Fragmentation of maternal, child and HIV services: A missed opportunity to provide comprehensive care

Background: In South Africa, coverage of services for mothers and babies in the first year of life is suboptimal despite high immunisation coverage over the same time period. Integration of services could improve accessibility of services, uptake of interventions and retention in care.Aim: This study describes provision of services for mothers and babies aged under 1 year.Setting: Primary healthcare clinics in one rural district in KwaZulu-Natal, South Africa.Methods: All healthcare workers on duty and mothers exiting the clinic after attending well-child services were interviewed. Clinics were mapped to show the route through the clinic taken by mother–baby pairs receiving well-child services, where these services were provided and by whom.Results: Twelve clinics were visited; 116 health workers and 211 mothers were interviewed. Most clinics did not provide comprehensive services for mothers and children. Challenges of structural layout and deployment of equipment led to fragmented services provided by several different health workers in different rooms. Well-child services were frequently provided in public areas of the clinic or with other mothers present. In some clinics mothers and babies did not routinely see a professional nurse. In all clinics HIV-positive mothers followed a different route. Enrolled nurses led the provision of well-child services but did not have skills and training to provide comprehensive care.Conclusions: Fragmentation of clinic services created barriers in accessing a comprehensive package of care resulting in missed opportunities to provide services. Greater integration of services alongside immunisation services is needed.

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Factors associated with Missed Opportunities for Vaccination among children in the first year of life at a tertiary health facility in Lagos

Annals of Health Research ◽

10.30442/ahr.0603-05-91 ◽

2020 ◽

Vol 6 (3) ◽

pp. 287-297

Author(s):

OA Kehinde ◽

YA Kuyinu ◽

OO Odusanya

Keyword(s):

Health Facility ◽

Health Workers ◽

Cross Sectional Study ◽

Vaccination Status ◽

First Year ◽

Cross Sectional ◽

Missed Opportunities ◽

Vaccination Rates ◽

Factors Associated ◽

First Year Of Life

Background: Low vaccination rates in children remain a major problem in resource-poor areas of the world. Missed opportunities for vaccination may be one of the important contributors to the menace. Objectives: To determine the prevalence of missed opportunities for vaccination and identify factors associated with this among Nigerian children in the first year of life. Methods: The study was a descriptive, cross-sectional study of children who were recruited consecutively and data were obtained using a questionnaire. Results: Two hundred and fifty-six children were recruited. The prevalence of missed opportunities for vaccination was 11.3%. Gender (p = 0.04) and parental socioeconomic status (p = 0.008) were significantly associated with missed opportunities for vaccination. Non- availability of required vaccines and reluctance to open a multi-dose vial of vaccine caused MOV in 55.5% and 51.8% of children respectively. The evaluation of vaccination status among subjects who were not fully vaccinated by health workers was low at 18.3%. Conclusion: The rate of missed opportunities for vaccination was low. Educating caregivers and encouraging health workers to evaluate the vaccination status of children at every contact with a health facility may reduce the prevalence of missed opportunities for vaccination.

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Longitudinal Analysis of State Patterns and Related Variables among Infants and Children with Significant Disabilities

Research and Practice for Persons with Severe Disabilities ◽

10.2511/rpsd.27.2.112 ◽

2002 ◽

Vol 27 (2) ◽

pp. 112-124 ◽

Cited By ~ 16

Author(s):

Doug Guess ◽

Sally Roberts ◽

Jane Rues

Keyword(s):

First Year ◽

Early Interventions ◽

Learning And Development ◽

Significant Disabilities ◽

Optimal Learning ◽

Developmental Skills ◽

Time Period ◽

Additional Group ◽

First Year Of Life ◽

Older Populations

Behavior states and related developmental and medical variables were observed during all or part of the first 4 years of life for 34 infants identified with severe cognitive and multiple disabilities. Eight infants died before 1 year of age. Extensive data were then collected for an additional group of 8 infants who were observed through the age of 4 years. Findings demonstrated emerging state profiles during this time period that were consistent with those found among older populations observed in previous investigations. Different behavior state profiles at age 4 years were indicated by several developmental skills in the first year of life. These results suggest the need for specific, early interventions with infants whose state patterns are inconsistent with optimal learning and development.

