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The promotion of good health and well-being for children is essential to improve adult health. Child health surveillance has been crucial in attempting to achieve this goal. The National Service Framework for Children promotes a new child health programme. If it is to be successful, nurses involved in primary care must play a central role.
The purpose of this study was to clarify the public health nurse's work and decision-making process in child health care during the years 1976-1986. The first study was carried out in 1976 and a subsequent one in 1986. The population of both studies consisted of public health nurses working in child health care centres. During these years many reforms were implemented in national child health care policy. According to the results of the 1986 study the public health nurses used the decision-making process, as a whole, better than in the study of 1976. The content of the health care they provided had become more varied.
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OBJECTIVE: To further validate a simple instrument for the measurement of parent-reported health and morbidity in infancy and childhood when used in routine child health surveillance as part of a whole year birth cohort study. Setting The socially and ethnically diverse city of Coventry. METHODS: Health visitors administered the Warwick Child Health and Morbidity profile (WCHMP), incorporated into the Parent Held Record (PHR), to the parents of infants born in 1996 and enrolled in the Coventry Cohort study as part of routine child health surveillance at 8 weeks and 8 months. Criterion validity was estimated for Hospital admission status and immunization status against health records and validity against medically plausible constructs was tested by comparing responses between domains and between the two data collection points for the whole cohort. RESULTS: Criterion validity for parental reporting of immunization status (Kappa 0.824 [95% CIs, 0.708, 0.940]) and hospital admission (Weighted Kappa 0.987 [95% CIs, 0.977, 0.997]) were high. There was a high level of concordance between parental responses to related domains and the medically plausible constructs. The proportion of parents reporting chronic illness, acute significant illness, chronic illness and accidents increased as expected between 8 weeks and 8 months. As expected, adverse outcomes at 8 weeks were associated with an increased risk of the same outcomes at 8 months. CONCLUSIONS: The WCHMP is a simple measure of parent-reported health and illness which was shown to be reliable and valid with low inter-observer variation on initial field-testing. Further validation of the WCHMP, incorporated into the PHR, in a routine child health surveillance programme demonstrates its suitability for use in infancy to collect cross-sectional and longitudinal health and morbidity data for research and service planning purposes.
Child health care financing must maximize access to quality, comprehensive pediatric and prenatal health care. This policy statement replaces the 1998 policy statement by the same title. Changes reflect recent state and federal legislation that affect child health care financing. The principles outlined in the statement will be used to evaluate the changing structure of child health care financing.
This paper provides a detailed analysis of the survival rates and health problems of a cohort of children born during a 5-yr period in part of the city of Ilorin, Nigera. The findings are linked to a demographic and environmental study which indicates that the study area was relatively stable in terms of family structure and population turnover. Most people work in the informal sector, in trading, small scale crafts and service industries. At the time the survey began, in 1979, the provision of piped water supplies to the area was unreliable and sanitation provisions rudimentary. Most of the people had little or no formal education and were very poor. The study indicated that health status had improved over the 5-yr period, compared to a baseline study conducted in 1979. Common causes of child mortality and morbidity included diarrhea, acute respiratory infections, measles, and malaria. The infant mortality rate was 41.5/1000. The availability of clinic care at nominal cost, and the attendance of mothers at the clinic for checkups and immunization, resulted in a higher level of health for their children than otherwise would have been possible. Some problems of primary health care in the area are mentioned, in the light of Nigeria's current budgetary problems, and the utilization of existing strong social support networks to improve health care and environmental sanitation and water supply is suggested.
Child health care financing must maximize access to and ensure quality comprehensive child and maternal care. This policy statement replaces the 1993 policy statement, "Principles of Child Health Care Financing." Changes reflect new state and federal legislation that affect child health care financing. The principles outlined in the policy statement will be used to evaluate the changing structure of health care financing.
OBJECTIVE: to validate a simple instrument for the measurement of parent-reported health and morbidity in infancy and childhood suitable for research and service planning purposes and capable of measuring both cross-sectional and longitudinal health and morbidity experience in a child population. SETTING: child health clinic (CHC), child development unit (CDU) and paediatric outpatient department (OPD) in Coventry. DESIGN: 3-phase field testing to establish test-retest reliability, validity and inter-observer variation of the instrument. Field testing samples: phases 1 and 2; 188 parents of pre-school children attending one of the three health service settings-CHC, CDU or paediatric OPD; phase 3; 40 parents of pre-school children attending CHCs. METHODS: test-retest reliability of each domain of the WCHMP was estimated using weighted Kappa; criterion validity was estimated for selected domains against health records; construct validity against medically plausible constructs was tested by comparing responses between domains; Inter-observer variation was estimated using weighted Kappa. RESULTS: the test-retest reliability of the WCHMP varied from 'moderate' for behaviour, functional health and life quality status to 'very good' for acute significant illness and hospital admission status; criterion and construct validity were high; weighted Kappas for all domains for inter-observer variation between the researcher and family health visitor were in the 'good' to 'very good' range and inter-observer variation remained unaffected by change in the order of administration of the WCHMP. CONCLUSIONS: the WCHMP is a simple measure of parent-reported health and illness which, on field-testing, has been shown to be reliable and valid with low inter-observer variation. After further development and validation including incorporation into the parent-held record, it should be suitable for use in infancy and early childhood to collect cross-sectional and longitudinal health and morbidity data for research and service planning purposes.
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The goal of equitable access to health care continues to be elusive for poor children. Medicaid, the major source of financing such care, has been eroded by a series of actions by the administration and the Congress. A survey of the Medicaid-based EPSDT (Early and Periodic Screening, Diagnosis, and Treatment) programs in the fifty states pinpoints shortcomings in adequate financing and sound standards of practice. Reconciling child health goals with program realities will require new federal and state initiatives.
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Because there is an association between the lack of knowledge of normal child development, high and unrealistic expectations for a child's performance, and child abuse, a questionnaire about normal child development, child health maintenance, child discipline aspects of childrearing, and child development was given to a representative sample of high school students in Iowa. Though high school students in Iowa rank high in academic performance, the results of this study indicated that students in grades 9 through 12 had a poor knowledge of child development and child health maintenance. Students whose highest probability of response to a child discipline problem was either to punish or abuse knew less about child development and child health maintenance than their peers. Boys at all grade levels knew less about child development and child health maintenance and were more likely to choose punishment and abuse than girls. Though the causes for child abuse are multifactorial and complex, there is a need to guarantee that all who are at risk for parenthood be informed about child development, child health maintenance, and child discipline to minimize the effects that ignorance of these factors may have on their approaches to discipline and their potential for child abuse.
Our aim was to study, by means of questionnaires, some specific opinions of dental personnel, giving information on dental health care at child health centers and Public Dental Service clinics. The questions dealt with the relative importance of dietary habits, oral hygiene, and fluoride for the occurrence of caries in small children and why some children develop caries. The material consisted of dentists, dental hygienists, and dental assistants, participating in 1983 and/or 1992. The results showed that, on the whole, the different categories had similar opinions. In both 1983 and 1992 diet was ranked first, oral hygiene second, and fluoride third, but the distribution of priorities changed. In 1992 the priority values for oral hygiene were more dispersed over the priority grades and those for fluoride considerably higher than in 1983. In contrast, parents of 4-year-old children interviewed in 1983 stated that toothbrushing is more important for dental health than diet. To the question why some children develop caries, most of the personnel responded that parents lack motivation to convert advice into practice. Besides unsatisfactory dietary habits and insufficient oral hygiene, deficiencies in the information process were other frequently quoted factors.