Assessing the utilisation of a child health monitoring tool

Abstract

Background. The Road-to-Health booklet (RtHB), a standardised national tool for growth monitoring and the assessment of health among children from birth to five years of age, was introduced in South Africa in February 2011.

Objectives. The study assessed the implementation of growth monitoring and promotion, immunisation, vitamin A supplementation, and deworming sections of the RtHB. Caregivers’ (CGs) and healthcare workers’ (HCWs') knowledge, attitudes and practices were investigated as well as HCWs’ perceptions of barriers undermining implementation.

Methods. A cross-sectional descriptive study was conducted on a proportional sample of randomly selected primary healthcare facilities across six health districts (35%; n=143) in the Western Cape Province. HCWs involved in the implementation of the RtHB booklet, children (aged 0 - 36 months) and CGs were included. Information was obtained through scrutiny of the RtHB, observation of consultations and structured questionnaires.

Results. A total of 2 442 children, 2 481 CGs and 270 HCWs were recruited. Weight measurements (94.7%, n=2 251/2 378) were performed routinely. Less than half (40.2%; n=997/2 481) of CGs reported that their child’s growth had been explained to them. Sixty-eight percent of HCWs (n=178/260) correctly identified criteria for underweight classification, whereas only 55% (n=134/245) and 39% (n=95/245) could do so for stunting and wasting, respectively. The RtHB sections were completed adequately for immunisation (89.3%; n=2 171/2 431) and vitamin A supplementation (94.6%; n=1 305/1 379) but not for deworming (48.8%; n=176/361). Most HCWs (93%; n=209/223) knew the correct regimens for vitamin A supplementation, but few CGs knew when treatment was due for vitamin A supplementation (16.4%, n=409/1 646) and deworming  (26.2%; n=650/2 481). Potential barriers identified related to inadequate training, staff shortages and limited time.

Conclusion. Focused efforts and resources should be channelled towards HCWs’ training and monitoring regarding growth monitoring and promotion to optimise utilisation of the RtHB. Mobilisation of community health workers is needed to strengthen community awareness of preventive health interventions.