Caretakers Of Children Research Articles

Impact evaluation of positive deviance hearth in Migori county, Kenya

A Positive Deviance (PD) Hearth intervention is a home and neighborhood-based nutrition program for children who are at risk for protein-energy malnutrition in a low resource community. The intervention uses the ‘Positive Deviance’ approach to identify those behaviors practiced by the mothers or caretakers of well-nourished children from poor families and transfers such positive practices to other mothers who are equally disadvantaged economically. Positive Deviance Hearth intervention is designed to treat malnourished children, enable the families to sustain their rehabilitation at home on their own and to prevent malnutrition in younger siblings. However, PD Hearth intervention monitoring system in Migori only assesses a program’s ability to treat, one of the three PD Hearth objectives. Thus, there was need for impact evaluation to measure outcomes of the PD Hearth intervention to sustain rehabilitation and prevent malnutrition in younger siblings. The objectives of the study were to determine the level to which PD Hearth enables families to sustain rehabilitation at home on their own and to identify the practices which influence PD Hearth outcomes. The study was designed as a pipeline quasi-experimental and mixed method was used to collect data and perform statistical analyses. Single stage cluster sampling was used to identify 53 and 54 children on the intervention and comparison group in five communities. Weight measurements of the children on the intervention aged 6 to 59 months at the entry, exit and graduation stages were retrieved from Kenya Medical Research Institute Family AIDS Care and Education Services programme activities reports. Anthropometry (height measurements) for the children on the intervention and comparison children was taken. Caregivers filled in a questionnaire, assisted by the researchers as necessary. At entry, 18.9% children on the intervention had moderate underweight while 43.4% had mild underweight. At current status though, 3.8% and 34.0% had moderate and mild underweight respectively. The regression model predicted that Weight-for-Height (WAZ) of the children on the intervention at current status lied on 51.5 percentile, thus, normal for underweight. Increased feeding frequency made the largest contribution to weight gain than other caregiver practices. Therefore, the Migori County government in collaboration with the Ministry of Health needs to scale up PD Hearth intervention to reverse cases of Moderate Acute Malnutrition (MAM) and prevent Severe Acute Malnutrition (SAM) in the County.

The Financial and Emotional Impact of Atopic Dermatitis on Children and Their Families

To examine the personal financial impact of atopic dermatitis (AD) and attempt to correlate cost of AD with emotional impact. Between March 2011 and December 2013, 82 caretakers of children 6 months to 12 years of age with moderate-to-severe AD were recruited at the time of dermatology clinic visits in Cleveland, Ohio, to complete surveys. The response rate was >95%. Participants were asked questions about direct expenses (medical visits, medications, and other products) and indirect expenses (time missed from work, childcare costs) related to AD in the past 4 weeks. Emotional impact was measured by the Childhood Atopic Dermatitis Impact Scale. The mean monthly personal cost of AD in the month before the office visit was $274 (median $114; IQR $29, $276), with $75 from direct costs (median $45; IQR $20, $110) and $199 from indirect costs (median $0; IQR $0, $208). An average of 34.8% of available monthly money was spent on AD care in the month before the office visit. For patients with Medicaid, there was a significant correlation between monthly adjusted personal cost and Childhood Atopic Dermatitis Impact Scale score (r = 0.548; P < .001); however, this correlation did not exist for patients who had commercial insurance (r = 0.269; P = .166). Our results illustrate the high emotional and financial burden of childhood AD and provide insight into spending patterns. In addition, our study correlate costs with emotional burden of AD for lower-income patients.

Continuing Breastfeeding With Paid Employment: Breastfeeding and Support From Women’s Informal Social Network

Social support is essential to enable employed mothers to continue their breastfeeding practices. In Pakistan, where child daycare facilities are rare, employed women are mostly dependent on offered support from people in their social network to fulfill their child care responsibilities. The aim of this research was to study the availability of support from informal social network (spouses, mothers/mothers-in-law, and child caretaker) to employed women having babies, up to 12 months of age, and to analyze the breastfeeding practices of these mothers. This quantitative descriptive study among 200 employed women revealed that 63.5% of mothers received encouragement from people in their informal social network to enable them to continue breastfeeding with employment. Employed women received help from family members (79.5%), husbands (83.5%), and mothers/mothers-in-law (74%). Employed women who received support from their informal social network were able to sustain their breastfeeding practices as compared to women who did not receive that support or received conflicting healthcare advice from their family members.

