An international perspective on child day-care health.

If we are committed to the health and development of children, we need to recognize that the vast majority of the world's women are working women. In Africa, 80% of the women are actively engaged in economic activities outside the home. The "economic miracle" in Southeast Asia was made possible by the nimble fingers of thousands of women working in textile and electronics factories. There is need for pre-day-care advocacy for infants, through promotion of breast feeding and maternity leave. When the mother returns to work, the standard of the International Labor Organization should be applied, namely" ...the care of children while the parents are working cannot be ignored because it forms a focal point on which three main concerns of development policy--work, health, and education--converge." Several principles emerged from the presentations in the international panel: 1. Child-care programs must be community based, using the resources of the families and the community organizations themselves. 2. Programs require the active involvement of the communities, women's groups, and other partners. 3. Programs are modified by innovations created by community organizations, universities, and other groups. 4. Programs require the mobilization of trained young men and women into the field of early childhood education and development. This international panel provided an overall uniting theme, that throughout the world the hope for the survival and better life for children unites parents of every country and every creed. This is one of the most powerful and strongest motivational resources in the world.(ABSTRACT TRUNCATED AT 250 WORDS)

Child abuse: measuring a global problem.

Child abuse and neglect include four distinct conditions: physical abuse, neglect, emotional abuse and sexual abuse. The magnitude of the problem is not well defined. The lack of epidemiological data limits the extent to which sound public health and social welfare policies and intervention programmes could be developed, implemented and evaluated. In recent years two approaches have been developed to document the magnitude and nature of child abuse and neglect: regional or national case registers; and a screening instrument for suspected cases of child abuse and neglect (SCAN) for use in health service facilities. We are proposing an additional approach for monitoring presumed child abuse and neglect-related mortality. Applying this approach to regions or groups of countries for which there are sufficient data, the expected under-5 rate of presumed child abuse and neglect would be between 13 and 20 per 100,000 live births. These estimates are higher than those made either from community-based registers or forensic reporting systems. Differences in these estimates will need to be resolved through further research. Injury and injury-related mortality can be classified as intentional, unintentional or resulting from varying degrees of neglect. Death from physical abuse represents a willful act or series of actions. Death from neglect may arise from willful behaviour but may also arise from ignorance and irresponsible behaviour. These include failure to recognize hazardous circumstances or children's nutritional, health and developmental needs, and leaving infants and children unattended or inadequately supervised. Mortality data provide virtually no measure of sexual abuse.(ABSTRACT TRUNCATED AT 250 WORDS)

The home-based maternal record: a tool for family involvement in health care.

PIP: The home-based maternal record offers an opportunity for family involvement in health care. Home-based records of maternal health have been used in several developing countries, and have led to increased detection and monitoring of women at high risk for complications during pregnancy. Home-based cards that include menstrual information remind health workers to educate and motivate women for family planning, and serve as a source of health statistics. Records that use pictures and symbols have been used by illiterate traditional birth attendants, and had an accurate completion rate of over 90%. The WHO has prepared a prototype record and guidelines for local adaptation. The objectives were to provide continuity of care throughout pregnancy, ensure recognition of at-risk women, encourage family participation in health care, an provide data on maternal health, breastfeeding, and family planning. The guidelines have been evaluated and results show that the records have improved the coverage, acceptability, and quality of MCH/FP care. The records have also led to an increase in diagnosis and referral of at-risk women and newborns, and the use of family planning and tetanus toxoid immunization has increased in the 13 centers where the reports are being used. Focus group discussions have shown that mothers, community members, primary health workers, and doctors and nurses liked the records. It is important to adapt criteria for high-risk conditions to the local areas where the records will be used to ensure the relevance of risk diagnosis. The evidence shows that home-based maternal and child records can be an important tool in the promotion of self-reliance and family participation in health care. In addition, home-based records can be used for the implementation of primary health care at the local level, and serve as a resource for data collection.^ieng

Psychosocial sequelae of abortion and sterilization: a controlled study of 200 women randomly allocated to either a concurrent or interval abortion and sterilization.

PIP: 201 women who sought abortion and sterilization were randomly assigned to 2 study groups to compare the incidence of psychosocial sequelae. The 1st group (95 women) had abortion and concurrent sterilization, while the 2nd group (106 patients) had abortion followed by interval sterilization 6 weeks-3 months later. 6 weeks after concurrent abortion and sterilization, 96% of the women in the 1st group were satisfied with the concurrent approach. In contrast, at 6 weeks after sterilization, only 75% of women in the 2nd group were satisfied with the interval approach. At 12 months, 2-3% of women in both groups expressed regret at having been sterilized. There was no difference in the self-perceived health status of the women in the 2 groups, nor were there any significant differences in perceived changes in menstrual patterns, marital relationships, and libido. There was a tendency for women in the 2nd group who failed to return within 6 weeks for interval sterilization to be Moslem Malays, to have a nuclear family, and to have 1 or no sons. In general, factors to be taken into account in determining whether sterilization should be concurrent or interval include whether the couple has any sons, whether the woman has thought about sterilization before the current pregnancy, and whether the husband and wife have reached agreement on sterilization.^ieng

Impact of hormonal contraceptives vis-à-vis non-hormonal factors on the vitamin status of malnourished women in India and Thailand. World Health Organization: Special Programme of Research, Development and Research Training in Human Reproduction. Task Force on Oral Contraceptives.

