Barefoot and in a German kitchen: federal parental leave and benefit policy and the return to work after childbirth in Germany

"Since 1979 German federal maternity leave and benefit policy has given women incentives to stay at home and take care of their newborn and youngest children. In 1986 this leave and benefit policy was changed in several ways, turning it into a powerful instrument for delaying mothers' return to work after childbirth.... We estimate post childbirth return to work hazards for women during the federally protected leave protection period and immediately upon completion of this leave period. During the leave mothers are less likely to return to work the longer is the time left in the leave protection period; however, this result cannot be attributed generally to high levels of maternity benefits. When the leave protection period ends, mothers with strong labor force attachment who are still on leave return to their jobs."

Safe child care and women's empowerment in the developing world

Women's ability to provide for the health and well-being of their children and families is linked in complex ways to the degree of empowerment they experience. Empowerment for women in the developing world is a perplexing venture, hampered by patriarchal barriers and cultural confusion. Our purpose in conducting this research was to discover how disadvantaged Namibian women experienced empowerment when they had access to safe child care. Fifty-two women participated in the study. A qualitative design and ethnographic techniques were used to elicit women's experiences. Five themes, descriptive of women's empowerment, emerged from the data: (a) increasing vitality, (b) freedom from worry, (c) opportunities to increase financial security, (d) strengthened parenting competence, and (e) personal satisfaction and a sense of fulfillment. The findings add a voice from the developing world to the growing understanding of women's diverse journeys toward empowerment. Discussion focuses on the significance of the themes and implications for further research that promotes women's empowerment and community health.

Hmong cultural practices and beliefs: the postpartum period

The purpose of this study was to explore the cultural practices and beliefs of the Hmong in the postpartum period. Using the qualitative research method of in-depth interviewing, data were collected through semistructured interviews. A convenience sample of 52 childbearing Hmong women was interviewed with the help of Hmong interpreters. The interviews were audiotaped and transcribed for analysis. Data analysis revealed cultural practices and beliefs categories related to diet, rest period, appropriate clothing, breast feeding, and sex practices in the postpartum period. Implications for nursing include both cultural sensitivity and an understanding of such traditional practices, before suggesting or implementing any health-promotion activities.

Further observations on ghee as a risk factor for neonatal tetanus

BACKGROUND

Previous case-control studies of neonatal tetanus (NNT) in the North West Frontier Province of Pakistan indicated that clarified butter (ghee) applied to the umbilical wound of newborns was a significant risk factor for NNT. However, the mechanisms underlying the risk remained undisclosed.

METHODS

A hospital-based case-control study was undertaken to evaluate further ghee and other factors possibly associated with risk of NNT. Mothers of several recent ghee-associated cases were visited in their homes, asked to simulate the procedures used in preparing the ghee, and samples of ghee were collected for culture.

RESULTS

Topical application of ghee to the umbilical wound was again shown to pose a significant risk for NNT. In-use contamination of ghee was documented as mothers repeatedly heated and manipulated samples of ghee set aside in special containers for this purpose. Ghee was usually applied to the umbilical wound of the baby several times each day for the first few days of life. Mothers of cases were again confirmed to be substantially more likely to report prior NNT cases than mothers of controls.

CONCLUSIONS

Educational interventions to reduce umbilical ghee use or to wash hands before each manipulation might reduce the risk of NNT in babies exposed to ghee who are born to non-immunized mothers. Increased efforts to immunize women of childbearing age with tetanus toxoid are also needed, with special priority for mothers known to have been associated with a previous NNT case. Topical antibiotics should be further evaluated for protective effects in non-immunized mothers.

Acute childhood diarrhoea and maternal time allocation in the northern central Sierra of Peru

Interventions to improve child health depend, at least implicitly, on changing maternal knowledge and behaviour and a reallocation of maternal time. There have been few studies, however, of the time cost involved in the adoption of new health technologies and even fewer that examine changes in maternal activities in response to child illness. The present study examines maternal daytime activities and investigates changes that occur when children are ill. We examine the impact of acute childhood diarrhoea episodes on the activity patterns of the mother/caretaker in this setting. The results show that mothers alter their usual activity patterns only slightly in response to acute diarrhoea episodes in their children. They continue to perform the same variety of activities as when the children are healthy, although they are more likely to perform them with the child 'carried' on their back. There is some indication that diarrhoea perceived to be more severe did result in the mother acting as caretaker more frequently. These findings have important implications for health interventions that depend on changing the amount of maternal or caretaker time spent for child health technologies, but the implications may vary depending on the reasons for the observed lack of changes in caretaker activities.

