Comparison of anxiety, stress, and social support levels of female patients with type 1 diabetes and mothers whose children have type 1 diabetes

Purpose

Patients with type 1 diabetes mellitus (T1DM) are insulin-dependent from diagnosis. Both the individual and their immediate circle are at risk for psychiatric morbidity. We aimed to compare the anxiety, stress, and social support levels of adult women with a diagnosis of T1DM and adult women with a child diagnosed with T1DM. Besides, the study intended to examine two groups' stress and anxiety factors.

Methods

The data were collected using the Sociodemographic Data Form, State-Trait Anxiety Inventory, Perceived Stress Scale, Multidimensional Scale of Perceived Social Support. Sixty-three women participated in the study.

Results

There was no difference between the groups regarding anxiety, stress, and perceived social support score averages (p > 0.05 each). However, clinically significant state anxiety was higher in the group of mothers (χ²=4.234 df = 1 p = 0.040). In women with T1DM, higher education was associated with lower stress, lower state, and lower trait anxiety (r=-0.455 p = 0.004, r=-0.428 p = 0.007, r=-0.317 p = 0.049); higher numbers of insulin injections were associated with higher state anxiety (r = 0.368 p = 0.021), social support was associated with lower stress and lower trait anxiety (r=-0.478 p = 0.002, r = 0.449 p = 0.004). In mothers of diabetic children, the increase in the child's HbA1c level was associated with an increase in the mother's state anxiety (r = 0.433 p = 0.035); social support was associated with lower trait anxiety (r=-0.421 p = 0.040).

Conclusion

Caring for a child with T1DM was stressful and anxiety-provoking as having T1DM. Interventions including social support, may benefit mental health in mothers of diabetic children and women with T1DM.

Comparison of the Quality of Life of Physically Active and Inactive Grandmothers Caring and Non-caring for Grandchildren: A Cross-Sectional Study

Background

Nowadays, grandparents have a major role in taking care of their grandchildren. Also, caring for grandchildren is a common and normative experience for many Iranian grandparents. The present study aimed to compare the quality of life of physically active and inactive grandmothers caring and non-caring for grandchildren.

Methods

This analytical cross-sectional study was conducted on 300 grandmothers at the age range of 50 to 70 years old, who lived in Bojnurd, northeastern Iran (2018). Data were collected using the questionnaires of 36-Item Short Form Health Survey (SF-36) and Baecke Physical Activity, and demographic information.

Results

The total scores of quality of life in caring physically active, physically inactive, non-caring physically active and non-caring physically inactive grandmothers were 76.95±6.33, 71.74±9.41, 75.56±5.9, and 56.06±11.23, respectively. There was a significant difference in the comparison of the quality of life score in caring grandmothers in two active and inactive groups (P<0.001). In addition, the quality of life score of non-caring grandmothers indicated a significant difference in physically active and inactive grandmothers (P<0.001).

Conclusion

According to the results of this study, it seems that caring physically active grandmothers have higher quality of life. It can be suggested that the grandmothers who care for their grandchildren may improve their health and quality of life by incorporating the programs to increase physical activities in their daily life.

Inequality in Early Care Experienced by US Children

Using every major nationally representative dataset on parental and non-parental care provided to children up to age 6, we quantify differences in American children's care experiences by socioeconomic status (SES), proxied primarily with maternal education. Increasingly, higher-SES children spend less total time with their parents and more time in the care of others. Non-parental care for high-SES children is more likely to be in childcare centers, where average quality is higher, and less likely to be provided by relatives where average quality is lower. Even within types of childcare, higher-SES children tend to receive care of higher measured quality and higher cost. Inequality is evident at home as well: measures of parental enrichment at home, from both self-reports and outside observers, are on average higher for higher-SES children. We also find that parental and non-parental quality is reinforcing: children who receive higher quality non-parental care also tend to receive higher quality parental care.

A Qualitative Study Exploring the Experiences of Mothers Caring for Their Children with Thalassemia in Iran

BACKGROUND

Mothers of children with thalassemia usually experience many sufferings and challenges in caring of their children. The present study aimed to explore the experiences of mothers caring for their children with thalassemia.

