Impact of maternal and child health strategy on child survival in a rural community of Pondicherry

OBJECTIVE: To determine the impact of Maternal and Child Health (MCH) services on child survival in a socio-economically backward rural community. SETTING: Twelve villages in Pondicherry with a population of 16,803. DESIGN: Prospective study. SUBJECTS: A birth cohort of 356 live births (LB) born between January 1st and December 31st 1988. METHODS: The live births were followed-up from birth to five years age (1988-1993). The health care received by this cohort and the antenatal services received by the cohort mothers was reviewed. Outcome measures related to child survival were determined and their changing trend since 1967 was examined. RESULTS: Fifty-four per cent of the cohort children were from families below the poverty line. Antenatal registration and tetanus immunization coverage of the mothers of the cohort was 100%. Immunization coverage of the cohort children was more than 98% for BCG, DPT (three doses) and OPV (three doses) and 82% for measles. The infant mortality rate had reduced from 201/1000 LB in 1967 to 64/1000 LB (95% CI 58.9-68.1) in 1989. The child death rate decreased from 29.4/1000 children 1-4 years of age (1970) to 18/1000 (95% CI 13.9-22.1) in 1992. There were no deaths due to neonatal tetanus or measles. Neonatal mortality (35/1000 LB; 95% CI 29.9-40.1) was higher than the post-neonatal mortality (29/1000 LB; 95% CI 24.1-33.9). Fifty eight per cent of the neonatal deaths were due to non-infective causes like prematurity, birth asphyxia, birth injuries and congenital anomalies. Eighty per cent of post neonatal deaths were due to infections. Overall, the child survival index was high (91.27%; 95% CI 88.14-94.26). This was inspite of the low socio-economic background of the children's families. CONCLUSIONS: Good MCH services can substantially improve child survival inspite of prevailing low socio-economic situations. Inputs for neonatal care need to be strengthened to further enhance child survival.     

Mother role satisfaction, mother–child interaction, and child temperament: A process model.

Using data from the New York Longitudinal Study (begun by A. Thomas and S. Chess in 1956 and continuing through to the present), the present authors tested the hypothesis that the relation between maternal role satisfaction and child adjustment is mediated by the quality of the mother–child relationship. Data were obtained on 51 children from unemployed mother families and 38 children from employed mother families. Beginning in the 1st mo of the child's life, the parents were interviewed periodically (approximately every 3 mo) for the 1st 2 yrs, and every 6 mo until after 5 yrs of age, after which they were interviewed in adolescence and young adulthood. Using the child's temperamental difficulty as an index of adjustment, results of several path analyses indicate that mothers who were dissatisfied with their roles showed more rejection of the child, and, in turn, had more difficult children. Findings illustrate the use of a process model in explaining the relation between maternal role satisfaction and child development. (36 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Role of fine-needle aspiration biopsy and frozen section examination in determining the extent of thyroidectomy

Ten years' experience with neonatal necrotizing enterocolitis (NNEC) was reviewed retrospectively to determine long-term survival and quality of life and to analyze risk factors associated with in-hospital mortality. Institutional records were queried to identify all neonates who required emergent surgical intervention for NNEC. These records were then reviewed and survivors' families interviewed by phone to determine patient status, persistent gastrointestinal problems, and overall quality of life. Once identified, long-term survivors (LTSs) were compared to in-hospital deaths by the analysis of birth weight, gestational age, time interval from birth to diagnosis, indications for laparotomy, and extent of intestinal involvement. Between 1986 and 1996, 69 patients required surgical intervention for NNEC. Eleven patients were lost to follow-up. Of the remaining 58 patients, 31 were ultimately discharged home, with 28 patients having survived an average of 4.18 years. The acute, or in-hospital, mortality rate was 39.1 per cent. Infants who died did so within an average of 23 days postoperatively, and those who were discharged home required an average of 121 days of inpatient convalescence. Twenty-one of the 28 LTSs achieved a normal quality of life with no persistent health problems. One patient required a hepatic-intestinal transplant, and another six had minor problems with frequent diarrhea. Average birth weight, age at NNEC diagnosis, and gestational age were not significantly different between LTSs and those with acute deaths. Aggressive in-hospital care is warranted for infants with NNEC. The excellent quality of life achieved in 75 per cent of survivors implies that the expense of heroic surgical care for these seriously ill premature infants is a worthwhile investment.     

Genetic liability, environment, and the development of fussiness in toddlers: The roles of maternal depression and parental responsiveness.

