Mamas voices, mamas choices: understanding maternal beliefs that drive decision making around feeding practices which influence childhood obesity

OBJECTIVE: To explore the beliefs shaping maternal decision-making around feeding practices in early childhood in a subset of Jamaican mothers from rural and urban communities. DESIGN AND METHODS: Focus group discussions guided by semi-qualitative questionnaires were conducted with thirty mothers of infants 6-24 months recruited from health clinics in 2 urban and 2 rural Jamaican communities. Data from discussions transcribed from audio recordings and field notes were categorized and interpreted using pre-set themes through an iterative process to identify emergent themes. Analysis was guided by the Theory of Reasoned Action embedded in the Socio-Ecological Perspective. RESULTS: Rural and urban mothers’ beliefs, and by extension their actions, were influenced by (a) their instincts, (b) their accepted knowledge (from personal and observed experience, credible professional input, and personal experimentation), (c) cultural norms (i.e. views of body weight/health relationship and visual perceptions of ‘healthy’); (d) input of experienced family members; and (e) their accepted concept of infants’ innate ability to express needs. Additionally, rural mothers’ beliefs were influenced by non-family social networks. For all mothers, the use of growth charts in portable health records and reliance on specific local television programs with health segments for health information was salient. The latter presents a unique tool for potentially building maternal confidence for healthy feeding practices. CONCLUSION: Early childhood food choices are predominantly dictated by parental belief-driven actions. Effective interventions targeting the impact of maternal feeding practices on childhood obesity should incorporate supportive, credible professional input, address how and what knowledge influences individual beliefs, increase community-wide knowledge, and target cultural norms.

Maternal stress associated with raising autistic children in Jamaica

OBJECTIVE: Our objective was to determine the level of stress associated with raising an autistic child in Jamaica, a developing nation with fewer available resources for affected families. METHODS: Fifty-two autistic children were identified through medical records of hospitals and private paediatricians, and from registers of special schools. Mothers completed the Parental Stress Index (PSI), the Brief Symptom Inventory (BSI) (a measure of mental health status), and a socioeconomic questionnaire. The PSI identified stress in two major domains, the Parent and Child Domains. It also included a life event stress scale. The severity of autism was assessed by using the Childhood Autism Rating Scale. Results were compared with national sample of healthy children, in which similar parent questionnaires had been completed. SPSS software version 7.5 was used for data analysis and a "p" value less than 0.05 was considered significant. The sample of autistic children consisted of 41 males (78.8 percent) and 11 females (21.2 percent) with a mean (ñ standard deviation) age of 6.5ñ3.7 years. The control group consisted of 72 males (50.3 percent) and 71 females (49.7 percent) with a mean/SD age of 6.0ñ0.4 years. RESULTS: Both study and control groups had similar Parent Domain scores, but parents of autistic children had significantly higher scores in the Child Domain (p<0.001). Mothers of non-autistic children obtained significantly higher scores in somatization, (p<0.001), depression (p<0.05), hostility (p<0.05) and paranoia (p<0.001) using the BSI Crowding (p<0.05), maternal level of education (p<0.05), and occupation (p<0.01) were significantly associated with stress in the control group, but not in the study group. The severity of autistic features (p<0.001) significantly contributed to stress associated with raising autistic children. Factors that did not significantly contribute to stress in either group included: socio-economic status, age and gender of the child, and stressful life events. CONCLUSIONS: Mothers of autistic children experienced significantly higher levels of stress than did mothers of non-autistic children. Parental stress was directly attributed to dificulties of the child (Child Domain), but not to parenting inadequacy (Parent domain). With autism on the increase, public services aimed at assissting parents by providing respite care and/or training in behaviour management will need to be developed. (AU)

Maternal lifestyle and pregnancy outcome in Jamaica: the effects of cigarette and marijuana smoking, alcohol use and sexual activity

Cigarette smoking, marijuana and alcohol use, and coital activity have been investigated for effect on foetal birth weight and gestation chiefly in developed countries. Apart from the relationship between cigarette smoking and heavy alcohol intake and growth retardation, the evidence for poor birth outcome is controversial. Little is known of the effect of these lifestyle factors in developing countries where poor pregnancy outcome is common. Using data from a population based perinatal study in Jamaica, the effect of lifestyle factors was ivestigated in 8486 babies. Data collected by midwives at birth included the date of the last menstrual period, socio-demographic characteristics and frequency of tobacco, marijuana and alcohol use during pregnancy, as well as coital frequency at quickening and at delivery. Babies were weighed and measured. Live birth outcomes investigated were low birth weight, preterm birth and growth retardation, with population rates of 10.1 percent, 8.7 percent and 9.7 percent, respectively. Data were processed using SPSS and BMDP statistical packages. The prevalence of cigarette, marijuana and alcohol use was 7.0 percent, 2.1 percent and 16.4 percent respectively. 74 percent and 27 percent of women were having sexual intercourse at quickening and in the week prior to delivery, respectively. Apart from coital frequency at quickening, life style factors were strongly associated with each other. All life style factors were associated with social class. On univate analysis, significant associations were found between cigarette smoking and low birth weight (p,0.04) and growth retardation ,0.05). Association between marijuana use and low birth weight and between alcohol use and lower incidence of preterm birth failed to reach significance (p=0.05, p=0.16). When stratified by frequency of use, there was a significant trend in both cases (p<0.05, p<0.04). After controlling for socio-demographic characteristics and other life style factors, associations were maintained between cigarette smoking and low birth weight. Foetal effects of maternal cigarette smoking are present even in al low prevalence country. The effect of marijuana use is less conclusive, but the data suggest that this activity may be detrimental to the foetus. (Au)

