Parent and caregiver knowledge, beliefs and responses to seizures in Jamaican children

OBJECTIVE: To determine the knowledge and beliefs about seizures and actions during seizures of parents/ caregivers of children hospitalised for convulsive seizures. DESIGN AND METHODS: This was a cross-sectional study of parents and caregivers of children with acute convulsive seizures hospitalised at the Bustamante Hospital, Kingston, Jamaica between May 1 and October 31, 2013. Subjects were identified by admission records. Parents/caregivers were invited to participate. A questionnaire on the knowledge, beliefs and response of parents/ caregivers during the child’s current seizure episode was administered face to face. Data were analysed for frequencies; comparisons between groups using Chi Square analysis for categorical variables, and the Mann-Whitney U test for data not normally distributed. RESULTS: Fifty participants were enrolled; 39 (78%) mothers; mean age (SD) was 33.8 (10.1) years. All sought medical care first. Twenty-two (44%) had plausible beliefs about the cause of seizures. Twenty-seven (54%) knew of appropriate actions during a seizure, 10 (20%) knew of appropriate precautions and 11 (22%) responded appropriately during the seizure. Eleven (22%) reported receiving seizure education. Witnessing a previous seizure, education level and seizure education were positively associated with knowledge of seizures (p < 0.05). Socioeconomic status was higher in those with plausible beliefs about seizures and lower in those who took appropriate action during a seizure (p<0.05). CONCLUSION: Parents/caregivers of children with convulsive seizures have appropriate health-care seeking behaviour but inadequate knowledge. Seizure education should be prioritised to improve parental knowledge of and response to convulsive seizures.

Parents' views on factors influencing the dental health of Trinidadian pre-school children.

OBJECTIVE: To describe parents' views on the dental health of pre-school children in Trinidad. BASIC RESEARCH DESIGN: Self-administered 22 item questionnaire by 138 parents and guardians of pre-school children. CLINICAL SETTING: University paediatric dentistry clinic. PARTICIPANTS: Consecutive parents or guardians of pre-school children attending a university paediatric dentistry clinic. MAIN OUTCOME MEASURES: Views on dental health and dental care of pre-school children, perceptions of own oral health and demographic information. RESULTS: Most participants (80 per cent) were educated up to secondary school level and 59 per cent were from homes where the head of the household was either in manual work or unemployed. One-half of the participants (50.7 per cent) felt that teeth of young children should be brushed three times a day, with (75.4 per cent) choosing a small brush. Most participants (65 per cent) considered the position of supervised brushing of childrens' teeth from 'in front' to be the most effective method while 4.5 per cent choose 'from behind'. Twenty seven percent did not know if their child's toothpaste contained fluoride and 82.6 per cent did not know how much fluoride it should contain. Thirty three percent of the respondents had given their child a sweetened baby bottle or comforter at night. Fifty four percent felt a child's first dental visit should be when all baby teeth were present. Forty two percent would want a decayed baby tooth filled, 31.9 per cent would want it extracted and 22.4 per cent were unsure. CONCLUSION: The generally inaccurate factual knowledge and low awareness of preventive care among parents suggest the need for accurate information about factors influencing the dental health of pre-school children. These findings have significant implications for the delivery of effective health promotion strategies and the accuracy of health education messages in Trinidad and Tobago.

An evaluation of parental knowledge, attitude and practice in the early diagnosis of acute splenic sequestration in sickle cell disease

Sickle cell disease is a global health problem. It is an inherited blood disorder affecting the red blood cells. There are different types of sickle cell disease. Homozygous sickle cell (SS) disease, results when the infant inherits two abnormal sickle genes, one from each parent. In Jamaica SS disease affects approximately 1 in 300 births and some form of sickle cell disease, 1 in 150 births. Complications of sickle cell disease include acute splenic sequestration. The cause and triggers of acute splenic sequestration (ASS) are largely unknown. The spleen becomes acutely enlarged, trapping a proportion of the red cell mass and leading to acute anaemia, circulatory failure and sometimes death. Emergency blood tranfusion is extremely important in the management of acute splenic sequestration. Parental education may allow prevention of death from ASS by early transfusion. Parents need to be taught how to diagnose splenic enlargement, and to recognize the signs and symptoms of increasing anaemia characterized by pallor. It is important for mothers to examine splenic size on a regular basis and when the child looks ill. At the Jamaican Sickle Cell Unit, parents are instructed to examine the spleen at least once a day. The aim was to identify the parents' and guardians' knowledge of ASS, their attitudes towards the examination of the abdomen and practices in detecting an enlarging spleen. The objectives were to determine the percentage of parents and guardian who regularly examined the abdomen to determine spleen size; who had detected an enlarging spleen and the outcome; who were aware of the proper technique for examining the spleen; who were aware of what to do if an enlarging spleen was found; and identify the barriers that prevent regular examination for splenic enlargement. The study was carried out on the parents and guardians of children four years and younger, with homozygous sickle cell disease, attending the sickle cell unit. At the time of the study, the population of children four years and younger with SS disease was 23.7. A questionnaire was designed based on the objectives of the study, to solicit data from the partcipants. The researcher administered the questionnaire to 60 parents and guardians who attended the clinic over a two-month period- March and April 2000. The participants were also asked to demonstrated their competence in examining the spleen.(Au)

