Background to the Research

• The DHSS Regional Strategy 'Health & Social Well-Being into the Millennium' (1996) recommends that health and social well-being should be addressed through community development approaches. With this in mind, CHIP entered into negotiations with FHSST in June 1994 with a view to carrying out a survey of the health and social needs of children under five years of age in Creggan. The survey was carried out in June 1997 by local people with the support of professionals in the statutory, community and voluntary sectors.
  

Research Approach

• A questionnaire was administered by the survey team to the parents of all children born in the Creggan after 2 July 1992. Data was collected for the 397 children living in 312 households in the estate - this represented 93% of the total of 337 households identified as having children of five years of age or under. The data was analysed using SPSS.
  

Main Findings

The Parents

• The majority of mothers were between 26 and 30 years of age, 6% (17) were under 21 years. The majority of fathers were aged between 31 and 35 years and 5 were under 21 years.
• The average number of children per household under 16 years was 2.8 and 25% of families had more than one child under 5 years.
• Forty-four per cent of the fathers and 71% of the mothers surveyed were unemployed. Over half of the mothers who were working were in part-time employment, as were around a third of the fathers. The most common occupation for both men and women was factory work.
• In 71% of households surveyed, neither parent had ever participated in an Employment Training Scheme. In 75% of households surveyed, neither parent had ever participated in adult education and those that had were mainly the mothers.
• Whilst the majority of respondents dwell in houses, 31 families (12%) occupy flats or accommodation shared with wider family. A third of respondents stated that their accommodation didn't meet their needs. A quarter reported their accommodation was either too small (not enough rooms) or that the kitchen was too small.
• The daily bus service from the Creggan to Derry city stops at 6:30pm and there is no service on a Sunday. Fifty-seven per cent of respondents live in households without a car.
• Three quarters of mothers had never attended anti-natal classes. The majority of women surveyed had their babies in hospital - which was their place of choice - and 12 had their babies at home. Fifty-seven women (nearly one-in-seven) had complicated births, of these 37 had Caesarean Sections, 10 forceps deliveries, seven vacuum assisted and three induced labour.
• One-in-six mothers stated that their health was not good, a sixth of mothers reported a variety of symptoms including depression, anaemia, asthma and a combination of these and other symptoms.
• Almost a third of mothers (98) reported being depressed after the birth of their baby, with just under a third of these seeking medical help. Over a quarter of those who reported having difficult births complained of depression in the post-natal period.

The Children

• The majority of respondents felt their children were developing well, twenty-two raised concerns. Most respondents stated that they took part in activities which helped their children to develop. Almost nine out of ten children are read to or played with on a regular basis by various members of the family.
• Half of the respondents reported that their source of knowledge about child development came from 'experience', over a third cited their own mothers and sisters and one in ten mentioned health visitors, community mothers and 'parentcraft'.
• Over a half of respondents reported that their children were enrolled at play school and a third at nursery school. Where more than one child under five was in a household, a fifth of the older siblings under five were not enrolled anywhere and many of these parents cited a lack of knowledge about availability or eligibility for places.
• The majority of parents reported trying to protect their children's first teeth and one in seven said they did nothing to prevent decay. Overall there was a feeling that few dental services were available to families. A quarter of families said they lacked information about dental care.
• Eighty-nine per cent of respondents stated that their last born child's immunisation schedule was up to date and the figure for older children was 91%. Half the parents used their GP practices to have children immunised and the other half used the Creggan Baby Clinic.
• One child in six suffers from the symptoms of asthma and one in seven children had eczema. Eighteen children were hyperactive, six had behavioural problems and three children had epilepsy. The majority of respondents reported that they lacked information about their children's condition.
• Almost a third of children had had an accident that required hospital treatment, these included broken limbs and abrasions due to falls. The same proportion of children had been admitted to hospital mainly due to asthma or other chest problems.
• Forty-four children in the survey were identified as having special needs. Occupational therapy was the service most commonly used by more than half this group. The majority of respondents reported they had support from their own families with these children with special needs. Parents with a child with identified special needs are more likely to receive support from family and professionals if they have only one child.

Support Services

• When a child was ill, four out if five respondents consulted a family member or friend first, one in five reported that they would consult a doctor first, whilst one- third said they would try and deal with the situation themselves.
• Three quarters of respondents said they would turn to family or friends when they needed help of a general kind. The remainder mentioned a variety of agencies, including councillors and only a few mentioned health and social service staff.
• Nine out of ten respondents reported being satisfied with the health services overall, just over a tenth of mothers reported being dissatisfied with some aspects of the health services.
• Four out of ten respondents reported having contact with the social services, one third found this contact dissatisfactory.
• One in five respondents did not find it easy to get to their GP's surgery. Access to transport was problematic for many families, especially when the 'out of hours' service was operating at night.

The Physical Environment

• The highest levels of satisfaction were reported for the supermarket, taxis and mobile shops and the highest levels of dissatisfaction were recorded for the play facilities, parks and youth facilities.
• When asked what other services were needed in Creggan, respondents mentioned a swimming pool, a leisure centre and facilities for the 12-15 year olds in the area.

Key Recommendations

• Community employment initiatives should be introduced which focus on the provision of neighbourhood services addressing the needs of local people.
• A locally based initiative should be set up to look at new approaches in the areas of employment and the delivery of community-led services.
• Creggan Pre-school Carers should formulate a policy and secure the commitment of the public, voluntary and private sectors on the provision of child-care facilities.
• The T&EA, the Department of Education and the WELB should ensure that the education and training needs of local people (particularly the long-term and young unemployed) are prioritised.
• Homework clubs should be set up and parents encouraged to be involved in their establishment and running.
• Foyle Trust should develop a campaign to raise awareness that the Community Dental Service provides for any child who has difficulty in obtaining care from General Dental Services and offer all children a first visit to their service.
• Derry City Council's environmental Health Department alongside the WHSSBs Public Health Medicine Department, should investigate the factors related to the increased incidence of asthma in Creggan.
• Derry City Council and the DOE should undertake an audit of safe playing facilities in Creggan and increase provision of such playing areas.
• A survey of transport should be undertaken by local groups within the context of a community transport scheme. The DOE, Derry City Council and local transport authorities should develop an efficient public transport system which takes into account the physical layout of the area.
• FHSST, in partnership with local people, should develop a community based, holistic approach to meeting the needs of mothers and their families.
• Government should recognise the capacity and cost effectiveness of local providers in delivering high quality pre-school care. They should fund provision in this area and help raise standards.
• A community initiative should be developed to raise awareness about good nutrition, this should be combined with a multifaceted practical approach, including a vegetable co-operative and community garden.
• Foyle Trust should review support services for parents of children with identified special needs and develop mechanisms for the determining and meeting of these needs.
• There is an urgent need for a 'user friendly' Healthy Living Centre in Creggan which can provide reliable information and assistance to people in accessing appropriate services.
• A mutli-sectoral audit of all services in Creggan should be undertaken by FHSST, in partnership with community groups and Government must provide the resources to implement the findings.
• CHIP, in partnership with the Health Promotion Department of the Trust should develop a public education programme raising awareness of the availability and value of the health and social services in the area.
• The Trust's Family and Child Care Programme should appoint a social worker exclusively for Creggan to work in a pro-active, educational and supportive role in partnership with relevant community groups.
• The GP unit of WHSSB should investigate the possibility of piloting an Emergency Phone System linked to the GP Co-operative and Altnagelvin Hospital.
• Altnagelvin Hospitals Trust should conduct an audit regarding the services it provides including the attitudes of staff. It should raise awareness among staff of the adverse effects on health of poverty and low income.