Culturally appropriate measures for monitoring child development at family and community level: a WHO collaborative study.

Culturally appropriate techniques for monitoring child psychosocial development were prepared and tested in China, India and Thailand on a total of 28,139 children. This is the largest study of its kind ever undertaken. Representative groups aged between birth and 6 years were examined and the results were used to produce national development standards-separately for rural and urban children in China and India, and for all children combined in Thailand-which are considered to be more satisfactory than foreign-based standards. In each country, between 13 and 19 key milestones of psychosocial development were selected for a simplified developmental screening operation and these have been incorporated on a home-based record of a child's growth and development. Between 35 and 67 tests have been devised in each country to test the children at first-referral level.

PIP: Protocols of psychosocial development for children 0-6 years old, locally developed in order to be culturally appropriate, were applied to 8995 children from urban and rural areas from 6 provinces in Shanghai, China; fewer than 13,720 children in Chandigarh, Hyderabad, and Jabalpur states in India; and 5424 children from urban and rural areas in Thailand. The findings were intended to be used to develop national child development standards. This study was the largest multicultural study of its kind ever conducted. Cultural variation was the major reason accounting for the very wide range of differences in the age of attainment of a small number of items (e.g., use of cups). A wider variation between urban and rural living conditions in China and Thailand account for differences between urban and rural children in these countries. The tests did not assume that rural children might have an advantage in some areas (e.g., recognizing different types of grain or plant). Very high intertester reliability within centers existed. Lack of time and money prevented the researchers from checking reliability between centers. The researchers discarded two of the culturally appropriate tests initially selected in Thailand (walks on coconut shells and walks on sticks before 72 months of age) since few children could do them before age 6. Teams in all 3 countries selected appropriate test items (milestones) and incorporated them on the weight-for-age home-based record (19 in China, 13 in India and Thailand). The Chinese records present the milestones in pictorial form with red and yellow to represent high and moderate risks, respectively. The next phase of the study aims to determine whether developmental screening can be applied in the home, the community, and primary health care programs to identify developmental delays early enough to implement simple interventions to improve performance and prognosis.

Weight and height of Saudi children six to 16 years from the eastern province.

Measurements of weight and height of 21,638 Saudi boys and girls ages six to 16 years from the Eastern Province were taken. It was observed that the occurrence age of children could only be made out in Hegira years, as age is recorded by parents and at schools by the Hegira calendar. Age is a crucial factor in studies such as this and for valid comparison with any international reference standard, the latter must be adapted to the Hegira calendar year. Curves for weight and height percentiles for age have been constructed and compared with the Hegira adaptation of the NCHS growth standard.

Hegira adaptation of the NCHS weight and height charts.

The ages of Saudi children are recorded and based on the Hegira calendar. When charted on the National Center for Health Statistics (NCHS) weight and height charts, children will be at disadvantage since the Hegira year is shorter than the Gregorian year. In this paper, centiles for the NCHS reference population are estimated for age in Hegira years from 2-18 for height and weight for both sexes using mathematical interpolation. Charts are prepared for use in hospitals and health centers for children whose ages have been reported based on the Hegira calendar.

Changing trends in mortality and morbidity in a teaching hospital in central India.

A comparison of mortality and morbidity pattern of hospital admissions of children under 14 years during 1966-68 and 1977-81 has been made. Annual admission rate has increased from 1515 to 2515, which is in proportion to the population increase of 3 lacs from 1966 to 1981. Recently more than 70% were discharged within a week as against 52% during 1966-68, indicating a faster turnover and a need for more beds. Protein energy malnutrition, infections and diarrhoea with dehydration were main killers. The pattern of mortality and morbidity has not much changed from 1966 to 81 but mortality rates at all ages have considerably declined in recent years (neonatal, post neonatal, preschool and school). Measures to decline it further have been discussed. The data should be of interest to those engaged in planning health strategies and to teachers in defining priorities in Medical education.

PIP: A comparison of mortality and morbidity patterns of hospital admissions for children under age 14 between 1966-68 and 1977-81 has been made. Annual admission rate has increased from 1515 to 2515, which is in proportion to the population increase of 3 lacs from 1966-81. Recently, more than 70% were discharged within 1 week as compared to 51% during 1966-68, indicating a faster turnover and a need for more beds. Protein energy malnutrition, infections, and diarrhea with dehydration were the main causes of death. The pattern of mortality and morbidity has not changed much from 1966-81, but mortality rates at all ages have declined considerably in recent years (neonatal, postneonatal, preschool and school-age). Measures to decrease it even further have been discusses. the data should be of interest to those engaged in planning health strategies and to teachers in order to help define priorities in medical education.

Perinatal and infant mortality in urban slums under I.C.D.S. scheme.

PIP: Perinatal and infant mortality during the year 1985 was analyzed through a prospective study conducted in 12 Anganwadis (total population of 13,054) located in slum areas of India's Jabalpur city. Overall, the infant mortality rate was 128.7/1000 live births and the perinatal mortality rate was 88.5/1000 live births. 58.5% of deaths occurred in the neonatal period. Causes of neonatal deaths included prematurity, respiratory distress syndrome, birth asphyxia, septicemia, and neonatal tetanus. Postneonatal deaths were largely attributable to dehydration from diarrhea, bronchopneumonia, malnutrition, and infectious diseases. All mortality rates were significantly higher in Muslims than among Hindus. Muslims accounted for 28% of the study population, but contributed 63% of stillbirths and 55% of total infant deaths. This phenomenon appears attributable to the large family size among Muslims coupled with inadequate maternal-child health care. The national neonatal and postneonatal mortality rates are 88/1000 and 52/1000, respectively. The fact that the neonatal mortality rate in the study area was slightly lower than the national average may reflect the impact of ICDS services.^ieng