Infant death rates and animal-shed delivery in remote rural areas of Nepal.

This article outlines a community-based retrospective study in a remote area of Nepal and describes local birth practices and their impact on infant mortality. Data collection was carried out in two steps, a household survey from September to October 1996 and a qualitative research phase. Data collected include socio-economic background, reproductive history, birth practices and child survival. Among 3007 live-born children, 660 (22%) died before their first birthday. In keeping with local customs, approximately half of the children were delivered in an animal shed and the other half in the home. Children born in an animal shed were at significantly higher risk of dying than were those born in the home even after adjusting for socio-economic status and biological variables. The association was stronger in the neonatal period (OR = 2.8, 95% CI 1.9-4.1) than during the post-neonatal period (OR= 1.3, 95% CI 1.02-1.6). The preparation of the delivery place was inadequate and thereby facilitated infection of both the newborn and the mother. Traditional norms and animal-shed delivery practices are common in the Jumla community. The reasons addressed for giving birth in the animal shed included (1) Household Deity's anger if delivery takes place in the home and (2) easy to clean the shed following the birth.

Triangulation research among culturally diverse populations.

There exists an ongoing challenge in the health sciences to develop research methods that effectively describe patterns of health beliefs and actions in different cultures. While the dominant framework for research has traditionally been the quantitative paradigm, qualitative methods place more emphasis on holistic descriptions of the human phenomena and thus may be more appropriate for transcultural research. Triangulation offers an alternative for investigators studying transcultural health by integrating the inherent strengths of both quantitative and qualitative data while minimizing their limitations. This article discusses six approaches for employing triangulation research in transcultural health.

Responding to the cultural and spiritual needs of clients.

Spirituality has been central to nursing practice since the time of Florence Nightingale although for many years spiritual care has fallen into disuse. With the increasing movement toward holistic nursing care within a multicultural community, the need to integrate cultural sensitivity with spirituality has become essential. By incorporating spirituality and cultural dimensions into the plan of care, nurses can more holistically provide efficient and quality care within both the hospital and community environment.

Traditional birth attendants' advice toward breast-feeding, immunization and oral rehydration among mothers in rural Bangladesh.

Traditional birth attendants (TBAs) are regarded as essential child health care providers in Bangladesh. A community-based cross-sectional study was completed using questionnaires and interviews to compare trained and untrained TBAs' advice on (1) breast-feeding, (2) immunizations and (3) oral rehydration therapy as an extended part of their maternity care training. Twenty-eight trained TBAs (TTBAs) and 27 corresponding untrained TBAs (UTBAs) in the Dhaka district were interviewed to investigate the effect of their advice on the three outcome variables of maternal health care. Additionally, 276 questionnaires were distributed to the mothers cared for by these TBAs to determine their knowledge of infant-care practices. In-depth interviews with 25 mothers provided additional insight. While TTBAs may have more knowledge and be more willing to disseminate health care information to mothers with new infants than UTBAs, the mother's health practices were independent of the advice provided by the two groups of TBAs. Additionally, the mother's health practices equaled or exceeded expected norms.

PIP: A cross-sectional study conducted in rural Bangladesh's Dhaka District compared the appropriateness and accuracy of advice given by 28 trained and 27 untrained traditional birth attendants (TBAs) on breast-feeding, immunization, and oral rehydration. In addition, perceptions of care provided by trained and untrained TBAs were analyzed through a questionnaire administered to 276 clients of these TBAs. TBAs in both groups tended to be poor, married, Islamic women with no formal education. Although the trained TBAs provided more accurate information than their untrained counterparts in terms of breast-feeding, colostrum, and when to introduce solid foods, mothers' breast-feeding knowledge and practices were unrelated to whether they had been cared for by a trained or untrained TBA. Similarly, while trained TBAs provided more correct information on both immunization and oral rehydration therapy, mothers' adherence to immunization schedules and use of rehydration when their child had diarrhea were not affected by the type of TBA who provided care. Both groups of TBAs reported providing more information to mothers about these three issues than mothers reported receiving from the TBAs. In general, maternal health practices met or exceeded expected norms.

AIDS in southern Thailand: stories of krengjai and social connections.

HIV-disease in southern Thailand has reached epidemic proportions. The declining Thai economy, coupled with social discrimination among people with the disease, has adversely affected individual, family and community krengjai. Among Thai's, krengjai is used to describe social order, avoid personal conflict, and maintain harmony in relationships. Using the framework of story, this narrative study explores the experiences of five individuals with HIV-disease and their tenuous relationship with krengjai.

PIP: This narrative study explored the experiences of five Thais with HIV infection and their tenuous relationship with society. In Thailand, HIV parallels the fear and mistrust of society, and is synonymous with leprosy and other physically debilitating diseases. During nonstructured interviews, the respondents were openly allowed to tell their story, and the central theme presented by the participants were connections to family between past and present, with little regard for the future. The need to incorporate family to social networks and fulfill a social purpose was likewise emphasized. The results also revealed that despite the disintegration of social networks, krengjai (social order) remains the core theme in the establishment of social patterns. Thus, this study underscores the importance of providing a holistic and systematic effort by professional nursing organizations to promote family and community strengths by encouraging krengjai. This effort would be the most effective mechanism in reducing patterns of AIDS morbidity and mortality and enhancing the health of women and children worldwide.

Integrating cultural diversity in patient education.

Diversity among clients in the American health care system is increasing as the population of the United States changes in composition. Health providers, educators, and supervisors are in unique positions to enhance patient education among members of diverse cultures by incorporating cultural research and health beliefs into patient and staff education. Using a culturally defined framework, health providers can more holistically assess the client and subsequently plan culturally appropriate care.

Assessing culturally diverse pediatric clients.

For many pediatric nurses, providing culturally sensitive care among children of diverse backgrounds is frustrating and time-consuming because elements of cultural care theory were not assimilated into their educational programs. Using a transcultural model developed by Giger and Davidhizar (1995), pediatric nurses can now integrate a holistic and efficient assessment into the child's treatment plan. Essential health beliefs and practices are synthesized into the model's six components to assist the pediatric nurse in providing culturally appropriate care.

The efficacy of Bobath neurodevelopmental interventions at home for patients after postcerebrovascular accidents.

The traditional approach to rehabilitating patients after cerebrovascular accidents encourages the patient to use only the unaffected side for all activities. This article presents the Bobath approach, which focuses on patients using both sides to regain former capabilities. The rationale and implementation of this method are outlined so that the home care nurse can learn how to use this method, used so commonly by rehabilitative therapists.

Research implications for alternative health therapies.

Nontraditional health practices have gained in popularity during the past 10-15 years. Unfortunately, the effectiveness of many nontraditional approaches have been inadequately investigated. Furthermore, tradition research protocols often have fallen short in providing satisfactory strategies for these types of investigations because the nature of the personal belief system between patient and provider has not been examined. The authors discuss the implications for triangulation techniques in nursing research related to nontraditional treatments. Six types of triangulation are defined and methods for utilizing these techniques are explained.