Effects of Abusive Parenting, Caretaker Arrests, and Deviant Behavior on Dating Violence Among Homeless Young Adults

Although dating violence is widespread among young adult homeless populations, its risk factors are poorly understood by scholars. To address this gap, this study uses a social learning theory to examine the effects of abusive parenting and caretaker arrests on dating violence among 172 homeless young adults. Results from path analyses revealed that child physical abuse and caretaker arrests were positively associated with engaging in a greater number of school fights, which, in turn, was strongly and positively correlated with participating in more deviant subsistence strategies (e.g., stealing) since being on the street. Young people who participated in a greater number of delinquent acts were more likely to report higher levels of dating violence. Study results highlight the extent of social learning within the lives of homeless young adults, which is evident prior to their leaving home and while they are on the street.

Maternal Allostatic Load, Caretaking Behaviors, and Child Dental Caries Experience: A Cross-Sectional Evaluation of Linked Mother-Child Data From the Third National Health and Nutrition Examination Survey.

We evaluated the associations between chronic maternal stress measured by allostatic load (AL), maternal caretaking behaviors, and child dental caries experience. We also assessed the role of socioeconomic status in these associations. We used data from the Third National Health and Nutrition Examination Survey (1988-1994). We included children aged 2 to 6 years who linked to a maternal record (n = 716 maternal-child pairs). The main exposure was maternal AL index (0, 1, or ≥ 2). The primary outcome of interest was child dental caries experience (none or any). We evaluated the association between maternal AL and (1) maternal caretaking behaviors, and (2) child caries status and the role of socioeconomic status in these relationships. Children of mothers with an AL index of at least 2 were significantly more likely to have not been breastfed and to have dental caries than were children of mothers with a normal AL before adjusting for measures of socioeconomic status. Maternal chronic stress, indicated by elevation in markers of AL, has an important role in child caretaking behaviors and in children's oral health.

Mothers in Cameroonian Prisons: Pregnancy, Childbearing and Caring for Young Children

According to the Cameroonian Penal Code, pregnant women, nursing mothers and children may not be admitted to prison and, by implication, there are no facilities to cater for these vulnerable categories of prisoners. Yet pregnant women are arrested occasionally and they deliver children in prison and some women are sentenced as nursing mothers. There is an implicit belief and practice that women are the primary caretakers of children – hence their imprisonment impacts on children both inside and outside of prison. This article first discusses the discrepancies between policy and practice regarding female inmates and their children in the Cameroonian penitentiary system. It then goes on to show how pregnancies, deliveries and being a mother are dealt with by female prisoners, given the constraints under which they are living. The research is based on observations and interviews at six out of 73 prisons in Cameroon. The data for this article is based on qualitative analysis of the narratives of 13 female inmates, who have experienced motherhood in prison, interviews with five prison staff members and two NGO representatives working in close collaboration with these inmates. The study was approached with standpoint feminist theory as a point of departure.

Childcare, Health and Mortality at the London Foundling Hospital, 1741–1800: “Left to the Mercy of the World.” by Alysa Levene (review)