Using a longitudinal, prospective adoption design, the authors of this study examined the effects of the environment (adoptive parents' depressive symptoms and responsiveness) and genetic liability of maternal depression (inferred by birth mothers' major depressive disorder [MDD]) on the development of fussiness in adopted children between 9 and 18 months old. The sample included 281 families linked through adoption, with each family including 4 individuals (i.e., adopted child, birth mother, adoptive father and mother). Results showed that adoptive mothers' depressive symptoms when their child was 9 months old were positively associated with child fussiness at 18 months. A significant interaction between birth mothers' MDD and adoptive mothers' responsiveness indicated that children of birth mothers with MDD showed higher levels of fussiness at 18 months when adoptive mothers had been less responsive to the children at 9 months. However, in the context of high levels of adoptive mothers' responsiveness, children of birth mothers with MDD did not show elevated fussiness at 18 months. Findings are discussed in terms of gene–environment interactions in the intergenerational risk transmission of depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of early maternal employment on toddlers, mothers, and fathers.

Investigated the effects of early maternal employment on toddler development and mothers' and fathers' parenting styles using a family system orientation. The 75 families with firstborn 20-mo-olds varied in maternal employment status (nonemployed, part-, and full-time). Observations were conducted of qualitative dimensions of parent–child relationships (toddler–mother and toddler–father attachment and child–parent problem-solving behavior), quantitative dimensions of family time allocation, and parental childrearing attitudes. Each mother had been employed outside the home prior to the baby's birth. 24 mothers had not been employed since the birth of their children; 23 mothers were employed part-time. Results indicate that maternal employment was not related to toddler outcomes (security of attachment or problem-solving behavior). It was related to the amount of time mothers spent with their children and to some childrearing attitudes and behaviors of fathers and mothers. Findings highlight the importance of examining direct (mother–child) and indirect (father–child) effects in the study of early maternal employment and the ability of families to adapt to a variety of lifestyles. (24 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

What are we teaching about lifting and transferring patients?

Parents' perceptions of how they were told that their child has special needs were examined. Thirty-nine families on the Isle of Wight completed a structured interview. Participants formed two groups. The first group comprised of 23 families who had a child aged from birth to 5 years with special needs. In the second group there were 16 families who had a child aged between 15 and 20 years with special needs. Parents were asked about their perceptions of how their child's special needs were disclosed, their satisfaction with how they were told and what improvements they would have liked. Differences between the two cohorts were examined, and changes in how services were perceived were investigated. Overall, parents in the group with younger children were more satisfied about the way in which they were told that their child had special needs than those with older children. Implications for service delivery and future research are considered.     

Population policies and reproductive patterns in Vietnam

BACKGROUND: Vietnam's population policy since the 1980s had stipulated a limit on family size to two children, born 3-5 years apart, and recommends a minimum age of 19 for the mother of a first child. We analysed trends in the timing of marriages and births, and in fertility and abortion rates, among women born between 1945 and 1970, to assess the impact of these policies on reproductive patterns. METHODS: Reproductive histories were recorded in a random sample of 1432 married women aged 15-49 in a rural province in northern Vietnam. Mean age at marriage and at birth of the first child, birth intervals, fertility, and abortion rates were examined in relation to the woman's year of birth. FINDINGS: Later-born women married and had their first child at a younger age than women born earlier. Birth intervals had increased among later-born women but 25% still had only a 1-year interval between first and second child. Fertility had gradually decreased while abortion ratios had increased rapidly. Childbearing patterns had become "earlier, longer, and fewer" rather than "later, longer, and fewer" as stipulated by the policies. The results also show that women with more schooling married and had their first child later. Women involved in farming had shorter spacing between children. INTERPRETATION: There are signs that Vietnam's population policy has focused too strongly on contraception and abortion while ignoring the connection between fertility and women's opportunities for education and employment. In these respects, rural women are at particular risk.     

