Source: Dissertation Abstracts International, Volume: 70-03, Section: B, page: 1622. Adviser: Stephen H. Linder. Includes bibliographical references.

Adviser: Stephen H. Linder. UMI number 3350227. Includes bibliographical references (p. 130-134).

published_or_final_version / abstract / toc / Nursing Studies / Master / Master of Nursing in Advanced Practice

The health picture in the developing world is still very bleak. The varlOUS Black populations of South Africa (be they Africans, Indians or Coloureds) are part of this developing world. In a total world population of 4,607 million (of which 75 % are in the developing world); there are 10.3 million annual infant deaths (0-11 months) (of which 97 % are ln the developing countries); and 4.3 million annual child deaths (1-4 years) (of which 98 % are in the developing countries).*l The infant mortality rate (IMR) (infant deaths per 1,000 live births) in 1980 for the developing countries as a whole, and for Southern Africa specifically is 100; as compared to the IMR of 20 for developed countries. South Africa has an IMR of 90 (1982). However, a few relatively simple and inexpensive methods could enable parents themselves to bring about a revolution ln child survival and development. The idea that could make this revolution possible is primary health care. The vehicles that could make this revolution achievable are the spread of education, communications and social organization. The techniques which could make this revolution affordable even with very limited resources, are growth monitoring, oral rehydration therapy, breast-feeding and immunization (GOBI). These four principle life line techniques are low-cost, available now, achieve rapid results and a l most universally relevant. They involve people in taking more responsibility for their own health, and thus promote primary health care. In combination they offer an even greater degree of protection against the synergistic alliance of malnutrition and infection which is the central problem of child health and child development today. *3 In addition, three other changes-female education, family spacing and food supplementation (FFF) are also among the most powerful levers for raising the level of child survival and child health. Although more costly and more difficult to achieve, these changes in the lives of women are of such potential significance that they must also now be count ed among the breakthrough in knowledge which could change the ratio between the health and wealth of nations. *3 However, against this information is the stark reality that only up to 15 % of the world's families are using oral rehydration therapy (ORT), the revolutionary low-cost technique for preventing and treating diarrhoeal dehydration, the biggest single killer of children in the world. *4 This then rai ses the vital question that although the potential for child survival and a healthy and normal child development is there, to what extent is the average mother aware of and implementing these cost-effective methods of GOBI-FFF in her own situation? These questions are thus addressed in this study in an African and an Indian urban communities ln Natal/Kwa Zulu. / Thesis (M.Med.)-University of Natal, Durban, 1985.

The existing District Health Information System in South Africa can be described as a facility based Information System, focusing on the clinics and hospitals and not on the community. Consequently, only those who access health services through these facilities are included in the system. Many children do not have access to basic health and social services and consequently, are denied their right to good health. Additionally, they are excluded from the routine Health Information System. Policy and resource decisions made by the District Managers, based on the current health facility information, reinforces the exclusion of these already marginalised children. The premise behind this research is that vulnerability of children can be tackled using two interconnected strategies. The first is through the creation of awareness of the situation of children and the second through mobilising the commitment and action of government and society to address this situation. These strategies can be supported by designing an Information System for action / an Information System that can be used to advocate and influence decisions and policies for the rights of these children / an Information System that includes all children. An interpretive participatory action research approach, using a case study in a rural municipality in South Africa, was adopted for the study of a child-health Community-Based Information System. The context in which the community is placed, as well as the structures which are embedded in it, was examined using Structuration Theory. This theory also influenced the design of the Information System. As the aim of the research is to change the Information System to include vulnerable children, a Critical Social Theoretical and longitudinal perspective was adopted. In particular, concepts from Habermas, such as the creation of a public sphere and the &rsquo / Ideal Speech Situation&rsquo / , informed the methodology chosen and were used to analyse the research undertaken. <br /> <br /> Based on the research conducted in this municipality, four main changes to the Health Information System were made. These were: &bull / determination of the community&rsquo / s own indicators / &bull / changes in data collection forms / &bull / creation of forums for analysis and reflection, and / &bull / changes in the information flows for improved feedback. Other practical contributions of the research are the development of local capacities in data collection and analysis, the development of practical guidelines on the design of a child-health Community-Based Information System, and the development of strategies for enabling participation and communication. In line with the action research approach adopted, and the desire to link theory and practice, the research also contributed on a theoretical level. These contributions include extending the use of Structuration Theory, in conjunction with Habermas&rsquo / Critical Social Theory, to the empirical context of South Africa / addressing the gap of Community-Based Information Systems in Information System design / extending the debate on participation and communication in Information Systems to &rsquo / developing&rsquo / countries, and developing generalisations from a qualitative case study.