Reviewed by: Childcare, Health and Mortality at the London Foundling Hospital, 1741–1800: “Left to the Mercy of the World.” by Alysa Levene Marjorie Levine-Clark Alysa Levene. Childcare, Health and Mortality at the London Foundling Hospital, 1741–1800: “Left to the Mercy of the World.” Manchester: Manchester University Press, 2012. xi + 223 pp. Ill. £14.99 (978-0-7190-7355-7). In this short, tightly argued book, Alysa Levene provides a quantitative and qualitative analysis of the infants and children of the London Foundling Hospital and their wet nurses. While her study spans the 1740s to the end of the eighteenth century, she focuses on the period of the “General Reception,” 1756–60, when the hospital opened its doors to all infants abandoned there and received thousands of foundlings a year as opposed to the tens and hundreds in other periods. Levene makes a significant contribution to our knowledge about the foundlings, their health experiences and survival chances, and their lives with their nurses. The book also has much to offer about the history of wet nursing itself. The establishment of the hospital in 1741 by Thomas Coram was very much embedded in the eighteenth-century emphasis on national strength in numbers, new ideas about philanthropy, and concerns about the Poor Law. Levene argues that abandonment was not always a callous, anonymous process, but rather should be seen as part of the mixed economy of welfare, in which poor mothers, unable to care for a child, imagined a better life for an infant sent out to nurse through the hospital. Her evidence challenges assumptions that the London Foundling Hospital received predominantly illegitimate children and shows that infants from all over the country were brought to the hospital, often sent by a parish wishing to avoid Poor Law expenses, to place their welfare burden elsewhere. Levene provides rich demographic data, with chapters covering the characteristics of foundlings and nurses, infant and childhood mortality of foundlings, their likelihood of survival in the hospital and their nurses’ communities, their life [End Page 605] chances compared to those of other infants and children, and the relationships between foundling health and the local disease environments into which they entered. For example, Levene clearly shows that infants were much more likely to die from their conditions when they entered the hospital than from the environment in the hospital itself, and that this was especially true during the period of open admissions. Their poor state upon arrival resulted in a much higher mortality rate than in London at large, but for infants who survived into childhood, their life chances were no worse than others in London. Indeed, the hospital was often at the forefront of innovative health practices such as vaccination, which was required for all foundlings to protect them as well as their nurses and the new communities to which they were sent. Infants who remained in the hospital itself rather than being sent to nurse, however, did not have good survival prospects. Levene argues that these foundlings most likely were already so weak upon entry that there was little chance of their thriving so they were not sent to nurse. Levene’s chapters on nursing itself are fascinating, as she identifies a “nursing network” (p. 90) that the hospital drew on to place its foundlings. Nurses existed all over the country, overseen by inspectors, who reported back to the hospital on the health and safety of the children entrusted to their regions. According to Levene, wet nursing (and the subsequent caretaking of children who remained with their nurses for years) provided a significant employment opportunity for poor women, who often took in more than one foundling or a succession of foundlings. Levene stresses that the majority of nurses integrated foundlings into their households, challenging “the common depiction of nurses as careless and blameworthy” (p. 114). Analyzing case studies of four communities that took in large numbers of foundlings, and using microhistorical methods and family reconstitution, Levene closely examines the health and welfare of these infants and children within their local contexts. She illustrates the demographic impact of foundlings on their communities, showing that while these children did not affect the local disease environment, their...

The usefulness of a handwashing proxy in large household surveys

Handwashing with soap is a cost-effective way of reducing diarrheal disease mortality in children under 5. Tracking this practice among child caretakers is a challenge, as the gold standard method – structured observations – is cumbersome, costly, and conducive to over-performance. The water, sanitation, and hygiene (WASH) field needs a valid, reliable proxy to track handwashing with soap in large surveys. This proxy is crucial as the new 2015–2030 Sustainable Development Goals (SDGs) may track hygiene. Using data from the Multiple Indicators Cluster Survey (MICS) and the Demographic Health Survey (DHS) from five countries, we conducted multivariate analyses to explore an association between the presence of functional handwashing stations (HWSs), (together with needed supplies) and the likelihood of lower reports of child diarrheal disease. A limited to moderate association exists in three of the five countries considered, characterized by comparable rates of childhood diarrhea: Malawi, Sierra Leone, and Zimbabwe. The relationship was detected when controlling for potential confounding factors (other WASH elements, socio-demographic factors, nutrition practices, and immunization status) and when accounting for cluster effects. The likelihood of reported diarrhea among children under 5 increases when there is no HWS, just a handwashing device with no supplies, only water or only soap. The relationship is moderate in Malawi and less strong in Sierra Leone and Zimbabwe. No relationship was found in Ethiopia and Ghana. Further exploration of the usefulness of this proxy in other African and non-African contexts is warranted.