Quality of life in children with sickle cell disease in Amsterdam area

OBJECTIVE: To determine the differences in quality of life between children with sickle cell disease and healthy immigrant children. DESIGN: Descriptive, comparative. METHOD: The quality of life of children with sickle cell disease between 5 and 15 years old being treated in the Emma Children's Hospital AMC in Amsterdam, the Netherlands, was assessed by using a questionnaire for parents (TNO-AZL Children's Quality of Life Questionnaire (TACQOL) parent form) if the child was between 8 and 15 years old. The study period was April-October 1998. The questionnaires were completed by 45 (parents of) patients. The results were compared with a healthy reference group of immigrant children. Statistical analysis was performed using the Student t-Test. RESULTS: Children with sickle cell disease as well as their parents scored signifcantly lower on the items general physical, motor and independent daily functioning and on occurrence of negative emotions. No significance was observed for the items cognitive functioning and school performance nor for social functioning or occurrence of positive emotions. CONCLUSIONS: In children, sickle cell disease leads to compromised physical and possibly also psychological wellbeing, as well as the experience of decreased independence in daily functioning, but not to compromised cognitive or social aspects of the quality of life. (AU)

Problems reported by parents of children in multiple cultures: the Child Behavior Checklist syndrome constructs

OBJECTIVE: The purpose of this study was to compare syndromes of parent-reported problems for children in 12 cultures. METHOD: Child Behavior Checklists were analyzed for 13,697 children and adolescents, ages 6 through 17 years, from general population samples in Australia, Belgium, China, Germany, Greece, Israel, Jamaica, the Netherlands, Puerto Rico, Sweden, Thailand and the United States. RESULTS: Comparisons of nine cultures for subjects ages 6 through 17 gave medium effect sizes for cross-cultural variations in withdrawn and social problems and small effect sizes for somatic complaints, anxious/depressed, thought problems, attention problems, delinquent behavior, and aggressive behavior. Scores of Puerto Rican subjects were the highest, whereas Swedish subjects had the lowest scores on almost all syndromes. With great cross-cultural consistency, girls obtained higher scores than boys on somatic complaints and anxious/depressed but lower scores on attention problems, delinquent behavior, and aggressive behavior. Although remarkably consistent across cultures, the developmental trends differed according to syndrome. Comparison of the 12 cultures across ages 6 through 11 supported these results. CONCLUSIONS: Empirically based assessment in terms of Child Behavior Checklist syndromes permits comparisons of problems reported for children from diverse cultures (Au)

Experience of parents of children with disabilities with health services in Jamaica

In order to determine the experiences with health services of caregivers of children with disabilities (CWDs), and the attitudes of health care workers (HCWs) towards CWDs and their caregivers, a survey was conducted of 26 caregivers of clients of 3D project, St. Mary, Jamaica, using a checklist, and of 113 HCWs in St. Mary and Kingston who completed a questionnaire. Half of the CWDs referred by the HCWs to hospital in Kingston because of the lack of facilities in St. Mary eventually defaulted because there was no apparent improvement. 10 caregivers said that the cause of the disability was not explained, three others did not understand the explanations given, and only 4 understood the instructions of HCWs. These problems led to unrealistic expectations about the outcome of rehabilitation. 13 caregivers attributed disabiltiy of their CWDs to negligence, carelessness or poor treatment by HCWs during pregnancy or the early neonatal period. 87 percent of the HCWs, particularly Community Health Aides (CHAs), acknowledged at least some responsibility for the care of CWDs; but 10 percent, notably some nurses and midwives, denied responsibility. 90 percent referred patients for further care and 90 percent thought that they had made an impact on caregivers' "belief"; but more than half the CHAs, and 25 to 30 percent of the other groups, expressed dissatisfaction with their management of CWDs. This study has highlighted inadequacies in the care of CWDs in St. Mary and indicates that more appropriate preparation of all health staff for this important aspect of their work is required.(AU)

Experiences of parents of children with disabilities with the health services in Jamaica - abstract

