Browsing by Author "Dewey, Deborah"

Now showing 1 - 20 of 45
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    A longitudinal study of hand preference in children with autism
    (2000) Hauck, Joy Alison; Dewey, Deborah
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    Age-related functional brain changes in young children
    (Elsevier, 2017-07-15) Long, Xiangyu; Benischek, Alina; Dewey, Deborah; Lebel, Catherine A.
    Brain function and structure change significantly during the toddler and preschool years. However, most studies focus on older or younger children, so the specific nature of these changes is unclear. In the present study, we analyzed 77 functional magnetic resonance imaging datasets from 44 children aged 2-6 years. We extracted measures of both local (amplitude of low frequency fluctuation and regional homogeneity) and global (eigenvector centrality mapping) activity and connectivity, and examined their relationships with age using robust linear correlation analysis and strict control for head motion. Brain areas within the default mode network and the frontoparietal network, such as the middle frontal gyrus, the inferior parietal lobule and the posterior cingulate cortex, showed increases in local and global functional features with age. Several brain areas such as the superior parietal lobule and superior temporal gyrus presented opposite development trajectories of local and global functional features, suggesting a shifting connectivity framework in early childhood. This development of functional connectivity in early childhood likely underlies major advances in cognitive abilities, including language and development of theory of mind. These findings provide important insight into the development patterns of brain function during the preschool years, and lay the foundation for future studies of altered brain development in young children with brain disorders or injury.
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    The Alberta Pregnancy Outcomes and Nutrition (APrON) cohort study: rationale and methods
    (Maternal & Child Nutrition, 2014-01) Kaplan, Bonnie; Giesbrecht, Gerald; Leung, Brenda; Field, Catherine; Dewey, Deborah; Bell, Rhonda; Manca, Donna; O'Beirne, Maeve; Johnston, David; Pop, Victor; Singhal, Nalini; Gagnon, Lisa; Bernier, Francois; Eliasziw, Misha; McCargar, Linda; Kooistra, Libbe; Farmer, Anna; Cantell, Marja; Goonewardene, Laki; Casey, Linda; Letourneau, Nicole; Martin, Jonathan; APrON Study Team
    The Alberta Pregnancy Outcomes and Nutrition (APrON) study is an ongoing prospective cohort study that recruits pregnant women early in pregnancy and, as of 2012, is following up their infants to 3 years of age. It has currently enrolled approximately 5000 Canadians (2000 pregnant women, their offspring and many of their partners).The primary aims of the APrON study were to determine the relationships between maternal nutrient intake and status, before, during and after gestation, and (1) maternal mood; (2) birth and obstetric outcomes; and (3) infant neurodevelopment. We have collected comprehensive maternal nutrition, anthropometric, biological and mental health data at multiple points in the pregnancy and the post-partum period, as well as obstetrical, birth, health and neurodevelopmental outcomes of these pregnancies. The study continues to follow the infants through to 36 months of age.The current report describes the study design and methods, and findings of some pilot work. The APrON study is a significant resource with opportunities for collaboration.
