This biocultural study of infant health and the sensitivity of maternal caretaking strategies was conducted between November 2004 and February 2006 among Datoga, a semi-nomadic pastoral group living in north central Tanzania. A sample of 40 mother-infant dyads were selected to examine the political economy of household constraints and how maternal decisions interact with infant biology to 'embody' social inequality and create patterns of health and illness among young Datoga children. The primary objectives of the research were: 1) Identify the critical periods within early childhood where interactions between household production, nutrition, and health status increase the vulnerability of Datoga infants; 2) Identify how caregivers perceive of changes in infant health and how they use this information to balance allocation of resources between caregiving and household production; 3) Examine how sociopolitical marginalization is impacting Datoga households by determining the intrahousehold variables that act most strongly to constrain women's ability to care for children; 4) Identify how household ecology and caretaking interact with infant development to create patterns of resilience within the mother-infant dyad. The findings from the study indicate that the socioeconomic marginalization of Datoga has severe consequences for child health and well-being. These consequences are evident in the relationship between 'idioms of distress' used to express feelings of vulnerability and disparities in health among both Datoga children and adults. Thus, more attention needs to be paid to the 'socialization' of disease in local contexts and the ways in which the marginalization of Datoga is influencing their exposure to risks for poor health outcomes. Nonetheless, the sensitivity of maternal response has a positive influence on patterns of child health among Datoga, even in the most marginal conditions. Although the cumulative effects of maternal condition during pregnancy and post-natal feeding practices are acting to create patterns of poor nutrition and high illness rates among Datoga children, other variables (such as the amount of time spent in close proximity with the infant) can shift the negative cascade of events and mediate the long-term consequences of even severe adversity.

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The topic, Men’s health practices in dual income families, is worthy of investigation because social change continues to challenge gender roles that have been used to justify a segregation of parental responsibilities. Although child health has primarily been the responsibility of mothers, the increasing trend toward dual income families has resulted in mothers being less available for this role. An emerging substitute for maternal health care is that provided by fathers. Key researchers of fatherhood have reported that men desire more pragmatic interactions with their child, aimed at directly improving health and wellbeing (Burgess, 1990; Burgess & Ruxton, 1997; Burghes, et al., 1997). However, little is known about men’s willingness and capability in performing the range of practices necessary to effectively reduce the morbidity and mortality associated with child illness and injury (Hallberg, 2007; Laws, 2003a). This study used several methods of data collection that ultimately identified new knowledge of men’s health practices not previously recorded in the literature. Document searches, for evidence of men’s health practices, are presented as six chapters; each chapter explores a discrete category of child health or illness; Acute illness, Chronic illness, Mental health problems, Terminal illness, Health promotion and Accident and injury prevention. All six document searches revealed scant information on men’s health practices; this finding supported the need for additional methods. Focus group discussions and individual interviewsm aimed to identify men’s knowledge of child health problems, their repertoire of skills and experiences of practicing health. A questionnaire survey was distributed to households to assess respondent’s attitudes toward the concept of gender equity, shared parenting and to measure the actual health practices performed toward children. Analysis of focus group discussions and survey data revealed a) strong support for gender equity in the workplace and the home b) strong support for equitable parenting c) a repertoire of health practices and frequency of performance far in excess of that evident in the literature. These findings suggest more equitable parenting is occurring and a reclaimed fatherhood role. However, all three methods of data collection identify that men experience substantial barriers to expanding their parental role into child health care; these findings and emerging evidence indicate the need for health professionals and policy makers to develop strategies that enhance men’s inclusion, as partners, in child health practices. / Thesis (Ph.D.) -- University of Adelaide, School of Population Health and Clinical Practice, 2009

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No description available.

The relationship between parent and child is one of the most important and most studied of all human relationships. The purpose of this descriptive study was to compare first-time fathers’ attendance at an entire series of prepared childbirth classes and presence at the delivery with father-infant acquaintance/attachment at three to four months post-birth. First-time fathers living with the infant’s mother were asked to complete the How I Feel About My Baby Now scale and a demographic survey. Two groups of fathers were compared. The first group attended classes, and the other group did not attend classes. Results of a statistical analysis utilizing descriptive statistics, t-tests, and one way ANOVA indicated that fathers who attended the classes felt significantly more angry at their babies than those who did not, and that fathers in the group under 30 years of age felt more playful toward their babies than those over thirty years.

