Care Of Sick Children Research Articles

Patient costs for paediatric hospital admissions in Tanzania: a neglected burden?

Tanzania has a policy of free provision of inpatient care for young children in order to promote timely access and thus reduce the current levels of mortality. However, little is known about out-of-pocket costs that may be incurred by families in seeking care for sick children. We conducted this study to identify the magnitude of these costs in relation to family income. Five hundred and ten caretakers were interviewed on the day of discharge of their child from 11 hospitals in north-east Tanzania. Caretakers were asked to report expenditure related to hospitalization in various categories and family wealth was assessed through reported expenditure in the previous month. Food (mean US$2.2, median US$1.6), transport (mean US$1.7, median US$0) and medicines (mean US$1.0, median US$0.4) were the leading categories of expenditure, and overall the mean out-of-pocket expenditure was US$5.5 (median US$3.7) per admission. Mean out-of-pocket expenditure was more than 1.5 times higher for households in the highest monthly expenditure quintile compared with those in the lowest. However, this differential was reversed when expenditure was considered as a proportion of family expenditure in the previous month; for the lowest quintile, families spent more than three-quarters of their total monthly expenditure on a single paediatric admission. Out-of-pocket expenditure on child hospitalization places a considerable burden on poor families. Our findings justify a closer scrutiny of how this expenditure could be reduced, particularly through the provision of adequate food for both children and caretakers and through reducing stock-outs of essential medicines.

The Impact of a Community-based Pilot Health Education Intervention for Older People as Caregivers of Orphaned and Sick Children as a Result of HIV and AIDS in South Africa

The increasing HIV and AIDS epidemic in South Africa poses a substantial burden to older people, in particular older women who mainly provide care for sick adult children and their grandchildren who have become orphaned and rendered vulnerable by the death or illness of their parents. In this study, 202 isiXhosa speaking older caregivers from Motherwell in the Eastern Cape Province of South Africa were trained to provide care for grandchildren and adult children living with HIV or AIDS. Based on a community needs assessment, a health education intervention comprising four modules was designed to improve skills and knowledge which would be used to assist older people in their care-giving tasks. Some topics were HIV and AIDS knowledge, effective intergenerational communication, providing home-based basic nursing care, accessing social services and grants, and relaxation techniques. Structured one-on-one interviews measured differences between pre-intervention and post-intervention scores among those who attended all four modules vs. those that missed one or more of the sessions. The results demonstrated that older people who participated in all four workshops perceived themselves more able and in control to provide nursing care. The participants also showed a more positive attitude towards people living with HIV or AIDS and reported an increased level of HIV and AIDS knowledge. The results provided valuable information upon which the development of future interventions may be based and psychosocial and structural needs of the older caregivers may be addressed by relevant stakeholders.

Care for Sick Children as a Proxy for Gender Equality in the Family

Swedish parents are entitled to government paid benefits to take care of sick children. In this paper we show that the gender distribution of paid care for sick children is a good proxy for the gender division of household work. Using two examples we show that registry data on care for sick children is a useful data source for studies on gender equality in the family. Our first example shows that increased effort at work leads to a lower effort in household work, and a higher effort at home for the other spouse. Our second example provides some evidence for a pro-cyclical pattern in gender equality.

