This study explores discourses around private three- and four-dimensional (3/4D) ultrasound scans in pregnancy, the experiences of women who have 3/4D scans and what impact these scans may have on pregnant women. A critical discourse analysis of scanning company websites was undertaken to explore the discourses, identities and genres set up on the websites. Longitudinal interviews exploring women’s experiences of 3/4D scans were analysed using interpretative phenomenological analysis. Case studies, using longitudinal questionnaire and interview data, were used to investigate the psychological impact of 3/4D scans on pregnant women. The critical discourse analysis revealed mixed discourses, identities and genres. While 3/4D scans are not overtly medical, they nevertheless contain medical aspects. They are promoted as enhancing bonding and reassurance. In the interview analysis, two superordinate themes emerged: ‘Getting to know the baby’ and ‘Experiences of pregnancy’. While the women’s physical and emotional experiences of pregnancy varied considerably, there were more convergences in the desire to ‘get to know’ the fetus and how women approached this. While routine and 3/4D scans played an important role, fetal movement also emerged as a significant factor. The case studies showed that the psychological impact was not consistent. Scans had no effect on fetal health locus of control, may have reduced anxiety about specific issues for some women and may have had a positive impact on some components of bonding for some women. It is not possible to state categorically that they reduce anxiety or increase bonding. The psychological impact of 3/4D scans appears to be individually mediated and depends on pregnancy experience and individual psychological differences, highlighting the significance of individual factors in both research and practice. Two opposing discourses portray 3/4D scans as either beneficial, by enhancing reassurance and bonding, or problematic, by undermining women’s embodied knowledge and experience and being potentially risky. This study suggests that neither of these two conflicting discourses are reflected in women’s experiences. The women in this study were not motivated primarily by bonding or reassurance when choosing 3/4D scans, but considered them a nice experience; on the other hand, the scans do not seem to have had a detrimental impact either. The interview analysis suggests that women acquire knowledge about the fetus through scans and fetal movement and combine these to make sense of the fetus. This study also provides evidence that the concept and measurement of bonding during pregnancy is problematic and that professional and academic perspectives are not necessarily reflected in women’s experiences.

Throughout the twentieth century there has been academic debate about the relationship between early life experience and adult health. This thesis examines the origins of that debate, its manifestation in different scientific fields of inquiry, and its recent re-emergence in epidemiological research. It shows how the changing nature of the debate was inextricably related to changes in the notion of adult health, the development of methods of empirical investigation, and the consequent availability of scientific evidence. The thesis therefore spans a number of disciplines and draws on the relevant knowledge from each. During the first forty years of this century the debate was policy-led. Adult health was assumed to depend on child health but empirical investigations of the link were limited. Research concentrated on early life factors, such as the behaviour of the mother, which were thought to influence morbidity and mortality in infancy and childhood. The focus of the academic debate was whether these factors were environmental or genetic in origin. This debate had important policy implications. Public acceptance of the significance of the early environment provided the rationale for the emerging infant and child health services. More recent interest in the influence of early life on adult health sprang from two different hypotheses about the basis of adult health, both of which focus on adult chronic disease. The first hypothesis puts forward the view that adult lifestyle is the main source of risk for chronic disease, and considers early life factors only to the extent that they are associated with the development of healthy and unhealthy lifestyles. The interdisciplinary, American dominated debate associated with this hypothesis is policy-led, and lacks a common conceptual model for understanding the risk processes that may be involved in the lifetime development of health related behaviour. In contrast the second hypothesis gives a causal and dominant role to environmental factors during critical periods of growth in utero and infancy which affect particular body systems, with long term consequences for adult chronic disease. This epidemiological research is science-led and dominated by one British investigator (Professor DJP Barker) and his research team who have developed the concept of 'environmental programming'. The academic debate associated with this hypothesis concerns the interpretation that is given to research findings which show associations between early life and adult chronic disease. Whereas for Barker they are evidence of a biological process occurring at the beginning of life, for others they reflect continuity of social deprivation throughout life. It is the relative influence of the intrauterine, childhood and adult environment which is in dispute. The thesis addresses these questions in respect of cardiovascular and respiratory disease by drawing on data from the Medical Research Council's National Survey of Health and Development, a unique prospective study of the health and development of over 5000 men and women followed up since their birth in March 1946. Evidence is presented which suggests that the effect of early life factors on adult blood pressure, lung function and overall health status is irrespective of later socioeconomic experiences, thus providing support for the environmental programming model. A second model, based on Rutter's concept of 'chains of risk' is put forward to explain the lifetime development of health related behaviour, and is used to account for the links between adult physical activity and early social, educational and individual characteristics which are found in data from the National Survey. In the recent debate there has been little engagement with the policy process, although Barker's new theories have attracted considerable public attention. The thesis draws on its historical reviews of epidemiological research and child health services to consider what effects the evidence presented may have on health and social policies for children in the 1990s.