The anthropology of childhood: cherubs, chattel, changelings

How are children raised in different cultures? What is the role of children in society? How are families and communities structured around them? Now available in a revised edition, this book sets out to answer these questions, and argues that our common understandings about children are narrowly culture-bound. Enriched with anecdotes from ethnography and the daily media, the book examines family structure, reproduction, profiles of children's caretakers within the family or community, their treatment at different ages, their play, work, schooling, and transition to adulthood. The result is a nuanced and credible picture of childhood in different cultures, past and present. Organised developmentally, moving from infancy through to adolescence and early adulthood, this new edition reviews and catalogues the findings of over 100 years of anthropological scholarship dealing with childhood and adolescence, drawing on over 750 newly added sources, and engaging with newly emerging issues relevant to the world of childhood today.

Evaluating the socioeconomic and cultural factors associated with pediatric burn injuries in Maputo, Mozambique.

Pediatric burn injuries are one of the leading causes of preventable morbidity and mortality in Sub-Saharan Africa. Research on the complex system of social, economic and cultural factors contributing to burn injuries in this setting is much needed. We conducted a prospective questionnaire-based analysis of pediatric burn patients presenting to the Hospital Central de Maputo. A total of 39 patients were included in the study. Interviews were conducted with the children's caretakers by two trained medical students at the Eduardo Mondlane Medical School in Maputo with the aid of local nursing staff. Most burns occurred from scald wounds (26/39) particularly from bathwater, followed by fire burns (11/39). Burns occurred more frequently in the afternoon (16/39) and evening (16/39). Over one quarter of burns (9/33) occurred in the absence of a caretaker. One-third (12/36) of participants attempted to treat the burn at home prior to bringing the child into the hospital, and roughly two-thirds (24/37) reported using traditional remedies for burn care. The average household had just 2 rooms for an average of 5 family members. Most burns were second degree (25/37). Prevention efforts in this setting are much needed and can be implemented taking complex cultural and social factors into account. Education regarding regulation of water temperature for baths is important, given the prevalence of scald burns. Moreover, the introduction of low-cost, safer cooking technology can help mitigate inhalation injury and reduce fire burns. Additionally, burn care systems must be integrated with local traditional medical interventions to respect local cultural medicinal practices.

Less Than One-Third of Caretakers Sought Formal Health Care Facilities for Common Childhood Illnesses in Ethiopia: Evidence from the 2011 Ethiopian Demographic Health Survey.

Background. Most of the childhood illnesses can be proven with effective interventions. However, countless children die needlessly in developing countries due to the failure of their guardians to seek care timely. The aim of this study was to assess health care seeking behavior of caretakers of children under the age of five years for treatment of common childhood illnesses. Methods. Further analysis of the Ethiopian 2011 demographic and health survey was done. All children under the age of five reported to have been ill from the three common childhood illnesses and their caretakers were included in the analysis. A complex sample logistic regression model was employed to determine factors associated with the health care seeking behavior of caretakers. Result. A total of 2,842 caregivers who reported that their index child had at least one of the three common childhood illnesses in the two weeks preceding the survey were captured, of which 849 (29.87%; 95% CI: 28, 32%) sought formal health care facilities. Conclusion and Recommendation. In Ethiopia health care seeking behavior of caretakers for common childhood illnesses is low. Increasing mass media exposure can possibly improve the health seeking behavior of caretakers.

