Tom W.J. Schulpen

Influences of ethnicity on perinatal and child mortality in the Netherlands

AIMS To investigate the differences in perinatal death and child mortality between different ethnic groups in the Netherlands. METHODS Retrospective analysis of data collected between 1990 and 1993 in the national obstetric registry comprising 569 743 births. Retrospective analysis of all death certificates of 0 to 15 year old children routinely collected between 1979 and 1993, comprising 20 211 deaths. RESULTS Black mothers had the highest perinatal death rate compared with indigenous Dutch mothers (odds ratio 2.2). Hindustanis (West Indian Asians) had an odds ratio of 1.4 and Mediterraneans 1.3. The increased rate for black and Hindustani women could be fully explained by preterm birth. In the Mediterranean group the differences were explained by teenage pregnancy, grand multiparity, and socioeconomic status rather than prematurity. The death rate of Turkish and Moroccan children was twice as high as that of native Dutch children. For the different diagnostic categories this was: infectious diseases, relative risk (RR) 2.2; hereditary (metabolic) disorders, RR 2.0; accidents and drowning, RR 1.9. One quarter of the Turkish and Moroccan children died while on holiday in their country of origin. Sudden infant death syndrome was twice as high for Turkish infants as for Dutch children and four times higher than for Moroccan infants. CONCLUSION Ethnic minorities in the Netherlands have a higher perinatal and child mortality rate than the indigenous Dutch. Apart from socioeconomic differences, sociocultural and lifestyle factors play an important role.

Migration and child health: the Dutch experience

Nearly one million of the fifteen million inhabitants of the Netherlands are directly descending from migrant parents. Of these inhabitants, 75% come from former colonies (Surinam and the Netherlands Antilles) and Mediterranean countries like Turkey and Morocco. The mortality rate of Turkish and Moroccan children under 15 years of age is two to three times higher compared to Dutch children. Main causes are perinatal death (including congenital malformations), accidents and drowning, infectious diseases and death during holidays in the country of origin. Inequalities in health between the migrant and Dutch children are demonstrated in several surveys conducted at both national and local levels. Apart from socio-economic differences, this can be attributed to three main causes; different pathology due to imported infectious diseases or inherited disorders, different life style and sociocultural factors. The cumulative factor explains the differences in health, comparable with several other countries in Europe where migrants from Mediterranean countries and former colonies live.ConclusionMigration has an increasing impact on the daily practice of Dutch paediatricians as well as elsewhere in Europe. Inclusion of intercultural and international aspects of health in the curriculum of the medical paediatric education is paramount.

Results of group-circumcision of Muslim boys in Malaysia with a new type of disposable clamp.

This study evaluates the safety and results of surgery using TaraKlamp Circumcision DeviceR during a group circumcision. A total of 64 circumcisions of Muslim boys were performed by Medical Assistants supervised by Medical Doctors in a hall in Kuala Lumpur, Malaysia. A new type disposable clamp was used, which was removed 4 days after the operation. No major complications occurred and the boys experienced in general mild pain postoperatively. Mostly good cosmetic results were obtained and 90% of the parents would recommend this new clamp to others. Group circumcisions with TaraKlamp Circumcision DeviceR (Kuala Lumpur, Malaysia) are safe, although proper patient selection and adequate training in using the device are mandatory.

Religious circumcision under local anaesthesia with a new disposable clamp.

Objective To compare the results using a new disposable clamp (the Taraklamp Circumcision Device®, TCD, Taramedic Europe BV, Bilthoven, The Netherlands), used since 1998 in one clinic, and the conventional dissection technique (CDT) in another clinic, for religious circumcision in infants.

Cultuur en communicatie

SummaryThe Dutch health care is as yet insufficiently prepared and equipped for the diversity of patients in the multicultural society, leading to problems in the care for ethnic minority patients. Besides language problems, differences in culture and frame of reference can play roles; ethnic minority patients often have different beliefs about health (care) and disease than the native-born health care professional. Differences in perception and explanation of disease and differences in communication possibilities may raise wrong expectations in physician and patients in relation to each other and to the treatment. The physician who realises that his clinical reality can differ from that of the patient, can prevent these difficulties. Open attitude and good intercultural communication can help narrowing differences in clinical reality between physician and patient. More attention has to be given in medical education in learning the right attitude and skills for communication with patients of other cultural backgrounds.SamenvattingDe Nederlandse gezondheidszorg is vooralsnog onvoldoende voorbereid en toegerust op de diversiteit van de hulpvragers in de multiculturele samenleving. Dit blijkt uit de problemen in de zorg aan allochtone patiënten. Naast taalproblemen spelen ook verschillen in cultuur en referentiekader een rol; allochtonen hebben vaak andere opvattingen over gezondheid, gezondheidszorg en ziekte dan de autochtone hulpverlener. Verschillen in beleving en uitleg van de ziekte en verschillen in communicatieve mogelijkheden kunnen verkeerde verwachtingen opleveren bij zowel hulpverleners als hulpvragers, ten opzichte van elkaar en van de zorg. Besef bij de hulpverlener dat diens klinische realiteit kan verschillen van die van de patiënt, kan knelpunten voorkomen. Een open houding en goede interculturele communicatie kunnen eveneens bijdragen aan het overbruggen van verschillen in klinische realiteit tussen arts en patiënt. In de medische opleidingen moet meer aandacht worden besteed aan het aanleren van de juiste attitude en vaardigheden om te kunnen communiceren met patiënten met een andere achtergrond.