The role of an early intervention on enhancing the quality of mother-infant interaction

The study examines an intervention designed to influence mothers' sensitive responsiveness toward their infant by presenting information about the newborn's competence to interact and promoting affectionate handling and interaction with the infant. Thirty-six primiparous mothers and their newborn infants participated in the study. On day 2/3 after delivery, mother-infant dyads were assigned to either: (1) an experimental group that received an intervention program designed to enhance mother-infant interaction; or (2) a control group that was presented with an intervention that emphasized basic caregiving skills. One month later an observation was undertaken in the home to assess mother-infant synchronous and asynchronous co-occurrences during free-play and infant bathing. The enhancement group showed a reliably greater frequency of co-occurrences involving vocal exchanges, looking to the partner, and physical contact. There also were differences in mothers' responsiveness to infant crying and involuntary responses. The findings show that even a modest videotaped early intervention can enhance mothers' sensitive responsiveness to the infant.

The effect of two child-care practices of market women on diarrhoea prevalence, feeding patterns and nutritional status of children aged 0-24 months

A cross-sectional comparative study was conducted in seven markets in Enugu and Nsukka, Nigeria, to evaluate the child-care practices, occurrence of diarrhoea, feeding patterns and nutritional status among 506 and 157 children aged 0-24 months taken to the market (CTTM) by their mothers and those left at home (CLAH) respectively. A lack of a caretaker at home was the most common reason for taking children to the market. The majority (92%) of the caretakers at home were young (< 20 years). There was no difference in the occurrence of diarrhoea in the last month between the CTTM (39%) and the CLAH (41%) groups (p > 0.05). However, there were differences in reported diarrhoea episodes between children aged 0-6 months and higher age classes (chi 2 = 20.0; p = 0.003). Very few children (0.8%) were exclusively breastfed. More CTTM (58%) were still being breastfed than the 42% of CLAH (OR = 1.87; 95% C.I. = 1.27-2.37; p < 0.001). Children cared for at home had a slightly better but nonsignificant (p > 0.05) anthropometric status as characterised by weight-for-age and height-for-age. There was no relationship between feeding patterns and diarrhoea.

Impact of HIV on families of HIV-infected women who have recently given birth, Bangkok, Thailand

The objective of this study was to assess changes in the family situation of HIV-infected women who have recently given birth. As part of a prospective perinatal HIV transmission study, interviews were conducted with a subset of HIV-infected women at 18 to 24 months postpartum, and answers were compared with baseline information obtained during pregnancy. Standardized scales were used to assess levels of psychosocial functioning. A convenience sample of 129 HIV-infected women enrolled during pregnancy was interviewed at 18 to 24 months postpartum. At delivery, the women were young (median age, 22 years), primiparous (57%), and asymptomatic (93%). When baseline and follow-up data were compared, more women were living alone (1% versus 6%; p = 0.03), fewer women were living with their partners (98% versus 73%; p < 0.001), and 30% of families had reduced incomes. At follow-up, 10% of partners had died, and more partners than wives had become ill or died (21% versus 4%; p = 0.02). Most children (78%) were living with their mothers, but only 57% of the HIV-infected women were the primary caretakers. Fewer women had disclosed their HIV status to others (e.g., family, friends) than to their partners (34% versus 84%; p < 0.001), largely because of fear of disclosure. The women appeared to have high levels of depression and worry. The women's greatest worries were about their children's health and the family's future. Within 2 years after childbirth, substantial change within the families of HIV-infected women was evident. These were manifest by partner illness or death, family separation, reduced family income, shifting responsibilities for child care, and signs of depression and isolation. Providing family support is a major challenge in Thailand as the perinatal HIV epidemic progresses.

Strategies for providing care and support to children orphaned by AIDS

As a result of the severe HIV/AIDS epidemic in sub-Saharan countries such as Zimbabwe, where between 25-30% of the adult population are estimated to be infected, there are a growing number of orphans requiring care and support. Traditionally, orphans have been absorbed within the extended family but this is becoming more difficult because of the large number of young adults dying. The burden of care and support is falling on the very young and the very old. A number of strategies have been introduced to provide this care and support. Institutions, though popular, are very expensive to run, have limited capacity and only really cater for physical needs. Interventions which simply react to those who present to them may not reach the most needy and may encourage dependency. Community-based orphan care has been identified as the best and most cost-effective way of caring for orphans. An example of a community-based orphan visiting programme is presented. In the last six months of 1996, the FOCUS programme's 88 volunteers made a total of 9,634 visits to 3,192 orphans in 798 families at an average cost of US+1.55 per visit. The key elements of such programmes have been identified. They need to be implemented by a community-based organization (CBO) within a defined community. Volunteers should be selected from within the community. They need to be trained and supported as they enumerate orphans, identify the most needy and carry out regular visits. The volunteers should keep records of all their activities. These records can then be used as a basis for monitoring the programme. In order to cope with the increasing number of orphans in resource-poor settings like Zimbabwe, it is essential that such programmes be replicated and scaled up. This not only an economic necessity but is also a way of providing appropriate and effective services to those who need them.

