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.

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.

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.

Adjustment to the death of a sibling.

Despite the recent increase in interest in terminally ill children and their families and the post death adjustment of parents, there has been little research examining the adjustment and self concept of surviving siblings in such families. This paper discusses the results of a preliminary descriptive study of 28 children (from 14 families) whose brother or sister had died of cancer between 18 and 30 months previously. Behaviour checklists were completed by parents and teachers and self concept scales administered to the children. A lengthy semistructured interview was carried out, and measures of parental adjustment were gathered. A high percentage of children were found to be exhibiting emotional or behavioural difficulties, or both, and the results indicated that low self esteem was common. Parental and child adjustment were not found to be related inter se, nor did they seem to relate to the child's self esteem. Thus for many children the loss of a sibling might cause long term distress. Further, many children who did not manifest overt difficulties perceived themselves unfavourably in comparison with either their ideal or their dead sibling.