers of undernourished children came from poorer homes but had similar social support to mothers of adequately nourished children. They were more depressed, had lower levels of parenting self-esteem (both P <0.01), reported higher levels of economic stress ( P <0.001) and provided a less stimulating home environment ( P <0.05). However, after controlling for social background variables there was no independent relationship between either psychosocial function or home stimulation and nutritional status. Undernutrition was found to be mainly explained by economic factors. The mothers' self-esteem was independently associated with the level of stimulation provided to the child. Conclusions : When caring for undernourished children attention should be paid to the psychosocial status of the mother as well as the physical condition of the child. Sponsorship : Thrasher Research Fund; Campus Research and Publication Fund, UWI, Jamaica

The relationship between physical growth and change in mental development on the Griffiths mental development scales was investigated in 127 stunted Jamaican children over a 2‐year period. The role of nutritional supplementation in this relationship was examined. There were no consistent associations between changes in weight‐for‐height or head circumference and developmental change. Height gain over 2 years was significantly associated with change in mental age, and locomotor and hearing and speech subscale scores. Height gain in the first year predicted change in mental age, and hearing and speech in the second year. Some of the effect of supplementation on development was shared with linear growth. Therefore, nutrition probably explains part of the relationship between growth and development. However, supplementation also had effects on development independent of growth. The benefits of supplementation on development and the extent to which they were shared with growth varied among the subscales.

18 severely malnourished children (IM) who participated in a 3-year home-visiting program were compared with 2 other comparison groups comprising 17 severely malnourished (NIM) and 19 adequately nourished children (controls). On enrollment, all the groups were in the same hospital, and both malnourished groups had lower developmental levels than the controls. The IM group received intervention for 3 years after hospitalization, consisting of weekly or 2 weekly home visits with toy demonstrations. At 7, 8, 9, and 14 years after leaving the hospital, the 3 groups were compared on tests of school achievement and IQ. The NIM group showed no sign of reducing their deficits, and at the 14-year follow-up they had markedly lower scores on the WISC verbal and performance scales, the Wide Range Achievement Test (WRAT), and the Peabody Picture Vocabulary Test (PPVT), than the controls. Throughout the follow-up the IM group's scores were intermediate between the NIM and the controls in every test. At the 14-year follow-up, their scores were significantly higher than those of the NIM group in the WISC verbal scale, and the difference approached significance in the WRAT. We conclude that psychosocial intervention should be an integral part of treatment for severely malnourished children.

Bioelectrical impedance (BIA) and anthropometric measurements were taken of 129 stunted and 32 non-stunted children aged 9-24 months in Kingston, Jamaica. The reliability of BIA in such young children was examined and the relationships between impedance and anthropometry were determined. The stunted children had significantly lower body mass index (BMI) and smaller triceps skinfolds than the non-stunted children, suggesting differences in body composition between the groups. Resistance was significantly higher in the stunted children than the non-stunted children and nutritional group (stunted or non-stunted) contributed significantly to the variance in resistance after controlling for length, weight, mid-upper arm circumference, triceps and subscapular skinfolds, age and sex. This suggests that there were differences in body composition and/or body shape between the groups beyond that measured by the anthropometric indices used. Total body water (TBW) was estimated using an equation for Jamaican children of comparable age. As a percentage of body weight the TBW estimates were the same for the two groups, a finding which is inconsistent with the anthropometric data.

The 1st 12 months of a study on the effects of nutritional supplementation on the development of stunted children have been completed. Low height-for-age (stunting) is the most prevalent form of childhood undernutrition in developing countries. Poor levels of development usually accompany stunting. It is not certain whether this is due to socioeconomic disadvantage undernutrition or both. The supplement--1 kg full of cream powdered milk for the child and 1 kg skim milk and cornmeal for other family members--was given alone or combined with psychosocial stimulation. 128 stunted children (height more than 2 standard deviation (SD) below US standards) age 9 to 24 months from poor neighborhoods in Kingston Jamaica were randomly assigned to 4 treatment groups: 1) control 2) nutritional supplementation; 3) stimulation and 4) both. A 5th group of 32 nonstunted children matched for age and sex from the same neighborhoods was also studied. All children had Griffiths developmental and anthropometric assessments when they enrolled and 6 and 12 month later. At the beginning the nonstunted groups mean developmental quotient (DQ) was significantly higher than any of the other groups. During the 12 months the control groups DQ declined 6.7 DQ points. The nonstunted group declined 3.2 DQ points. A decline is expected in deprived children this age in Kingston. Supplementation had a significant benefit on height. Both stimulation and supplementation had small but significant benefits on development. The group that received both treatments benefitted most; the effects being additive not interactive. Improving childrens growth through home nutritional supplementation is very difficult. The developmental gains reported here occurred with only small gains in growth. Nutritional supplementation does have a small benefit on stunted childrens development independent of stimulation. Part of the association between stunting and poor development can be attributed to undernutrition. Both interventions are required to make a substantial improvement in stunted childrens development.

Two studies were made of home visiting and psychosocial stimulation with deprived urban children in Jamaica. The aim was to determine the relative effectiveness of different frequencies of visiting on the children's developmental levels and the feasibility of integrating the model into government primary health care services. Health paraprofessionals supervised by a nurse from a local health center conducted the intervention. In the first study, 152 children aged 6 to 30 months were assigned to groups visited biweekly, monthly, or not at all by area of residence. The biweekly group showed small but significant increases in scores on the Griffiths Mental Development Scales (developmental quotient) and performance subscale compared with the monthly and control groups, whereas no benefit was shown in the Griffiths scores of the monthly group. In the second study, 58 children aged 16 to 30 months from the same neighborhoods were randomly assigned to weekly visited and control groups. The group visited weekly showed marked improvements in the performance and hearing and speech subscales as well as the developmental quotient scores. The results indicate that as the frequency of visiting increases from none through monthly and biweekly to weekly, the benefits increase as well.

We evaluated the effects of giving the standard Jamaican government school meal to a class of school children. Unlike many other school-feeding studies, this project was carefully controlled and carried out with undernourished children who had low levels of school attendance and achievement. In spite of this, no improvement was found in the children's nutritional status as reflected by weight for age. However, small benefits were found in attendance and school achievement. These findings remained when sex, age, improvements over the previous term, and the effects of 'benevolent attention' were taken into account.