Use of Folk Remedies among Families of Children Hospitalised in Taiwan

To describe the attitudes toward and the use of folk remedies among caregivers of children who were hospitalised in Taiwan. Parents incorporate folk remedies into the care of sick children in many cultures, including Taiwan. Twelve common folk remedies are commonly used in the Taiwanese culture for the care of sick children. The study employed a descriptive, exploratory design using survey methods. Participants were 92 caregivers (parents) whose children were hospitalised for at least three days in a hospital in the middle district of Taiwan. Sixty per cent of the participants used some form of folk remedies in the care of their hospitalised children. The most frequently used remedies were: spirit-calling (63%); carrying a cross or incense bag (47%), praying a Buddhist mantra (36%). There was a positive relationship between a positive attitude towards folk remedies and current use with children (p < 0.05). Logistic regression analysis revealed that parents' previous experience of using folk remedies (odds ratio = 0.272, p = 0.037), and parents' knowledge of the care of disease (odds ratio = 18.044, p = 0.015) were the strongest predictors of use of folk remedies. Almost three-fourths (73%) of all participants expected that health care providers would respect and not interfere with their use of folk remedies; 72% of parents stated that they would not tell healthcare providers about the use of folk remedies. The majority of the parents of hospitalised children in Taiwan can be expected to use folk remedies for the purpose of psychological and spiritual support during child hospitalised. Healthcare providers need to be aware of the folk remedies used within various cultural groups so that culturally appropriate and safe care can be provided for the child and family.

Flexible friends

An agency that offers home care for sick children is in huge demand. Carol Davis finds out why the service is so popular

Rotavirus: The challenges ahead

Diarrhea remains one of the most common illnesses of children worldwide.(1) Rotaviruses are the single most important etiologic agents of severe diarrhea among young children, responsible for 114 million cases, 25 - 55% of all hospital admissions for diarrhea and more than 610,000 deaths worldwide every year.(2) Rotavirus is ubiquitous and by the age of three to five years, 95% of the children worldwide would have been infected.(3) It is estimated that 82% of these deaths occur in developing countries (the third most common cause of death, with about two million deaths per year) equivalent to approximately 1,205 child deaths each day, because of poorer access to treatment and a greater prevalence of malnutrition.(2) In India, 350,000 children, under five, die every year due to diarrheal diseases, out of which one-third is due to rotavirus gastroenteritis. The prevalence of rotavirus diarrhea in India has been found to vary between 5 and 71% in hospitalized children < 5 years of age, with acute gastroenteritis.(4) Apart from the primary burden of rotavirus disease on childrens' health (mortality and morbidity), rotavirus also has a significant economic impact, which can be both direct and indirect. Examples of direct costs include medical costs resulting from hospitalizations, out patient visits, personnel, facilities, diagnostics, and medication. Indirect costs include those incurred to society and households as a result of lost work time when parents are forced to stay home to take care of sick children – resulting in reduction of labor productivity and loss of wages. Intangible costs such as pain and suffering add to the burden. A review of available preventive measures against rotavirus infection in relevance to India was hence undertaken. Rotavirus The rotavirus genus belongs to Reoviridae family of viruses. Rotaviruses are highly contagious and the predominant mode of transmission is the fecal–oral route.(3) It remains stable and infective in human feces for up to one week and can survive for weeks in recreational or drinking water, hence nosocomial infections are also widespread. Person-to-person spread, via contaminated hands, is probably the most important means by which rotaviruses are disseminated in close communities, such as hospitals and homes. Transmission among non-toilet trained children in nurseries and day care centers is facilitated by direct close contact, as well as sharing contaminated food, drinks or toys.(5) Asymptomatic excretion of rotavirus occurs in half of the infected children before the onset of clinical symptoms, and persists in one-third of the children a week after the symptoms end. Rotavirus infection is preceded by an incubation period of 24 – 48 hours. Symptoms range from vomiting and mild watery diarrhea of short duration to severe gastroenteritis with life-threatening dehydration, secondary to gastrointestinal fluid loss, a problem associated with developing countries. Significant rotavirus shedding occurs during an episode of diarrhea, but many infected individuals shed the virus without experiencing diarrhea. Respiratory transmission has been speculated because of (i) the high rates of infection in the first three years of life regardless of sanitary conditions, and (ii) the failure to document fecal oral transmission in several outbreaks of rotavirus over large geographic areas in the winter.(3,6) Published epidemiological studies covering 18 Indian cities (1996 – 2001) showed that G1 was the single most common serotype, and the burden of severe disease and hospitalization is borne predominantly by G1, G2, G3, G4, and G9.(7)

Relationship Between Parenting Stress and Concerns Identified by Developmental Screening and Their Effects on Parental Medical Care—Seeking Behavior