A survey was conducted in the parish of St Mary, Jamaica, in 1996, to gain a better understanding of experiences of parents of children with disabilities (CWDs) with health services, and to determine the attitudes of health care workers (HCWs) towards CWDs and their parents. Twenty-six personal interviews were conducted with the caregivers of clients (CWDs) of 3D Projects using a predefined checklist as a guideline, and 113 HCWs completed a questionnaire with closed and open-ended questions. The health services in St Mary do not offer much special help to CWDs, so doctors referred CWDs to hospitals in Kingston. After a while parents stopped going there because they did not see any improvement. Parents claimed the information given by medical personnel was too vague or too difficult to understand. They therefore have unrealistic ideas about the rehabilitaton possibilities for their children. It seemed that parents with a positive attitude towards their child and the disability had better experiences with health services. The majority of problems parents experience have to do with communication. HCWs are not adequately trained to manage all aspects of disability. Therefore they only feel responsible for medical care and treatment. There is also an educational barrier between doctors and parents. This, together with inadequate training, results in doctors not explaining at the parents' level of understanding. The findings have a wider implication than just the childhood disability field as it was found that many parents blame medical personnel for their children's disabilities, believing that unexplained procedures, treatment or neglect damaged their children. Clearly there is a need for more appropriate preparation of all health staff so that parents get full and clear information from the start. It is incumbent on medical staff to find ways to communicate more effectively so that parents can understand, use, follow through and get information even when no medical treatment is necessary. (AU)

A community based rehabilitation service and food related problems of parents/caregivers of children with disabilities

Community based rehabilitation is a concept first documented by WHO in 1979 which covers all disabilities and all age groups. It places the responsibility for service delivery on the family and is administered by a health infrastructure. In other words it is a service which includes older persons as well as children with all types of disability, provided in the community by the community. The 3D Projects Limited is the first fully established community based rehabilitation programme in Jamaica which has been in operation since 1980. The programme is unique in that it utilizes local resources within the community, and low cost methods in meeting the needs of the disabled in the community. The study aimed to determine how a comunity based rehabilitation service is meeting the nutritional needs of parents/caregivers of children with cereberal palsy. All parents/caregivers of children with cerebral palsy enrolled in the 3D Projects programme and the community rehabilitation workers within the four urban areas in the parish of St. Catherine were included in the study. Data were collected by focus group discussions and self-administered questionaires in three of the 3D Projects Limited facilities in the parish of St. Catherine. The sample consisted of 55 participants of which 40 were parents/caregivers (1 male and 39 females), and 15 community rehabilitation workers (1 male and 14 females) participated in the study. Parents/caregivers ranged from 18-60 years. Data were coded and analyzed manually, as well as in Epi Info Version 5, a statistical package for analysis of epidemiological data. Mean nutrition knowledge scores were slightly higher for CRWs than parents/caregivers. Using the correlation coefficient there was no correlation between mean nutrition knowledge score and age for both groups. However, when the t-test was used to compare mean nutrition knowledge score and gender, education and occupation for both groups no significant difference were observed. (AU)

Improved survival in homozygous sickle cell disease: lessons from a cohort study

OBJECTIVE: To examine whether simple interventions in a sickle cell clinic improve survival in sickle cell disease. DESIGN: Survival curve analysis and hazard ratios in a cohort study followed from birth. SETTING: MRC Laboratories (Jamaica) at the University of the West Indies, and Victoria Jubilee Hospital, Kingston, Jamaica. SUBJECTS: 315 patients with homozygous sickle cell disease detected during the screening of 100,000 consecutive non-operative deliveries between June 1973 and December 1981 at the main government maternity hospital, Kingston, Jamaica. INTERVENTIONS: Prophylactic penicillin to prevent pneumococcal septicaemia, parental education in early diagnosis of acute splenic sequestration, close monitoring in sickle cell clinic. MAIN OUTCOME MEASURES: Survival. RESULTS: Survival appeared to improve, the log rank test for trend comparing the first, second, and last third of the study reaching borderline significance (P = 0.05). Combined deaths from acute splenic sequestration and pneumococcal septicaemia-meningitis declined significantly (test for trend, P = 0.02). CONCLUSION: Early diagnosis and simple prophylactic measures significantly reduce deaths associated with homozygous sickle cell disease (AU)

The identity of mixed parentage adolescents

Theories about black identity are discussed in relation to a study of adolescents with one white and one African or African-Caribbean parent. Interview findings on their racial self-definition, attitudes to their mixed parentage, and allegiance to black and white people and cultures reveal a wide range of racial identities and cultural allegiances. Differences are related to type of school, social class, and the degree of politicisation of the young person's attitudes to race. The findings are discussed in relation to the issue of interracial adoption and fostering, and to recent debates about the concept of an essential black identity.(AU)

A comparison of immunization knowledge, attitude and practice among parents and guardians in two health districts in the parish of Clarendon