METHODS

In this qualitative study, 14 mothers caring for their children with thalassemia in Hamedan and Babol Cities, Iran were selected using purposeful sampling, from December 2019 to August 2020. Data were collected through semi-structured face-to-face interviews. Graneheim and Lundman's approach of conventional content analysis was used for data analysis.

RESULTS

After data analyzing, four themes, including physical distress, psychological suffering, hellish life, and self-negligence, as well as nine categories, including the mother's physical problems, physical weakness, confusion, painful emotions, restless life, involvement in a painful caring process, turmoil in the family, neglect of one's health, and disregard for the occurrence of psychosomatic illnesses, were extracted.

CONCLUSION

Our findings provide a broad range of context-specific challenges that mothers of thalassemic child faced during caring of their children that can affect different aspects of their life and health. Thus, mothers of children with thalassemia need various types of support such as social, emotional, and informational support during caring process of their children.

How Do Mothers Take Care of Their Infants with Colic Pain? A Mixed-Method Study

Background

Colic pain is one of the main reasons for stress and anxiety in infants' parents, especially mothers, and there is still no specific treatment. Thus, mothers always try their best to relieve their infants' pain.

The researchers attempted to investigate how mothers take care of their infants with colic.

Methods

This study was conducted with a mixed-method approach and a sequential explanatory design. In the quantitative phase, a cross-sectional study was conducted to assess how to control pain. One hundred fifty mothers of infants with colic living in Kerman, Iran, were chosen by convenience sampling. In the qualitative phase, the researchers interviewed 18 mothers using semi-structured in-depth, and face-to-face approaches. These participants were selected by purposive sampling method. The interviews were analyzed by the conventional content analysis method.

Results

In the quantitative phase, the mothers' most common methods to relieve colic pain were herbal medicines (3.55±0.51) and the change of position (3.35±0.67). The least methods used were probiotics (1.4±0.2) and acupuncture (0). In the qualitative phase, the main theme was “mothers support needs for care,” which includes the following subcategories: “lack of trust in doctor”; “full-time care”; “feeling of inadequacy,” “persistent anxiety, “care without help,” and “looking for ways to control pain.”

Conclusion

Mothers need support to relieve their infants' colic. The provision of educational and psychological supportive packages can be helpful for the mothers. In addition, nurses can help mothers improve their quality of care.

[Childhood and the pandemic: Chronicle of an absence foretold]

As the COVID-19 pandemic has made visible, childhood is the virus's proverbial south: a world where care is not a value chosen from a place of desire, and where children's voices are silenced at the hands of an ancestral epistemic injustice. Thus, the transformation that human societies are undergoing due to COVID-19 has significantly impacted the rights of children, both at the micro and the macro levels. In Spain - a country that has been particularly hard-hit by the pandemic - we find that both infancy (especially through obstetric violence) and childhood at all its stages fall victim to an adultcentric paradigm based on control and epistemic injustice. This essay analyzes and discusses some of the negative consequences observed in this country related to the care for and the confinement of minors and their families - which has occurred as a result of the pandemic - and considers that the crisis triggered by COVID-19 may be an opportunity to shed light on situations of ancestral injustice towards children.

Opportunities to Promote Healthy Weight Through Child Care Licensing Regulations: Trends in the United States, 2016-2020

BACKGROUND

Policies that support healthy nutrition and physical activity environments in early care and education (ECE) settings can help promote healthy weight in children. State child care licensing regulations are a critical mechanism for setting such policies.

OBJECTIVES

To develop a research instrument to evaluate the promotion of healthy child weight in state child care licensing regulations and assess the strength of the regulations over time.

DESIGN

For measure development, systematic reviews of evidence on the impact of healthy weight strategies relevant to the ECE environment were combined with expert stakeholder input to identify 15 healthy weight promotion policy standards and a coding tool to measure the strength and comprehensiveness of regulatory language matching these standards. For assessing the strength of regulations, the coding tool was applied to child care regulations nationwide in 2016 and again in 2020.

SUBJECTS/SETTING

Child care licensing regulations in 2016 and 2020 for all 50 US states plus Washington DC.

OUTCOME MEASURES

Strength and comprehensiveness scores for state licensing regulations.

STATISTICAL ANALYSES

Intraclass correlation coefficients were calculated to estimate interrater reliability of the coding tool. Paired t tests were used to compare scores within states from 2016 to 2020.