The Impact of Pediatric Brachial Plexus Injury on Families

To determine the impact of brachial plexus injuries on families to best meet their clinical and social needs. Our cross-sectional study included families with children between the ages of 1 and 18 years with birth or non-neonatal brachial plexus injuries (BPIs). The consenting parent or guardian completed a demographic questionnaire and the validated Impact on Family Scale during a single assessment. Total scores can range from 0 to 100, with the higher the score indicating a higher impact on the family. Factor analysis and item-total correlations were used to examine structure, individual items, and dimensions of family impact. A total of 102 caregivers participated. Overall, families perceived various dimensions of impact on having a child with a BPI. Total family impact was 43. The 2 individual items correlating most strongly with the overall total score were from the financial dimension of the Impact on Family Scale. The strongest demographic relationship was traveling nationally for care and treatment of the BPI. Severity of injury was marginally correlated with impact on the family. Parent-child agreement about the severity of the illness was relatively high. Caretakers of children with a BPI perceived impact on their families in the form of personal strain, family/social factors, financial stress, and mastery. A multidisciplinary clinical care team should address the various realms of impact on family throughout the course of treatment. Prognostic II.

W. S. Cooper As I Knew Him: Teacher, Mentor and Friend

W. S. Cooper As I Knew Him: Teacher, Mentor and Friend

Household Animal and Human Medicine Use and Animal Husbandry Practices in Rural Bangladesh: Risk Factors for Emerging Zoonotic Disease and Antibiotic Resistance.

SummaryAnimal antimicrobial use and husbandry practices increase risk of emerging zoonotic disease and antibiotic resistance. We surveyed 700 households to elicit information on human and animal medicine use and husbandry practices. Households that owned livestock (n = 265/459, 57.7%) reported using animal treatments 630 times during the previous 6 months; 57.6% obtained medicines, including antibiotics, from drug sellers. Government animal healthcare providers were rarely visited (9.7%), and respondents more often sought animal health care from pharmacies and village doctors (70.6% and 11.9%, respectively), citing the latter two as less costly and more successful based on past performance. Animal husbandry practices that could promote the transmission of microbes from animals to humans included the following: the proximity of chickens to humans (50.1% of households reported that the chickens slept in the bedroom); the shared use of natural bodies of water for human and animal bathing (78.3%); the use of livestock waste as fertilizer (60.9%); and gender roles that dictate that females are the primary caretakers of poultry and children (62.8%). In the absence of an effective animal healthcare system, villagers must depend on informal healthcare providers for treatment of their animals. Suboptimal use of antimicrobials coupled with unhygienic animal husbandry practices is an important risk factor for emerging zoonotic disease and resistant pathogens.

Investigation of hand hygiene among caretakers of children with chemotherapy and intervention effect

Objective To investigate hand hygiene awareness and performance for caretakers of children with chemotherapy, and explore effective intervention measures. Methods For 60 caretakers of children with chemotherapy in Hematology Department, we carried out a questionnaire survey of hand hygiene, and tracked the hand washing implementation. Also we carried on a six steps hand washing technique training for the caretakers, then compared and analyzed the hand washing qualified rate before and after the technique training. Results The hand washing cognitive rate of the caretakers when they directly contacting with sick children and before feeding food or medicine for sick children were 88.33% and 93.33%, and the implementation rate of those situation were 76.67% and 89.13% respectively. In addition, the hand washing cognitive rates of before contacting sick children′s objects and after contacting other people (including other sick children) were just 21.67% and 41.67%, and the implementation rates were 14.89% and 28.95% respectively. Before and after the six steps hand washing technique training, the bacterial colony count of the caretakers hands were (82.36±53.32)cfu/cm2 and (16.21±18.83)cfu/cm2 (t=9.061, P<0.01), but after training, the pathogenic bacteria detection rate was 31.67% and the qualified rates 61.67% with statistical difference (χ2=28.420, 27.638, respectively; P<0.01). Conclusions The hand hygiene cognition for caretakers of children with chemotherapy is relatively low, and the implementation and hand washing qualified rate are unacceptable. The health education propaganda of hand hygiene and hand washing technique training for caretakers should be further strengthen. Hospital should supervise and urge the hand hygiene implementation, in order to improve the hand washing qualified rate of caretakers, reduce the nosocomial infection through hand contact, and protect the health and safety of children with chemotherapy. Key words: Antineoplastic combined chemotherapy protocols; Children; Caretakers; Hand hygiene