Orphan prevalence and extended family care in a peri-urban community in Zimbabwe

An orphan enumeration survey was conducted in 570 households in and around Mutare, Zimbabwe in 1992; 18.3% (95% CI 15.1-21.5%) of households included orphans. 12.8% (95% CI 11.2-14.3%) of children under 15 years old had a father or mother who had died; 5% of orphans had lost both parents. Orphan prevalence was highest in a peri-urban rural area (17.2%) and lowest in a middle income medium density urban suburb (4.3%). Recent increases in parental deaths were noted; 50% of parental deaths since 1987 could be ascribed to AIDS. Orphan household heads were likely to be older and less well-educated than non-orphan household heads. The majority of orphaned children were being cared for satisfactorily within extended families, often under difficult circumstances. Caregiving by maternal relatives represents a departure from the traditional practice of caring for orphans within the paternal extended family and an adaptation of community-coping mechanisms. There was little evidence of discrimination or exploitation of orphaned children by extended family caregivers. The fact that community coping mechanisms are changing does not imply that extended family methods of caring are about to break down. However, the emergence of orphan households headed by siblings is an indication that the extended family is under stress. Emphasis needs to be placed upon supporting extended families by utilizing existing community-based organizations. Orphan support programmes may need to be established initially in high risk communities such as low-income urban areas and peri-urban rural areas.

Potential interventions for the prevention of childhood pneumonia in developing countries: a systematic review

This article describes the background and framework for a systematic review of potential interventions for preventing pneumonia among under-5-year-olds in developing countries. Twenty-eight intervention areas are identified in six groups -- immunization, case management/chemoprophylaxis of high-risk children, improving nutrition, reducing environmental pollution, reducing transmission of pathogens, and improving child care practices. Calculation of the potential impacts is illustrated and the expected outcomes are also described.

Inter-rater reliability of a paediatric outcome measure in Nepal

The Hospital and Rehabilitation Centre for Disabled Children (HRDC) in Nepal identified the need to evaluate their in-hospital and community programmes. An instrument was developed to provide information regarding the functional level of the children treated by the HRDC as well as to provide information regarding care-givers' attitudes towards disability. Inter-rater reliability of the measure was tested in three regions of Nepal with 49 children. Six HRDC field workers travelled in pairs to the childrens' homes and alternated in roles as test administrator and observer. Correlations between the scores documented by the administrator and observer were used to estimate inter-rater reliability. Inter-rater reliability coefficients, calculated using a weighted kappa statistic, varied from 0.60 to 1.0. We conclude that the instrument demonstrated an acceptable level of inter-rater reliability in the field setting. Future studies to measure construct and concurrent validity, test-retest reliability and responsiveness of the instrument are recommended as well as testing the instrument in different cultures.

Time use in child care and housework and the total cost of children

"The use of time for child care and housework among Swedish families is investigated. We allow the effect of children on child care and housework to vary by age of the child and also by whether the child is cared for outside the home or not. Our estimates allow us to compute the total cost of children in the form of the cost of time, and the cost of goods, services and housing. The result shows that time used for child care decreases sharply with the age of the child but this is not the case for time used for other housework."

Infant mortality decline in Germany, 1871-1925: the roles of changes in variables and changes in the structure of relations

"This paper applies regression decomposition procedures to the infant mortality decline in Germany 1871-1925.... Data concern 59 administrative areas at seven times. In contrast to contemporary less developed countries, little of this historical infant mortality decline is explained either by changes in the relationships between infant mortality and the variables considered here or by exogenous factors. Rather, trends in variable values account for most of the decline. Smaller family size and more hygienic child care improved living conditions for infants, thereby increasing their survivorship." (SUMMARY IN FRE AND ITA)

Drinking water as an iron carrier to control anemia in preschool children in a day-care center

OBJECTIVE

Several foods have been used as iron (Fe) carriers to fight widespread global Fe deficiency and anemia. This paper describes the longitudinal effect of Fe-fortified drinking water given to a group of Brazilian preschool children.

DESIGN

The experimental design included 31 preschool children who attended a day-care institution. Hemoglobin and serum ferritin were the blood parameters used to check the Fe status. Fe++ sulfate (20 mg Fe/L) was added daily to their drinking water container and measurements were obtained before the addition, 4 and 8 months later.

RESULTS

The number of Fe-deficient children decreased drastically after they started drinking the Fe-enriched water. Mean hemoglobin values increased from 10.6 to 13.7 g/dL and serum ferritin from 13.7 to 25.6 micrograms/L. There were no problems related to the salt addition or to the children drinking the Fe-enriched water.

CONCLUSION

Fe-enriched drinking water was shown to be a practical alternative to supply Fe to children attending a day-care institution.