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    An Examination of Mode of Birth, Maternal Postpartum Mental Health, and Childhood Behavioural Problems
    (2024-01-26) Grisbrook, Marie-Andrée; Letourneau, Nicole; Dewey, Deborah; Cuthbert, Colleen; McDonald, Sheila
    Cesarean section (C-section) deliveries account for 21% of all deliveries worldwide (Betran, Ye, Moller, Souza, & Zhang, 2021). They are frequently considered a medical necessity in labour dystocia, placenta previa, and malpresentation (Caughey, Cahill, Guise, & Rouse, 2014). However, delivery via C-section has been associated with an increased risk of internalizing (anxiousness, depressiveness, withdrawal) and externalizing (aggression, hyperactivity) behavioural problems among children (Rutayisire et al., 2018; Sirvinskiene, Zemaitiene, Jusiene, & Markuniene, 2016). Research evaluating the link between C-section and child behaviour is inconclusive and limited. Delivery via an emergency C-section is the strongest factor linked to a negative perception of the birth experience (Waldenstrom & Schytt, 2009). A negative perception of the birth experience is strongly associated with postpartum post-traumatic stress disorder (PTSD) (Dekel, Ein-Dor, et al., 2019; Soderquist, Wijma, & Wijma, 2002; Verreault et al., 2012), which may be comorbid with postpartum depression (PPD) (Soderquist, Wijma, & Wijma, 2006). Therefore, it is hypothesized that the relationship between C-section and child behaviour depends on the type of C-section, and postpartum PTSD and PPD mediate this association. This manuscript-based dissertation is comprised of five papers. The first and second manuscripts include a review protocol and systematic review outlining the procedures and current evidence regarding the association between C-section delivery and child externalizing and internalizing behavioural problems. The third manuscript presents results regarding the association between C-section delivery and maternal PPD and the role of maternal PTSD in mediating this association. The fourth manuscript presents the study findings on the association between C-section delivery and child behavioural problems and the role of maternal postpartum PTSD and PPD as mediating factors. The final manuscript reviews the current landscape of maternal postpartum mental health screening in Canada and suggests improvements for screening. The dissertation concludes with implications for nursing practice, policy, education, and research.
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    Brain white matter structure and language ability in preschool-aged children
    (2018-01) Walton, Matthew; Dewey, Deborah; Lebel, Catherine A.
    Brain alterations are associated with reading and language difficulties in older children, but little research has investigated relationships between early language skills and brain white matter structure during the preschool period. We studied 68 children aged 3.0-5.6 years who underwent diffusion tensor imaging and participated in assessments of Phonological Processing and Speeded Naming. Tract-based spatial statistics and tractography revealed relationships between Phonological Processing and diffusion parameters in bilateral ventral white matter pathways and the corpus callosum. Phonological Processing was positively correlated with fractional anisotropy and negatively correlated with mean diffusivity. The relationships observed in left ventral pathways are consistent with studies in older children, and demonstrate that structural markers for language performance are apparent as young as 3 years of age. Our findings in right hemisphere areas that are not as commonly found in adult studies suggest that young children rely on a widespread network for language processing that becomes more specialized with age.
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    Cluster-specific associations between the gut microbiota and behavioral outcomes in preschool-aged children
    (2024-03-21) van de Wouw, Marcel; Wang, Yanan; Workentine, Matthew L.; Vaghef-Mehrabani, Elnaz; Barth, Delaney; Mercer, Emily M.; Dewey, Deborah; Arrieta, Marie-Claire; Reimer, Raylene A.; Tomfohr-Madsen, Lianne; Giesbrecht, Gerald F.
    Abstract Background The gut microbiota is recognized as a regulator of brain development and behavioral outcomes during childhood. Nonetheless, associations between the gut microbiota and behavior are often inconsistent among studies in humans, perhaps because many host-microbe relationships vary widely between individuals. This study aims to stratify children based on their gut microbiota composition (i.e., clusters) and to identify novel gut microbiome cluster-specific associations between the stool metabolomic pathways and child behavioral outcomes. Methods Stool samples were collected from a community sample of 248 typically developing children (3–5 years). The gut microbiota was analyzed using 16S sequencing while LC-MS/MS was used for untargeted metabolomics. Parent-reported behavioral outcomes (i.e., Adaptive Skills, Internalizing, Externalizing, Behavioral Symptoms, Developmental Social Disorders) were assessed using the Behavior Assessment System for Children (BASC-2). Children were grouped based on their gut microbiota composition using the Dirichlet multinomial method, after which differences in the metabolome and behavioral outcomes were investigated. Results Four different gut microbiota clusters were identified, where the cluster enriched in both Bacteroides and Bifidobacterium (Ba2) had the most distinct stool metabolome. The cluster characterized by high Bifidobacterium abundance (Bif), as well as cluster Ba2, were associated with lower Adaptive Skill scores and its subcomponent Social Skills. Cluster Ba2 also had significantly lower stool histidine to urocanate turnover, which in turn was associated with lower Social Skill scores in a cluster-dependent manner. Finally, cluster Ba2 had increased levels of compounds involved in Galactose metabolism (i.e., stachyose, raffinose, alpha-D-glucose), where alpha-D-glucose was associated with the Adaptive Skill subcomponent Daily Living scores (i.e., ability to perform basic everyday tasks) in a cluster-dependent manner. Conclusions These data show novel associations between the gut microbiota, its metabolites, and behavioral outcomes in typically developing preschool-aged children. Our results support the concept that cluster-based groupings could be used to develop more personalized interventions to support child behavioral outcomes. Video Abstract
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    Differential patterns of maternal and child adaptation to chronic illness
    (1999) Oke, Carolyn Louise; Dewey, Deborah
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    Early Language Abilities and the Underlying Neural Functional Reading Network in Preschoolers
    (2018-06-25) Benischek, Alina Marie; Lebel, Catherine A.; Dewey, Deborah; Bray, Signe L.; Graham, Susan A.