A mobile application to screen for autism in Arabic-speaking communities in Oman

Abstract Background Epidemiological studies of autism spectrum disorders (ASDs) in Arab communities have usually shown lower prevalence than those from Western nations. In Oman, the ASD prevalence is estimated to be 0·14 per 1000 Omani children aged 0–14 years. Many factors contribute to this low estimate including lack of awareness, non-standardisation of diagnostic tools, and unequal distribution of services. This study aimed to develop and pilot a mobile application to provide families with a reliable and easy-to-use tool to screen their children for ASDs. Using culturally appropriate images, this mobile application also seeks to reduce ambiguity in the interpretation of the standard Modified Checklist for in Toddlers (M-CHAT) screening tool that arises from language and cultural differences. Methods Between December, 2013, and March, 2014, a team of software developers used an improved and validated version of the M-CHAT in Arabic to create the mobile application called Autism Fingerprint. The application uses animations and comparative images to demonstrate autistic and non-autistic behaviours. We customised images to Omani culture to reduce ambiguity and misunderstanding. In addition, the application includes general information about ASDs to increase awareness and knowledge. We conducted a validation study between March and October, 2014, with volunteers from Arabic-speaking countries. Through collaboration with the Oman Association (the national autism support group), potential participants were approached during exhibitions and autism awareness activities. Validity was assessed by calculating sensitivity and specificity of the screening test. The gold standard was the confirmed diagnostic status as indicated in medical reports issued by specialised medical centres. The reliability was assessed by measuring the correlation coefficient of test-retest reliability. Findings We included 130 participants in the validation study, of whom 65 (50%) were caretakers of children with a confirmed ASD and the rest were caretakers of children with typical development. Of the 65 confirmed cases of ASD, the mobile application identified 58 of these cases as high likelihood of ASD (positive), giving a sensitivity of 0·89. Of the 65 confirmed non-cases of ASD, the mobile application indicated 53 as low likelihood of ASD (negative), revealing a specificity of 0·82. The realiability assessment shows that the application had a high test-retest reliability (correlation coefficient, r =0·86). Interpretation We have developed a mobile application to screen for autism in Arabic-speaking populations that is both sensitive and specific. Future versions of the Fingerprint application will have an option for English, be available for download on Apple iOS devices, and have the ability to directly send the results to a chosen physician. Effectiveness and validity will continue to be monitored, and any updates to the M-CHAT will be incorporated into future versions. Funding Funding sources included Information Technology Authority (Oman), ASM Technologies (Oman), Sultan Qaboos University through Strategic Project SR/MED/FMCO/11/01 (Oman), and the Fulbright US Student Program (USA).

Determinants of child Immunization under expanded programme on Immunization (EPI) in a rural setting of Bangladesh

Objective: The aim of the study was to evaluate immunization status of children aged 12 to 23 months and to find out reasons for non-immunization and partial immunization, if any, under national Extended Programme on Immunization (EPI). Methods: This cross sectional study was done among a representative sample of 249 mothers/ principal caretakers of children under 2 years of age from households with varying socioeconomic status and with varying levels of education, from a rural setting, village Mulaid under Telihati union at Sreepur Upozilla under Gazipur district, in between March and June of 2011. Results: The study found that 221 (88.76%) of the children were fully immunized (FI) with BCG, PENTA3, OPV3 and measles; 27 children (10.84 %) were partially immunized and only 1 (0.40%) was non-immunized according to the recommendations used. Four of the children were missing full coverage of PENTA, seven of the children were missing OPV, 8 children were missing BCG where as 9 children were missing measles. The vaccination rate increased with an increase in the age of the children and the education level of the mother. Children of older mothers were more likely to have had the correct vaccinations. The mothers’ knowledge of and attitudes to vaccination showed a strong relationship with the vaccination status of their children. When the coverage rate for each vaccine was taken separately, the economic level of the households significantly affected the vaccine coverage. Most vaccinations occurred in public outlet agencies. Postponement of immunization due to the illness of the child, mother’s lack of information about place, schedule and eligible age of immunization, parental lack of knowledge for the need for vaccines and family size constituted the main reasons for partial /onimmunization. A significant number of children in this study were found to be lacking recommended immunizations for age; a large number of their mothers stated that they did not know further vaccines were needed. Future efforts targeting immunization must emphasize better education of parents. Conclusion: It was concluded that lack of appropriate information is still the main hurdle for success of primary immunization in rural areas. Improvement could be achieved by improving IEC activities especially among females, as well as making this program success by putting all efforts in the case of EPI. DOI: http://dx.doi.org/10.3329/jdmc.v22i2.21543 J Dhaka Medical College, Vol. 22, No.2, October, 2013, Page 201-206

