Social epidemiology of childhood diarrhoea in a Kashmiri Himalayan village

This cross‐sectional investigation of childhood diarrhoea in a remote Kashmiri village blended methodologies from anthropology and epidemiology, including rapid ethnographic and health assessment. Household interviews with 29 mothers, representing 93 children, were conducted to ascertain the extent of diarrhoeal illness of children in the village. The diarrhoea burden in the village was substantial: 44.1% of children under age 13, representing 75.9% of village households, experienced diarrhoea at least once during the 3 months prior to the study. Boys were more likely to have experienced diarrhoea in the 3 months prior to the study (odds ratio 2.5) than were girls. Girls, however, experienced diarrhoeal episodes which lasted, on average, 5 days longer than in boys. Mothers were more likely to help control a diarrhoea episode in boys than they were in girls (odds ratio 3.3). Finally, children whose diets were restricted while they had diarrhoea had episodes that were, on average, 2.5 days longer than other children. Diarrhoea was a component of the illness domain of Kashmiri mothers, and women indicated that food and medicines were used as treatments for diarrhoea. Oral rehydration therapy, not presently known or used in the village, would be likely to be acceptable to mothers of this region to reduce diarrhoeal illness.     

Children of mothers with mental ilness: attachment,emotional and behavioural problems

This study describes the pattern of emotional and behavioural difficulties of children whose mothers have mental illness, and explores the relationship between children’s behavioural and emotional difficulties and maternal perceptions of attachment. Thirteen mothers previously admitted to psychiatric hospital for mental illness completed a measure of their own symptoms (Brief Symptom Inventory), their children’s emotional and behavioural problems (Strengths and Difficulties Questionnaire (SDQ)), and attachment security (Parent/Child Reunion Inventory) (n?=?21). Mean scores for child SDQ profiles were found to be within the ‘normal’ range, although (on some indices) mothers reported more ‘case’ scores for their children, than would be expected from standardized norms. It was found that there were significant positive correlations between ‘insecurity’ scores and all problem scales of the SDQ. Best predictors from the Parent/Child Reunion Inventory factors for each SDQ scale are reported and discussed.     

Violence and Other Stressful Life Events as Triggers of Depression and Anxiety: What Psychosocial Resources Protect African American Mothers?

Understanding the risk and protective factors related to maternal mental health problems is important for improving the well-being of mothers and children, particularly in African American populations which may be at greater risk for maternal depression and resulting child behavior problems. This study explored whether three psychosocial resources??emotional resilience, social support, and ethnic identity??serve as protective factors in the face of specific stressful events that may trigger African American mothers?? depression and anxiety symptoms. Standard self-report measures of depression, anxiety, negative life events, community violence, abuse, emotional resilience, social support, and ethnic identity were administered to African American mothers (N = 209) of 2?C18 month-old children. Linear regression models revealed main effects of negative life events and abuse on increased depression and anxiety symptoms, while emotional resilience and social support predicted decreased symptoms. There was also a significant interaction revealing a protective-reactive effect of ethnic identity on the associations of witnessed community violence with depression and anxiety symptoms. It is important for primary care providers to screen African American mothers for negative life events and abuse to identify those at increased risk for maternal depression and anxiety symptoms. Treatment programs should target emotional resilience, enhanced social support, and stronger ethnic group affiliation, which may be most effective at preventing mental health problems among mothers exposed to relative lower levels of community violence.     

Maternal Self-Assessed Health and Emotionality Predict Maternal Response to Child Illness

This study examined relations between mothers' neuroticism, depression, and self-assessed health and both behavioral and emotional responses to child illness. Individual difference measures (neuroticism, depression, and health) were completed by 98 mothers who also indicated their responses to hypothetical child illness scenarios. In addition, mothers rated their children's health. Findings indicated that mothers with poorer self-assessed health responded to the vignettes with more negative emotions, reported more extensive caretaking behaviors, tolerated more extreme sick-role behaviors from the child, and rated their child's overall health more poorly. Maternal depression was related to the report of more negative emotions and more extensive caretaking behaviors. Maternal neuroticism was related only to negative affect in response to the vignettes. Findings suggest that mothers' self-assessed health and depressive symptoms may influence their role as caretakers of their children's health and may be important variables in understanding the development of health cognition and behavior in children.     

