A description of growth monitoring and promotion activities at primary care level in Grahamstown, Makana Sub-District, Eastern Cape.

Abstract

Aim To describe growth monitoring and growth promotion (GMP) activities in children aged 0-24 months at primary healthcare facilities in Grahamstown, Makana Sub-District, Eastern Cape. Methods A cross-sectional descriptive study design was implemented. A sample of one hundred and sixty-four children from birth to twenty four months attending seven clinics in Grahamstown for well-baby visits, sick visits and growth monitoring and promotion from November 2012 to January 2014were included in this study. A Road-to-Health Booklet audit checklist and caregiver questionnaire were used to collect the data. Frequency distributions were reported for appropriate GMP activities. Appropriate GMP was defined as: correct use of weight-for-age index; growth interpreted correctly and discussed with caregiver; interventions promoted or given as indicated; and follow-up scheduled according to the relevant Department of Health policies. Results From the Road-to-Health Booklets sampled at the seven clinics and from caregiver interviews forty-seven (28.7%) of the children had evidence of appropriate GMP, although the majority of children sampled were weighed at their clinic visit. One hundred and twenty (80.0%) of the caregivers reported that their children were weighed by community health workers. The prevalence of appropriate GMP was significantly different according to the primary healthcare facility attended by the child (p=0.046 for the seven facilities using Fisher’s exact test). In the children sampled, seventeen (18.1%) had a recorded length in their Road-to-Health Booklet and for only nine (10.0%) of the children was the length for age plotted. There was no documented evidence in any of the Road-to-Health Booklets indicating that length measurements were interpreted. Discussion There is over emphasis on the technical aspects of GMP such as weighing of children, i.e. growth monitoring compared to growth promotion. Optimal GMP practice requires growth measurement, interpretation and intervention, e.g. nutritional counselling for growth promotion, with caregiver engagement in discussions about child growth. Sub-optimal GMP persists after the implementation of the new Road-to-Health Booklet, as evidenced by: inadequate interpretation of growth indices; lack of appropriate interventions for growth faltering; and poor follow-up. Length-based measurements are not used routinely in child growth assessment since their addition to the RTHB in 2010. Conclusion Implementation of quality growth monitoring and promotion activities at primary care facilities in Grahamstown remains problematic after the introduction of the revised Road-to-Health Booklet and additional growth indices.