Postpartum depression in Jamaican women: an analysis done at six-weeks postpartum at the University Hospital of the West Indies

This study aimed at determining the incidence of postpartum depression and to see if there are any differences in the risk factors between this Jamaican population and other countries. Data was gathered over a six week period, 14.2.96 to 25.3.96, in the postnatal clinic at the University Hospital of the West Indies. The Edinburgh Postnatal Scale was used to detect postpartum depression in the women. A Likert Scale was used to assess their attitudes toward their babies. Demographic, obstetric and psychosocial data were gathered from these women. The results showed a 26 percent incidence of pospartum depression in a population of 189 women. The factors that found significance were : attitude scores (P value <0.001, T value >1.96), having a worse than expected experience in having their babies (T value >1.96) and having being less frightened due to the information they received on the ward and the clinic (T value >1.96). The women detected with postpartum depression did not necessarily look or feel depressed. This study population had only one risk factor in common with studies from other countries, i.e. having a worse than expected experience in having their babies. This factor was significant in the first week of the puerperium while in this study it was significant at six weeks postpartum. (AU)

The epidemiology of perinatal death in Jamaica

Information from the Jamaican Perinatal Mortality Survey was used to identify features of mothers and their pregnancies that were independently associated with perinatal death. social, biological, environmental, life style and medical aspects of mothers and their pregnancies were collected on two inter-locking subsamples: (1) all births on the island of Jamaica in the 2 months of September and October 1986, the 'cohort months', and (2) all fetal deaths of weight 500g or more, together with all neonatal deaths, in the 12-month period from 1 September 1986 to 31 August 1987. Singleton survivors from the cohort months were compared with all perinatal deaths in the 12-month period using logistic regression. The first model omitted items concerning past obstetric history, but these were included in the second model. In total, 21 variables entered the first model and 24 the second. The only item that became non-significant when past obstetric history was included was maternal age. The final model compared 1017 perinatal deaths with 7672 survivors. It consisted of the following: union (marital) status (married being at lower risk, P<0.01), maternal employment status (housewives at lowest risk, P<0.001), number of adults in household (the more the higher the risk, P<0.05), the number of children aged <11 (the more the lower the risk, P<0.0001), use of toilet facilities (shared with other households increased risk, P<0.001), maternal height (tall women at reduced risk, P<0.001), mother's report that she was trying to get pregnant (P<0.001), maternal alcohol consumption (drinkers had lower risk, P<0.05), maternal syphilis (higher risk, P<0.0001), bleeding before 28 weeks or more (higher risk, P<0.0001), first diastolic blood pressure (80mm + at higher risk, P<0.0001), highest diastolic blood pressure (100mm + at increased risk, P<0.0001), highest proteinuria (++ or more at increased risk, P<0.0001, vaginal discharge/infection (untreated at increased risk, P<0.001), pre-eclampsia diagnosed in antenatal period (increased risk, P<0.01), maternal diabetes (increased risk, P<0.05), start of antenatal care (first trimester at reduced risk, P<0.01), iron taken (reduced risk, P<0.0001), type of perinatal care available in parish of residence (reduced risk if consultant obstetricians and paediatricians available at all times, P<0.0001), number of miscarriages and terminations (the more the higher the risk, P<0.0001), previous stillbirth (higher risk, P<0.0001), previous early neonatal death (higher risk, P<0.001), previous Caesarean section (higher risk, P<0.01). The implications for reduction in perinatal mortality rates are discussed (Summary)

Does maternal behaviour influence the risk of perinatal death in Jamaica?

Features of behaviour of mothers of singleton perinatal deaths collected over the 12-month period from 1 September 1986 to 31 August 1987 were compared with 9919 mothers of singleton infants born in September and October 1986 and surviving the first week of life, as part of the Jamaican Perinatal Mortality Survey. For perinatal deaths as a whole, and in the presence of maternal age and social environmental features, logistic regression analyses showed that the following were independently related with higher risk of mortality: (1) deliberately trying to get pregnant; (2) ever having used Depo Provera; (3) not drinking alcohol in pregnancy; and (4) smoking cigarettes in pregnancy. There were no associations with coital frequency, ever using the contraceptive pill or smoking ganja (cannabis). Deaths were classified using the Wigglesworth scheme, and separate analyses carried out for the three major groups-antepartum fetal deaths, deaths from immaturity and deaths from intrapartum asphyxia. Antepartum fetal deaths were at increased risk if (1) mothers were deliberately trying to get pregnant or (2) they had ever used Depo Provera. Deaths from immaturity were not associated with any health behaviour variables. Deaths from intrapartum asphyxia were more likely if (1) the mother was deliverately trying to get pregnant or (2) she had never used and used and intrauterine contraceptive device (Summary)