Causal reasoning and the treatment of diarrhoeal disease by mothers in Kenya

A study of reasoning about the cause and treatment of childhood diarrhoea by Maasai schooled and unschooled mothers was carried out in Kenya, using a method of analysis developed within cognitive psychology. A dramatic difference in the conceptual structures of mothers' reasoning about both the cause and treatment of diarrhoea was found between the unschooled and schooled group. The unschooled mothers' explanation of diarrhoea was in terms of illness, resulting from social and moral factors. The knowledge structures generated showed global coherence. The schooled mothers explained diarrhoea with a series of quasi-biomedical facts about the disease with little or no connections between facts. The role of understanding the underlying disease processes for learning in health education is discussed in the context of Kenyan culture.     

Children of mothers with mental ilness: attachment, emotional and behavioural problems

This study describes the pattern of emotional and behavioural difficulties of children whose mothers have mental illness, and explores the relationship between children's behavioural and emotional difficulties and maternal perceptions of attachment. Thirteen mothers previously admitted to psychiatric hospital for mental illness completed a measure of their own symptoms (Brief Symptom Inventory), their children's emotional and behavioural problems (Strengths and Difficulties Questionnaire (SDQ)), and attachment security (Parent/Child Reunion Inventory) (n = 21). Mean scores for child SDQ profiles were found to be within the 'normal' range, although (on some indices) mothers reported more 'case' scores for their children, than would be expected from standardized norms. It was found that there were significant positive correlations between 'insecurity' scores and all problem scales of the SDQ. Best predictors from the Parent/Child Reunion Inventory factors for each SDQ scale are reported and discussed.     

Avoidance Symptom Presentation of Preschoolers Exposed to Intimate Partner Violence in a Group Therapy Setting

Post-traumatic stress disorder (PTSD) is a serious problem for children exposed to intimate partner violence (IPV). Recent changes to diagnostic criteria for PTSD include a reduction in avoidance symptom criteria from three to one and the separation of emotional numbing from avoidance symptoms, thus creating a need to better understand how avoidance symptoms of PTSD present themselves in young children. This study evaluated 56 children aged four to six as they participated in an intervention for mothers and children exposed to IPV. Therapists documented behaviours indicative of avoidance symptoms during group sessions. Data were analysed and coded into symptom categories and thematically emergent domains. Results demonstrated that avoidance symptoms fell into three separate categories: physical avoidance, emotional avoidance, and changing topics. Additionally, the data support the Diagnostic and Statistical Manual of Mental Disorders (5th edition) change to remove emotional numbing from the avoidance symptom category. These results give insight into how to develop more targeted treatments for PTSD as well as improve the assessment and diagnosis of PTSD symptoms in preschoolers.     

Mothers' Experiences of an Adult Child's HIV/AIDS Diagnosis: Maternal Responses to and Resolutions of Accountability for AIDS*

Based on 13 in‐depth interviews, this paper addresses mothers' initial reactions to an adult child's HIV diagnosis. Mothers described responses that included intense personal and emotional reactions. Additionally, mothers acknowledged the importance of resolving initial blame paradigms for the diagnosis, which included facing and resolving feelings of personal responsibility for the adult child's illness. Addressing feelings of blame and initial emotional reactions helped mothers to play active roles in the social support of their children.     

The personal development of mothers of terminal cancer patients: how Japanese women change through the experience of caring for and losing their children to cancer

The author interviewed 57 mothers who had lost children to cancer about their experiences concerning their children's illness and death. These mothers became their children's main caretakers because they felt responsible and unable to count on others. They maintained emotional stability while interacting with their children and worked to protect their children from mistakes made by health care professionals. These experiences made many mothers tougher. After their children died, they had to form a different kind of relationship to their children to overcome their grief. This process compelled the mothers to reconsider issues concerning life and death and changed their fundamental values.     