    Early childhood is a critical time for language development. Language impairments that go untreated in the early years can result in decreased academic achievement and future mental health concerns. Despite the importance of early language development, very little research has focused on the functional brain systems supporting language in typically developing young children. We investigated relationships between age, language abilities, and the brain’s functional connectivity (FC) patterns seeded from brain areas associated with reading. The study included 50 healthy children aged 2.9-5.6 years (3.8 ± 0.6 years, 21f/29m) who completed a language assessment (NEPSY-II Phonological Processing and Speeded Naming) and underwent functional MRI (magnetic resonance imaging) scanning while watching a movie. Phonological Processing scores positively correlated with FC between the left angular gyrus and contralateral sensorimotor cortices, as well as between the right angular gyrus and the left supramarginal gyrus. Speeded Naming scores positively correlated with FC between the left inferior frontal gyrus, pars triangularis and the left fusiform gyrus, extending to the posterior region of the middle/inferior temporal gyrus and negatively correlated with the precuneus of the default mode network. Despite these variations in the FC patterns associated with speeded naming and phonological processing, both language measures positively correlated with FC between the ROI and the angular gyrus, supramarginal gyrus, and precentral gyrus. Age positively correlated with FC between regions within the ventral language pathway, including the inferior frontal gyrus and middle/inferior temporal gyrus and negatively correlated with FC between ipsilateral language regions and contralateral visual areas within the occipital cortex. The results demonstrate that better language abilities in young children are associated with stronger functional connections between brain regions within the language network identified in older children and adults who can perform more complex language processes.
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    The Effects of ‘Does Not Apply’ on Measurement of Temperament with the Infant Behavior Questionnaire-Revised: A Cautionary Tale for Very Young Infants
    (Early Human Development, 2014-10) Giesbrecht, Gerald; Dewey, Deborah; APrON Study Team
    Background: The Infant Behavior Questionnaire-Revised (IBQ-R) is a widely used parent report measure of infant temperament. Items marked 'does not apply' (NA) are treated as missing data when calculating scale scores, but the effect of this practice on assessment of infant temperament has not been reported. Aims: To determine the effect of NA responses on assessment of infant temperament and to evaluate the remedy offered by several missing data strategies. Study design: A prospective, community-based longitudinal cohort study. Subjects: 401 infants who were born >37 weeks of gestation. Outcome measures: Mothers completed the short form of the IBQ-R when infants were 3-months and 6-months of age. Results: The rate of NA responses at the 3-month assessment was three times as high (22%) as the rate at six months (7%). Internal consistency was appreciably reduced and scale means were inflated in the presence of NA responses, especially at 3-months. The total number of NA items endorsed by individual parents was associated with infant age and parity. None of the missing data strategies completely eliminated problems related to NA responses but the Expectation Maximization algorithm greatly reduced these problems. Conclusions: The findings suggest that researchers should exercise caution when interpreting results obtained from infants at 3 months of age. Careful selection of scales, selecting a full length version of the IBQ-R, and use of a modern missing data technique may help to maintain the quality of data obtained from very young infants.
