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.

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

This book marks the first step in a new review of health policy - a review that focuses specifically on sub - Saharan Africa. Several factors make this exercise particularly timely: 1) the concern that the economic downturn of the early 1980s may have adversely affected the health sector in Africa; 2) the need to evaluate the impact of primary health care strategies, especially the key elements of immunization and oral rehydration; 3) the completion of a substantial body of epidemiological and demographic analyses, which provides a much improved empirical basis for assessing health conditions and recent health trends; 4) the concern that the global emergence of Acquired Immune Deficiency Syndrome (AIDS) and its sharp impact in selected African foci have undermined development prospects in some countries; and 5) the potential value of explicitly seeking lessons from the Bank's experience with health sector operations in Africa. The chapters in this book were commissioned to address the third point - to assemble in one place lessons from the analyses of the epidemiological and demographic conditions that define the problems facing Africa's health systems. This book sets an important part of the agenda of work for African health officials over the next decade.

Disease and Mortality in Sub-Saharan Africa

The objective of the Motor Development Study was to describe the acquisition of selected gross motor milestones among affluent children growing up in different cultural settings This study was conducted in Ghana, India, Norway, Oman, and the United States as part of the longitudinal component of the World Health Organization (WHO) Multicentre Growth Reference Study (MGRS) Infants were followed from the age of four months until they could walk independently Six milestones that are fundamental to acquiring self-sufficient erect locomotion and are simple to evaluate were assessed: sitting without support, hands-and-knees crawling, standing with assistance, walking with assistance, standing alone, and walking alone The information was collected by both the children's caregivers and trained MGRS fieldworkers The caregivers assessed and recorded the dates when the milestones were achieved for the first time according to established criteria Using standardized procedures, the fieldworkers independently assessed the motor performance of the children and checked parental recording at home visits To ensure standardized data collection, the sites conducted regular standardization sessions Data collection and data quality control took place simultaneously Data verification and cleaning were performed until all queries had been satisfactorily resolved

Assessment of gross motor development in the WHO Multicentre Growth Reference Study.

Background Evidence exists that normal gestational length varies with ethnicity. This UK-based study compares gestational length amongst a cohort of white European, Black and Asian women. Methods The cohort comprised 122 415 nulliparous women with singleton live fetuses at the time of spontaneous labour, giving birth in the former North West Thames Health Region, London, UK. Results The median gestational age at delivery was 39 weeks in Blacks and Asians and 40 weeks in white Europeans. Black women with normal body mass index (BMI) (18.5-24.9 kg/m(2)) had increased odds of preterm delivery (odds ratio [OR] = 1.33, 95% CI: 1.15, 1.56, adjusted for deprivation and BMI) compared with white Europeans. The OR of preterm delivery was also increased in Asians compared with white Europeans (OR = 1.45, 95% CI: 1.33, 1.56, adjusted for single unsupported status and smoking). Meconium stained amniotic fluid, which is a sign of fetal maturity, was statistically significantly more frequent in preterm Black and Asian infants and term Black infants compared with white European infants. Conclusions This research suggests that normal gestational length is shorter in Black and Asian women compared with white European women and that fetal maturation may occur earlier.

Does gestation vary by ethnic group? A London-based study of over 122 000 pregnancies with spontaneous onset of labour

https://ecommons.aku.edu/cgi/viewcontent.cgi?article=1103&context=eastafrica_fhs_mc_paediatr_child_health

Pediatric cerebral palsy in Africa: a systematic review.

A review of 965 children with neurological disorders, seen at the Paediatric Neurology Clinic of the University of Nigeria Teaching Hospital (UNTH), Enugu, over a 3-year period (1985-1987), revealed that epilepsy was the most common neurological problem affecting 60% of the children, followed by cerebral palsy (16%), speech disorders (8.3%), mental retardation (7.2%), behaviour disorders (2.2%), paralytic poliomyelitis (1.55%), premature craniosynostosis (1.0%), visual and auditory impairment (1.0%) and muscle disorders (0.72%). Perinatal problems such as birth asphyxia, severe neonatal jaundice and infections were the most common aetiological factors identified. Facilities for rehabilitation of the children were inadequate and this, together with the people's ignorance of the natural history of some of the neurological disorders, may account for the high rate of default from follow-up observed in this study. The need for improved maternal and perinatal health services and vigorous health education strategies is emphasized by this review. The positive effect of the Expanded Programme on Immunization (EPI) is reflected in the sharp decline in the proportion of children with neurological disorders owing to paralytic poliomyelitis, from 9.2% in the period 1978-1980, to 1.55% in the present study.

A review of neurological disorders seen at the Paediatric Neurology Clinic of the University of Nigeria Teaching Hospital, Enugu

A prospective study of 320 Nigerian children was undertaken to determine their pattern of motor development by recording the age at attainment of 12 gross-motor milestones. The children were all born full term and were neurologically normal at birth. They were recruited in the first week of life and seen at regular intervals in a well-baby clinic, where their parents were questioned about the ages at attainment of milestones. Results show that most gross-motor milestones were attained at earlier ages by these children than by children studied to establish norms for the traditional tests of motor development that have long been in use. Our findings confirm several previous reports which emphasize the more rapid attainment of motor milestones such as 'sit without support', 'crawl', 'stand well alone' and 'walk well alone' by black as compared with white children. But, conversely, a number of transitional milestones such as 'roll over', 'pull self to stand' and 'stand holding on' were achieved later by children in this study than by their non-African counterparts. Girls in this study were slightly advanced, relative to boys, in their attainment of most milestones. The results of this study have been incorporated into a chart which can be used in well-baby clinics to detect children with motor delay.

Gross motor development of Nigerian children.

SummaryOf 965 children with neurological disorders seen in the Child Neurology Clinic of the University of Nigeria Teaching Hospital, Enugu over a 3-year period (1985–87), 80 (8–3%; 41 boys and 39 girls) had speech problems. The most common speech disorder was dyslalia. Twenty-six (32.5%) of the 80 children were mentally retarded. Besides speech problems, some of the children had other neurological disorders such as hyperactivity, recurrent seizures, microcephaly and deafness. Varying degrees of improvement in speech were observed in only eight girls and four boys, amounting to 24% of the 50 who were followed up for a period ranging from 3 months to 3 years (mean follow-up period 12.26 months). Eight of those who improved (66.6%) did so within the first 18 months of follow-up. There was a disturbingly high rate of default from follow-up, 30 of the patients (37.5%) failing to keep appointments at the clinic after the first assessment. Also, there was a long delay between onset of symptoms and presentation ...

S O Iloeje

Papers

A review of neurological disorders seen at the Paediatric Neurology Clinic of the University of Nigeria Teaching Hospital, Enugu

Gross motor development of Nigerian children.

The pattern and prognosis of speech disorders among children in Enugu, Nigeria.