Predictability of early atopy by cord blood-IgE and parental history

BACKGROUND: Atopic family history and cord blood IgE have been used as predictors of atopic disease in newborns for about 20 years, but at least for cord blood IgE the sensitivity has been shown to be very low. The objective of this paper was to evaluate whether parental history and cord blood-IgE were more accurate predictors for the appropriate atopic phenotypes in the infants rather than for any atopy. METHODS: A total of 1314 newborn infants was recruited in six German obstetric departments in 1990 and followed-up for 2 years. Four hundred and ninety-nine (38%) were at high risk for atopy with at least two first degree atopic family members and/or elevated cord-blood IgE concentrations. RESULTS: The cumulative incidence of atopic dermatitis over the first 2 years of life (AD24) amounted to 20.1%, and there was a significant association with AD history of the mother (OR 2.5, 95%CI 1.46-4.26) and of the father (OR 3.53, 95%CI 1.90-6.54). The cumulative incidence of recurrent wheezing in the first 2 years of life (RW24) amounted to 16.1%, and was positively associated with asthma history (OR 2.11, 95%CI 1.33-3.60) and sensitization history (OR 1.64, 95%CI 1.34-2.36) of the mother, but with neither for the father. RW24 was less prevalent in girls than in boys (OR 0.64, 95%CI 0.47-0.89). Thirty-one per cent of infants were sensitized (CAP test value > 0.35 kU/L) against at least one of nine food or inhalative allergens (S24) and this was significantly associated with cord blood-IgE value (OR 2.43, 95%CI 1.69-3.49), and sensitization history of the mother (OR 1.64, 95%CI 1.18-2.41). Using multiple logistic regression analysis, the prediction of AD24 by AD of parents, of RW24 by asthma of parents, and of sensitization by cord blood IgE was of low accuracy. CONCLUSION: The predictive capacity of parental history and cord blood IgE is not high enough to recommend them as screening instruments for primary prevention. The majority of atopic manifestations and of sensitization occur in infants with no demonstrable risk at birth.     

Prolonged fasting in pediatric outpatients does not cause hypoglycemia

The long-term results after the manipulation and strapping in flexion of selected extension supracondylar fractures of the humerus were evaluated in 43 children. Reduced fractures that were stable when immobilized in approximately 110 degrees of flexion, without producing circulatory obstruction, were treated in this manner. After a minimum review of 4 years, 95 per cent of the children had an excellent or good range of elbow motion and 88 per cent had excellent or good elbow alignment. No child had Volkmann's ischaemic contracture. Five children had cubitus varus which was due to malunion in three, but was unrelated to the treatment of the supracondylar fracture in two children. If these two latter children were excluded then excellent or good alignment was observed in all children who had a Baumann (humerocapitellar) angle of 80 degrees or less at the time of reduction and 84 degrees or less 10 days after the fracture. We concluded that manipulation and strapping in flexion was suitable for approximately 60 per cent of children with isolated displaced supracondylar fractures of the humerus.     

Contribution of curietherapy in the treatment of ENT tumors

The purpose of this study was to compare dental status and resource requirements in immigrants to Norway, three to 18 years of age, with Norwegians of the same age group. Data on dmft and DMFT, fillings placed and time spent for dental care were registered in the records of 9000 such children in the period 1992-93. Eleven per cent of the children were immigrant children. Immigrant children three to six years of age had fewer sound teeth and more decayed, missing and filled teeth than Norwegian children and the pre-school immigrant children had higher treatment needs. However, the time spent on a pre-school child with an immigrant background was shorter than the time spent on a Norwegian child with the same number of decayed teeth. The differences between immigrants and Norwegians disappeared with higher age. Immigrant children older than six years had dental health and resource requirements similar to those of Norwegian adolescents.     

Onset of cell proliferation in the shortened gut: growth after subtotal colectomy

Serum IgE levels were studied in 2 groups of children with a family history of atopic disease, 30 in whom the mother only and 38 in whom both parents had atopic disease. IgE antibodies were determined with Phadebas RAST Test and serum IgE with Phadebas IgE Test and Phadebas PRIST at 0, 3, 9, 12 and 18 months of age. There was no correlation between the serum IgE levels in mothers and their newborns. RAST tests were frequently positive in maternal sera but no positive RAST test was found in the newborns. Obvious and probable atopic disease developed during the observation period in 42.1% of the children with a double family history of atopic disease. In 75% of these the serum IgE level was above the upper limit of normal on an average 6 months before the onset of atopic symptoms. An elevated IgE level without atopic symptoms during the observation period occurred in only one child. It is concluded that the serum IgE in newborns seems to be of foetal origin and that the determination of serum IgE in infants is of value in predicting atopic allergy.     