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    Emergency Department Staff Knowledge and Practice of Caring for Individuals with Intellectual Disabilities Seeking Mental Health Care
    (2020-09-21) Aboumrad, Mona; Lashewicz, Bonnie M.; Hughson, E. Anne; Haines-Saah, Rebecca J.; Lashewicz, Bonnie M.; Hughson, E. Anne; Haines-Saah, Rebecca J.; Estefan, Andrew; Dewey, Deborah
    Individuals with intellectual disabilities have limited access to out-patient community-based mental health care. Emergency departments have become a fundamental entry for patients with intellectual disabilities to receive mental health care, leaving patients with intellectual disabilities being frequent users of the emergency department when compared to those without intellectual disabilities. The purpose of this study is to examine and unpack the knowledge, practice, and professional experience of emergency department staff regarding patients with intellectual disabilities seeking mental health care. The study aims to contribute to understandings about the ways in which emergency department staff utilize the emergency department space, time, and resources, and how this utilization impacts how responsive and supportive care is provided to patients with intellectual disabilities. Semi-structured face-to-face and phone interviews were conducted with seven emergency department social workers, registered nurses, and physicians from four emergency departments in Calgary, Canada. A qualitative descriptive study design was employed to collect, analyze, and describe and interpret findings. Emergency department staff described: the emergency department standard practice and procedures, environment, conflicting demands, professional and personal experience in the emergency department, and the ways these descriptions helped or hindered their ability to provide responsive and supportive care to patients with intellectual disabilities. Guided by a critical disability theoretical framing and the author’s experience as a disability service professional, the author has unpacked descriptive findings to illuminate that: the emergency department is not the place for any patient with or without an intellectual disability to receive adequate mental health care, the emergency department prioritizes physical health over mental health, emergency department staff do not have adequate time, space, resources, and academic or clinical training to provide responsive and supportive care, further illuminating how the knowledge, practice, and professional experience of emergency department staff additionally contribute to the marginalization of individuals with intellectual disabilities in various systems and practices, particularly the emergency department.
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    Evaluation of a Targeted Video for Transition from Pediatric To Adult Care For Patients with Type 1 Diabetes Mellitus
    (2016) Winston, Karin; Dewey, Deborah; Pacaud, Danièle; Rabi, Doreen; Hebert, Marilynne; Ho, Josephine
    Transition from pediatric to adult care is challenging for patients with complex, chronic illnesses such as type 1 diabetes mellitus. To optimize successful transition of care, providers put great efforts into preparing patients for the change. This thesis evaluated the use of videos for patient decision-making in general and one video in particular that was designed to facilitate transition of care. The scoping review demonstrated that there is a vast amount of published data, which show that videos are effective in helping patients make decisions. The focus group study affirmed that patients appreciate the incorporation of a video in their transition preparation. These participants also noted that the process of transition required then to deal with complex emotional ambiguity as well as navigate logistic challenges. Video resources, which may be particularly useful to prepare in youth and young adults for important junctions in care, are valuable tools that should continue to be developed and refined.
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    Experiences of Albertan Families with Young Children during the COVID-19 Pandemic: Descriptive Report
    (2020-11-30) McDonald, Sheila; Edwards, Sarah; Hetherington, Erin; Racine, Nicole; Mueller, Melissa; McArthur, Brae Anne; Madigan, Sheri; Dewey, Deborah; Letourneau, Nicole; Tough, Suzanne; Geisbrecht, Gerald