Sexuality, reproduction, and family planning in women with schizophrenia

This article reviews data about how schizophrenia affects sexuality, pregnancy, the puerperium, parenting, and family planning. Women with schizophrenia have high rates of coerced sex, sexual risk behavior, and unwanted pregnancies. High rates of obstetric complications and custody loss increase morbidity for women and their offspring. Since untreated psychosis increases these problems, the risks of withholding pharmacotherapy must be weighed against the risks of prescribing medications during pregnancy. The puerperium is a time when women are especially vulnerable to exacerbations of schizophrenia. Mothers with schizophrenia may have a reduced ability to read children's cues, and they often have weak social support networks. Their children may be more difficult to raise than other children. Parenting rehabilitation can address some of these problems. Often, women with schizophrenia who are sexually active and do not wish to become pregnant do not use contraception. Incorporating family planning measures into mental health care delivery systems may reduce unwanted pregnancies.

Mothers' management of childhood diseases in Yorubaland: the influence of cultural beliefs

Several studies have noted that, besides inadequate availability of health care services in many areas, especially the less developed countries, certain disease-specific and non-disease-specific cultural beliefs may influence people's health seeking behaviour. It has even been noted that health services may be underutilized and several health and child care instructions may be ineffective or ignored in traditional and transitional societies where people's ideas and behavioural patterns conflict with the knowledge being passed to them (Feyisetan and Adeokun 1992; Feyisetan 1992). Feyisetan and Adeokun (1992) argued that non-adoption of modern preventive and curative measures cannot be attributed to poverty alone since the costs of some preventive and curative measures are not exorbitant in several of these societies. Rather, they suggested that the gap between awareness of modern health measures and health seeking behaviour must be sought in the social and cultural determinants of behaviour in such matters as child care and disease management. Earlier studies have noted that children in Nigeria die mainly from malaria, diarrhoea, measles, neonatal tetanus, whooping cough, tuberculosis, and bronchopneumonia (Morley and MacWilliam 1961; Ogunlesi 1961; Morley, Woodland and Martin 1963, 1966; Baxter-Grillo and Leshi 1964; Animashaun 1977; Tomkins 1981). Because these diseases are preventable at low cost to the individual, there is a need to investigate why large percentages of children are still subjected to many episodes of these diseases. In this paper, we examine (1) the mothers' perceptions of the aetiology of the three most cited childhood diseases in our study areas, measles, diarrhoea and fever, and the effect of these perceptions on the mothers' suggested curative measures; and (2) the persistence of the belief in abiku and how this cultural belief can influence mothers' management of childhood diseases. Since, for most mothers, perceptions of the aetiology of the childhood diseases are rooted in cultural beliefs, a brief review of disease-specific cultural beliefs is undertaken. In order to determine the effect of socio-economic factors, the mothers' perceptions of the aetiology of the childhood diseases, their recommended curative measures and the belief in abiku are examined according to selected socio-economic variables.

Quality time: how parents' schooling affects child health through its interaction with childcare time in Bangladesh

A child health production function is presented with the key feature being an interaction term between a caregiver's schooling and their exposure time to the child. The production function is estimated using a 2SLS fixed effects model with lagged childcare time, resource allocation and child health as instruments for the first differences of these same endogenous variables. The 1978 Intrafamily Food Distribution and Feeding Practices Survey dataset from Bangladesh is used together with census data. The production function estimates indicate that part of the salutary effects of parental education on child health require that the child actually be exposed to the educated parent. Given the demographic makeup of the study sample and the assumption that age education and gender completely account for productivity, teenage brothers and fathers would have the highest marginal productivity for child health and mothers and grandmothers the least. If economic opportunity draws mothers away from childcare, the presence of other household members with higher schooling levels offers the potential for an improvement in the overall quality of childcare time. In the present study the households failed to set the marginal labour product of child health for each of the caregivers equal. Thus, the quality of childcare may not be the household's sole concern in determining time allocation.

