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Biomedical subjects

Jan Van den Broeck

Publications and source records attributed to Jan Van den Broeck.

7 recordsLinked to original sources
PubMed2004

The use of non-prescribed medication in the first 3 months of life in rural South Africa.

OBJECTIVE: This paper describes the use of non-prescribed medications given to a cohort of infants in the first 3 months of life in a rural South African district, and discusses some of the implications for primary health care. METHODS: As part of an ongoing study on breastfeeding, a cohort of 110 infants were visited at home at 6 and 12 weeks of age. Any medications given to the infant since the last visit, the reasons for their administration, and any visits made to traditional healers were recorded via a semi-structured questionnaire. Determinants of administration of non-prescribed medication were analysed, including maternal age, education, infant gender and socio-economic factors. RESULTS: A total of 107 (97%) infants received non-prescribed medications in the first 3 months of life: 98 (89%) rectally and 64 (58%) orally. The most common enema contained traditional Zulu medicine made from herbs, given more than once weekly, usually for perceived constipation; the most common oral medication was gripe water, given once daily, mainly for 'colic' or 'wind'. Twenty-nine (26%) mothers had consulted a traditional healer, most commonly because of concerns about a capillary naevus, thought to cause pain. Mothers with a 'clean' water supply were more likely to give non-prescribed oral medications than those without (OR=2.7 and P=0.0223), whilst those who had no education were less likely to administer them than those who had completed school (OR=0.19 and P=0.0326). CONCLUSIONS: Non-prescribed medications are given almost universally to young infants in our area, irrespective of socio-economic class. Health professionals need to be aware of the extent of, and reasons for, administration of non-prescribed medications to young infants, so that effective health messages can be targeted at mothers and caregivers.

Administration, Oral↗
PubMed2004

Local beliefs about childhood diarrhoea: importance for healthcare and research.

The aim of this study was to describe perceptions and beliefs about childhood diarrhoea in a rural South African area. A further aim was to describe mismatches with medical concepts that may influence quality of diarrhoea care and validity of population-based diarrhoea research. This was a descriptive study carried out in a rural district of KwaZulu/Natal, South Africa. Using a validated ethnographic method information was compiled from semi-structured interviews, card sorting exercises, case histories, and focus group discussions with 29 caregivers in total. Description of locally perceived diarrhoea types, signs, symptoms, causes and actions taken were recorded. Eleven 'local types of diarrhoea' were identified, which were classified into three categories: (A) natural causation, (B) supernatural causation, and (C) caused by 'germs' or change in diet. Conceptual mismatches included: (1) not all conditions with frequent or watery stools were perceived as diarrhoea; (2) hygiene was considered irrelevant in the causation of A and B; (3) signs of dehydration were not always attributed to loss of fluid; (4) medical care and oral rehydration therapy were considered useless in B; (5) potentially harmful treatments, such as herbal enemas, are always preferred in B, sometimes in A. These mismatches carry the potential to hamper health promotion, predispose to delayed and poor care and may lead to selection bias, under- and misreporting and poor compliance in research. This study highlights the discrepancies in concepts between medically trained and local people regarding the nature of childhood diarrhoea, the rationale behind care-seeking behaviour, and what can be expected from proposed interventions. Taking these discrepancies into account is not only essential to programmatic success and continued support but also for epidemiological surveys.

Adult↗
PubMed2004

Maternal perceptions of acute respiratory infections in children under 5 in rural South Africa.

OBJECTIVES: To assess maternal ability to recognize respiratory distress and to identify local beliefs and practices around respiratory infections in rural KwaZulu/Natal, South Africa. METHODS: A descriptive study: 15 knowledgeable mothers were shown a video of 10 children with respiratory distress and four normal children. Mothers were asked to describe perceived types, signs, symptoms, causes of and actions taken for each child. Sensitivity and specificity were calculated for maternal recognition of respiratory distress (chest indrawing, fast breathing) shown on the video. A focus group discussion with six mothers was held to corroborate and refine individually reported local concepts. FINDINGS: Maternal recognition of respiratory distress was good (sensitivity 91.3%, 95% CI: 86.8-95.8%; specificity 95%, 95%CI: 89.5-100%), with little variation between mothers (kappa = 0.704). Mothers described 12 'local types of respiratory illness', each with its own name and its own well-defined set of signs and symptoms. They were classifiable into five causative categories: supernatural, natural, tuberculosis, cold weather and unknown, indicating that perceptions of causation differed greatly from biomedical concepts. For illnesses of perceived supernatural causation, mothers were reluctant to seek medical care and antibiotics were deemed inappropriate. Traditional remedies were preferred instead. CONCLUSION: Knowledge of local vocabulary and concepts about respiratory infections is essential to design strategies for health care workers to communicate with mothers about respiratory disease, so that mothers will seek timely medical care, provide continued safe, supportive home care and comply with antibiotic treatment.

Acute Disease↗
PubMed2004

Measurement and standardization protocols for anthropometry used in the construction of a new international growth reference.

Thorough training, continuous standardization, and close monitoring of the adherence to measurement procedures during data collection are essential for minimizing random error and bias in multicenter studies. Rigorous anthropometry and data collection protocols were used in the WHO Multicentre Growth Reference Study to ensure high data quality. After the initial training and standardization, study teams participated in standardization sessions every two months for a continuous assessment of the precision and accuracy of their measurements. Once a year the teams were restandardized against the WHO lead anthropometrist, who observed their measurement techniques and retrained any deviating observers. Robust and precise equipment was selected and adapted for field use. The anthropometrists worked in pairs, taking measurements independently, and repeating measurements that exceeded preset maximum allowable differences. Ongoing central and local monitoring identified anthropometrists deviating from standard procedures, and immediate corrective action was taken. The procedures described in this paper are a model for research settings.

Anthropometry↗