This cross-sectional study examines the relationship between parenting stress and concerns identified by developmental screening and their effects on parents' decisions to seek medical care for their children. A total of 182 parents completed both the Parenting Stress Index (PSI) and the Parents' Evaluation of Developmental Status (PEDS) when their children were admitted to a sick child care program that provides parents the option of requesting medical evaluations for their children with mild acute illnesses. Although 31.6% of parents (N = 62) requested medical evaluations, neither PSI nor PEDS scores were associated with these requests. However, PEDS scores indicating significant parental concerns about their child's development or behavior predicted clinically significant levels of parenting stress on the PSI (odds ratio 4.9; 95% confidence interval, 1.5-15.9; P = .007). Primary pediatric health care providers who routinely perform developmental screening need to consider this relationship when interpreting developmental screening results and offer supportive and referral services to families as needed.

Disruption of parent participation: nurses’ strategies to manage parents on children's wards

To investigate parent participation in the hospitalized child's care from the perspectives of children, parents and nurses. Parent participation in the hospitalized child's care has been increasingly promoted in paediatric nursing for many years because it ameliorates the adverse aspects of hospitalization, avoids parental separation and contributes to quality care for sick children. Parent participation is assumed to be unproblematic but evidence exists that nurses often have difficulty caring for parents. Using grounded method, data were collected through in-depth interviews, questionnaires and observation with 12 nurses from four paediatric wards in two hospitals in England. The dominant process appeared to be the socialization of parents to their role on the ward through inclusionary and exclusionary tactics. Nurses controlled the nature of parents' participation and parents had to 'toe the line'. Although participation was presented as optional, parents were presented with no course other than acceptance. Parents were expected to stay with their child, behave properly and be involved in care. When parents did not adhere to these norms, they caused disruption to the order and routine of the ward. Compliance or non-compliance to the set of norms and rules was followed by reward or punishment. The nurses' dependence on parents' active participation in the organization and delivery of the work suggests that parent participation as it is practised is clearly about administrative efficiency, not consumer empowerment. Organizational and managerial issues must be examined to ensure that nurses are adequately prepared and resourced to support parents on the ward. Continuing assessment of parents' expectations though a structured assessment tool would help reduce misunderstandings and conflict. Nurses should assess the situational context before relying on subjective impressions and assumptions about parents' participation in care.

Bitter medicine

The German philosopher Dietrich Bonhoeffer (1906–1945) once famously commented that “the test of the morality of a society is what it does for its children.” Yet, in many cases, modern care of sick children seems to fail Bonhoeffer's test. Too often, drugs are inadequately tested for safety and efficacy specifically in children, and the relatively few paediatric studies that are performed often lack basic safeguards. There is even a deficiency of basic research to address questions as fundamental as how children react to and metabolize drugs. In response, legislators and regulatory authorities have implemented new legislation aimed at better protecting children and stimulating research into paediatric treatments. > …the data about a drug, provided by the company that supplied the medicine, does not usually contain the information that clinicians need to use the medicine safely in children Obviously, parents want their children treated with the most effective, safest and thoroughly tested medicines. In practice, however, paediatricians often have to base their treatment decisions on disturbingly flimsy evidence. Between 11% (in general practice) and 72% (in intensive care) of the drugs administered to children are not approved for the condition for which they are prescribed (Hill, 2005). Furthermore, the data about a drug provided by the company that supplied the medicine does not usually contain the information that clinicians need in order to use the medicine safely in children. A review of the data supplied with 1,497 drugs between 1999 and 2001 found that 81% of drugs used in children less than one month old, and 72% of drugs used in children 6–12 years old, contained inadequate dosing information for that age (Tan, 2003). “There is a very wide practice and knowledge gap between adults and children,” commented John Warner, Professor of Paediatrics and Director of Research for the Women and Children's …

Mind the gap: equity and trends in coverage of maternal, newborn, and child health services in 54 Countdown countries