Supporting children in need through a community-based orphan visiting programme

There is an urgent need for programmes to be established to support the growing number of orphans in countries severely affected by AIDS. Most orphans are being cared for by extended families under difficult circumstances. Few descriptions of community-based orphan support programmes exist. We describe one such programme established in Zimbabwe in 1993. Twenty-five volunteers identified 300 orphan households. During one year, volunteers made 1725 home visits and 123 households received an average of $11 in material support or school fees. In 292 orphan households there were 702 orphans, 14.7% of children under 15 years in the area. The rate of parental deaths was increasing with 3.5% of households in the area having a parental death in 1994. Forty-five per cent of caregivers were grandparents and 33% of caregivers were over 60 years. Three per cent of orphans were cared for by adolescent siblings. The poorest orphan households were those in receipt of school fees, with out-of-school children or with an older sibling as caregiver. Community members initiated activities to help orphans. The programme described is targeted, effective and replicable. Community-based organizations such as local churches and women's groups can be mobilized to administer programmes which provide support to the poorest orphan households.

[Rejoining the labor market once child-care leave is over]

"The author of the study analyses, from the aspects of a particular group, the situation of [women in the labor force] in Hungary. In sample surveys carried out in the first quarter of 1993 and 1995, mothers on leave for child-care were interviewed about their intentions...to renew their gainful activities. Of some 25 thousand households 1,450 and 1,491 women on leave for child-care answered the questions in 1993 and 1995, respectively.... The results indicate...that chances of women [rejoining] the labour market depend on the sector and regional location of their previous workplace, on their craft qualification etc." (SUMMARY IN ENG)

Sociodemographic risk factors associated with low birthweight in United Arab Emirates

This case-control study was undertaken to determine sociodemographic risk factors for low birth weight in Al-Ain (United Arab Emirates) over a 12-month period in 1992-93. A total of 3485 live births occurred of which 293 (8.4%) were low birth weight. The risk factors considered were mother's occupation, house conditions, place of residence (urban or rural), maternal smoking habits, antenatal care, availability of help in the home, maternal BMI and educational status. Multiple logistic regression analysis showed that mother's occupation, maternal smoking, antenatal care, and lack of help in the home were associated with increased risk of low birth weight.

A one-year community study of under-fives in rural Ethiopia: health and behavioural determinants of morbidity

Based on a one-year weekly home surveillance study, morbidity patterns of 1,304 children under five years of age in a rural Ethiopian community were measured, together with nutritional and health behavioural determinants. Using Poisson regression models, the study showed that nutritional and health care factors make a significant impact on under-five morbidity. Gastroenteritis was particularly associated with child care factors, while acute respiratory infections were particularly associated with nutritional factors. Lack of immunization, low birthweight and pre-term delivery (more than one month early) were not found to have any independent effect on morbidity. Breast feeding was universal, but the introduction of supplementary foods was found to protect from excess morbidity. The study concludes by discussing possible applications of the results in intervention programmes.

Childcare needs of female street vendors in Mexico City

This article reports on strategies developed by female street vendors (vendedoras ambulantes) in Mexico City to ensure the care of their young children in the absence of a specific and operational government policy to fulfil this need. The information concerning child care and health was gathered by a survey of 426 street traders selected by multi-stage random cluster sampling in four of the administrative districts (delegaciones politicas) of Mexico City during 1990. It was found that, as mothers of young children, street vendors most frequently looked after their children personally on the street or left them with other members of the family. Related factors were availability of alternative child care providers in the family, the age of the children and working conditions of the mother. Children who remained on the streets with their mothers suffered more frequently from gastro-intestinal diseases and accidents than the national average. The incidence of acute respiratory diseases, however, was similar in the cases of maternal care in the street and care by family members in another environment. Existing public health measures show a greater concern for the health of food consumers than that of workers in this area. Current public policy seeks to regulate street vending activities and to concentrate traders in ad hoc areas and facilities. Our research results document the need for actions that can contribute to an improvement in the care and health conditions of these young children.

Caring capacity in the management of the nutrition crisis in infants, young children and women in Nigeria

Nigeria's nutrition crisis has been shown to have a considerable negative impact on infants, young children and women. Available evidence suggests that 'caring capacity' when properly planned and targeted at the most-at-risk can help. Strategies that can achieve this care are increasing women's income and control over income, increasing investment in women's education and improving access to credit facilities. Others are the aggressive promotion of gender-biased labour saving technology, increasing women's access to basic health and family planning services and implementing reforms in land ownership while instituting social security for women.