Child guardianship in a Canadian home visitation program for women who use substances in the perinatal period.

BACKGROUND: Retaining guardianship of one's infant is often a priority for pregnant women who use substances, and may be beneficial to infants when they are safe in their mothers' care. Previous studies from the United States have identified several maternal psychosocial characteristics associated with the ability to keep an infant free from abuse or neglect; however, little is known about the impact of multiple risk factors on guardianship, particularly in Canadian intervention programs. OBJECTIVE: To describe maternal characteristics associated with child guardianship among pregnant women at risk of an alcohol and/or substance exposed pregnancy who attended a Canadian home visitation program. METHODS: Guardianship status at 6 months post-enrolment was extracted from a provincial program's records for all women enrolled between November 1999 and May 2005 (n=64). Bivariate analyses were performed to determine client characteristics most likely to have retained guardianship. RESULTS: At follow-up, 70% of participants were guardians of the index infant. Higher income, more prenatal care, no history of sexual abuse, better alcohol and psychiatric scores, and fewer risk factors on a cumulative risk index were significantly associated with retaining guardianship at 6 month follow-up (p<0.05). CONCLUSIONS: Retaining child guardianship may be the greatest challenge and opportunity for women experiencing problems in multiple domains of their lives, including those associated with substance dependence. Programs targeted at women who use substances while pregnant may best assist mothers to retain guardianship of their infants by supporting clients to address the complex social and health problems often found in conjunction with addictions.

Predictors of rate of weight gain in malnourished children within a realimentation programme.

The rate of weight gain of malnourished children in realimentation programmes varies substantially; however, predictors of variation are infrequently reported. The aim of this study was to assess a set of hypothesized predictors to the rate of weight gain of a sample of children attending a partial day treatment programme in the Dominican Republic. Data were available for 105 consecutive admissions (82% of total) to the programme between July 2004 and June 2006. Mean rate of weight gain, adjusted for initial weight, was 3.8 (SD 4.2) g kg(-1) day(-1) during the first 28 days of treatment. Rate of weight gain was associated with the amount of calories consumed by the child from the enriched milk-based formula consumed within the clinic. This relationship depended upon the initial degree of wasting and the amount of diarrhoea, such that caloric intake had a greater impact on those with the most wasting and greater amounts of diarrhoea. Other hypothesized variables were not related to rate of weight gain. Further investigation is required to identify other predictors of the variability in weight gain within nutrition treatment programmes with tighter control of possible sources of measurement error.

Evaluation of a partial day treatment realimentation program for malnourished children in the Dominican Republic.

The study determined the growth rates and clinical attendance patterns of malnourished children treated at an existing partial day treatment realimentation program. It was hypothesized that at least 50% of the children would achieve a minimum recommended growth rate of 5 g/kg/day and would attend at least 50% of the possible treatment days. All children consecutively admitted to a partial day treatment realimentation program on the outskirts of Santo Domingo, Dominican Republic between 2 July 2004 and 30 November 2005 were invited to participate in the study. Out of 92 caregivers, 88 (95.6%), agreed. Caregivers were interviewed and child anthropometrics were obtained at baseline and follow-up. Clinical attendance patterns were extracted from medical records. Mean rate of weight gain in the rehabilitation phase up to 4 weeks following admission was 3.9 g/kg/day (SD 4.5 g/kg/day) with only 27% of the children achieving a minimum recommended rate of > or =5.0 g/kg/day. On consecutive clinic attendance days, the mean growth rate was 4.2 (SD 8.6) g/kg/day, while on non-attendance days it was approximately 3.7 (SD 4.5) g/kg/day. Children attended 80% of the possible clinic days during the first 4 weeks of treatment. Within this time, 20% achieved the target of > or =-1 SD of the median weight for height. Caregivers reported having difficulty finding caretakers for their other children and their own illnesses as barriers to regular attendance. There was a substantial variation in growth rates of children attending the clinic with mean growth rates failing to achieve minimal standards. Though some children may have benefited from the partial day treatment program, alternative strategies should be considered at this clinic to improve resource utilization and outcomes including the use of a home recovery option and an enhanced day treatment program.