Page 67 - Demo

Chronic diseases are now the leading causes of illness and death in Jamaica and most Caribbean countries.
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Important findings and implications
The researchers found that there was significant clustering of low levels of physical activity, overweight/obesity and diabetes across Jamaican neighbourhoods. Greater levels of neighbourhood disorder (bad conditions of homes, streets, yards, high noise levels and poor air quality) and counterintuitively recreational space availability were associated with higher levels of physical inactivity among women. Additionally, among men, better neighbourhood infrastructure (paved roads, presence of sidewalks, electricity supply to homes, streetlights, clean streets and recreation areas) were associated with overweight and obesity in men. It was concluded that further studies are needed to better understand the driving forces behind these neighbourhood associations and the reasons for the sex differences. The results also suggest that public health efforts to increase levels of physical activity and reduce both overweight/ obesity and diabetes should include targeted neighbourhood- level interventions.
Arising from these findings, Dr Cunningham-Myrie and her collaborators have recently embarked on a project, dubbed Evaluating Quantitative/Qualitative Issues in Physical Activity in Jamaica (EQUIP-JA). Pilot observational studies evaluating physical activity in two public parks, the Emancipation Park and Papine Park, were completed in July 2015. Based on the preliminary findings, new funding partnerships are being sought to undertake intervention studies at the community level.
The drug, hydroxyurea, is cost-effective in preventing stroke recurrence in children with sickle cell disease Policymakers are particularly interested in the economic aspects of health, especially in resource constrained environments. The information is useful for prioritising which programmes to allocate the limited funds. In Jamaica, health service utilisation and expenditure are significantly higher in children with the Sickle Cell Disease (SCD), a chronic condition, compared to most other paediatric conditions. These children often have multiple strokes that can cause severe disability and even death. The best treatment is repeat blood transfusion, but this is expensive
to maintain in countries with financial constraints such as Jamaica. The drug Hydroxyurea (HU) had been used in Jamaican children with SCD, and significantly reduced stroke recurrence, moderate to severe physical disability and death. However, the drug was not subsidised, and this posed an additional economic burden for the patients and their families.
Dr Cunningham-Myrie collaborated with colleagues from The Sickle Cell Unit, Tropical Medicine Research Institute, UWI and the Department of Economics, UWI, to conduct a cost- effectiveness analysis of HU in preventing stroke recurrence and/or death. They assessed and compared costs for 10 children whose parents consented to the use of HU after the first clinical stroke with 33 whose parents opted not to have them use the drug. The period of assessment was from January 1, 2000 to September 30, 2009.
Results and policy actions taken
The findings were published in the journal, Pediatric, Blood and Cancer. The authors reported that for every case of stroke recurrence prevented by the use of HU, there were savings of approximately US $1,900; and for every case of death prevented by use of the drug, the savings amounted to approximately US $7,140.
On June 30, 2015 the Ministry of Health, Jamaica added SCD as one of the chronic conditions for which drugs would be subsidised under the National Health Fund. This list included HU.
Other publications
Other articles published by Dr Cunningham-Myrie in the academic year include: “Richer but fatter: the unintended consequences of microcredit financing on household health and expenditure in Jamaica”; “WHO/ISH total risk approach for primary prevention of cardiovascular disease shows greater decrease in costs for women but not the elderly in Jamaica”, and “Impact of a comprehensive sickle cell centre on early childhood mortality in a developing country: The Jamaican experience”.
Recognising Outstanding Researchers 2016