RESULTS

Interrater reliability for the coding tool had intraclass correlation coefficients of 0.81 for strength and 0.87 for comprehensiveness scores. Strength and comprehensiveness of states' healthy weight promotion policies increased significantly over time (P < .001). However, most states still lack important healthy weight policies in their licensing regulations, such as prohibiting serving sugary drinks.

CONCLUSIONS

This study presents a reliable research instrument for measuring the strength and comprehensiveness of healthy weight promotion standards in child care licensing regulations. States have increased their incorporation of strategies for healthy weight into state policy.

Proximal Interpersonal Processes in Early Childhood, Socioemotional Capacities in Middle Childhood, and Behavioral and Social Adaptation in Early Adolescence: A Process Model toward Greater Specificity

Early proximal interpersonal processes in central microsystems have been widely linked to child subsequent adaptation. What remains sparse is research spanning multiple developmental stages and examining unique, relative implications of distinct early proximal interpersonal processes for child later adjustment in various domains and the cognitive, emotional, and behavioral mechanisms underlying such associations. Using NICHD SECCYD data, a process model was tested in which negativities and positivities in three early proximal interpersonal processes (i.e., mother-child, child care provider-child, and child care peer interactions at 6-36 months) were simultaneously linked to child internalizing problems, externalizing problems, and social relationship quality in early adolescence (6th grade) via child hostile attribution bias, emotion reactivity, and social skills in middle childhood (3rd grade). Social skills mediated the associations between positivities/negativities in early mother-child and peer interactions and later behavioral and social adaptation. Emotion reactivity was identified as a process via which negativities in early peer interactions predicted later behavioral problems. Maternal negativities were positively associated with hostile attribution biases, but such biases did not relate to later adaptation. We also identified a negative direct link between maternal positivities and later externalizing problems and a positive direct link between maternal positivities and later social relationship quality. No effects emerged for child care providers-child interactions. Improving early mother-child and peer interactions may promote adaptation in early adolescence. For children with poor early mother-child and peer interactions, training socioemotional capacities may be a way to diminish consequences of early negative interpersonal processes.

[Disabled child, care and ethical aspects]

Disabled child, care and ethical aspects. The child's doctor occupies a privileged place in the life of a child with a disability. At all times, he must be an adviser, favouring a global approach and support to ensure optimal autonomy. Discovery of a neurodevelopmental disorder justifies a systematic search for the various causes known to date. Identification and knowledge of a precise diagnosis is an essential element in constructing the life plan for a disabled child. The announcement of the diagnosis is an integral part of the care system, it only makes sense when combined with tailor-made and step by step support. This requires that the doctor has a good knowledge of the main childcare structures, guidance agencies, and available financial aid. Multidisciplinary consultations enable a global approach to support a child with a disability. More children with disabilities become adults as medical care progresses. Transition from "children" to "adult" consultations represents a major challenge. However, some cases could be life-threatening. The decision on whether to continue the various therapies have to be considered and discussed with the child and his family, with reference to the notion of "unreasonable obstinacy". Drafting an individual certificate of "remarkable patient" will best help the implementation of end-of-life support measures.

Perceived Barriers to Fruit and Vegetable Gardens in Early Years Settings in England: Results from a Cross-Sectional Survey of Nurseries

Garden-based interventions may increase child intake of fruits and vegetables and offset food costs, but few have been conducted in early care and education (ECE). This study assessed whether nurseries were interested in and perceived any barriers to growing fruits and vegetables. Surveys were mailed to a cross-sectional sample of nurseries in 2012–2013 throughout England. Nurseries were stratified based on socioeconomic status as most, middle, or least deprived areas. We fit logistic regression models to assess the odds of nurseries interested in growing fruits and vegetables and perceiving any barriers, by deprivation tertile. A total of 851 surveys were returned (54% response). Most nurseries (81%) were interested in growing fruits and vegetables. After adjustment, there was no difference in interest in the middle (OR 1.55; CI 0.84, 2.78; p = 0.16) or most (OR 1.05; CI 0.62, 1.78; p = 0.87) deprived areas, compared to the least deprived. Nurseries reported barriers to growing fruits and vegetables, including space (42%), expertise (26%), and time (16%). Those in the most deprived areas were more likely to report space as a barrier (OR 2.02; 95% CI 1.12, 3.66; p = 0.02). Nurseries in the most deprived areas may need creative solutions for growing fruits and vegetables in small spaces.