Increasing the coverage of key maternal, newborn, and child health interventions is essential if Millennium Development Goals (MDG) 4 and 5 are to be reached. We have assessed equity and trends in coverage rates of a key set of interventions through a summary index, to provide overall insight into past performance and progress perspectives. Data from household surveys from 54 countries in the Countdown to 2015 for Maternal, Newborn and Child Survival initiative during 1990-2006 were used to compute an aggregate coverage index based on four intervention areas: family planning, maternal and newborn care, immunisation, and treatment of sick children. The four areas were given equal weight in the computation of the index. Standard measures were applied to assess current levels and trends in the coverage gap measure by wealth quintile. The overall size of the coverage gap ranged from less than 20% in Tajikistan and Peru to over 70% in Ethiopia and Chad, with a mean of 43% for the most recent surveys in the 54 countries. Large intracountry differences were noted, with a country mean coverage gap of 54% for the poorest quintiles of the population and 29% for the wealthiest. Differences between the poorest and the wealthiest were largest for the maternal and newborn health intervention area and smallest for immunisation. In 40 countries with more than one survey, the coverage gap had decreased by an average of 0.9 percentage points per year since the early 1990s. Declines greater than 2 percentage points per year were seen in only three countries after 1995: Cambodia, Mozambique, and Nepal. Country inequity patterns were remarkably persistant over time, with only gradual changes from top inequity (disproportionately smaller gap for the wealthiest) in countries with coverage gaps exceeding 40%, to linear patterns and bottom inequity (disproportionately greater gap for the poorest) in surveys with gaps below 40%. Despite most Countdown countries having made gradual progress since 1990, coverage gaps for key interventions remain wide and, in most such countries, the pace of decline needs to be more than doubled to reach levels of coverage of these and other interventions needed in the context of MDG 4 and 5. In general, in-country patterns of inequality are consistant and change only gradually if at all, which has implications for the targeting of interventions.

Why Parents Seek Medical Evaluations for Their Children With Mild Acute Illnesses

The reasons underlying parents' decisions to seek medical evaluations for their mildly ill children are not well understood. This cross-sectional study tracked parents' requests for on-site medical evaluations at a sick child care program. A logistic regression model identified factors associated with parents' decisions to seek medical evaluations for their children based on the data from parent-completed questionnaires. A convenience sample of 196 parents completed all questionnaires; 62 (31.6%) parents sought medical evaluations. Parents were more likely to seek medical evaluations if they were concerned about missing work (odds ratio = 8.6; 95% confidence interval, 3.3-22.0; P = .0001), if they smoked (odds ratio = 3.7; 95% confidence interval, 1.1-12.4; P = .037), or if their spouse's highest educational attainment was some high school (odds ratio = 0.4; 95% confidence interval, 0.1-1.0; P = .044). The data highlight the problems working parents have in accessing health care during usual working hours and the potential value of convenient health care programs.

Working HIV care-givers in Botswana: Spill-over effects on work and family well-being

Families provide most of the care to the tens of millions of HIV-infected and -affected in Africa. Little research exists on how care-givers balance the demands of holding a job with providing care for those who have become ill or orphaned by HIV/AIDS. Using data from a large survey administered to 1,077 working care-givers in Botswana, we compared the experience of HIV care-givers with non-HIV care-givers. Compared to non-HIV care-givers, HIV care-givers were more likely to worry about routine childcare (44% vs. 31%) and sick childcare (64% vs. 49%). Amongst those working far from home, more HIV care-givers were concerned that their children were not receiving adequate academic support (39% vs. 20%) and emotional support (57% vs. 33%). Parents who were HIV care-givers were less able to spend time with their own children. Children of HIV care-givers were more likely to have physical, mental and academic problems. While HIV care-givers were more likely to take leave from work for care-giving (53% vs. 39%), and for longer periods of time (13 vs. 7.6 days), this leave is more likely to be unpaid. Strategies to support those directly and indirectly affected by HIV and to avoid economic responsibility are discussed.

Alexander Logan Speirs

Alexander Speirs (“Sandy”) was a pioneer in the care of sick children in central Scotland. He was formerly consultant paediatrician at both Stirling Royal Infirmary and Falkirk and District Royal...