    This report describes data collected from Albertan families on the COVID-19 Impact Survey implemented in May 2020, which built on a unique collaboration across two longitudinal cohorts in Alberta: The All Our Families study (AOF) and the Alberta Pregnancy Outcomes and Nutrition study (APrON). Our objectives were as follows: (1) Describe household infections of COVID-19 in Alberta among families with school-aged children; (2) Describe urban Albertan family experiences of the pandemic within the first 3-4 months of the outbreak across the areas of financial impact, maternal mental health and well-being, school and daily life, and relationships in the home; and (3) Describe associations among key predictor variables (e.g., financial impact) and outcomes (e.g., maternal anxiety, concern for child’s well-being). Study Sample: AOF and APrON Cohort participants reflect families parenting at least one child in between the ages of 8 and 12. While the respondents represent a broad range of income, education and ethnicity, they are typified by adequate income, food and housing security and partnered marital status. Highlighted Results: Physical Impact: At the time of data collection in May, 2020, over 90% of families did not have personal experience with COVID-19, either through personal infection, infection of a child, extended family member or close friend. Vaccine Intentions: Although over 60% of mothers and their children would obtain a COVID-19 vaccine when available, almost 30% are undecided and 8% would not obtain a vaccine. Financial Impact: In 58% of all families, at least one parent experienced job loss, loss of main income source, or reduced employment hours. One in five mothers reported difficulty meeting financial needs for the household, and 5% of families were experiencing food insecurity. Over 40% of respondents reported at least some impact on their ability to meet financial obligations. Mental Health and Wellness Impact: Mothers reported elevated levels of stress (21%), anxiety (25%) and depression (35%). Approximately 26% of mothers reported having limited coping skills. Almost 90% of mothers have undertaken more domestic tasks in the home. Mothers also reported that their children showed increased sadness and behavioural challenges. The COVID-19 pandemic has had profound financial and mental health impact on some families. Investment in strategies to alleviate financial stress, provide parenting supports, and alleviate mental health concerns is critical. Suggested Citation: McDonald S, Edwards S, Hetherington E, Racine N, Mueller M, McArthur BA, Madigan S, Dewey D, Geisbrecht G, Letourneau N, Tough S. Experiences of Albertan Families with Young Children during the COVID-19 Pandemic: A Descriptive Report. Calgary, Alberta: University of Calgary; 2020.
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    Exposure to Arsenic and Mercury: Associated Pregnancy Outcomes, and Early Infant Developmental Outcomes in Gold Mining Areas in Tanzania
    (2020-04-29) Nyanza, Elias Charles; Dewey, Deborah; Manyama, Mange F.; Bernier, François P.; Hatfield, Jennifer M.; Martin, Jonathan W.
    The problem: Prenatal exposure to mercury and arsenic through artisanal and small-scale gold mining (ASGM) is an under-explored yet salient issue in Tanzania. ASGM operations are known to expose the entire community—including vulnerable pregnant women and children—to arsenic and mercury via the water they drink, the food they eat, the soil in which their food is grown, and the air they breathe. Prenatal exposure to arsenic and mercury is associated with adverse reproductive outcome including spontaneous abortion, stillbirth, low birth weight, and congenital anomalies, and with poorer developmental outcomes in the children. This study used a longitudinal prospective approach to examine the associations between level of exposure prenatally to arsenic and mercury, and reproductive outcomes and early developmental outcomes in ASGM communities in Tanzania. Methods: A total of 1056 (883 in ASGM and 173 in non-ASGM) out of 1078 pregnant women who were recruited during their antenatal care clinics visits consented to participate in this research. We used minimally invasive techniques to collect urine and blood samples for total arsenic (T-As) and total mercury (T-Hg), respectively. For T-As an unprovoked morning urine sample was collected, whereas for T-Hg, a drop of whole blood was collected on filter paper (Whatman #903) following a simple finger prick. All samples were analyzed using inductively coupled plasma mass spectrometry. Measures of association between maternal T-As or T-Hg exposure, and birth outcomes and early infants’ neurodevelopmental outcome were examined by calculating the coefficient of regression/correlation between variables with their respective 95% confidence interval. Conclusion: Findings from this study revealed that pregnant women living in ASGM communities have elevated arsenic and mercury levels compared to those in non-mining communities. Women in gold mining areas of northern Tanzania had higher incidence of adverse birth outcomes associated with arsenic and mercury exposure. Maternal exposure to mercury but not arsenic was associated with an increased prevalence of severe developmental impairment among infants in gold mining areas of northern Tanzania. These findings suggest that prenatal exposure to arsenic and mercury were associated with adverse reproductive and early developmental outcomes in ASGM communities in Tanzania.
