Schistosomiasis, helminth infection and health education in Tanzania: achieving behaviour change in primary schools.

Over a period of one school year a study was carried out into the feasibility and effectiveness of introducing active teaching methods into primary schools in Tanzania with a view to enhancing health education. The Lushoto Enhanced Health Education Project had as a focus personal hygiene with reference to the control of schistosomiasis and helminth infections. When a randomly selected group of children were compared with a comparison group there was evidence of changes in both knowledge and health-seeking behaviour. The passing of messages from children to the community met with mixed results. The observed changes were still evident over 1 year after the project had ended.

Community perception of school-based delivery of anthelmintics in Ghana and Tanzania.

This paper presents the results of an evaluation of community perception of two large-scale, government-run, school-based health programmes delivering anthelmintic drugs to primary school children, in Ghana (80 442 children in 577 schools) and Tanzania (110 000 children in 352 schools). Most teachers (96% in Ghana and 98% in Tanzania) were positive about their role in the programme, including administration of anthelmintic drugs, and parents and children fully accepted their taking on this role. The benefits of the programme were apparent to teachers, parents and children in terms of improved health and well-being of the children. Over 90% of parents in both Ghana and Tanzania indicated a willingness to pay for the continuation of drug treatment. The evaluation also highlighted areas that are critical to programme effectiveness, such as communication between schools and parents, the issue of collaboration between the health and education sectors, parents' perception of the importance of helminth infection as a serious and chronic health problem (compared with more acute and life threatening illnesses such as malaria), and who should pay for treatment of side-effects.

An association between chronic undernutrition and educational test scores in Vietnamese children.

OBJECTIVE: To examine the association between results of educational tests and the anthropometric status of schoolchildren. DESIGN: Cross-sectional data collected during the baseline survey of a randomised trial. SETTING: Eighty-one primary schools in three districts of northern Vietnam. SUBJECTS: A total of 3055 schoolchildren enrolled in class 3 and born in 1990. MAIN OUTCOME MEASURES: Tests of mathematics and Vietnamese language developed not to show floor or ceiling effects, and Z-scores of height-for-age, weight-for-age and weight-for-height. RESULTS: After controlling for age, sex, district and school the results of test scores in both mathematics and Vietnamese were significantly negatively correlated with Z-scores of height-for-age (P<0.001) and weight-for-age (P<0.001), but not with weight-for-height (P=0.75). CONCLUSIONS: A cross-sectional negative association was observed in Vietnamese primary school children between indicators of chronic undernutrition and tests of educational achievement. SPONSORSHIP: The study was funded by donors to the Partnership for Child Development including the Rockefeller Foundation and the World Bank.

An exploration of the Malawian perspective on children's everyday skills: implications for assessment.

PURPOSE: The aim of this study was to consider Malawian concepts of psychosocial development in children and to draw implications for the devising of an instrument to measure everyday skills in children. METHOD: Key informant interviews, focus groups and other interviews, video tapes and observations of children were undertaken in a rural village in Malawi, with a focus on 4-5-year-olds. RESULTS: A well adapted child of this age is expected to show first of all understanding of social responsibilities, with regards respect, obedience, cooperation, ability to socialize with other children, ability to carry out 'children's chores', to know people by names but more importantly how they are related to the child. The child should also show memory skills sufficient to carry messages. Such a child is described as intelligent/clever, characteristics important for survival. CONCLUSION: There are significant implications for the justification for the development of an instrument to measure everyday skills in African communities.

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.

Learning and teaching. Child-to-child.

PIP: Child-to-Child is an approach to health education which encourages children to care for themselves, younger children, and members of their community, and to work together to improve their education and health care. Children worldwide look after their younger siblings, helping them by caring for them, teaching them, and setting a good example. Children can also improve health practices in their families and communities by sharing knowledge they have learned in school, setting an example, and taking action in the community. To provide teachers, community workers, and other adults working with children with ideas on how to apply the approach, the Child-to-Child Trust produced a series of activity sheets on 35 child health topics, based on a step-by-step process. A health idea is chosen and adults help children learn the basic facts. Children then investigate how the topic directly affects people's health locally, potentially conducting a neighborhood survey. Next, children work with adults to decide what action to take in light of their new understanding and then act upon their decisions. The children evaluate what they have done after trying various activities, then meet again to discuss what to do next. At this point, participants may either continue on their course of action or pursue another direction. Experience with Child-to-Child improves children's ability to provide basic care for younger ones, while gaining greater understanding of how to improve the long-term health of the community. Millions of children have been helped to understand health issues through Child-to-Child activities and the work continues.^ieng

Screening test battery for assessment of psychosocial development.

A multicentric cross-sectional collaborative study was undertaken in 3 centres in India with the main aim of developing simple and reliable indicators for the early detection of developmental disabilities in children under 6 years of age and to compare the age of attainment of developmental milestones in children in the three regions. The study provided a simple low-cost and culture-appropriate psychosocial developmental screening test battery which can be used with ease by trained public health grass-roots functionaries. This instrument was standardized on a large rural, tribal and urban sample comprising more than 13,000 children from 3 regions in India. The procedure for sampling, selection of items and methodology for standardization of the instrument in the Hyderabad region detailed in this paper were replicated in other centres as well. Quality control of data was ensured through inter-rater and test-retest measures of reliability. During pre-testing, 66 culture-appropriate milestones were selected finally from a larger item pool. The 50th centile age reference values of the Hyderabad study children and those obtained by other 2 centres were comparable.

Intellectual development at 3 years of age of children who underwent major neonatal surgery.

Thirty full-term infants born with surgically correctable life-threatening abnormalities who underwent emergency neonatal surgery were followed up from birth to 3 years of age. Comparable data were obtained on a matched group of healthy newborn babies. At 3 years the cognitive functioning of children whose condition had been resolved in the early months of life was similar to the controls. Those children who required further medical or surgical treatment were functioning at lower levels than the controls, with language development being most affected. Number of operations, defined as all procedures under general anesthetic, was the medical factor most strongly associated with poorer outcome at 3 years. Family factors--higher maternal IQ and nonmanual social class--were also positively correlated with language development.

Facial deformity in childhood: severity and psychological adjustment.

This study examines the hypothesis that severe facial deformities may be less of a psychological burden than those that are more mild. Twenty-seven experimental children and 12 controls, plus 26 siblings of the experimental group and 12 control siblings, were assessed using tests of intelligence, self-concept and ratings of behaviour. The results provided some support for the hypothesis being considered.

The development of a hypnotherapy service for children.

In September 1988, a Pain and Symptom Management Team was set up to offer hypnotherapy as part of the treatment of pain, discomfort and anxiety. Children are taught self-hypnotherapy skills. Of the first 51 cases referred, 36 were taken on for hypnotherapy and after two to three sessions 29 were rated as improved or much improved. An account is given of the approach of the team and of some of the possible pitfalls.