Análisis del entorno de Malawi como guía del cuidado de un niño con discapacidad / Analysis of Malawi environment as a guide of the care of a disabled child

Objetivo principal: Analizar las creencias que guían las conductas de cuidado de un niño con discapacidad en Malawi, África. Metodología: Estudio cualitativo durante siete semanas en Malawi. Las principales técnicas empleadas para la obtención de datos fueron la observación participante y la entrevista en profundidad. La investigación finalizó con la saturación de datos respecto al objetivo planteado. Resultados principales: La pobreza y la cronicidad de algunas enfermedades en Malawi hacen a las personas más vulnerables a la discapacidad. Las dificultades del sistema sanitario promueven en Malawi una asistencia sanitaria múltiple. El modelo de autoatención tiene gran importancia en la vida de la comunidad y es desempeñado, principalmente, por el género femenino. Conclusión principal: El cuidado holístico de las personas con necesidades especiales en Malawi se ve obstaculizado por ciertas características de su contexto cultural y social

Objective: To analyse the beliefs that guide the caring behaviours toward a child with disabilities in Malawi. The research ended with the saturation of the data, regarding the intended purpose. Methods: Qualitative study for seven weeks in Malawi. The main techniques used for data collection were participant observation and in-depth interviews. Results: Poverty and chronicity of some diseases in Malawi make people more vulnerable to the disability. The difficulties of the health system in Malawi promote multiple healthcare. The model of self-care is very important in the life of the community and it is mainly developed by women. Conclusions: The holistic care for people with special needs in Malawi is hindered by certain characteristics of their cultural and social context

Effect of Family Income on the Relationship Between Parental Education and Sealant Prevalence, National Health and Nutrition Examination Survey, 2005-2010.

INTRODUCTION: We examined the association between sealant prevalence and parental education for different levels of family income, controlling for other covariates. METHODS: We combined data from 2005-2006, 2007-2008, and 2009-2010 cycles of the National Health and Nutrition Examination Survey. The study sample was 7,090 participants aged 6 to 19 years. Explanatory variables, chosen on the basis of Andersen and Aday's framework of health care utilization, were predisposing variables - child's age, sex, race/ethnicity, and parental education (high school diploma); enabling variables - family income (<100% of the federal poverty level [FPL]; 100%-200% of the FPL; and >200% of the FPL), health insurance status, and regular source of medical care; and a need variable - future need for care (perceived child health status is excellent/very good, good, fair/poor). We conducted bivariate and multivariate analyses and included a term for interaction between education and income in the multivariate model. We report significant findings (P ≤ .05). RESULTS: Sealant prevalence was associated with all explanatory variables in bivariate and multivariate analyses. In bivariate analyses, higher parental education and family income were independently associated with higher sealant prevalence. In the multivariate analysis, higher parental education was associated with sealant prevalence among higher income children, but not among low-income children (<100% FPL). Sealant prevalence was higher among children with parental education greater than a high school diploma versus less than a high school diploma in families with income ≥100% FPL. CONCLUSION: Our findings suggest that income modifies the association of parental education on sealant prevalence. Recognition of this relationship may be important for health promotion efforts.

Associations of food stamp participation with dietary quality and obesity in children.

OBJECTIVE: To determine if obesity and dietary quality in low-income children differed by participation in the Supplemental Nutrition Assistance Program (SNAP), formerly the Food Stamp Program. METHODS: The study population included 5193 children aged 4 to 19 with household incomes ≤130% of the federal poverty level from the 1999-2008 NHANES. Diet was measured by using 24-hour recalls. RESULTS: Among low-income US children, 28% resided in households currently receiving SNAP benefits. After adjusting for sociodemographic differences, SNAP participation was not associated with a higher rate of childhood obesity (odds ratio = 1.11, 95% confidence interval [CI]: 0.71-1.74). Both SNAP participants and low-income nonparticipants were below national recommendations for whole grains, fruits, vegetables, fish, and potassium, while exceeding recommended limits for processed meat, sugar-sweetened beverages, saturated fat, and sodium. Zero percent of low-income children met at least 7 of 10 dietary recommendations. After multivariate adjustment, compared with nonparticipants, SNAP participants consumed 43% more sugar-sweetened beverages (95% CI: 8%-89%), 47% more high-fat dairy (95% CI: 7%, 101%), and 44% more processed meats (95% CI: 9%-91%), but 19% fewer nuts, seeds, and legumes (95% CI: -35% to 0%). In part due to these differences, intakes of calcium, iron, and folate were significantly higher among SNAP participants. Significant differences by SNAP participation were not evident in total energy, macronutrients, Healthy Eating Index 2005 scores, or Alternate Healthy Eating Index scores. CONCLUSIONS: The diets of low-income children are far from meeting national dietary recommendations. Policy changes should be considered to restructure SNAP to improve children's health.