[Effects of a Reinforcement Program for Postpartum Care Behavioral Skills of Couples with Their First Baby]

PURPOSE

This study aimed to investigate the effects of a reinforcement program for behavioral skills in postpartum care for couples with their first baby.

METHODS

The study used a non-equivalent control group and pretest-posttest design. It was conducted from January 14 to April 10, 2016 at a postpartum care center in D city. It analyzed 43 couples (22 in the experimental group and 21 in the control group.) For data analysis, descriptive statistics, test of homogeneity in pretest, independent t-tests, and repeated measures ANOVA were used.

RESULTS

For maternal fulfillment of postpartum care and postpartum fatigue, there was no significant difference in the interaction between group and time. In terms of parent-newborns attachment, the interaction between group and time showed a significant difference for mothers (F=13.63, p=.001) and fathers (F=6.51, p=.001). In marital intimacy, the interaction between group and time showed a significant difference for mothers (F=14.40, p<.001) and fathers (F=9.46, p=.004). In parenting stress, the interaction between group and time showed a significant difference for mothers (F=31.8, p<.001) and fathers (F=11.69, p=.001). A significant difference was found for the mothers' postpartum sleeping hours (F=0.14 p=.004).

CONCLUSION

This program for behavioral skills in postpartum care, which is based on the information-motivation-behavioral skills model, improves postpartum care, parent-newborn attachment, marital intimacy, parenting stress, and maternal postpartum sleeping, by reinforcing behavioral skills required for postpartum care.

[Effect of Visiting and a Smartphone Application Based Infection Prevention Education Program for Child Care Teachers: A Non-Randomized Controlled Trial]

PURPOSE

This study was performed to develop an infection prevention education program for child care teachers and to verify its effects.

METHODS

The study was conducted using a nonequivalent control group with a pretest-posttest design. Four private daycare centers (2 centers per city) that were alike in terms of the number of children by age, number of child care teachers, and child care environment were chosen. Participants were assigned to the experimental group (n=20) or control group (n=20). As a part of the program, visiting education (90 min) was provided in the 1st week, and smartphone application education (10 min) was provided thrice a week, in the 2nd and 3rd weeks.

RESULTS

Child care teachers' self-efficacy for infection prevention revealed a significant interaction effect between the group and time of measurement (F=21.62, p<.001). In terms of infection prevention behavior, a significant difference was observed between the experimental and control groups (z=-5.36, p<.001).

CONCLUSION

The program implemented in this study was effective in improving the infection prevention self-efficacy and infection prevention behavior of child care teachers. Thus, this program may be effective in enhancing their infection control.

A randomised controlled trial of an online menu planning intervention to improve childcare service adherence to dietary guidelines: a study protocol

INTRODUCTION

The implementation of dietary guidelines in childcare settings is recommended to improve child public health nutrition. However, foods provided in childcare services are not consistent with guidelines. The primary aim of the trial is to assess the effectiveness of a web-based menu planning intervention in increasing the mean number of food groups on childcare service menus that comply with dietary guidelines regarding food provision to children in care.

METHODS AND ANALYSIS

A parallel group randomised controlled trial will be undertaken with 54 childcare services that provide food to children within New South Wales, Australia. Services will be randomised to a 12-month intervention or usual care. The experimental group will receive access to a web-based menu planning and decision support tool and online resources. To support uptake of the web program, services will be provided with training and follow-up support. The primary outcome will be the number of food groups, out of 6 (vegetables, fruit, breads and cereals, meat, dairy and 'discretionary'), on the menu that meet dietary guidelines (Caring for Children) across a 1-week menu at 12-month follow-up, assessed via menu review by dietitians or nutritionists blinded to group allocation. A nested evaluation of child dietary intake in care and child body mass index will be undertaken in up to 35 randomly selected childcare services and up to 420 children aged approximately 3-6 years.

ETHICS AND DISSEMINATION

Ethical approval has been provided by Hunter New England and University of Newcastle Human Research Ethics Committees. This research will provide high-quality evidence regarding the impact of a web-based menu planning intervention in facilitating the translation of dietary guidelines into childcare services. Trial findings will be disseminated widely through national and international peer-reviewed publications and conference presentations.