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Hospitalizations for Pediatric Anaphylaxis

International Journal of Immunopathology and Pharmacology ◽

10.1177/039463200802100422 ◽

2008 ◽

Vol 21 (4) ◽

pp. 977-983 ◽

Cited By ~ 13

Author(s):

M. Calvani ◽

D. Di Lallo ◽

A. Polo ◽

A. Spinelli ◽

D. Zappalà ◽

...

Keyword(s):

Emergency Department ◽

Emergency Departments ◽

Health Workers ◽

Central Italy ◽

Case Fatality ◽

First Year ◽

Day Hospitals ◽

Incidence Of Hospitalization ◽

First Year Of Life ◽

Food Anaphylaxis

The aim of the study is to examine the epidemiology of anaphylaxis in hospitalized children in Lazio (Central Italy) and to evaluate the incidence and case fatality rate. We also verified the concordance of diagnosis between the Emergency Department and Ordinary Hospitalizations. In order to obtain these results, we reviewed all ICD-9 codes indicative of anaphylaxis in all primary and secondary diagnoses from 2000 to 2003 in all Emergency Departments, Ordinary Hospitalizations and Day Hospitals in Lazio. We then identified 203 ICD-9 diagnoses of anaphylaxis in children aged between 0 and 17 years. Anaphylactic shock (995.0) accounted for 109 (53.7%) of cases. Food anaphylaxis (995.60 onwards) accounted for 87 (43.0%) of cases. Food anaphylaxis was more frequent in the first years of life. In fact, it decreased from 12.5/100,000 resident children/year in the first year of life to 6.1/100,000 resident children/year in the first two years of life, and less than 3/100,000 resident children/year after the seventh year (p <0.001). Only 12.5% of cases of anaphylaxis diagnosed in Ordinary Hospitalizations were subsequently diagnosed by the Emergency Department as anaphylaxis. Moreover, only 42.3% of the diagnoses of anaphylaxis made in the Emergency Department were later confirmed during Ordinary Hospitalization. In the four years of study, one child died from anaphylaxis. Thus, mortality was 0.038 cases/100,000 resident children/year. In conclusion, the incidence of hospitalization was highest in the first years of life, during which food anaphylaxis accounted for most hospitalizations. The inconsistency of diagnoses between Emergency Departments and Ordinary Hospitalizations suggests the need to increase awareness of anaphylaxis among health workers.

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Prevalence and clinical characteristics of wheezing in children in the first year of life, living in Cuiabá, Mato Grosso, Brazil

Revista Paulista de Pediatria ◽

10.1590/s0103-05822014000400006 ◽

2014 ◽

Vol 32 (4) ◽

pp. 313-319 ◽

Cited By ~ 1

Author(s):

Lillian Sanchez Lacerda Moraes ◽

Olga Akiko Takano ◽

Javier Mallol ◽

Dirceu Solé

Keyword(s):