Treatment of childhood diarrhoea in Nigeria: need for adaptation of health policy and programmes to cultural norms

A community survey of treatment regimens for acute diarrhoea in children was carried out in 10 villages in the Ona Ara Local Government Area of Oyo State, Nigeria, using a combination of qualitative (focus-group discussions) and quantitative (weekly surveillance of diarrhoea) methods. Focus-group discussions were conducted with parents of children aged less than 5 years, while a surveillance of diarrhoea among 550 children of same age was carried out during a 6-month period. The findings of the study showed that not all types of diarrhoea were recognized as illnesses, and only those considered to be illnesses were treated. Treatment often involved an adhoc group which comprised adults who were present at the time the illness occurred (including parents, neighbours, relatives, and elders). Certain beliefs and practices, such as associating types of diarrhoea with occupation or ethnic groups, categorizing the severity on perceived causes, and withholding certain foods during episodes of diarrhoea, were common factors in decision-making for seeking treatment. Antimicrobial agents were used in the case of 46.8% of 205 diarrhoeal episodes, and 28.5% were not at all treated. The usual practice of focusing on a target group, such as mothers, during educational interventions may need to be modified in communities where nearly every adult has a role in decision-making in relation to health. The need to adapt health policy and programmes to cultural norms should be addressed to improve the impact of programmes.     

Community-based cluster surveys on treatment preferences for diarrhoea, severe diarrhoea, and dysentery in children aged less than five years in two districts of Ghana

Hospital-based surveillance for severe diarrhoea has been recommended to assess the burden of disease due to rotavirus. However, information on healthcare-seeking patterns of residents in the hospital catchment area is needed first to obtain the burden of disease in the community using the hospital data. A community-based cluster survey was conducted in two districts of Ghana, each served by a single district hospital, to determine the prevalence of severe diarrhoea among and treatment preferences for children aged less than five years. Caretakers of 619 children in Tema, an urban district, and caretakers of 611 children in Akwapim South, a rural district, were interviewed. During the month preceding the survey, the prevalence of severe diarrhoea in children aged less than five years was similar in the two districts (13.6% urban and 12.9% rural), as was the proportion of mothers who sought care outside the home (69.0% urban and 70.9% rural). 48.8% of urban mothers of children with severe diarrhoea visited public/private clinics, 9.5% pharmacies, and 3.6% the district hospital. Whereas, 22.8% of rural mothers visited public/private clinics, 19.0% pharmacies, and 13.9% the district hospital. Results of the study suggest that rotavirus surveillance should be guided by community studies on healthcare-use patterns. Where hospital use is low for severe diarrhoea, rotavirus surveillance should include other health facilities.     

洪灾区儿童心理创伤症状与心理韧性的关系

目的调查洪灾3个月后灾区儿童心理韧性和创伤症状的关系。方法采用修订版儿童事件影响量表（CRIES）、青少年心理韧性量表、自编洪灾创伤暴露程度问卷对690名洪灾区儿童进行调查,用方差分析、logistic回归分析进行数据分析。结果1家里受灾组在CRIES量表侵入、高唤醒因子的得分高于家里未受灾组;感受到生命威胁组在CRIES 3个因子的得分均高于未感受到生命威胁组;2心理韧性高分组在CRIES量表回避、高唤醒的因子得分低于心理韧性低分组;3 Logistic回归分析结果显示感受到生命危险、目睹死亡正向预测PTSD倾向,心理韧性量表中的情绪控制因子得分负向预测PTSD倾向,积极认知因子得分正向预测PTSD倾向。结论家里受灾、感受到生命威胁、目睹死亡是重要的洪灾创伤暴露指标;心理韧性尤其是情绪控制能力是儿童重要的复原特征,但心理韧性中的积极认知不利于其心理复原。     

