Child health in the West Bank: Experiences from implementing a paediatric course for Palestinian doctors and nurses working in primary care.

Child health issues are of high importance in the occupied Palestinian territories, where half of the population are children. The Royal College of Paediatrics and Child Health have developed a comprehensive paediatric training programme for primary healthcare providers with the aim of improving child health in the area. The course has taken 8 years to develop with the pilot running in 2005-2007 and is now being extended to other centres in the region. In this article, we describe the process through which this course has developed, some of the difficulties faced and the final teaching programme as it has evolved. A number of lessons have been learnt, over the years, which are of potential value to others designing similar teaching programmes. Its greatest strength lies in the partnership developed with local paediatricians, which encourages us to believe that sustainability has been achieved. Evaluation confirms that the course is meeting the needs of local doctors and nurses and improving their paediatric skills. Although developed specifically for the occupied Palestinian territory, our experience offers a process and design for a teaching programme that could be adapted for use in other countries around the world.

The life and contribution of Professor David Sanders through his publications.

Professor David Sanders died in August 2019. He leaves a long legacy of analysis and teaching on global child health and public health particularly in relation to poverty and the roots of ill health, and how to tackle them. Sanders believed that the determinants of health lay in the social conditions of the population and that these had to be improved by social change and working at the grass roots rather than by top-down medical treatment with drugs; he was a strong proponent of primary healthcare as originally established by WHO and supported the appointment of community health workers who would be responsible to the local community. His work is covered in this article through a review of significant books of which the best known is The Struggle for Health and his research in the field.

Rights, justice, and equity: a global agenda for child health and wellbeing.

Worldwide challenges to child health and wellbeing are rapidly becoming existential threats to children and childhood. Inequities, armed conflict and violence, nuclear proliferation, forced migration, globalisation, and climate change are among the global issues violating children's rights to optimal survival and development. Child rights-based approaches will be required to enhance the response to the civil-political, social, economic, and cultural determinants of these global child health issues. In this Viewpoint, we present a global agenda for child health and wellbeing as a blueprint for the practice of paediatrics and child health in the domains of clinical care, systems development, and policy formulation. This global agenda is grounded in the principles of rights, justice, and equity and can address the root-cause determinants of health. The 30th anniversary of the UN Convention on the Rights of the Child is a relevant moment to recommit to shared goals for children's health and wellbeing.

Wellbeing of new mothers.

This paper reports indicators of wellbeing and early parenting stress in a representative sample of first-time mothers in north-east England. A total of 185 mothers were recruited in the antenatal period to a controlled trial of an early parenting intervention. They were interviewed at home when the baby was aged around one month, and completed the General Health Questionnaire (GHQ12) and the Parenting Daily Hassles Scale. Almost half of mothers reported psychological distress above the accepted GHQ12 cut-off point. However, distress was not related to variables such as low socio-economic status, as had been predicted. Early parenting stress was greater in relatively more educated and older mothers. New motherhood is likely to be stressful, even where mothers do not have postpartum depression, and so a range of supports is required.

What are the benefits of a parenting newsletter?

This paper presents the findings of a study on the perceptions of parents on an age-paced parenting newsletter for first time parents. The newsletter is based on an American model, conceived in Wisconsin, USA and has been adapted for use in the UK. Each issue of the newsletter (named Baby Express) contains topics relevant to the particular stage of the child's life, and is delivered free to the home, monthly in the first year. New parents in the district of North Tyneside were invited to participate in the study. Those who agreed, and who took part in the first interview just after birth, were randomised to one or other arm of the study. Those in the intervention group (receiving copies of Baby Express) numbered 94 and those in the control (normal services only, no newsletter) numbered 91. Parents completed a series of questionnaires at birth, and year one to determine the effectiveness of the newsletter for families of first-time babies. In year one, 67 (82%) of the 82 intervention families remianing in the study at one year found Baby Express very useful as a source of information on parenting. The findings showed that parents found the newsletters to be a more valuable source of information on parenting than any other source, including relatives and friends. We concluded that the age-paced newsletter Baby Express delivered to the home monthly in the first year is an effective information tool for parents.

Access to healthcare for children in Palestine.

Currently, 5 million Palestinian refugees live in Palestine, Jordan, Syria and Lebanon and around 40% of these are children. Mortality rates for Palestinian children are comparable to neighbouring Arab countries but the speed of reduction has faltered in recent years. Morbidity is greatly affected by the occupation which has increased violence towards children, mental health problems and poor nutrition, particularly in Gaza which is experiencing a health crisis. Access to healthcare for children in Palestine is constrained as a result of the requirement for visas to travel into Jerusalem where specialist hospitals are sited, by difficulties with ambulance transfers, by shortages of equipment in hospitals and by lack of trained staff. Palestinian health workers are developing new initiatives in healthcare and show a high level of resilience, despite the very considerable stress affecting most citizens.

Helping fathers understand their new infant: a pilot study of a parenting newsletter.

This paper presents the findings of a pilot study on the views of first-time fathers in the northeast of England on an aged-paced parenting newsletter, and what being a parent means to them.A monthly newsletter for new parents, initially conceived in Wisconsin, USA, has been adapted for use in the UK. Each issue of the newsletter (named 'Baby Express') contains topics relevant to the particular stage of the child's life, and is delivered free to the home monthly in the first year and bi-monthly in the second and third years, when it is renamed Toddler Express'.'Baby Express' is a glossy, eight-page, easy-to-read newsletter, which focuses on emotional development, parent interaction and play. Topics covered include father-related content, such as the father's role in caring for their child and father-child relationships. As part of a randomised controlled study of new parents, fathers were invited to complete a postal questionnaire at the one year follow-up; 42 of 75 fathers responded (56%). The findings showed that fathers wanted to be more involved in caring for their child, and felt it was important to obtain information that would help them to do this. A total of 37(88%) had read 'Baby Express' and all of the fathers who read it thought it was relevant to dads. We concluded that'Baby Express' is as effective an information tool for fathers as for mothers, but additional material for fathers would be valuable. Fathers need to be included in parenting education to a greater extent.