TRIAL REGISTRATION

Prospectively registered with Australian New Zealand Clinical Trial Registry (ANZCTR) ACTRN12616000974404.

Who Helps Single Mothers in Nairobi? The Role of Kin Support

Single mothers often turn to their extended kin for financial assistance and to help with child care. Such support may be especially important in areas of high poverty and poor environmental conditions. Using novel kinship data, this paper assesses the extent of support given by over 3,000 relatives to 462 single mothers living in a slum area of Nairobi, Kenya. Contrary to stereotypes about families in sub-Saharan Africa, the active kin network of single mothers is relatively small and nearly a fifth of mothers do not receive any financial or child care assistance. Different types of kin offer different kinds of support according to culturally proscribed roles. However, support also depends heavily on kin's employment status, geographic proximity, and age. These findings offer a nuanced picture of how single women living in slum areas draw upon their kin network to cope with their daily demands as mothers.

Signs of Change? At-Home and Breadwinner Parents' Housework and Child-Care Time

We analyze American Time Use Survey (ATUS) data to examine patterns in domestic work among at-home and breadwinner parents to further gauge how time availability, relative earnings, and gender shape time use in couples with extreme differences in earnings and work hours. We find that involvement in female-typed housework is an important driver of overall housework time. It is counter-normative housework behavior by at-home fathers that shapes conclusions about how time availability, relative resources, and gender influence parents' housework. While time availability appears to shape child care in comparable ways across parents, mothers are more engaged in child care than similarly-situated fathers. Overall, our comparisons point to the importance of distinguishing among gender-normative housework tasks and accounting for differences in engagement on work and non-work days. Our results also provide a basis for assessing the social significance of growing numbers of parents in work-family roles that are not gender-normative.

Utilization and Content Evaluation of Mobile Applications for Pregnancy, Birth, and Child Care

OBJECTIVES

The purpose of this study was to explore the use of mobile applications about pregnancy, birth, and child care among pregnant women and to review the characteristics, contents, and credibility of the applications used by these women.

METHODS

This study was cross-sectional and was conducted using a survey method. One hundred and ninety-three pregnant women participated in this study. The questionnaire was developed to examine the pattern and reasons for pregnancy-related application usage. The 47 mobile apps used by participants were reviewed and categorized based on functions and developers. The credibility of the information provided by the mobile applications was evaluated using a structured measurement.

RESULTS

Fifty-five percent of the participants were using mobile apps related to pregnancy, birth, and/or child care. First-time mothers used the apps significantly more often than women who were pregnant for the second time. Women who had used a smartphone for a longer period of time were more likely to use apps related to pregnancy, birth, and/or child care. The most frequently-used information concerned signs of risk and disease during pregnancy. Experts' quick opinions and Q&A formats related to diet and medication administration during pregnancy were the women's most cited need for content in applications. Information was the most common function of the apps. In the evaluation of information credibility, the 'information source' category had the lowest score.

CONCLUSIONS

The results showed that applications related to pregnancy, birth, and child care have become an important information source for pregnant women. To fulfill the needs of users, credible applications related to pregnancy, birth, and child care should be developed and managed by qualified healthcare professionals.

HOW MANY REPETITIONS OF CHILD CARE SKILLS ARE REQUIRED FOR HEALTH WORKER STUDENTS TO ACHIEVE PROFICIENCY? LEARNING CURVE PATTERNS IN CHILD CARE SKILLS ACQUISITION

Introduction:

The vulnerability of children under 5 years old requires paying more attention to the health of this group. In the Iranian health care system, health workers are the first line of human resources for health care in rural areas. Because most health workers begin working in conditions with minimal facilities, their clinical qualifications are crucial. The aim of this study was to determine the number of repetitions of child care skills, required for health worker students to achieve proficiency based on the learning curve.

Methods:

A time series research design was used. Participants in this study were first year health worker students enrolled in three health schools in 2011. Data were collected using a questionnaire consisting of demographic information and a checklist evaluating the health worker students’ clinical skills proficiency for child care. Data were analyzed using SPSS version 16.0 software (SPSS Inc., Chicago, IL) using descriptive and inferential statistics including Kruskal-Wallis and Pearson correlation coefficient tests.