Clinical Characteristics ◽

First Year ◽

Recurrent Wheezing ◽

Mato Grosso ◽

Male Patients ◽

Leukotriene Receptor ◽

First Year Of Life ◽

Primary Healthcare Clinics ◽

The City ◽

Brazilian Studies

OBJECTIVE: To evaluate the prevalence and the clinical characteristics of wheezing in infants aged 12 to 15 months in the city of Cuiabá, Mato Grosso State, Midwest Brazil.METHODS: Parents and/or guardians of infants were interviewed and completed a written standardized questionnaire of the Estudio Internacional de Sibilancia en Lactantes (EISL) - phase 3 at primary healthcare clinics at the same day of children vaccination or at home, from August of 2009 to November of 2010.RESULTS: 1,060 parents and/or guardians completed the questionnaire, and 514 (48.5%) infants were male. Among the studied infants, 294 (27.7%) had at least one episode of wheezing during the first year of life, beggining at 5.8±3.0 months of age, with a predominance of male patients. The prevalence of occasional wheezing (<3 episodes of wheezing) was 15.0% and recurrent wheezing (≥3 episodes) was 12.7%. Among the infants with recurrent wheezing, the use of inhaled β2-agonist, oral corticosteroid, leukotriene receptor antagonist, as well as night symptoms, respiratory distress, and hospitalization due to severe episodes were significantly more frequent. Physician-diagnosed asthma was observed in 28 (9.5%) of the wheezing infants. Among the wheezing infants, 80 (27.7%) were diagnosed with pneumonia, of whom 33 (11.2%) required hospitalization; neverthless, no differences between occasional and recurrent wheezing infants were found.CONCLUSIONS: The prevalence of recurrent wheezing and physician-diagnosed asthma in infants were lower compared with those observed in other Brazilian studies. Recurrent wheezing had early onset and high morbity.

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MEDICAL CARE OF URBAN INFANTS: THE COMMON COMPLAINTS

PEDIATRICS ◽

10.1542/peds.45.4.614 ◽

1970 ◽

Vol 45 (4) ◽

pp. 614-622

Author(s):

Rowland L. Mindlin

Keyword(s):

Middle Class ◽

Medical Care ◽

Ethnic Groups ◽

Health Workers ◽

First Year ◽

Random Samples ◽

The Common ◽

Delivery Of Medical Care ◽

First Year Of Life

Random samples of infants born in an interracial slum and a middle-class neighborhood were followed during the first year of life by monthly home interviews conducted by trained lay interviewers. Mothers were asked about infants' health and medical care. Caucasian infants had an average of 6.9 conditions per year; 4.0 conditions per infant were seen by a physician. Corresponding data for Negro infants are: 6.9 conditions, 4.1 seen; for Spanish infants: 8.0 conditions, 4.4 seen. Repeated interviewing tends to minimize these rates. Colds, rashes, teething, and gastrointestinal disturbances accounted for half of the health troubles. Most of the common conditions seen by physicians were similar in the three ethnic groups. Auxilliary health workers, properly trained, could share in the delivery of medical care to infants in a variety of settings.

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The Development of Swallowing Respiratory Coordination

Perspectives on Swallowing and Swallowing Disorders (Dysphagia) ◽

10.1044/sasd18.1.19 ◽

2009 ◽

Vol 18 (1) ◽

pp. 19-24

Author(s):

Maggie-Lee Huckabee

Keyword(s):

Cortical Activation ◽

First Year ◽

Healthy Children ◽

Nasal Airflow ◽

Single Session ◽

Primary Finding ◽

Patterns Of Behavior ◽

Cortical Modulation ◽

First Year Of Life ◽

Swallowing Apnea

Abstract Research exists that evaluates the mechanics of swallowing respiratory coordination in healthy children and adults as well and individuals with swallowing impairment. The research program summarized in this article represents a systematic examination of swallowing respiratory coordination across the lifespan as a means of behaviorally investigating mechanisms of cortical modulation. Using time-locked recordings of submental surface electromyography, nasal airflow, and thyroid acoustics, three conditions of swallowing were evaluated in 20 adults in a single session and 10 infants in 10 sessions across the first year of life. The three swallowing conditions were selected to represent a continuum of volitional through nonvolitional swallowing control on the basis of a decreasing level of cortical activation. Our primary finding is that, across the lifespan, brainstem control strongly dictates the duration of swallowing apnea and is heavily involved in organizing the integration of swallowing and respiration, even in very early infancy. However, there is evidence that cortical modulation increases across the first 12 months of life to approximate more adult-like patterns of behavior. This modulation influences primarily conditions of volitional swallowing; sleep and naïve swallows appear to not be easily adapted by cortical regulation. Thus, it is attention, not arousal that engages cortical mechanisms.

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