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    Fronto-striatal Network Dysfunction in Children with Developmental Coordination Disorder and Attention-Deficit/Hyperactivity Disorder
    (2015-04-06) McLeod, Kevin; Goodyear, Bradley; Dewey, Deborah
    Developmental coordination disorder (DCD) and attention-deficit/hyperactivity disorder (ADHD) are common neurodevelopmental disorders that significantly impact a child’s physical and mental health. Importantly, DCD and ADHD frequently co-occur. Behavioral, genetic and neuroimaging research have identified commonalities between children with these disorders. This thesis used resting-state functional magnetic resonance imaging (rs-fMRI) to determine the functional connections of the motor network of children with DCD, ADHD, and combined DCD and ADHD, in comparison to healthy children. In the first study, common and distinct alterations in the functional connections with the left motor cortex were identified in children with these disorders, including regions involved in sensorimotor processing and motor control. In the second study, differences in the hemispherical asymmetry of functional connections within the motor networks were also identified. These findings suggest that common brain functional networks are involved in DCD and ADHD, and that rs-fMRI is a valuable tool for furthering our understanding of the neurological underpinnings of these disorders.
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    Functional Connectivity of the Anterior Cingulate Cortex in Children with Post-traumatic Headache
    (2020-05-19) Ofoghi, Zahra; Barlow, Karen Maria; Dewey, Deborah; Yeates, Keith Owen; Bray, Signe L.; Noel, Melanie
    Post-traumatic headache (PTH) is among the most common persistent post-concussion symptoms following mild traumatic brain injury (mTBI). Investigating structural and functional neuroimaging correlates of pain or headache can help to understand biological mechanisms behind persistent PTH. In this dissertation, a systematic review was conducted to examine the neuroimaging correlates of headache or pain following mTBI. Here, in the adult populations with PTH, there was evidence to suggest alterations in descending pain modulatory mechanisms but there was a lack of research in the pediatric populations with PTH. The remainder of this thesis addresses this knowledge gap by investigating alterations in central pain processing networks with a focus on the anterior cingulate cortex (ACC). To do this, functional connectivity (FC) between the ACC and other pain-related regions was explored in children with PTH and compared to those without PTH following mTBI and uninjured healthy controls. The influence of a pre-injury headache history on ACC FC was then investigated. As other cognitive and affective symptoms are also common in children with PTH, the associations between attention problems and anxiety and ACC FC were studied. Functional connectivity of the perigenual ACC-cerebellum and the subgenual ACC-DLPFC were different in children with PTH compared to healthy controls. No significant differences, however, were found in children with and without PTH. Functional connectivity between the ventral ACC areas (rostral and perigenual) and cerebellum was significantly affected by a past history of headache problems; children with PTH and a history of headache having decreased negative FC. In children with PTH, better attention performance was associated with stronger subgenual ACC-cerebellum FC. Anxiety, however, was not associated with the ACC FC and pain-related regions. Taken together, this dissertation provides evidence of alterations in descending modulatory pain processing mechanisms in children with PTH following mTBI. Further, for the first time, neuroimaging evidence supported the effect of pre-injury headaches on connectivity between pain-related regions in children with PTH. Future studies should explore FC of other pain-related regions (e.g. periaqueductal regions, cerebellum) in central pain processing networks and their relationship with recovery.
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    Hand preference in children with autism
    (1997) Hauck, Joy Alison; Dewey, Deborah
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    Intergenerational transmission of adverse childhood experiences via maternal depression and anxiety and moderation by child sex
    (2018-07-23) Letourneau, Nicole Lyn; Dewey, Deborah; Kaplan, Bonnie J.; Ntanda, Henry N.; Novick, Jason; Thomas, Jenna C.; Deane, Andrea J.; Leung, Brenda My; Pon, Kylie; Giesbrecht, G. F.; APrON Study Team
    Adverse childhood experiences (ACEs) of parents are associated with a variety of negative health outcomes in offspring. Little is known about the mechanisms by which ACEs are transmitted to the next generation. Given that maternal depression and anxiety are related to ACEs and negatively affect children's behaviour, these exposures may be pathways between maternal ACEs and child psychopathology. Child sex may modify these associations. Our objectives were to determine: (1) the association between ACEs and children's behaviour, (2) whether maternal symptoms of prenatal and postnatal depression and anxiety mediate the relationship between maternal ACEs and children's behaviour, and (3) whether these relationships are moderated by child sex. Pearson correlations and latent path analyses were undertaken using data from 907 children and their mothers enrolled the Alberta Pregnancy Outcomes and Nutrition study. Overall, maternal ACEs were associated with symptoms of anxiety and depression during the perinatal period, and externalizing problems in children. Furthermore, we observed indirect associations between maternal ACEs and children's internalizing and externalizing problems via maternal anxiety and depression. Sex differences were observed, with boys demonstrating greater vulnerability to the indirect effects of maternal ACEs via both anxiety and depression. Findings suggest that maternal mental health may be a mechanism by which maternal early life adversity is transmitted to children, especially boys. Further research is needed to determine if targeted interventions with women who have both high ACEs and mental health problems can prevent or ameliorate the effects of ACEs on children's behavioural psychopathology.