Results:

Learning curve patterns in child care skills acquisition showed that for less than 20 and between 20 to 29 times, the level of skill acquisition had an upward slope. Between 30- 39 the learning curve was descending, however the slope became ascending once more and then it leveled off (with change of less than 5%).

Conclusion:

It seems that 40 repetitions of child care skills are sufficient for health worker students to achieve proficiency. This suggests that time, resources and additional costs for training health worker students’ trainees can be saved by this level of repetition.

The Role of Ultrasound Imaging of Callus Formation in the Treatment of Long Bone Fractures in Children

Background

In the process of diagnosis and treatment of fractures, an X-ray study is typically performed. In modern medicine very important is the development of new diagnostic methods without adverse effects on the body. One of such techniques is ultrasound imaging. It has a high value in imaging most areas of the body, including the musculoskeletal system. Reports on the use of ultrasound in the evaluation of the callus are rare and this could be a method equivalent to or even better than standard radiographs. The aim of the study was to analyze the correlation of ultrasound with radiographs in imaging of callus formation after fractures of long bones in children and to analyze the correlation of vascular resistance index (RI) and the degree of vascularization of the callus with a subjective radiological assessment of the bone union quality.

Material/Methods

The prospective study was planned to qualify 50 children treated for long bones fractures of the arm, forearm, thigh and lower leg. Ultrasound diagnosis was carried out using a Philips iU22 camera equipped with a linear probe with 17-5-MHz resolution and MSK Superficial program. During ultrasound examination measurements of the callus were performed. Using the Power Doppler callus vascularity was visualized and vascular resistance index (RI) was measured. The same measurements were made within the corresponding area of the healthy limb. The results obtained by ultrasound were compared with radiograph measurements and with the subjective assessment of the callus quality.

Results

Preliminary results were developed on a group of 24 patients, where 28 fractured bones and 28 corresponding healthy bones were examined. Fifteen boys and 9 girls participated in the study. The average age at injury was, respectively, 11 and 9 years. In both groups fractures without displacement were the most frequent. A similar frequency was observed in fractures requiring reposition and subperiosteal fractures. In contrast, fractures with a slight displacement of the fragments, were 3 times more common in girls. Statistical analysis of the measurements of length and width of the callus demonstrated that the differences between results obtained in the ultrasound in comparison with X-rays were not statistically significant. Moreover, preliminary results showed a significantly higher degree of vascularization of the callus than of the healthy periosteum.

Conclusions

Preliminary results indicate the high efficacy of ultrasound in the evaluation of callus formation after fractures of long bones in children and the possibility of its alternative use to X-ray examinations.

Policy regulation and demographic behaviour. Romanian population policy and its consequences

The effect of population policy in Romania up to 1989 is discussed. The author finds that "Romania's population policy up to 1989, for which any contraceptive method was illegal and punished, and where as a consequence there was a severe control of information regarding family planning,...had a real and very important impact on attitudes and behaviour...[and] on health, especially on that of women and children." Data on deaths from illegal abortion, maternal mortality, and child abandonment are presented.

[Children or profession: there is no alternative. The effects of child care leave provisions on women in the labor force in Austria]

"The author presents results of a study investigating the effects of maternity and child care leave on women's participation in the labour force in Austria. The data cited show that maternity legislation so far has not significantly reduced the risk of unemployment for women. The unemployment rate for women on maternity and child care leave is about four times as high as the average for actively employed women aged 15-44." (SUMMARY IN ENG)

Day-care supply by Dutch municipalities

"In this article we report and discuss our investigation into differences in day-care supply among Dutch municipalities....A description of day care in the Netherlands in relation to female labour supply is given.... Attention is given to the comparison of the Netherlands with other European countries.... Hypotheses are formulated concerning differences in day-care supply among Dutch municipalities." (SUMMARY IN FRE)

Paternal involvement in child care as a function of maternal employment in nuclear and extended families in India

Paternal involvement in childcare as a function of family structure and maternal employment status was assessed in 92 dual-wage and 103 single-wage Indian families with preschool-aged children residing in different areas of New Delhi, India. Mothers and fathers completed Radian's Paternal Involvement in Child Care Index (PICCI). Data showed that parents in single-wage families spent more time in primary care-giving compared with parents in dual-wage families. Fathers' involvement scores on the different components of the PICCI did not vary as a function of mother's employment status or family structure. Data are discussed with respect to the rigidity of men's role in a historically patriarchal society.