Long-term effectiveness of maternal dietary counseling in a low-income population: a randomized field trial.

OBJECTIVE: To assess the impact of dietary counseling given to mothers during the first year of infants' lives on food consumption, nutritional status, and lipid profile of the children up to 7 to 8 years old. METHODS: The randomized trial was conducted with 500 mothers who gave birth to full-term infants with birth weight ≥ 2500 g between October 2001 and June 2002 in São Leopoldo, Brazil. Mothers were randomly assigned to intervention (n = 200) and control groups (n = 300) and those in the intervention group received counseling on breastfeeding and complementary feeding by 12 fieldworkers on 10 home visits during the first year of children's lives. Blinded fieldworkers assessed dietary and anthropometric data at 12 to 16 months, 3 to 4 years, and 7 to 8 years and lipid profiles at 3 to 4 years and 7 to 8 years old. The lipid profile was the primary outcome. RESULTS: Of the 500 recruited children, 397 underwent the 12- to 16-month, 354 the 3- to 4-year, and 315 the 7- to 8-year assessment. The energy-dense foods intake was significantly lower in the intervention group at 12 to 16 months and 3 to 4 years old. At 3 to 4 years, serum lipid levels did not differ between groups. At 7 to 8 years, high-density lipoprotein levels were 0.11 mmol/L higher (0.00 to 0.20), and triglycerides concentration was 0.13 mmol/L lower (-0.25 to -0.01) in intervention children but only among the girls. Overweight/obesity rates did not differ between groups. CONCLUSIONS: Dietary counseling for mothers during infancy decreased the energy-dense foods consumption and improved lipid profile.

Saving the lives of South Africa's mothers, babies, and children: can the health system deliver?

South Africa is one of only 12 countries in which mortality rates for children have increased since the baseline for the Millennium Development Goals (MDGs) in 1990. Continuing poverty and the HIV/AIDS epidemic are important factors. Additionally, suboptimum implementation of high-impact interventions limits programme effectiveness; between a quarter and half of maternal, neonatal, and child deaths in national audits have an avoidable health-system factor contributing to the death. Using the LiST model, we estimate that 11,500 infants' lives could be saved by effective implementation of basic neonatal care at 95% coverage. Similar coverage of dual-therapy prevention of mother-to-child transmission with appropriate feeding choices could save 37,200 children's lives in South Africa per year in 2015 compared with 2008. These interventions would also avert many maternal deaths and stillbirths. The total cost of such a target package is US$1.5 billion per year, 24% of the public-sector health expenditure; the incremental cost is $220 million per year. Such progress would put South Africa squarely on track to meet MDG 4 and probably also MDG 5. The costs are affordable and the key gap is leadership and effective implementation at every level of the health system, including national and local accountability for service provision.

The post-opium scenario and rubber in northern Laos: Alternative Western and Chinese models of development.

BACKGROUND: In the past few years rubber planting has spread rapidly throughout northern Laos, especially in Luang Namtha province that borders China. The impetus for this boom has come partly from the spiralling demand for rubber in China (now the world's largest rubber consumer), the high world prices for rubber, and China's promotion of overseas investment through its opium-replacement policy. These economic factors have converged with the desperate need of impoverished highlanders in northern Laos to replace opium as a cash crop as a consequence of a recent opium-eradication campaign and inadequate alternative development. METHODS: This paper draws upon ethnographic and agro-economic research in northern Laos and neighbouring regions and reports of international development organisations operating in Laos. RESULTS: The rubber boom in northern Laos represents a fundamental clash between Western drug-oriented alternative development, on the one hand, and China's national economic strategies abroad and investment-led narcotics policy, on the other. CONCLUSION: China's opium-replacement policy has contributed to a type of unregulated frontier capitalism with socio-economic and environmental effects that threaten the principles and goals of alternative development and even to marginalise the role international development organisations in northern Laos.

Child poverty and environmental justice.