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    Is it home delivery or health facility? Community perceptions on place of childbirth in rural Northwest Tanzania using a qualitative approach
    (2020-05-06) Konje, Eveline T; Hatfield, Jennifer; Kuhn, Susan; Sauve, Reginald S; Magoma, Moke; Dewey, Deborah
    Abstract Background In low and middle-income countries, pregnancy and delivery complications may deprive women and their newborns of life or the realization of their full potential. Provision of quality obstetric emergency and childbirth care can reduce maternal and newborn deaths. Underutilization of maternal and childbirth services remains a public health concern in Tanzania. The aim of this study was to explore elements of the local social, cultural, economic, and health systems that influenced the use of health facilities for delivery in a rural setting in Northwest Tanzania. Methods A qualitative approach was used to explore community perceptions of issues related to low utilization of health facilities for childbirth. Between September and December 2017, 11 focus group discussions were conducted with women (n = 33), men (n = 5) and community health workers (CHWs; n = 28); key informant interviews were conducted with traditional birth attendants (TBAs; n = 2). Coding, identification, indexing, charting, and mapping of these interviews was done using NVIVO 12 after manual familiarization of the data. Data saturation was used to determine when no further interviews or discussions were required. Results Four themes emerge; self-perceived obstetric risk, socio-cultural issues, economic concerns and health facility related factors. Health facility delivery was perceived to be crucial for complicated labor. However, the idea that childbirth was a “normal” process and lack of social and cultural acceptability of facility services, made home delivery appealing to many women and their families. In addition, out of pocket payments for suboptimal quality of health care was reported to hinder facility delivery. Conclusion Home delivery persists in rural settings due to economic and social issues, and the cultural meanings attached to childbirth. Accessibility to and affordability of respectful and culturally acceptable childbirth services remain challenging in this setting. Addressing barriers on both the demand and supply side could result in improved maternal and child outcomes during labor and delivery.
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    Just Fun or Fundamental? Fathers’ Narratives of Leisure with Their Children with Autism Spectrum Disorder
    (2017) Mitchell, Jennifer; Lashewicz, Bonnie; Hughson, Anne; McIntyre, Lynn; Dewey, Deborah; McConnell, David; Badry, Dorothy
    Anchored in the generative fathering framework and critical disability studies (CDS), I used a narrative approach to study 11 fathers’ stories of leisure with their children with autism spectrum disorder (ASD) to highlight how leisure activities are given meaning and constructed as part of active fathering. I produced four narratives - narratives of action, narratives of adjustment, narratives of tension and narratives of relationships that captured fathers’ experiences of leisure with their children with ASD. Narratives of action are the stories of what fathers are doing in their day- to- day interactions with their children. Narratives of adjustment depict how fathers have shifted and re-defined expectations of their children and themselves following their children’s diagnosis of ASD. Narratives of tension capture fathers’ strain in concurrently having to acquiesce and advocate against financial, environmental and societal constraints. Lastly, in narratives of relationships, fathers illustrate the relational outcomes of their involvement with their children, including an appreciation of their children’s individuality and the father-child connection. The findings augment a deeper understanding of fathering children with ASD and the father-child relationship. By understanding fathers’ perceived successes and challenges in leisure activities in the home and community settings, service providers can better engage and support fathers in home- and community-based leisure.