Bakgrund: Det förekommer skillnader avseende hur barnhälsovårdssjuksköterskor identifierar utvecklingsavvikelser, och det har sedan länge efterfrågats evidensbaserade, standardiserade metoder för upptäckt av kommunikativa och motoriska utvecklingsavvikelser. Syfte: Att undersöka hur motoriska och eller kommunikativa utvecklingsavvikelser för barn upp till och med 18 månader uppmärksammas inom barnhälsovården, vilka förutsättningar det finns för bedömningen, samt vilka åtgärder som vidtas vid utvecklingsavvikelser. Metod: En beskrivande kvalitativ studie baserad på individuella semi-strukturerade intervjuer med 12 barnhälsovårdssjuksköterskor som arbetade på barnavårdscentraler inom Region Uppsala genomfördes. Materialet har analyserats utifrån Malteruds analysmetod systematisk textkondensering. Resultat: Barnhälsovårdsjuksköterskorna använde klinisk blick, vilken de utvecklat genom erfarenhet, när de bedömde barns utveckling. Den kliniska undersökningen beskrevs i termer av att erhålla en helhetsbild av barnet, samt att den motoriska och kommunikativa utvecklingen hör samman, och bedömdes i denna helhet. Kontinuiteten beskrevs som betydelsefull och något som underlättade bedömningen av barnets utveckling. Ett kollegialt stöd beskrevs som värdefullt, och vid utvecklingsavvikelser kunde barnhälsovårdssjuksköterskorna konsultera varandra. Vid misstanke om utvecklingsförsening följdes barnet upp, samt fick ofta uppgifter att öva på till återbesöket. I de fall utvecklingsavvikelsen kvarstod eller då det handlade om en tydlig avvikelse remitterades barnet vidare. I analysen framkom att det fanns individuella skillnader i barnhälsovårdsjuksköterskornas bedömning. Slutsats: Dagens riktlinjer med fokus på milstolpar kan försvåra barnhälsovårdssjuksköterskans utvecklingsbedömning för barn upp till och med 18 månader. En standardisering, eller ett screeninginstrument för att tydliggöra bedömningarna bidrar till en jämlik och rättvis barnhälsovård. Tidig upptäckt och tidiga insatser har stor betydelse för barnets framtida utveckling. / Background: There are differences in how Child health nurses identify developmental disorders. Furthermore, it has been requested evidence-based methods for detection of communicative- and motor disorders. Aim: Investigate how motor and communicative disorders for children up to, and including 18 months, are noted in Child health centres. Also, the basis for the assessment, what measures are taken in case of developmental disorders, and if there are any differences in the assessments. Method: Descriptive qualitative interview study, based on individual semi-structured interviews, with 12 Child health nurses working at Child health centres in Uppsala Region. The transcriptions were analysed with systematic text condensation by Malterud. Result: Child health nurses used intuition when assessing children's development, which they had procured through experience. The clinical examination was described as getting a general picture of the child. The motor and communication development was assessed in whole, due to their related. Continuity was described as meaningful and something that facilitated the assessment of the child. Collegial support was valuable, and the Child health nurses could consult each other, in case of developmental disorders. If the Child health nurses suspected development delay, the child was followed up. The family then often got exercises to practice before the re-visit. In cases where the developmental delay remained, or when the disorder was obvious, the child was referral further. The analysis found that there were individual differences in the assessment done by Child health nurses. Conclusions: Today's guidelines focusing on milestones can aggravate the Child health nurse's developmental assessment of children up to and including 18 months. A standardized method, or a screening tool, contributes to an equal and fair Child healthcare. Early detection and early intervention are of great importance to the child's future development.

Through the application of the Delphi technique, this study draws on the expertise of British child protection academics and practitioners from a wide range of disciplines in seeking to develop a consensus opinion on possible early indicators of child abuse and neglect. Underpinned by children's rights theory the study reflects an ideologically oriented mode of inquiry. The literature on childhood and research findings from work undertaken with adult survivors of abuse forms an important part of the background. The search for early indicators is described in the context of a secondary preventative approach to the problem of child maltreatment. The Delphi study was conducted through three rounds of data collection. Consensus was defined as 75% or more of the panel agreeing (or 75% or more disagreeing) that an item was a possible early indicator of child abuse and neglect. A total of 73 items were generated. Of these 46 reached a consensus of agreement, four reached a consensus of disagreement and the remaining 23 items failed to reach consensus. The findings from the Delphi study were then examined in the context of a retrospective case-notes review of 20 families known to have had a child protection concern. Although, it is well recognised that inter-agency working is a crucial component of child protection practice, secondary analysis of the Delphi data suggested a number of significant differences in the strength and extent of inter-agency agreement on a number of the possible early indicators. The implications of this finding are discussed in light of contemporary policy and practice. A very tentative conclusion arising from the study is that the early indicators of child abuse and neglect that achieved consensus of agreement may help in diagnosing child abuse and neglect at an earlier stage, although they are not necessarily diagnostic. Alternative explanations, differential diagnoses and information gathering are paramount, as is a willingness and ability to act on concerns. Although great caution is urged, it is suggested that the findings from the study are credible and of interest to those who are working towards more timely recognition and referral of abused and neglected children. Possible applications of the findings in practice, education and further research are suggested.

