Childbirth fear is a health concern in women living in high-income countries; however, little is known about childbirth fear among women living in low-income countries like Malawi. In this study, we explored childbirth fear and associated factors among pregnant and postpartum women in Malawi. A cross-sectional study of 152 pregnant and 153 postpartum women was conducted at a district hospital in Malawi. Participants were assessed for childbirth fear using the Wijma Delivery Expectancy/Experience Questionnaire (WDEQ). Demographic and obstetric variables were collected using a structured questionnaire. The Multidimensional Scale of Perceived Social Support (MSPSS) was used to measure social support. Using a multinomial logistic regression, factors related to childbirth fears were examined, namely demographic and obstetric characteristics, and social support. The mean age of participants was 26 (standard deviation: 6.4) years. During pregnancy, 39% women reported a low level of fear, 41% reported moderate fear, and 20% reported high fear; while after birth, 49, 41, and 10% women reported low, moderate, and high fear, respectively. Pregnant women who were illiterate (odds ratio (OR): 5.0, p < 0.01) or unemployed (OR: 12.6, p < 0.01) were more likely to report moderate and high fear. Postpartum mothers who were illiterate (OR: 4.2, p < 0.01) or unemployed (OR: 11.8, p < 0.01) were more likely to have moderate and high fear. Furthermore, postpartum women who sustained perineal tears had significantly higher odds of experiencing moderate (OR: 5.3, p < 0.01) or high (OR: 19.9, p < 0.01) fear than their counterparts. Childbirth fear is common in Malawi, and pregnant women are more likely to experience high levels of fear than postpartum women. This study highlighted the connection between childbirth fear with mother’s education, employment, and perineal tears during delivery. Identifying and developing interventions for women with these associated characteristics is of clinical importance for the reduction of childbirth fear before and after childbirth in Malawi.

The purpose of this study was to pilot test the effects of a culturally adapted early intervention influenced by the Early Start Denver Model (ESDM) on reduction of autism symptoms and severity categorization for young children with autism spectrum disorders in China. Participants were randomly assigned to either the control or intervention groups. The children’s age ranged from 24 to 60 months in this study. Children in the control group (n = 20) received eclectic intervention services for a minimum of 2 hr per day, 10 hr per week, while children in the intervention group (n = 16) received the culturally adapted intervention 1 hr per day, 5 hr per week, plus 5 hr per week of the same services as the control group for a total of 8 weeks. After 8 weeks, children in the intervention group demonstrated a significant decrease in autism symptoms and improved severity categorization, compared with children in the control group. Future studies and implications of the culturally adapted early intervention in China are discussed.

Effective strategies to address communication and behavior challenges are critical in early intervention programs. The purpose of this study was to investigate the effects of the Picture Exchange Communication System (PECS) on vocal mands and aggressive behavior displayed by a child with autism in China. One 4-year-old boy with autism participated in this study. The experimental design was a multiple baseline across three settings. The PECS intervention involved the first three phases described in the PECS manual. The results indicated that PECS effectively increased vocal mands and decreased aggressive behavior maintained by access to preferred items in all three settings. The results also suggested that vocal mands were potentially controlled by pictures in the PECS book. One week following the completion of the intervention, the child maintained the PECS exchanges at a high level with increased vocal mands. His aggressive behavior remained at almost zero occurrences. Results of this study have important implications to early intervention educators working with children with autism.