Family planning and parenthood needs of women with severe mental illness: clinicians' perspective

Family planning and parenthood are important issues for women with severe and persistent mental illness (SPMI). The role of adult mental health clinicians with regard to these issues has been under investigated. Clinicians treating patients with SPMI at a large community health center completed survey forms on 419 women. Clinicians reported that a large fraction of sexually active women were not thought to be using birth control. Despite this, many clinicians had not discussed birth control with these patients. Clinicians had concerns about childcare in 72% of cases where the patient with SPMI was the primary custodian of a younger child; however, the majority of these families were not receiving child or family services. Further consideration of the role of the adult mental health clinician in addressing issues of family planning and parenting is required.

Knowledge, attitudes and practices of mothers and knowledge of health workers regarding care of the newborn umbilical cord

OBJECTIVE

To determine the knowledge, attitudes and practices (KAP) of mothers and the knowledge of health workers regarding care of the newborn umbilical cord.

DESIGN

Cross-sectional survey.

SUBJECTS

Mothers with infants less than three months of age attending well child clinics and health workers (HW) in the clinics, maternity and newborn units of public health, facilities serving an urban slum area in Nairobi, Kenya.

RESULTS

Of the 307 mothers interviewed, 91% and 28% of mothers knew of the need for hygiene whilst cutting and tying the cord, respectively. Regarding postnatal cord care, 40% had good knowledge and 66% good practice. Fifty-one percent of mothers knew and 54% practised postnatal cord care for the appropriate duration of time. Seventy-nine percent of mothers were afraid of handling an unhealed cord. After multivariate analysis, the following variables showed significant independent association with good maternal KAP; increased level of education (OR 2.3, p < 0.001), living in middle class areas rather than slums (OR 1.5, p < 0.03), increased maternal age (OR 1.8, p < 0.001), acquisition of knowledge from a HW rather than from other sources (OR 1.5, p < 0.001), and living in stone/brick houses rather than mud houses (p = 0.01). Fifty per cent of HW had correct knowledge on type of postnatal cord care, and 79% had correct knowledge on duration required for the same. The knowledge of 50% on type of care was incorrect by international standards, but was in keeping with Nursing Council of Kenya teaching.

CONCLUSION

Mothers had good knowledge on the need for hygiene when cutting the cord, had poor knowledge and practice in other aspects of cord care, and were afraid of handling the cord. Poor KAP was associated with young, poor mothers of low education, who had acquired their knowledge from sources other than HW. The knowledge of a large proportion of HW was incorrect and outdated. We recommend that health education on cord care be given at all levels of contact with mothers and that knowledge of all primary HW on cord care be updated.

Growth and development of abandoned babies in institutional care in Nairobi

OBJECTIVE

To determine the pattern of growth and development of institutionalised infants and to compare the outcome with that of infants living with their biological mothers.

DESIGN

A cross-sectional survey.

SETTING

Seven children's homes; Kenyatta National Hospital's New Born Unit and Well Baby Clinics in Nairobi, Kenya.

PARTICIPANTS

Eighty-two abandoned babies who fulfilled the selection criteria were recruited and for each abandoned baby two mothered babies matched for age and sex were selected from the well baby clinics.

MAIN OUTCOME MEASURES

Anthropometric measures of weight, length, head circumference and left mid arm circumference (LUMAC) were taken and the mean values and Z scores determined to demonstrate growth pattern and nutritional status of the babies. The Revised Denver Development Screening Test (RDDST) was used to assess the development pattern of infants.

RESULTS

Seventy per cent of infants were below six months old and 73% were abandoned within the first week of life. Abandoned babies were significantly thinner with the mean LUMAC of 10.8 cm versus 12.3 cm (p = 0.02) Institutionalised babies were significantly wasted (p = 0.00001) and stunted (p = 0.00001). Abandoned babies were significantly delayed in development (p < 0.0001). In all the four sectors tested for, institutionalised babies showed significant delay, p < 0.0001 in each sector.

CONCLUSION

This study demonstrates that infants under institutional care have poorer growth and development compared to mothered infants.