Acceptability and Utilization of Community Health Workers after the Adoption of the Integrated Community Case Management Policy in Kabarole District in Uganda

Background Malaria, pneumonia and diarrhea remains to be the major causes of morbidity and mortality among children in Uganda. To address such challenges, the government adopted a national policy on Integrated Community Case Management (ICCM) for malaria, pneumonia and diarrhea in 2010. The aim of this study was to assess household access, utilization and acceptability of ICCM services in Kabarole District. Methods A cross sectional household survey was conducted amongst caretakers of children below 5 years of age and a total of 384 respondents were interviewed about distance from nearest health facility and community health worker, socio-demographic characteristics, type of housing, history of fever, health-seeking behavior, perceptions of quality and utilization of ICCM services. Data was cleaned, coded and analysed using STATA 14.0 to produce results. Results Most 53.1% of the studied children were males and their age ranged from 1-52 months. Nearly all the care takers, 97.1% (373/384) had utilized health services for their children in the three proceeding months to the study and only 27.3% (102/373) had utilized ICCM services. Trust in CHWs (AOR 0.85, 95%CI [0.641-1.135]), level of awareness (AOR 0.73, 95%CI [0.538-0.979]) and distance (≤1km) to CHWs (AOR 1.65, 95%CI [1.075-2.522]) are positively associated with the utilisation of ICCM services. Conclusion The implementation of ICCM policy in kabarole has been an effective approach in increasing the utilization of malaria, diarrhea and pneumonia treatment services and hence increasing access to health services at community level. Trust in the CHWs, level of community awareness and distance to the CHWs are positively associated with the utilisation of ICCM services

Using an eIMCI-Derived Decision Support Protocol to Improve Provider-Caretaker Communication for Treatment of Children Under 5 in Tanzania.

In Tanzania, significant effort has been made to reduce under-5 mortality rates, and has been somewhat successful in recent years. Many factors have contributed to this, such as using standard treatment protocols for sick children. Using mobile technology has become increasingly popular in health care delivery. This study examines whether the use of mobile technology can leverage a standardized treatment protocol to improve the impact of counseling for children's caretakers and result in better understanding of what needs to be done at home after the clinical visit. A randomized cluster design was utilized in clinics in Dar es Salaam, Tanzania. Children were treated using either test electronic protocols (eIMCI) or control paper (pIMCI) protocols. Providers using the eIMCI protocol were shown to counsel the mother significantly more frequently than providers using the pIMCI protocol. Caretakers receiving care by providers using the eIMCI protocol recalled significantly more problems and advice when to return and medications than those receiving care by providers using the pIMCI protocol. There was no significant difference among caretakers regarding the frequency and duration to administer medications. This study indicates the use of mobile technology as an important aide in increasing the delivery and recall of counseling messages.

Women's Burdens: Exploratory Analysis on Matrifocality, (re)Production and Social Protection in Douro Region, Portugal

Drawing from the concepts of matrifocality, kinship and gender inequality, this paper develops a brief discussion around the overloading of duties faced by socially and economically vulnerable women. The accumulation of such duties burdens women with social and parental responsibilities, reinforcing their role as income providers, household custodians and primary caretakers of dependent children and elders. These duties, often culturally and socially informed, are especially overwhelming for women belonging to less affluent social strata. Manifestly exploratory, the analysis is based on three case studies of women, all of them in their fifties, living in the Douro vineyards region. They all assume the headship of their households and benefit or were beneficiaries of the Social Insertion Income (SII), a state social protection device intended to alleviate economic hardships and promote active labor insertion.