The Kambia Appeal

By: Erin Lieber

Each year, childbirth and near term complications take the lives of roughly 529,000 women, with the most deaths taking place in sub-Saharan Africa (Blum et al. 2006). Most developing countries have adopted a multi-pronged approach in an effort to reduce maternal mortality. The strategy stems from the “Safe Motherhood” (SM) campaign and concentrates on family planning, antenatal care, including proactive education and reassurance, skilled assistance at delivery and access to emergency obstetric care for complicated and high risk labor. “Safe Motherhood” was introduced in the 1980’s and research shows that the success and execution of each of these aspects significantly varies. While coverage for antenatal care is estimated at 70-90%, coverage of skilled assistance at delivery, defined as a trained health professional such as a midwife, nurse or doctor, is only 30-40%. There are many barriers that contribute to the challenge and low coverage of skilled assistance at delivery such as inadequacies of local health systems, patient perceptions of quality causing women to bypass their local centers, as well as financial constraints of accessing a skilled birth attendant.

A significant factor in health system demand constraints includes low quality of local facilities and patients choosing higher level care although further away geographically. Research shows that more than 40% of women who chose to deliver in a poor rural area of Tanzania, bypassed their nearest health facility, choosing to deliver at the government hospital or mission facility (Kruk et al. 2009). Although there are often health centers close to the patients home, the perceptions of quality of those centers is low. Tanzania, for example, has invested in designated village level primary care facilities, often called dispensaries, to be the main point of care for uncomplicated births, an effort that led to 90% of the population living within 10km of a health center (National Bureau of Statistics, Tanzania and Macro International 1997). Despite effective proximity, research cites poor quality as a concern in dispensaries in both delivery of care and the degree of skilled labor. A recent study in Tanzania even found that providers in rural areas tend to be less skilled than those in urban areas (Leonard and Masatu 2007).

Financial constraints also contribute to low coverage of skilled workers, as highly trained clinicians such as doctors or midwives require higher compensation, which generates the need for various fees that may discourage woman from using these services. This, in turn, decreases funding for skilled care at delivery, and the overall number of workers with specific obstetric skill sets decrease as well.

There are many initiatives working on solutions to improve maternal health in low-resource countries and they are emphasizing the skilled care approach in their strategies. Some ways to improve the coverage of skilled care include increasing the number of skilled birth attendants and quality care in the dispensaries closest to the women’s home. An organized referral system should also be in place so that higher risk and complicated births are taken to the next closest higher level facility in an efficient manner. This sort of organization will provide quality data to plan for investments in each both types of facilities, so that confidence is restored in the local facilities and woman do not bypass the first facility unless referred. Education and awareness on the quality of first level dispensaries is extremely important within the community so that women are comfortable not only with prenatal and preventive obstetric care but also with giving birth at these facilities. A strong commitment to strengthen local health centers will give donors the confidence to invest more in increasing the coverage of skilled birth attendants and quality care in an effort to reduce maternal mortality in developing countries.

Flickr: drgandy

By Kimberly Mayo-Achan MA, CCC-SLP

Attention Deficit and Hyperactivity Disorder is the most commonly studied and diagnosed disorder in children. In the United States alone, it is estimated that approximately 6 million children are currently diagnosed with ADHD, as opposed to 1985, where that number was just at 500,000. Because of the large and somewhat sudden increase in numbers, there has been much controversy over the diagnosis of this disorder. Is this a true psychiatric disorder or are the good old days of “kids being kids” being exploited as an excuse for another medical condition?

We all have moments of impulsivity. Children definitely spend a lot of their time running around. Students all, at one time or another, shout out answers in class. Kids will climb on furniture and throw things just for fun. They will not all be able to sit through full length movies, or even short television programs. But does that automatically mean that this child has an attention disorder accompanied by a component of hyperactivity? Definitely not. However, when these behaviors become excessive, uncontrollable, and socially hindering, it is time to look into possible reasons why.

Attention Deficit/Hyperactivity Disorder is not something that can be as easily diagnosed as diabetes, high blood pressure or a thyroid disorder. While there is no lab test that can conclude that a child has ADHD, the American Psychiatric Association in their Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), has listed definitive criteria for a diagnosis (for more information on this criteria, visit http://www.cdc.gov/ncbddd/adhd/diagnosis.html).

There is no need to be alarmed if you look at these criteria and realize your child has exhibited some, or many of these symptoms. Children are very active and believe it or not, most of these behaviors are quite normal in developing children. It is when these behaviors impede on a child’s ability to learn and socialize that there is cause for further investigation.

