acase@tulane.edu

acase@tulane.edu

acase@tulane.edu

Statement of the Problem. The Epidemiology Unit of the Louisiana Department of Health and Human Resources had determined previously, through a systematic investigation, that children with subclinical hepatitis A infections in day-care centers (DCC) were transmitting the virus to parents and to other family members The secondary spread of hepatitis from DCC children to adult family members is known to be costly in terms of morbidity and economics. A cost of illness survey was conducted by this investigator and associates on 17 households affiliated with an outbreak center in 1977. The estimated minimum cost, including lost wages, was $1,952 per household The purpose of this study was to describe factors associated with hepatitis A outbreaks in DCC of Jefferson and Orleans Parishes and to determine which factors would differentiate outbreak from non-outbreak centers. Nine (9) research questions were addressed. Is there a difference between outbreak and non-outbreak DCC in relation to: (1) handwashing practices? (2) diapering practices? (3) employee characteristics and policies? (4) child characteristics? (5) water usage? (6) sanitarian review index? (7) demographic characteristics? (8) cleaning procedures? (9) hours of day-care operation? Methods and Material. Three (3) instruments were developed to collect data for this study: an Interview Schedule, an Observation Guide, and a Sanitarian's Inspection Schedule for Day-Care Centers. The Interview Schedule was designed to record information on 43 study variables from interviews with center directors. The purpose of the Observation Guide was to record observations on some of these same variables during on-site visits to DCC. The third tool, Sanitarian's Inspection Schedule for Day-Care Centers, was constructed from a standardized form routinely used by Louisiana Department of Health sanitarians for recording conditions in DCC Between July and November 1980, letters were written to day-care center directors informing them of the study. Appointments were then scheduled to conduct interviews and to perform observations and sanitarians' inspections of the centers The study sample consisted of 8 DCC which experienced hepatitis outbreaks in 1979 and a stratified random sample of 28 non-outbreak centers Data from coded questionnaires were key punched to computer cards and cross tabulation tables with raw scores and percentages were developed on study variables by outbreak status. Chi square tests were performed on all nominal level data and the t test was used on interval level data. The SPSS computer program was used for the data analysis Findings and Conclusions. Statistical analyses revealed that 5 of the 43 study variables selected for examination were significantly different (p < .05) between outbreak and non-outbreak DCC: (1) handwashing supervision after bathroom use, (2) a specific area designated for diapering, (3) employees who served food and changed diapers, (4) the number of children in diapers, and (5) the number of operation hours per day These findings suggest that a stringent program of personal hygiene for center children and employees, adherence to specific rules regarding diapering, restriction of the number of non-toilet trained children admitted, and restriction to an average of 10 or less hours of daily operation may decrease the risk of hepatitis A outbreaks in DCC Since the results of this study cannot be generalized to all DCC, it is recommended that similar studies be conducted in other communities and in other care facilities Certain factors identified in this study appeared to contribute to the transmission of hepatitis in DCC. Based on these findings, the investigator plans to develop a handbook that will assist DCC directors in formulating policies necessary for the prevention and/or control of hepatitis A in their centers / acase@tulane.edu

acase@tulane.edu

acase@tulane.edu

acase@tulane.edu

acase@tulane.edu

A large body of evidence suggests that short inter-pregnancy intervals negatively impact birth outcomes; however, relatively little is known about the extent to which these impacts persist beyond birth or affect children's post-natal growth and cognitive development. This thesis uses data from the Cebu, Philippines Longitudinal Health and Nutrition Survey to examine the impact of short inter-pregnancy intervals (both preceding and subsequent to the index child) on the growth and development of index children from birth to 21.5 years. The following outcomes were of interest: birth weight; birth length; linear growth from 0-2, 2-11.5, and 11.5-21.5 years; attained height at 21.5 years; cognitive performance at 8.5 and 11.5 years; and educational attainment at 21.5 years. The results show that inter-pregnancy intervals of less than 12 months negatively impact birth outcomes and early linear growth. The effect sizes were as follows: 84-93 g for birth weight; 0.23-0.32 cm for birth length; 0.83-0.94 cm for attained height at 10.5 months; and 3.0-4.2 cm for attained height at 6.75 years. These effects did not generally persist later in life and did not extend so far as to negatively impact children’s cognitive performance and educational attainment. It was sociological effects associated with sib-ship size not biological effects associated with a short inter-pregnancy interval that negatively impacted children’s cognitive development and educational attainment, with each older sibling associated with a 0.5-1.0 point deficit in IQ score and each younger sibling associated with a 1.0-2.0 point deficit in IQ score at 8.5 and 11.5 years. These results indicate that the promotion of appropriate inter-pregnancy spacing is not sufficient alone to improve child development in developing countries. To address children’s cognitive development also requires addressing family size. Further efforts are therefore needed to generate and meet demand for family planning in developing countries with high fertility rates. / acase@tulane.edu

acase@tulane.edu