Maternal attitudes towards their pregnancies - abstract

The aim of this study was to determine the feelings and other related information of pregnant women toward their pregnancies. Women were classified into social classes I (highest) to V (lowest) based on socio-economic factors. Information was obtained through interviews by 3 final year medical students. Subjects were 322 women attending antenatal clinic during the period November 14-23, 1988, and ranged in age from 12 - 44 years. The majority (71 per cent) were in social classes IV and V. Unplanned pregnancies (221 or 67 per cent) were the highest among teenagers (41/49 or 84 per cent) and women over 35 years (23/31 or 74 per cent), and the percentage increased with increasing parity and decreasing social class. Overall, 29 per cent of women with unplanned pregnancies considered having an abortion. Virtually all (99 per cent) women whose pregnancies were planned considered them favourably and 82 per cent of women with unplanned pregnancies had a similar positive attitude. Negative or ambivalent feelings toward their pregnancies were commoner among grand multiparae (33 per cent) than among primiparae (8 per cent) and teenagers (12 per cent). Such negative attitudes were also more frequent in women in social classes IV and V (13 per cent) than those in social classes I to III (3 per cent). Women who considered an abortion were more likely to have an unfavourable attitude to their pregnancies (29 per cent) than those who did not (8 per cent) (AU)

Maternal handling and motor development: an intracultural study

Citing a distinction between informal and formal routines used by mothers in handling their infants, we examined formal handling routines, in which the caregiver acts as in a pedagogical manner; these routines are widespread in many non-Western countries. We hypothesised that formal handling servs to facilitate gross motor development during early infancy. To examine this hypothesis, the effect of a Jamaican formal handling routine on a broad range of developmental outcomes was examined. Results showed that the effects were specific to early gross motor development an in particular to postural control along the vertical axis of the body. Information is also provided on other aspects of Jamaican child care. It seems that the handling routine forms part of a folk (developmental) medicine system and may serve not only to promote child health but also as a sort of developmental neurological examination. (AU)

The epidemiology of infantile gastroenteritis in the Eastern Caribbean with special reference to the role of rotavirus infection

The objectives of this work were (1) to determine the relative importance of rotavirus, cytopathic viruses, selected bacteria and faecal parasites in infantile gastroenteritis in Guyana, Trinidad and St. Vincent; (2) to study the occurrence and distribution of rotavirus gastroenteritis and the clinical course of the disease; (3) to investigate transmission of faecal micro-organisms in families; (4) to assess the influence of malnutrition and respiratory disease on the course of illness; (5) to explore the role played by maternal characteristics, environment and economic status in this continuing problem; (6) to seek for rotavirus in calves in Trinidad. Human study subjects were 397 hospitalized gastroenteritis cases under three years of age. Healthy controls, registered at district health offices, were matched by age, sex and approximate home address. Data were collected from hospital records and by questionnaire. Weights were taken during hospitalization and follow-up. Stool samples were tested for viruses, bacteria and parasites. Rotavirus was detected by counterimmuno electrophoresis and ELISA with confirmation by electron microscopy. Forty-seven random family pairs were used for transmission data and samples of five-year old children were screened for rotavirus antibody. Rotavirus, the most prevalent pathogen, occurred in 21 percent of cases and one percent of controls. It was found more frequently in children 6-35 months old and not in premature newborn infants. Eighty-four percent of five-year olds had antibody. The illness was generally mild, but 5 of 30 fatal cases excreted rotavirus. Significantly increased morbidity and mortality were associated with age (<6 months), low birth weight (<2.5 kg), malnutrition (Gomez 11 or 111) and little or no breast-feeding (<1 month). Gastroenteritis cases had mothers with less education and interest in health services and fathers with more unskilled jobs and lower incomes. Case families were similar in size and structure to controls but had more diarrhoeal illness, more gastrointestinal infections and less pipe-borne water at home. Rotavirus was detected in calves with and without diarrhoea. Persistence in the environment was suspected (AU)

Early maternal-child contact: effects on later behaviour

Fifty normal, healthy, full-term infants were allowed 45 minutes contact with their mothers immediately after birth at Victoria Jubilee Hospital, Kingston, Jamaica. The behavior of these infants and their mothers was compared with matched controls at six and 12 weeks in a hospital follow-up interview. More early-contact mothers solely breast-fed their infants than did control mothers. Early-contact infants were less likely than controls to be restless or crying during the interviews. At 12 weeks, early-contact mothers were more likely than control mothers to rise and follow when their babies were taken from them, gazed more frequently at their infants, and were more likely to vocalise to their infants during the interview. These diferences indicate that early contact promotes a closer relationship between a woman and her infant. Given the importance of breast-feeding as protection against gastro-enteritis and malnutrition, this closer relationship may be especially valuable in developing countries where such diseases are common (AU)