Socioeconomic and health programme effects upon the behavioral management of diarrhoeal disease in northeast Thailand

This study investigates the effects of socioeconomic and health programme factors on preventive and curative health behaviors and assesses the impact of preventive health behaviors on the incidence of diarrhoea among children under five years of age. Methodological approaches included focus groups to uncover local definitions of diarrhoeal disease, a baseline survey which collected data on maternal preventive health behaviors for 1,364 children, and a monitoring system which collected data on the incidence of diarrhoea and on maternal curative behaviors among the same group of children. Results indicate that socioeconomic status and exposure to health programmes showed significant relationships with selected maternal preventive behaviors. Children whose mothers washed their hands before breastfeeding, gave their child food immediately after cooking and warmed foods each time before meals had significantly lower proportions with diarrhoea than children of mothers who did not practice these behaviors, and 70 percent of the children with diarrhoea were exposed to high risk of severe dehydration and related health complications. Implications of these findings for health programmes are discussed.     

A child with puzzling complaints--does he have a disease?

Two children were presented to the physician with serious, long-lasting and unexplained complaints. The first was a girl aged four years with diarrhoea, vomiting and subfebrile temperature, the other was a boy aged almost 1 year with sudden spells of cyanosis and tachycardia. The mothers were found to falsify and fabricate the illness of their children: Münchausen syndrome by proxy. As a consequence of this behaviour, the children underwent extensive and sometimes invasive diagnostic investigations and treatment for their puzzling illness. A number of alarm signals associated with the condition, the parent and the child may help the physician to recognize and diagnose this syndrome at an early stage. Confrontation of the mother with the incriminating findings must take place under carefully prepared circumstances. The syndrome is related to the mothers' need for medical attention in order to retain a certain psychological balance. The fathers often have a passive role in the family life.     

The mental health of Australian mothers and fathers of young children at risk of disability

OBJECTIVES: To: (1) determine the strength of the relationship between risk of child disability and parental mental health in a nationally representative sample of Australian families with young children; (2) estimate the contribution of distress among parents of children at risk of disability to overall parental psychiatric morbidity; and (3) explore the extent to which between-group differences in parental mental health may be attributable to differences in exposure to other risk factors. METHOD: Secondary analysis of cross-sectional data collected in Wave 1 of the Longitudinal Study of Australian Children (n=4,983; 6.5% of children identified as being at risk of disability). RESULTS: Elevated rates of psychological distress indicative of serious mental illness were found among mothers (OR=5.1, 95% CL 3.5-7.6), but not fathers (OR=1.4, 95% CL 0.5-3.4) of children at risk of disability. Psychological distress among mothers of children at risk of disability accounted for 23% of estimated total maternal psychiatric morbidity. Approximately 50% of the elevated risk of distress for mothers was accounted for by increased rates of poverty among children at risk of disability and their families, an association possibly mediated by increased exposure to adverse life events, poorer maternal health and reduced personal-social capital. CONCLUSIONS: The association between risk of child disability and maternal mental health is strongly confounded by increased rates of poverty among children at risk of disability. Any residual risk appears to be related to the poorer social, emotional and behavioural development of children at risk of disability. Social and health policy responses need to focus on poverty reduction, enhancing the personal social capital of mothers living in poverty and on improving the social, emotional and behavioural development of the children.     