Children with serious illnesses experience life disruptions that are of consequence to long-term health and development. The spiritual is integral to health, yet many healthcare providers claim a lack of understanding and comfort with attending to spiritual issues in practice. This hermeneutic phenomenological inquiry explores spirituality as lived by children with cancer and cystic fibrosis and highlights the importance of spirituality in the provision of holistic child healthcare. Four children aged nine to fourteen from each illness group (six males and two females) were interviewed and asked to draw pictures, forming the primary data for interpretation. Conversations with family members were also included in the analysis as supplements to the primary data. Study findings offer insights into children’s lived experiences of the spiritual. They reveal unmet spiritual needs and unique ways of living the spiritual that often went unrecognized by adults. The experiences shared were profound and deeply meaningful, revealing hidden wondering and wisdom that defies contemporary views of how children understand and deal with the complexity of living with serious illness. Findings provide more nuanced understandings of the spiritual that allow for the voices and emotions of children to be heard, revealing a sense of struggle and the need to find meaning in illness with all its disruptions and demands on time and freedom. Findings also reveal the meanings in relationships that sustained children in their efforts to live well with illness. These findings provide possibilities for viewing child health differently—a view that includes the spiritual and its implications—that can lead to a more conscious awareness, wisdom, and sensitivity in practice. Findings offer ways of engaging children in conversations about illness meanings and the spiritual that recognize the complexity in language and the need for alternate strategies to mine the depths of experiences that are often hidden. Because the spiritual does not always wait for experts to arrive, findings are relevant to all healthcare providers and caregivers of ill children. Implications for interprofessional research, education, and practice are also explored, providing possibilities for seeing, exploring, and living the spiritual in our practices of caring for ill children.

No description available.

Thesis (Ph.D.)--Aberdeen University, 2009. / With: Health status and health needs of the orphan children of Kathmandu Nepal : the findings of the pilot study / S. Sing, Edwin R. Van Teijlingen, P. Simkhada. Stupa Journal of health services. 2007: 3, 1-2. With: Health status and health needs of orphan children of Kathmandu Nepal / S. Sing, P. Simkhada, Edwin R. Van Teijlingen. Journal of Nepal Heath Research Council. 2007: 5, 2. Includes bibliographical references.

Reducing maternal and child mortality has been a top global health priority for the past two decades. Through this thesis, I underline some of the strategies, barriers and determinants to optimal maternal and child health (MCH) in three specific districts of Jimma Zone in the southwest of Ethiopia. My first paper has a particular focus on the quality of MCH data collected within the health management information system (HMIS), while the second paper focuses on the utilization of antenatal care (ANC) services, assessments of malaria in pregnancy, and women’s access to malaria preventive measures using data from a cross-sectional survey conducted in the three study districts. The quality of MCH data collected within the HMIS from July 2014 to June 2015 for the 26 primary health care units (PHCUs) located within the three districts was evaluated using the World Health Organization’s Data Quality Report Card (DQRC). To complement the methods recommended in the DQRC, Pearson correlation coefficients, intraclass correlation coefficients, and Bland-Altman analysis were used to determine the agreement between MCH indicator coverage estimates derived from the HMIS and a population-based survey conducted with 3,784 women who had a birth outcome within the same time frame. The quality of MCH data collected within the HMIS was determined to be unsatisfactory, with many health facilities located in the three districts not reporting completely, consistently, or accurately MCH key indicators relating specifically to ANC, skilled birth attendance at delivery, and postnatal care. This finding is important since poor data quality can compromise effective decision-making and resource allocation processes aimed at contributing to better health outcomes in mothers and newborns. vi To address the objectives set in the second chapter, analysis of cross-sectional survey data from 3,784 women who had a birth outcome in the year preceding the survey was performed through logistic regression models adjusting for clustering of the participants by PHCU. While close to 85% of the women attended at least one ANC visit, less than 50% of the participants received four or more ANC visits. Lack of necessity, distance to health facility and unavailability of transportation were determined as key reasons for not attending ANC. Women who completed secondary or higher education, were from the richest households, were exposed to different media sources, and were able to make decisions about their healthcare by themselves or jointly with their husband were more likely to attend ANC services. Frequent visits by a health extension worker and pregnancy intendedness also influenced ANC attendance. Bed net ownership and utilization during last pregnancy were also relatively low (52% and 26%, respectively). The results also showed that the odds of owning and always using a mosquito net were higher in participants that attended ANC, with odds ratios of 1.98 (95% CI: 1.55-2.53) and 1.62 (95% CI: 1.23 – 2.13), respectively. The prevalence of malaria infection during pregnancy was low in our recruited sample, with 1.45% of the participants reporting suffering from malaria during their last pregnancy. We determined significant negative relationships between malaria infection and maternal age and education level. This work emphasizes the importance of improving the quality of MCH data within the HMIS in Ethiopia as well as addressing the inequities relating to ANC attendance in Jimma Zone. Given the adverse effects that malaria can have on the progress and outcomes of a pregnancy, the importance of promoting mosquito net ownership and use as part of ANC services is also highlighted.