One hundred and fifty nine parents and guardians from the May Pen West and Chapelton were interviewed between March and April 1994 to compare their knowledge, attitude and practice on immunization. The data were collected through the administration of questionnaires. Both parents and guardians had similar knowledge on immunization in both health districts. However, in the Chapelton District there were more highly educated respondents. Their attitude toward immunization as being very important to them. The practice of taking their immunization card to the clinic on each visit was given high priority because of the Governments legislation that children would not be admitted to school without being fully immunized. This study reaffirms the importance of health education on immunization to the public, not only in the health centres but to make the information available on the media and in literature (AU)

Further comparisons of teacher and parent ratings of behavior and emotional problems in Jamaican children

As a sequel to comparisons between parent and teacher reports on behavioral/emotional problems in clinic-referred Jamaican 6-11 year-old youngster were compared. Similar to clinic-refered findings,low to moderate correlations emerged for parent and teacher reports on nonreferred children. Correlations were also significantly higher for ratings of undercontrolled (eg., disobedience, stealing, fighting) than ratings of overcontrolled (eg., shyness, depression, fearfulness) behavior, suggesting that some findings may be robust across cultures and referral status. However, correlation coefficients varied across referral status for ratings of overcontrolled problems in boys. Overall, the findings suggest that the study of child behavior requires attention to the reporter of the behavior and the context in which such behavior occurs (AU)

Parent evaluation of a community-based rehabilitation project in St. Catherine, Jamaica - abstract

Two hundred and seventeen families with disabled children in St. Catherine were surveyed to determine their views of a community-based rehabilitation programme in which they are visited by community workers (CWs). All were able to give a disability diagnosis and the pattern of distribution resembled the actual distribution. The respondents gave positive answers to questions about the home visits, the CWs, and the activities conducted. They felt satisfied with the information given, though 65 percent requested more, particularly on education, behaviour, speech and medical aspects. Sixty-seven per cent had changed their attitudes and 70 percent their practices since the programme. Ninety-five percent said they would recommend a home visiting programme to other parents. The least satisfactory finding was the low percentage (48 percent) of parents who had attended parent training and meetings (AU)

Management of the infant of the diabetic mother

The objective of this monograph is to assist the medical student and nursing staff in recognising the complications occurring in the infants of the diabetic mother and managing these infants to minimise morbidity and mortality(AU)

Profile of teenage mothers and their parents' attitudes to teenage sexuality and pregnancy - abstract

The purpose of this study was to obtain a profile of the Barbadian pregnant teenager and to ascertain from them their parents' attitudes to teenage sexuality and pregnancy. From April 1 to July 31, 1989, information was obtained by questionnaire from 160 teenage mothers during hospitalization. Pregnant teenagers ranged in age from 13 to 19 years, and 131 (82 per cent) were over 16 years, the legal age of consent. All attended, but only 84 per cent completed secondary schooling. They were predominantly of lower socio-economic class and 65 per cent had teenage mothers. Seventy-one per cent lived in homes with no resident male authority, and 54 per cent reported strict parental discipline. Fifty-nine per cent had their first sexual encounter before 16 years of age (legal consent age), only 2 per cent were married and 22 per cent were in commom-law union. Most teenagers (94 per cent) had some knowledge of contraception before becoming pregnant but only 19 per cent practised family planning. Pregnancy was unplanned in 82 per cent and 80 per cent wished to have delayed pregnancy. Sex education was received from school (78 per cent) and mother (33 per cent), but 78 per cent felt it was inadequate. Mothers of pregnant teenagers were mostly single parents (71 per cent), of lower socio-economic class, and 50 per cent were < 40 years of age. Mothers' reaction to the boyfriend were reportedly angry (25 per cent), approving (23 per cent), not angry (15 per cent) and no reaction, (38 per cent). Only 2.5 per cent of teenagers were evicted from the home, and 90 per cent of parents were supportive (AU)

Teacher and parent ratings of behavior problems in Jamaican children and adolescents: convergence and divergence of views

In child assesment, mental health workers often collect behavioral information from parents and teachers. The literature, however, generally indicates low correlations between parent and teacher child problem ratings. One possible explanation is that parents and teachers, in home and school settings, respectively, have disparate opportunities to observe some child problems. Teachers and parents may have equally good opportunities to observe Undercontrolled problems (eg., fighting, lying, disobedience), but teachers may have fewer opportunities to observe overcontrolled problems (e.g., depression, withdrawal, shyness). We explored this possibility, examining parent and teacher reports of overcontrolled and undercontrolled problems in Jamaican children. As expected, when parents and teachers rated overcontrolled problems we generally found nonsignificant correlations and generally significant correlations when they rated Undercontrolled problems. We inferred that because undercontrolled problems are directed outwardly they may be more objectively and similarly observed. Conversely, and thus less concordant judgments (AU)