The purpose of this study was to describe the utilisation of maternal and child health (MCH) care services by mothers from four selected health facilities in the Balaka District of Malawi. A non- experimental quantitative descriptive research was conducted to determine the knowledge of mothers with regard to MCH services and to identify factors that impact on the utilisation of the MCH care, based on the Andersen’s behavioral model of health services utilization. A combination of proportionate stratified sampling and convenience sampling was used and data was collected by means of self-administered questionnaires. It was found that mothers know the available services and that a number of factors have an impact on the utilisation of health care services. These relate amongst others to educational level, finances and cultural beliefs. / Health Studies / M.A. (Public Health)

The study sought to determine the meaning and interpretation by facility managers and nurses on utilisation of expanded programme on immunisation and integrated management of childhood illnesses (EPI and IMCI) programmes for follow-up and antibody testing of HIV-exposed infants (HEI) at 18 months. Also to understand the factors within the health systems that influence the follow-up and antibody testing. The study setting selected was six facilities in Steve Tshwete subdistrict in Nkangala district of Mpumalanga province in South Africa. The study used a hermeneutic phenomenology using in-depth interviews for collecting data from 4 facility managers and 12 nurses. The major themes that emerged from the interviews were referral, defaulting, integration, stigma, and off-site ART initiation within the health system. These were found to influence the utilisation of HEI and IMCI services for follow-up and management of HEI. It was also found that the importance of integrating the management of HEI into the EPI and IMCI cannot be overemphasised. It was concluded that the Health Department needs to be vigilant and use all available resources to manage HEI to meet the MDG 4 of prevention of infant mortality / Health Studies / M.A. (Nursing Science)

Childhood obesity is the most serious public health challenge of the 21st century. Whilst evidence supports a family-based lifestyle approach to childhood obesity treatment, research is needed to understand how interventions work and how practitioners can effectively support families to sustain behavioural changes in the long-term. This thesis evaluated the feasibility of a family-based behaviour change intervention for overweight children (GOALS) and explored the psychosocial process of long-term behavioural change in families with overweight children. Study 1 measured the impact of GOALS on the body composition, lifestyle behaviours and self-perceptions of children and parents who completed the intervention. A complete case analysis (n=70) showed a significant 6-month reduction in child BMI SOS (-0.07, p < 0.001) that was maintained at 12-month follow up. There was a significant year-on-year increase in the proportion of children reducing BMI SOS (42.9% year 1, 62.5% year 2, 80% year 3, p < 0.05) and a strong positive relationship between parent and child BMI change (r = .479, p < 0.001). Parents reported positive changes to their own and their children's physical activity and diet. BMI SOS reduction during the intervention was associated with improved global self-esteem and perceived physical appearance at 12 months. Study 2 explored the experiences of families six weeks into the 18-session intervention through focus groups with parents and children. Motivators to attend GOALS included the non-judgemental approach, being in the same boat as others and child enjoyment. The whole family approach was perceived positively and families used BCTs both as a core component of GOALS and to facilitate their behaviour change at home. As well as the challenges of living with childhood overweight, families described a lack of support from extended family members and a perceived need for on-going professional support. Study 3 followed up 15 families 3-5 years after they attended GOALS. Child and parent BMI was collected and parents took part in a semi-structured interview to explore their perceptions of "success" and their experiences of changing physical activity and eating behaviours. Mean child BMI SOS change from baseline was -0.47 for the 14 families who had completed GOALS. The majority of families perceived positive long-term outcomes, but these were not always aligned with actual child weight change. The most "successful" families placed a priority on changing child weight-related behaviours and parents took responsibility for these changes. While weight-control was a conscious process for these families, it was not necessarily made a "big issue" and parents used practices of an authoritative nature to facilitate change. Physical activity had become a way of life for the children, and mothers had reached a stage of feeling in control of their own weight. This is the first UK childhood obesity treatment study to follow children up beyond 12 months, and the first known study worldwide to employ qualitative methods to explore parental perceptions of long-term success. Findings provided a unique insight into the process of long-term behavioural change for overweight children and raised questions about the way "success" is defined following participation in childhood obesity treatment. Recommendations are made to enhance the delivery of family-based childhood obesity treatment and policy-makers are urged to adopt a multilevel approach to tackling childhood obesity, with child weight management care pathways that recognise the heterogeneity of familial needs. Further research is required to substantiate the impact of GOALS, and to prospectively explore the process of behavioural change in overweight children and the familial factors that serve as moderators in this process.