The development of socio-emotional competence in middle childhood is an essential acquisition that will enable a child to negotiate interaction with peers and others (Robbins & Rutter, 1990). A substantial body of research has arisen concerned with the identification and prevention of risk factors that might impede certain children's ability to thrive socially and emotionally (Doge & Coie, 1987, Parker & Asher, 1993). This expansion in prevention and evidence-based practice has led to changes in national policy. As a consequence of the revised Children's Act (2004) the promotion of emotional health and well-being in schools, through both the curriculum and school-based intervention, has become a recognised priority. The studies in this thesis describe a pragmatic evaluation of a Year 3 intervention, (Pyramid), which is designed to be delivered in school and targeted at children who are quiet, behaviourally inhibited and at risk of social isolation (Pyramid, 2007). Children's socio-emotional health was measured using the teacher-rated version of the Strengths and Difficulties Questionnaire (Goodman, 1997) both pre- and post-intervention and at a twelve-month follow-up. The views of the children who attended were elicited through a series of focus groups. Pyramid attendees showed greater levels of improvement than Comparison group classmates at both post-intervention time-points. Evidence of preservation of gains for Pyramid attendees was also shown at the twelve-month follow-up. Emergent themes from the focus groups supported these results with Pyramid attendee children reporting self-recognised improvements post-intervention and with no personal costs experienced as a result of the intervention. These results augment both the existing evidence base for Pyramid (Davies, 1999, Fitzherbert, 1985, Skinner, 1996) and add to the evidence base regarding the efficacy of school-based preventative interventions. This thesis proposes a novel conceptual model for the monitoring of socio-emotional health and wellbeing in primary schools and highlights the importance of the need to discern how these interventions can influence future policy and practice.

Podoconiosis is a neglected tropical skin disease caused by a fault in skin barrier function (SBF) combined with a genetic predisposition. Irritant minerals and pathogens entering breaches in plantar skin cause an inflammatory reaction and lower leg lymphoedema. This has a considerable negative impact on the quality of life and economic status of some of the poorest people in 20 countries. Podoconiosis is preventable and treatable but not curable. No previous pre/post controlled intervention studies on skin treatment for the disease have been published. The aim of this randomised control trial (RCT) was to evaluate the effectiveness of a low-cost evidence-based skin care intervention to improve the SBF in the legs/feet and enhance disease related quality of life. A pilot study (n=10) indicated that adding 2% glycerine to the existing skin management regime used in Ethiopia could have a positive effect on stratum corneum (SC) hydration levels and trans-epidermal water loss (TEWL). The study recruited participants from two Ethiopian clinics (n=193). The control group used the existing treatment regime: washing legs/feet with soap, soaking in 6 litres of water with disinfectant added and applying Vaseline®. The experimental group added a 2% dilution of glycerine to 1/6 of the amount of soaking water and 0.0045% less disinfectant. After 3 months the experimental intervention had a highly significant positive effect on TEWL (p = < 0.001) and SC hydration (p = < 0.002) compared to the control. The reduction in foot circumference was highly significant (p = < 0.001). There was no significant group difference in Dermatology Life Quality Index (p = 0.907). The study indicates the very positive effect on SBF of adding 2% glycerine and less disinfectant to the current treatment. This finding offers a significant contribution to the body of knowledge on the management of the disease. The addition of 2% glycerine to treatment regimens may also have positive effects on other skin diseases with compromised SBF.

The aim of the study is to explore aspects of child safety in registered day care centres situated in a lower socio-economic area of the Cape Town Metropole. This can be achieved by: a) describing the physical environment in day care centres b) assessing the infrastructure of day care centres to deal with potential injurjes c) reviewing injury reporting systems already in place d) highlighting the issue of child safety in the course of conducting the study.

A cross-sectional, descriptive study combining with open-ended (qualitative) interview questions with quantitative component was conducted to explore disclosure experiences of mothers and caregivers of HIV-infected children. The study was conducted with 102 parents and caregivers at a tertiary hospital in Cape Town delivering care to 303 HIV-infected paediatric patients. The study sample included 102 participants, ranging in age from 16 years to 71 years. The sample included 73 mothers (72%), six fathers (6%), 11 foster-mothers (11%), and 12 caregivers or grandmothers (12%). The median age of participants’ children was 4 (IQR 2-8) years and ranged from five months to 16 years. Only 48 (47%) were old enough for disclosure to be possible. Disclosure or disclosure delay was associated with several factors, including the child’s age or ability to understand, anxiety and guilt about being blamed for infecting the child, fear of exposing the child to stigma, discrimination and social exclusion related to the child disclosing to others, and the hope that the child would be adherent if they understood their illness and the way in which the medication could improve their health outcomes. Only 16 (33%) of 48 participants actually disclosed the child’s HIV status. The results indicate that HIV-disclosure remains a challenging, emotionally-charged experience for mothers and caregivers. The findings of this research, and similar studies, point to the value of integrating disclosure support and planning into routine care for children and adolescents, as well as their parents and caregivers.