Attitudes of women of childbearing age towards prenatal diagnosis in southeastern France

The objective of this study was to explore women's attitudes towards prenatal diagnosis of trisomy 21 and to examine some of the factors possibly responsible for these attitudes before implementing in real practice serological screening of pregnant women at risk for trisomy 21. We carried out a telephone survey on a representative sample of women who had recently had a normal livebirth delivery in the Marseille district in 1990. The participation rate was 80 per cent and the average age of the mothers was 28.9 years. Among the 514 women interviewed, 78 per cent stated that they would ask for an amniocentesis for a 1 per cent risk of trisomy 21 at their next pregnancy. When adjusting for confounding factors, the decision to have or not to have an amniocentesis was found to depend not only on the women's attitude towards induced abortion, but also on their understanding of the risk involved and on the social context (knowing a handicapped child, discussion with the father). It also depended on the women's age and on what they knew about amniocentesis from the medical point of view. The risk of miscarriage can influence a woman's choice but this objection was not found to affect the women's decisions significantly in our survey. The data showed the existence of a high potential demand for fetal karyotyping.     

The natural history of childhood eczema: observations from the British 1958 birth cohort study

The National Child Development Study (NCDS) is a birth cohort study whose longitudinal design makes it suitable for examining the natural history of common diseases in childhood such as atopic eczema. We have analysed the age of onset and clearance rates for examined and/or reported eczema in 6877 children born during the period 3-9 March 1958 for whom linked data were available at birth and at the ages of 7, 11, 16 and 23 years. Of the 870 cases with examined or reported eczema by the age of 16 years, 66% had age of onset by the age of 7 years. Of the 571 children with reported or examined eczema by the age of 7 years, the proportion of children who were clear in terms of examined eczema or reported eczema in the last year at ages 11 and 16 years was 65% and 74%, respectively. These 'apparent' or short-term clearance rates fell to 53% and 65%, respectively, after allowance for subsequent recurrences in adolescence and early adulthood. Age of onset of community-ascertained cases of atopic eczema may be later than that reported in hospital-based studies. The long-term prognosis of childhood eczema may be worse than some previous studies have suggested, especially when subsequent recurrences are taken into account.     

Prevalence of Down's syndrome in Asturias, 1987-1993. Members of the Work Group of the RCDA

OBJECTIVE: To determine the frequency of Down Syndrome (DS) in Asturias and the prenatal diagnosis impact on the birth prevalence of this chromosomal anomaly. METHODS: The analysed data came from the Registry of Congenital Defects of Asturias (1990-1993) and from a retrospective study conducted by the same working group (1987-1989). The total prevalence rates and the prevalence at birth were calculated. RESULTS: Out of 55,601 births, DS was recorded in 83 cases: 69 livebirths, two fetal deaths and 12 induced abortions following prenatal diagnosis, giving a total prevalence rate of 14.9 per 10,000 and a birth prevalence of 12.8. The proportion of induced abortions was 15 per cent in this period; the proportion of cases in the high risk maternal age group (35 years and over) was around 50% of the total. The proportion of induced abortions was 15 per cent in this period. CONCLUSIONS: The frequency of DS in Asturias is comparable to the other populations. Prenatal diagnosis had little impact on the birth prevalence figures. These results may help us draw up prevention and prenatal diagnosis policies for these defects in Asturias when giving the frequency of this health problem.     

Risk factors for aboriginal low birthweight, intrauterine growth retardation and preterm birth in the Darwin Health Region

Risk factors for Aboriginal low birthweight (< 2500 g), preterm birth (< 37 weeks' gestation) and intrauterine growth retardation (under the tenth percentile of Australian birthweights for gestational age) were examined in 503 live-born singletons recorded as born to an Aboriginal mother and routinely delivered at the Royal Darwin Hospital between January 1987 and March 1990. Infants born to mothers with body mass index less than 18.5 kg/m2 had five times the risk of having low birthweight and 2.5 times the risk of intrauterine growth retardation. Population-attributable risk percentages suggest that 28 per cent of low birthweight and 15 per cent of growth retardation could be attributed to maternal malnutrition. Risk percentages for maternal smoking of more than half a packet of cigarettes a day were 18 per cent for low birthweight and 10 per cent for growth retardation. For growth retardation, 18 per cent could be attributed to a maternal age under 20 years. Risk factors for preterm birth were predominantly obstetric: the population-attributable risk percentage for pregnancy-induced hypertension was 26 per cent and for other obstetric conditions was 16 per cent. For Aboriginal births in the Darwin Health Region, maternal malnutrition and smoking are key elements in the prevention of low birthweight and intrauterine growth retardation. Teenage pregnancy is an important risk for intrauterine growth retardation, and pregnancy-induced hypertension is a risk for preterm birth.     