Unmet Needs for Medical Care for Sick Children in Rural Bangladesh

While a country's health policy aims to provide health services to all who need them, very little in known about unmet need for medical care from users’ perspectives in Bangladesh. This study examines unmet medical need of 2,123 under-15 sick children by illness and child's socio-economic characteristics in rural Bangladesh. The 1996 health and socio-economic survey conducted in Matlab (Peterson et al. 1996) recorded children's chronic and acute morbidity and unmet needs for medical services in mothers’ views to combat illness. The survey also recorded household socio-economic data. Logistic regression was used to examine the effects of illness and household socio-economic characteristics on unmet medical need for sick children. The results reveal that unmet need for medical care was 5.4 per cent for children with acute illnesses, and 30.2 per cent for children with chronic illnesses. It was lower for girls than for boys. Economic inequalities existed: odds ratio of unmet medical need for children in top one-third of households was 0.42 (95 per cent CI = 0.28–0.64) times the unmet medical need for children in lowest one-third. The critically high unmet needs for children's chronic morbidity reveal that the chronic disease control programme needs urgent revisiting and strengthening.

Children’s nurse education in Ireland: current status and challenges ahead

It is generally accepted that children require ‘special nursing’ because they are different from adults and have unique needs. To ensure the highest standard of quality care, it is imperative that appropriately educated nurses care for sick children. Successive policy reports have made recommendations about the need for nurses caring for children to be appropriately prepared, linking this to the quality of care that children should receive. Despite numerous reports and explicit recognition of the need for children’s nurse education, children’s nursing as a distinct speciality has waxed and waned over the years. In Ireland the profession were fortunate in 2006 to achieve the establishment of a direct entry degree programme in children’s nursing, albeit combined with general nursing. This paper will discuss the developments that led to this position, by reviewing the background to children’s nursing education in Ireland. These developments will be contrasted with current challenges to the education of children’s nurses in the UK. This paper will conclude with recommendations on how we, as children’s nurses, should meet the challenges to children’s nursing remaining as a distinct speciality and a direct entry programme.

Not an obligation, not a mission, a privilege

Not an obligation, not a mission, a privilege

Out of Athens, looking forward

At the first international congress on paediatric nursing, hosted by The International Paediatric Association (IPA) as part of their 1998 congress meeting in Amsterdam, the nurses there launched the International Association of Paediatric Nurses (IAPN). The Dutch Association of Pediatric Nurses, with the support of the International Pediatric Association (IPA), was highly instrumental in developing the IAPN and subsequently the Paediatric Nursing Association of Europe, which was established in April 2003 as a regional group of the IAPN to encourage collaboration between professional organizations for nurses caring for children and young people in Europe. Prime movers in these initiatives have been JCYPN board members Corry van den Hoed-Heerschop, from the Dutch Association of Paediatric Nursing, and Dr Imelda Coyne, newly appointed associate professor and director of children’s nursing research at Trinity College Dublin. This is highly significant, not only because it demonstrates the growing maturity of a profession dedicated to the care of sick children everywhere, but also because of these individuals’ willingness to actively collaborate with other professionals in the pursuit of this goal.

Outdated education

In his article ‘Now and then: Nursing’s unwanted child’ in the May issue(PN 19, 4,12), Jeremy Jolley provides an interesting overview of children’s nursing’s fight for recognition. However, strongly disagree with his suggestion that nurses wanting to care for sick children should already have proved themselves as general (adult) nurses.

Oxford Handbook of Children’s and Young People’s NursingOxford Handbook of Children’s and Young People’s Nursing

This pocket-size reference offers fast access to the latest evidence-based information and practical advice on an extensive range of topics. Subjects covered include normal growth and development, care of the child and family in home and hospital settings, assessing the sick child, palliative and high-dependency care, safeguarding children, paediatric emergencies and professional issues.

The Role of an Institution for Day Care for Sick Children :

The Role of an Institution for Day Care for Sick Children :