Peter Underwood

Postpartum health in a Dhaka slum

This study examines the health, nutritional status, and health care seeking behaviour of a community based sample of 122 postpartum women from an urban slum in Dhaka, Bangladesh. It describes a physically impoverished environment in which malnutrition is serious, and non-trivial morbid episodes as a consequence of childbirth are very common. Malnutrition was found to be widespread: about one-quarter of the study mothers were short in stature, measuring 145cm or less in height; over two-thirds of the women weighed <45 kg; and a similar proportion had a BMI of <20. Based on mid-upper arm circumference, an overwhelming majority (96%) suffered from some degree of malnutrition. During the first 6 weeks postpartum over three-quarters of the women reported a non-trivial illness. The frequency of reported illnesses was significantly associated with both increasing age and parity. Despite severe poverty, most of the women reporting illnesses (71%) received some form of health care from a wide range of western and traditional health care providers, with Traditional Birth Attendants (TBAs) and unqualified western care providers being the most frequently utilised. This study highlights the plight of these women in a precarious environment and shows how their health is compromised by cultural and political constraints. We conclude that while the burden of postpartum morbidity is very high, the incorporation of traditional practitioners and unqualified western care providers into maternal health training programs, together with efforts to empower women, could be effective in improving the health status of mothers in this marginalised and fragmented community. To achieve this outcome, a clearly articulated and integrated approach to development in slum communities is required.

High levels of childhood rickets in rural North Yemen

Despite a warm sunny climate, rickets is extremely common in children living in an isolated mountainous area of North Yemen. In a small township the overall prevalence amongst children under five years attending for vaccination was 27%. The condition was most common at the end of the first year and had disappeared by the fifth year. Marasmus was commonly associated with rickets. Children from the rural villages outside the township had significantly lower rates of rickets. Several factors may contribute to the very high rates of rickets in rural Yemen. However, lack of exposure to sunlight as a consequence of particular cultural practices is likely to be the most important. The major social and behavioural factors which restrict the young child access to sunlight are outlined, and possible remedies discussed.

Health care needs of the children of single mothers in a Perth suburb

This paper reports a prevalence study of illness in children in a lower socioeconomic suburb of Perth. The study shows that single mothers reported higher rates of both emotional and physical disorder in their children compared with mothers from nuclear families. The children from single families were also reported as having a poorer immunization status. It is argued that children from single families constitute a vulnerable group and deserve special attention from those in the health system who care for children.