This dissertation reports on a formative evaluation of a high school sexuality education programme. The evaluation aimed to generate a greater understanding of pupils' attitudes to sexuality and insight into pupils' responses to a sexuality education programme. A qualitative method using focus groups was used. The groups comprised pupils, with programme staff acting as facilitators and observers. The foremost findings were that pupils had considerable understanding of many of the issues which the programme aims to teach them about. Pupils requested that the programme address issues of their concern, including lifeskills development. They expressed dislike of lectures, and requested the use of small group discussions. They also expressed the need for individual counselling under circumstances where the pupils could develop a trusting relationship with the counsellor. Pupils expressed difficulty communicating with their parents about sexuality, and distrust for their teachers in the role of counsellors or educators in this field. In conclusion, the evaluation yielded much information of potential use in development of the sexuality education programme, and recommendations are put forward. By basing a Family Planning Advisor at each school the pupils needs could be better addressed. Such an arrangement would allow the advisor to encourage parents and the wider community to participate in the programme. This type of broad approach appears to be a prerequisite for success in this field.

Background Since 2010, adult studies and clinical concerns about stavudine (d4T) toxicity had led to the phasing out of d4T from many antiretroviral treatment (ART) guidelines globally with substitution by abacavir. Recent studies, within Southern Africa, however have shown poorer virological suppression with abacavir (ABC) compared to d4T at their respective centres. Methods A retrospective study of HIV-positive children, who had been initiated on ART from 2005 to 2017, was conducted at an ART unit at New Somerset hospital, Western Cape, South Africa. Data was extracted from clinical notes and electronic medical records and virological suppression reviewed in those started on ABC and d4T based regimes. Results A total of 672 children were included in the study with a median age of 8.9 months (interquartile range (IQR) 4.1- 24.1 months) in the d4T based group and 11 months (IQR 3.5 - 29.9 months) in the ABC group. 64 of the 437 patients in the d4T containing group were transferred out, 15 reported to have died, and 49 were lost to follow up within the first 6months on treatment. Of the 181 ABC containing regimen group, 1 was transferred out to another care facility, 1 reported death within 6months of treatment and 2 children were lost to follow up. There was a noted increased risk of being virologically unsuppressed at 6months while taking ABC containing regimen compared to a d4T containing regimen. . The relative risk of being virologically unsuppressed at 6 months while taking abacavir/lopinavir (LPV/r) was 1.39 (95% confidence interval 1.03 to 1.88, p=0.04) compared to stavudine/LPV/r. The relative risk of being virologically unsuppressed at 6 months while taking abacavir/efavirenz (EFV) was 1.82 (95% confidence interval 0.98 to 3.37, p=0.054) compared to stavudine/EFV. Conclusion Our analysis again raises concerns about virological suppression in the abacavir era of paediatric ART, compared to the previous stavudine era, particularly in combination with LPV/r in the younger, more vulnerable children. Whether this is because of intrinsic properties of the different medications or is a marker of the evolving complexity of the South African ART rollout, may never be resolved. However, this is of concern as abacavir and LPV/r appear to be entrenched as first-line paediatric ART in a setting where attrition is high, many children are lost to follow up and virologic surveillance is not always optimal. Clinicians need to optimize retention strategies, especially of young infants, to ensure that children are retained in care, have viral load testing timeously, so that those virologically unsuppressed can be detected and treated early and appropriately.

Master of Science

Well-Child Examinations are an integral part of monitoring growth and development for children. These visits allow for establishment of a therapeutic relationship between patient and caregiver, and provide opportunities to screen for underlying conditions while simultaneously following growth and development milestones. Well-child examinations provide opportunities for parents to voice concerns and help to identify those children at risk for delays or underlying medical conditions. When these conditions are identified early, they tend to have an improvement of outcomes. Since the core items to be included in wellness examinations vary by age, insurance provider, and risk factors, our aim is to measure and improve the knowledge and comprehension of examination components among a group of Family Medicine resident physicians that provide primary care to a pediatric population. Provider knowledge and understanding was measured by means of a set of multiple-choice questions prior to an educational session. A post-educational examination was then administered to assess recruitment and retention of information. There appeared to be an overall positive trend toward increased knowledge base following the education session, indicating and improvement of understanding and medical knowledge.