Parenting in a crisis: conceptualising mothers of children with cancer

Much research on the experiences of parents of children with cancer has been conducted within a discourse of psycho-pathology, or has tended to see parents mostly as a proxy source of information on the well-being of their children. Using empirical data from semi-structured interviews with 20 mothers of a child with cancer, in one area of the UK, we draw on sociological literatures on motherhood, childhood, caring, and chronic illness to suggest a more helpful and informative way of understanding their experiences. We suggest that mothers, although not ill themselves, experience many of the consequences of chronic illness. Biographical disruption begins for them when they first notice something wrong with their child, and intensifies with diagnosis, altering their sense of self and their social identity. The diagnosis brings with it a set of new responsibilities and role expectations, including an obligation of 'proximity'-being physically close to their child at all times to provide 'comfort' and 'keep-watch'. For mothers, caring evokes an intense emotional interdependence with their sick child, and involves a range of technical tasks and emotional work, including acting as 'brokers' of information for their child and managing their cooperation with treatment. Managing these obligations was achieved at high cost to the mothers themselves, and resulted in severe role strain by compromising their ability to function in other roles, including their role as the mother of their other children. Against the backdrop of a severe and life-threatening illness, everyday concerns about their child's diet or appropriate discipline take on a new significance and carry a heightened potential for generating conflict and distress for mothers. In presenting their accounts, mothers draw on prevailing cultural discourses about motherhood, childhood and cancer, and these clearly influence the context in which they care for their child, and shape their reflexive constructions of their experiences. Caring for a child with cancer had many adverse implications for the quality of life of the women we studied. Mothers of a child with cancer warrant study in their own right, and such study benefits from interpretive perspectives.     

An illness behavior paradigm: a conceptual exploration of a situational-adaptation perspective

A situational-adaption perspective is developed as a basis of an analytic illness behavior paradigm. The situational-adaption perspective is derived from the ideas of Dubos wherein health is viewed as adaption and the interactionist conception of the defined social situation. The situational-adaption perspective is then applied to symptomatic episodes where signs and symptoms are contained in everyday situations without direct medical consultation, everyday illness behavior; to illness experiences where coping necessitates medical consultation, acute illness behavior; to chronic diseases where adjustment and long-term care are necessary, chronic illness behavior; and to emergent life threatening illness episodes which require definitive medical care, life threatening illness behavior. For each of these illness behavior types a primary process, role behavior and patient-practitioner relations are specified.     

Illness behaviour in mothers with young children

113 families with young children were studied over a 12-month period, when all contacts with the general practitioner and hospital emergency services were recorded. Socioeconomic data was obtained at interview, together with responses to a vignette instrument describing common childhood problems. Health diaries were completed by 70% of mothers, providing further information about illness and mothers anxiety about it. Analyses showed that significant disease in any child was the strongest predictor of frequency of new consultations, with measures of mothers anxiety, number of children in the family, mothers education level and her response to the vignettes also contributing significantly. Socioeconomic deprivation was associated with increased utilisation, even when the effects of prevalence of chronic diseases, size of family and mothers' anxiety were taken into account. From the spontaneous comments made during the vignette responses further information was obtained about how mothers reach the decision to consult the family doctor about children's illness. Thus in a Primary Care setting some systematic differences have been demonstrated between high and low consulting families, which may partly explain the wide variation in spontaneous consultation rates observed.     

Partnership with nursing mothers: an interim strategy for combating childhood enteric diseases in Nigeria

Five hundred and fifteen homes of nursing mothers in Ile-Ife, Nigeria, who had earlier brought their children for treatment of diarrhoeal diseases at the IUTHC infant child welfare clinics were visited between January 1982 and June 1984. The mothers' perceptions as to causes, prevention and control of childhood enteritis were elicited: 49.7% of the mothers attributed the cause of the disease to evil spirits; and 9.5% believed enteritis in children to be due to contamination of children's feeds. Modern medicine was perceived to be the ideal method for treating this disease by only 7.4% of the mothers, while 88.8% opted for any of the traditional methods. In order to reduce the devasting effects of enteric diseases among children born to mothers in tropical countries of Africa and Asia, it is imperative that all health workers understand the cultural and social perceptions of their clients towards the disease in question. Illiteracy, and unsanitary and unhygienic environmental conditions were found to be the main factors precipitating enteritis. Implications and strategies for minimizing diarrhoea and other childhood enteric diseases are discussed in the text.