The effects of combined oral contraceptives containing 30 or 50 micrograms ethinyl oestradiol and 150 micrograms levonorgestrel or a 3-monthly injectable preparation depo-medroxyprogesterone acetate (DMPA) on the vitamin status of low-income group women from two urban centres in India (Bombay and Hyderabad) and one rural centre in Thailand (Chiang Mai) were examined in a follow-up study over a period of 1 year. The magnitude of malnutrition in the study population vis-à-vis a middle-income reference group was assessed by comparing the baseline data on the two groups. Effects of time-related variables such as lactation and season were also examined by a cross-sectional analysis of the baseline data on the study population. In all three centres the majority of the study population suffered from biochemical riboflavin and/or pyridoxine deficiency even before initiating contraception. Lactation appeared to have an effect on the vitamin status, which varied among the different populations. Seasonal effects were seen, but showed inconsistent trends in the three centres. Both the oral contraceptive pills and DMPA tended to increase serum vitamin A and blood folate. The thiamin, riboflavin and pyridoxine status of the women who were already deficient did not deteriorate further with the use of hormonal contraception, as judged by enzyme saturation tests. Some deterioration in the riboflavin status of the normal women of Hyderabad was seen with the use of oral pills. Women who were biochemically deficient prior to the use of oral contraceptives tended to show some improvement in B-vitamin status, over the 1-year period of hormonal contraception.

A randomized, double-blind study of two combined and two progestogen-only oral contraceptives.

A randomized double-blind study of two combined oral contraceptives and two progestogen-only oral contraceptives was conducted using the same protocol at WHO Collaborating Centres for Clinical Research in Human Reproduction in Bombay and Ljubljana of the 518 women admitted to the trial, 123 received mestranol 50 micrograms + norethisterone 1mg (MES 50 + NET 1); 137 received ethinyl estradiol 30 micrograms + levonorgestrel 150 micrograms (EE 30 + LNG 150); 130 received norethisterone 350 micrograms/NET 350); and 128 received levonorgestrel 30 micrograms (LNG 30). At one year, between 52.6 and 61.0 percent of those recruited had discontinued oral contraceptive use for all reasons, and by two years, between 70.5 and 76.5 percent had discontinued the treatment. These rates did not differ between the four treatment groups. However, discontinuation rates for all medical reasons at one and two years, and at two years pregnancy rates and discontinuation rates for bleeding disturbances, were significantly lower in the EE/LNG preparation. The groups receiving the MES/NET, LNG and NET had similar pregnancy rates, discontinuation rates for all medical reasons and all bleeding disturbances. There were two ectopic pregnancies among the 22 pregnancies in the progestogen-only groups. Discontinuation because of headache, dizziness and other central nervous system symptoms were significantly more common in those receiving MES/NET compared to EE/LNG. In contrast, discontinuation for gastro-intestinal disturbances were significantly higher in the EE/LNG combined preparation. Bleeding disturbances in the first few cycles tended to be higher in NET than in the LNG group. The data suggest that greater consideration be given to the benefits and risks of including progestogen-only oral contraceptives in the family planning programmes of some countries.

Safety of postabortion sterilisation compared with interval sterilisation. A controlled study.

406 women--about one-fifth of those requesting an induced abortion and sterilisation over a thirty-three-month period--volunteered to be allocated randomly to either a concurrent induced-abortion/sterilisation group or a group which was sterilised six weeks after abortion. The abortion-attributable and sterilisation-attributable complication rates of 3.8% and 5.2%, respectively, for the concurrent group did not differ significantly from the 6.7% and 6.9% rates for the interval group. The estimated 2%-10% of women who would have changed their minds must be set against the 4% of women who became pregnant again before being sterilised. Efforts should be made to identify women likely to regret sterilisation.

PIP: In order to determine the optimal time for performing sterilizations on women requesting both abortion and sterilization, a prospective, comparative study of 406 women, who agreed to be randomly allocated to either a postabortion or an interval sterilization group, was undertaken at the Kandang Kerbau Hospital in Singapore. The combined immediate and delayed complication rate for the interval groups was higher than for the postabortion group, but the difference was not significant. Among the women in the interval group, 6.7% had complications stemming from the abortion and 6.8% had complications attributable to the sterilization procedure. For the postabortion sterilization group, the respective rates were 3.8% and 5.2%. Initially 195 women were allocated to the interval abortion group, but 64 of these women changed their minds and did not keep their sterilization appointments. 51 of these 64 women were contacted from 3 months to 3 years later, and 20 of the women, at last contact, still did not want to be sterilized. Given this data, the investigators estimated that 2-10% of the women who undergo postabortion sterilization can be expected to regret their decision. On the other hand, women electing interval sterilization have a 4% risk of becoming pregnant before the sterilization is performed. There were no sterilization failures reported in the study. The postabortion and interval groups were comparable in terms of age, parity, and gestation duration prior to abortion. Tables included 1) distribution by age, family size, ethnic affliation, and gestation duration for postabortion and interval groups and for those women who did not appear for their interval sterilization appointments; and 2) distribution of types of complications associated with abortion and sterilization for both the interval and the postabortion groups.

The safety of local anesthesia and outpatient treatment: a controlled study of induced abortion by vacuum aspiration.

The safety of early vacuum aspiration performed as an outpatient procedure using local anesthesia was examined in a controlled study sponsored by the World Health Organization and undertaken in two centers in Yugoslavia and Singapore. The sample consisted of healthy women whose pregnancies were between 7 and 12 weeks in duration. Follow-up four weeks after abortion was nearly 100 percent in both centers. No important differences in complication rates were found between the different types of services and anesthesia, even though overall complication rates differed markedly between centers. Overnight postabortion observation was not associated with any decrease in complications.

Complications following induced abortion by vacuum aspiration: patient characteristics and procedures.

Complications following early induced abortion by vacuum aspiration were examined in a controlled study. Data were collected on healthy women 7--12 weeks pregnant at the time of abortion. No association was found between complication rates and age, marital status, or parity. However, women in their first pregnancies and those who had experienced an induced or spontaneous abortion in their previous pregnancy had a higher rate of complications following the current induced abortion.