Nutrition education message topics and accessibility for the well-being of infants in an urban slum area

[摘要] ENGLISH ABSTRACT:The aim of the study was to contribute to the nutritional well-being of 0 - 24 month old children who attendprimary health care clinics (PHC) in Duncan Village, an urban slum. This was to be achieved by firstformulating essential nutrition-related message topics and second by formulating recommendations foroptimising the accessibility of services, including nutrition-related messages, aimed at mothers attendingPHC clinics in Duncan Village.In order to formulate targeted and relevant nutrition-related messages for mothers attending the PHC clinics(Phase I of the research) the need for more information on the six focus areas for intervention that wereidentified in the previous Duncan Village Day Hospital (DVDH) study was determined. This was donethrough key-informant interviews and studying other relevant published research. Eleven research questionsrelated to the six focus areas were subsequently formulated to guide further research. Non-scheduledstructured interviews were conducted with mothers with children in specific age groups until data saturationwas achieved. A total of 31 interviews were thus conducted at the homes of participants and observation datawas also collected at the same time. Three focus groups with corresponding participant categories were alsoconducted to check the information obtained through the interviews. Two focus groups were conducted withgrandmothers to serve as a further form of checking research but also to obtain a different perspective on theresearch questions. The data available for the formulation of the message topics was analysed qualitativelyby hand. The focus areas and the research questions gave a specific focus to the analysis process and theunprocessed data was available in these broad predetermined categories. All the information from all sources(DVDH study, the non-scheduled structured interviews with mothers, focus groups with mothers andgrandmothers and observation data) was studied, interpreted and integrated for each identified category.During this process key-factors, which need to be addressed in nutrition-related messages essential for thewell-being of infants attending PHC clinics in Duncan Village, were identified. The final step in the analysisprocess was the formulation of message topics based on these key-factors. During the analysis process itbecame clear that some of the identified key factors were not suitable for the formu lation of nutrition-relatedmessage topics but rather give insight into the total context of the mothers attending the clinics in DuncanVillage. It was evident that the information contained in the key factors could be used by health workers toidentify and assist vulnerable mothers. These key-factors led to the formulation of relevant help topics.Eighteen main message topics and 16 help topics were formulated. The message topics included topics on:self-development, household food security, breastfeeding, good feeding practices, mothers' health andnutrition and hygiene practices.in Phase 2 of the study the accessibility of services, including nutrition-related messages, to mothersattending PHC clinics in Duncan Village was determined. This was done by determining how mothers inDuncan Village experience the clinics where they could be exposed to nutrition-related messages and bydetermining the experiences of health care workers with mothers as clients as well as with service delivery.This information was obtained through focus group discussions with different participant categories. Thesecategories included mothers with children in the same age groupings as in Phase I who had either attendedclinic for all the child's immunisations or who had not attended clinic for all the child's immunisations orwho had attended clinics outside Duncan Village for immunisation purposes. Pregnant women who hadeither attended antenatal clinics or had not attended antenatal clinics were also included. The last participantcategory involved health workers. This category included health workers from the obstetric unit wheremothers from Duncan Village give birth, the primary health care clinics and community health care workers.The data obtained was analysed with ATLAS/ti, computer software specifically designed for qualitative dataanalysis. Twelve code families were created during the analysis process, each family referring to a specificaspect of accessibility of services provided at the PHC clinics. A detailed description of each code family ispresented after which six networks were compiled. The data and networks were used to create a frameworkfor data interpretation. According to the framework it is proposed that the final elements in the process ofproviding accessible nutrition-related messages to clients at clinics are (1) that the clients must attend theclinic and (2) that appropriate nutrition-related messages must be available. Problems with interpersonal andorganisational aspects of service delivery were found to be two of the most important aspects that influenceaccessibility of clinic services and therefore nutrition-related messages at the clinics.The last phase of the study (Phase 3) involved the formulation of recommendations to the relevant authoritiesabout targeted and relevant nutrition-related message topics to be included in the education of mothers andpregnant women as well as recommendations to optimise accessibility of nutrition-related messages at thethree PHC clinics in Duncan Village and the obstetric unit where mothers of Duncan Village give birth. Atotal of fifteen recommendations were formulated based on the frndings and recommendations of Phase Iand Phase 2. These recommendations focus especially on the necessity for the municipality to create a healthempowering environment at the clinics, on the provision of appropriate nutrition-related messages at theclinics and on the need to reach vulnerable mothers. The importance of involving the community in theseprocesses was also emphasised in the recommendations.It is concluded that the implementation of the recommendations will contribute to the nutritional well-beingof all young children in Duncan Village and could play an important role in realising the rights of childrenliving in the area.

[发布机构] Stellenbosch University