While this information alone may leave many still skeptical about the validity of Attention Deficit/Hyperactivity Disorder, there is further evidence that there may actually be a difference in brain development in children with ADHD than in those without it.

Dr. Philip Shaw, who led the research team at the Child Psychiatry Branch of the National Institute of Mental Health (NIMH), released a study in 2007 which offered physiological evidence for ADHD. Shaw found that there was a developmental “lag” or delay in the part of the brain (prefrontal cortex) responsible for functions such as attention, focusing, memory and the ability to suppress impulsive responses, while the primary cortex, or the area of the brain responsible for generating neural impulses which control the execution of movement, develops at a more rapid pace. The inverse development of these two areas of the brain may be the reason why children with ADHD are so impulsive and restless.

Unless you have direct contact with a child with ADHD, this disorder may be far fetched and hard to comprehend. Even Tom Cruise has publically stated his opinion that this disorder and psychiatry as a whole is a “quack”. Unfortunately, this opinion is shared too widely by many people, making it hard for these children to get the attention and treatment they deserve. Is ADHD being overdiagnosed? Maybe. But that still does not take away from the many children whose lives are affected by this very real disorder. Just ask a teacher who has a child with ADHD in her classroom or a competent, firm parent who has a child that is completely impulsive and hyper. Take a minute to become educated on this before you pass judgment.

Flickr: babyeinstein2008

by Kimberly Mayo-Achan MA, CCC-SLP

Everybody wants their baby to be the smartest, brightest, most gifted child on the block, so naturally, as parents, we tend to buy products that represent themselves in such a way that makes consumers believe just this. There are many products on the market, but products with names such as Baby Einstein, a subsidiary for Disney, catch our attention quicker than one with a more generic name. So, do Baby Einstein products really make your child a genius?

According to babyeinstein.com, this company offers a diverse range of products from books, to flashcards, to DVD’s. These products were created by a mother from a baby’s point of view and incorporate language, art, music and poetry into their merchandise. The DVD’s actually stated in them that their purpose was for educational intent rather than just entertainment. Upon further investigation, it was revealed that no conclusive research or evidence supported these claims made by the company and in fact, studies have shown children who watched these videos extensively actually preformed worse on IQ exams later on in life than children who were not frequently exposed to them.

One woman has made it her priority to inform the public about this false advertising and has brought this company under such intense scrutiny that Disney’s Baby Einstein has decided to offer a full refund or exchange to any parent who has purchased their DVD’s between June 4, 2004 and September 5, 2009 and is not completely satisfied with their child’s progress or the product itself.

The bottom line is that Baby Einstein DVD’s are probably no worse than some of the other material out there, but there is no educational research to support this. If used as a bonding or teaching experience, instead of a babysitter, these products may not be as “risky” as people claim them to be. As a parent, instead of complaining about what material your child is watching, monitor it closely and choose for yourself what you feel is beneficial or not. Any excessive amount of unsupervised television will ultimately result in less interactive, educational time spent between a parent/caregiver and a child.

For more information visit www.babyeinstein.com

Tell us what you think about these methods of education for children

by Kimberly Mayo-Achan MA, CCC-SLP

Many children today are receiving some type of Speech-Language Therapy, either at home, in school or in after school programs. Holidays are the perfect time to incorporate some fun, festive, relevant ideas into your therapy sessions or into your family time at home! This year, steer clear of the tricks, and read about some frighteningly fun Therapy Treats!

Feeding Therapy/Oral Motor Strengthening: All of the candy kids get while trick-or-treating can actually be used for more than just a sugar rush! Allow your child to chew a piece of gum for a few minutes to help strengthen their jaw muscles. Let them twirl a lollipop in their mouth from side to side to improve tongue lateralization and coordination. Use another lollipop to practice tongue elevation by licking it from the bottom up. Practice blowing big bubbles with a piece of bubble gum; it is a great exercise for breath control as well as lip pursing. You can also play a “balancing game” with a skittle or M&M by placing the candy on the very tip of your tongue, sticking your tongue out as far as it can go and holding it there for 15 seconds at a time. This works on tongue protrusion as well as muscle control!

Make some spooky Halloween treats such a pumpkin muffins, gingerbread caramel corn, or ghost shaped cookies. These fun foods will be physically appealing for the picky eater! Adults, make sure you thoroughly check your child’s candy basket before they eat anything and watch them closely as they enjoy it. Fruit candies, sugarless gum or any frozen fruit treats can also be used if you want to limit sugar for your child!

Check back for Therapy Treats; Part II where I will talk about using Halloween to focus on improving vocabulary and descriptive language skills. Remember, have fun, be creative, and use every moment as a learning opportunity!