Families created through surrogacy: Mother–child relationships and children's psychological adjustment at age 7.

Each year, an increasing number of children are born through surrogacy and thus lack a genetic and/or gestational link with their mother. This study examined the impact of surrogacy on mother–child relationships and children's psychological adjustment. Assessments of maternal positivity, maternal negativity, mother–child interaction, and child adjustment were administered to 32 surrogacy, 32 egg donation, and 54 natural conception families with a 7-year-old child. No differences were found for maternal negativity, maternal positivity, or child adjustment, although the surrogacy and egg donation families showed less positive mother–child interaction than the natural conception families. The findings suggest that both surrogacy and egg donation families function well in the early school years. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Relations between early child care and schooling.

The purpose of this article is to examine relations between aspects of early child care (age entered, full- or part-time structure, and number of child-care arrangements and their quality) and school adjustment. The early child-care experiences of 87 children who entered a laboratory elementary school at 3 years, 9 months of age were documented, and their first-grade adjustment was assessed 3 years after school entrance. Although single-parent families and families in which the mother was employed used more child care and enrolled their children at earlier ages, maternal education was more closely associated with children's school adjustment than was maternal employment or marital status. After family characteristics were accounted for, academic progress, school skills, and few behavioral problems were predicted by high-quality, stable child care. The structure of the early child care (full- or part-time) was not associated with school adjustment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Selection and identification of single domain antibody fragments from camel heavy-chain antibodies

OBJECTIVE: Our purpose was to determine whether women who were themselves small for gestational age at birth are at risk of giving birth to a small-for-gestational-age child and whether women who were themselves preterm at birth are at risk for preterm delivery. STUDY DESIGN: Women born in Copenhagen as subjects in the Danish Perinatal Study (1959 to 1961) were traced through the Danish Population Register. Information was obtained on their pregnancies during 1974 through 1989. RESULTS: A total of 25% of the children of small-for-gestational-age women were small for gestational age compared with 11% of the children of non-small-for-gestational-age women. Eleven percent of the children of preterm women were preterm compared with 7% of the children of women born at term. The adjusted odds ratios were 2.0 (95% confidence interval 1.4 to 3.0) for women who were small for gestational age to have small-for-gestational-age children and 1.5 (95% confidence interval 0.9 to 2.5) for women who were born preterm to have preterm children. Small-for-gestational-age women were not at significantly increased risk of preterm delivery (odds ratio 1.2), and preterm women were not at significantly increased risk of having small-for-gestational-age children (odds ratio 1.3). CONCLUSIONS: Reduced intrauterine growth of the mother is a risk factor for reduced intrauterine growth of her children. However, preterm birth of the mother is not strongly associated with preterm birth of her children.     

Donor insemination: child development and family functioning in lesbian mother families

Findings are presented of a comparative study investigating the family relationships and the emotional and gender development of children raised in lesbian mother families. A total of 30 lesbian mother families with 4-8 year old children created as a result of donor insemination (DI) were compared with 38 heterosexual families with a DI child and with 30 heterosexual families who had a naturally conceived child. A variety of assessment measures, including a standardized interview and questionnaires from the parents and psychological testing of the child were used to collect the data. The quality of the couples' relationships and the quality of the mother-child interaction did not differ between lesbian mother families and either of the heterosexual family groups. The quality of the interaction between the social mother and the child in lesbian families was superior to that between the father and the child in both groups of heterosexual families. Childrens' own perception of their parents was similar in all family types; the social mother in lesbian families was regarded by the child to be as much a 'parent' as the father in both types of heterosexual families. With regard to their emotional/behavioural development, boys and girls raised in lesbian mother families were well adjusted and their gender role development did not differ from that of children raised in heterosexual families. These results indicate that child and family development in lesbian mother families is similar to that of heterosexual families.     

Birth cohort analyses of dependent children and lone mothers living in one-parent families in Great Britain

This paper uses the recently published updated estimates of the numbers of one-parent families and dependent children living in them to construct two sets of birth cohort analyses. In the first set, the proportion of children who were living in one-parent families is analysed by the child's age and birth year, whilst in the second set, the proportions of all mothers with dependent children who were lone mothers are analysed by the mother's age and birth year. Finally, the paper presents trends in the proportions of lone mothers and married mothers who were working, and compares them with the corresponding trends for similar mothers whose youngest child was aged under 5.