How can growth monitoring and special care of underweight children be improved in Zambia?
Msefula, D.
Tropical Doctor 23(3): 107-112
1993
ISSN/ISBN: 0049-4755 PMID: 8356736 DOI: 10.1177/004947559302300306Document Number: 336283
In 1988 in Zambia, an evaluation of the growth monitoring program in Lusaka occurred. The training survey involved interviews with teachers of nutrition, community health, or child health, and examination of the courses' curricula. The service survey encompassed health worker activities at 11 growth monitoring clinics. 405 mothers served by these clinics made up the community survey. All 8 institutions adequately trained students in weighing, plotting weight, and how to read the growth curve. Yet, teachers did not cover growth monitoring as a cohesive whole but separately under various subjects. They did not teach growth promotion. Just 2 institutions informed students about the curative role when growth falters and used participatory learning techniques. None addressed growth monitoring consultation and follow-up action in the case of growth faltering. Health workers tended to handle growth monitoring techniques well, but they failed to calibrate scales, to keep they at eye level, and often to remove extra clothing. Crowded clinics allowed healthy workers little time (mean, 30 seconds) to interact with mothers and children and to give mothers practical advice. 75% of the clinics provided group health education that used appropriate education technics (e.g., mothers' participation and audiovisual aids). Children and mothers attended the clinics infrequently, especially after 12 months. The attendance pattern matched the immunization schedule. In fact, most mothers (77%) took their children to the growth monitoring clinic for immunizations. Most mothers (73%) could interpret the growth curve, yet they could not do what the health workers told them to do because they could not afford to buy the suggested foods (89% of mothers). These findings showed that insufficient growth promotion, beginning during training, has a ripple effect at the service level and with mothers.