BACKGROUND: Child poverty and social inequality in Western countries are growing both in scope and in complexity. The clustering of income poverty in urban settings reflects the complex process of residential segregation. Living in segregated neighbourhoods with much poverty and predominantly substandard housing is usually associated with poor physical, chemical and social environmental living conditions at the individual and community level which influence and shape children's health both directly and indirectly. OBJECTIVE: This paper shows research data on the link between child poverty and income-related health inequalities according to the unequal exposure to environmental hazards as well as the unequal distribution of environmental resources in the domestic environment and within the local context as an increasing public health issue in Germany. The links between these factors are drawn from the conceptual framework of environmental justice. Examples are shown of integrated approaches to alleviate social and environmental disparities at the community level. CONCLUSION: The implications of environmental justice for public health include the need to uncover the link between socioeconomic factors and environmental health disparities related to the man-made environment. Developing relevant indicators for environmental inequalities in the context of housing and health is an important task for public health research. More emphasis should be placed on a comprehensive holistic approach to understand the mechanisms by which socioeconomic factors modify children's susceptibility and exposure to environmental hazards, particularly in low-income areas.

Impacto obtenido sobre la morbilidad infantil suplementando vitamina A, hierro y cinc a niños <5 años de edad residentes en una zona de alta pobreza: caso: Relleno Sanitario Sector Walter Marquez / The impact obtained about infantile morbidity supplement with vitamin A, iron and zinc to children <5 years old that live in poverty places

La ciencia y la tecnología nunca resolverán todos los problemas suscitados por la insuficiencia de alimentos y la falta de servicios de salud y saneamiento, propiciantes de la desnutrición infantil. Pero los éxitos de los adelantos científicos y los conocimientos obtenidos, han dado pie a nuevas esperanzas de lograr vidas más saludables y productivas, tanto para los niños como para los adultos. Parte de estos conocimientos, como el fortalecimiento del sistema de inmunidad gracias a los efectos de la vitamina A, están bien establecidos. Con el objetivo de demostrar que la suplementación de micro nutrientes a niños en situaciones de pobreza puede propiciar una reducción en la aparición de enfermedades infecciosas más frecuentes, se diseñó un estudio experimental de campo, descriptivo y longitudinal, sobre una población integrada por niños de educación inicial ubicados en el Barrio “Hugo Rafael Chávez” del Sector Walter Márquez de San Josecito, Municipio Torbes. Luego de visitas de inducción, capacitación y censo de morbilidad, se procedió a desparasitar con albendazol y a suministrar dosis pediátricas de vitamina A en capsulas blandas 3 días, sulfato de cinc en tabletas 15 días y sulfato ferroso en jarabe 3 meses, para cumplir un plan de seguimiento mensual durante tres meses. Se incorporan 25 niños y niñas, de los cuales el 50 por ciento de los menores de 2 años de edad tenían algún grado de desnutrición aguda. Mientras que el 36 por ciento de los mayores de dos años tenían desnutrición crónica. De las enfermedades conseguidas, las del aparato respiratorio fueron las más frecuentes, seguidas por las intestinales. Dentro de las respiratorias, las gripes, rinitis y catarro fueron el 81,3 por ciento. Las diarreas fueron el 57,8 por ciento de las digestivas. Las piodermitis fueron el 50 por ciento de las infecciones de piel. Finalmente, la caries dental como enfermedad infecciosa bucal, fue el 55,8 por ciento de otras enfermedades.

Poverty rates in Venezuela: getting the numbers right.

This article looks at household and individual poverty rates in Venezuela over the past seven years. For more than a year, the statement that poverty in Venezuela has increased under the government of President Hugo Chávez has appeared in scores of major newspapers, on major television and radio programs, and even in publications devoted to foreign policy. There are no data to support such statements, and in fact the available data show a decline in poverty for both individuals and households over the seven-year period: the percentage of people in poverty declined from 50 percent in the first quarter of 1999 to 43.7 percent in 2005. Further, there is no evidence to suggest any change in the methodology for measuring poverty during this period, as has been alleged in a number of reports. The article also examines briefly the impact of significant changes in non-cash benefits such as free health care, which are not taken into account in the measured poverty rate, on poor people in Venezuela. Finally, the authors look at how the mistakes in reporting on Venezuela's poverty rate were made; an appendix gives examples of mistakes in major media and foreign policy publications.

Strengthening mental health services in Head Start. A challenge for the 1990s.

Steps must be taken to strengthen mental health services by building on Head Start's philosophy and by translating innovations in mental health services for older children and adolescents into improved services for young children and their families. Recommendations for strengthening Head Start's mental health program include creating a unified vision that reaffirms a holistic, family-focused, and comprehensive services approach; ensuring that mental health services are responsive to the diversity in families served; increasing coordination of mental health services and linkages with new initiatives; increasing resources and providing assistance in gaining access to new sources of funding; supporting innovation; and integrating the new paradigm for children's mental health services into more traditional approaches to intervention within Head Start.