Community-based growth monitoring in a rural area lacking health facilities

[摘要] ENGLISH ABSTRACT:A community-based growth monitoring (GM) project was established in a rural village inKwaZulu-Natal. The project is an example of community-based activities that were based on aparticipatory approach of problem assessment and analysis. The first phase of the studycomprised of a situation assessment. The aim was to evaluate the nutritional status and relatedfactors of children aged 5 years and younger. It included a cross-sectional survey(questionnaire and anthropometric measurements), focus group discussions and interviewswith key informants. From a nutritional point of view, the situation assessment identified aneed for regular GM of infants and small children, increased availability of foods rich in micronutrients,and nutrition education.Relevant findings of the situation assessment were used during a project planningworkshop that was attended by community representatives. The community's concern aboutthe health of the preschool children and the lack of health facilities, and the need for regularweighing of their children prompted the establishment of a community-based GM project.The GM project was run by nutrition monitors, through home-based centres (namedIsizinda). Monthly activities at the Isizinda included GM, nutrition education, and recording ofmorbidity and mortality data. Children who were either in need of medical attention or showedgrowth faltering were referred to the nearest clinic. During the latter half of the study, the GMproject was integrated with a household food production project and the Isizinda served aspromotion and training centres for agricultural activities.Project activities were continuously monitored by reviewing the attendance register,scrutinising the Isizinda files, observation and staff meetings. Community meetings (at leasttwice a year) allowed for two-way feedback and addressing questions and concerns.Acceptability of the GM activities was measured in terms of attendance and maternalperceptions. The coverage of the Isizinda project was estimated at approximately 90% and atleast 60% of these children were adequately covered. The Isizinda data showed an equaldistribution of child contacts over the various age categories and was representative of thecommunity. The attendance data suggest that community-based GM is a viable option to beused for screening and nutrition surveillance, and as platform for nutrition education.Most mothers comprehended the growth curve. Positive behavioural changes havebeen observed in the community and the Isizinda data showed a steady decline in theprevalence of diarrhoea. The Ndunakazi mothers were appreciative towards the Isizinda project because of abetter understanding of the benefits of regular GM. They expressed a sense of empowermentregarding the knowledge that they have gained. The community had a strong desire for theproject to continue.The Isizinda project showed that community-based GM can provide theinfrastructure for developing capacity for agricultural activities within the community. Datafrom the household food production project showed that maternal knowledge regardingnutritional issues can be improved through nutrition education given at the GM sessions andthat, when GM is integrated with agricultural activities, a significant improvement in childmalnutrition can be obtained. The Isizinda project falls within the framework of the IntegratedNutrition Programme, and can bridge the gap in areas which lack health facilities.

[发布机构] Stellenbosch University