1
|
Taylor M, Tapkigen J, Ali I, Liu Q, Long Q, Nabwera H. The impact of growth monitoring and promotion on health indicators in children under five years of age in low- and middle-income countries. Cochrane Database Syst Rev 2023; 10:CD014785. [PMID: 37823471 PMCID: PMC10568659 DOI: 10.1002/14651858.cd014785.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
BACKGROUND Undernutrition in the critical first 1000 days of life is the most common form of childhood malnutrition, and a significant problem in low- and middle-income countries (LMICs). The effects of undernutrition in children aged under five years are wide-ranging and include increased susceptibility to and severity of infections; impaired physical and cognitive development, which diminishes school and work performance later in life; and death. Growth monitoring and promotion (GMP) is a complex intervention that comprises regular measurement and charting of growth combined with promotion activities. Policymakers, particularly in international aid agencies, have differing and changeable interpretations and perceptions of the purpose of GMP. The effectiveness of GMP as an approach to preventing malnutrition remains a subject of debate, particularly regarding the added value of growth monitoring compared with promotion alone. OBJECTIVES To evaluate the effectiveness of child growth monitoring and promotion for identifying and addressing faltering growth, improving infant and child feeding practices, and promoting contact with and use of health services in children under five years of age in low- and middle-income countries. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was 3 November 2022. SELECTION CRITERIA We included randomised controlled trials (RCTs), cohort studies, and controlled before-after studies that compared GMP with standard care or nutrition education alone in non-hospitalised children aged under five years. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods to conduct a narrative synthesis. Our primary outcomes were anthropometric indicators, infant and child feeding practices, and health service usage. Secondary outcomes were frequency and severity of childhood illnesses, and mortality. We used GRADE to assess the certainty of evidence for each primary outcome. MAIN RESULTS We included six studies reported in eight publications. We grouped the findings according to intervention. Community-based growth monitoring and promotion (without supplementary feeding) versus standard care We are unsure if GMP compared to standard care improves infant and child feeding practices, as measured at 24 months by the proportion of infants who have fluids other than breast milk introduced early (49.7% versus 70.5%; 1 study; 4296 observations; very low-certainty evidence). We are unsure if GMP improves health service usage, as measured at 24 months by the proportion of children who receive vitamin A (72.5% versus 62.9%; 1 study; 4296 observations; very low-certainty evidence) and the proportion of children who receive deworming (29.2% versus 14.6%; 1 study; 4296 observations; very low-certainty evidence). No studies reported selected anthropometric indicators (weight-for-age z-score or height-for-age z-score) at 12 or 24 months, infant and child feeding practices at 12 months, or health service usage at 12 months. Community-based growth monitoring and promotion (with supplementary feeding) versus standard care Two studies (with 569 participants) reported the mean weight-for-age z-score at 12 months, providing very low-certainty evidence: in one study, there was little or no difference between GMP and standard care (mean difference (MD) -0.07, 95% confidence interval (CI) -0.19 to 0.06); in the other study, mean weight-for-age z-score worsened in both groups, but we were unable to calculate a relative effect. GMP versus standard care may make little to no difference to the mean height-for-age z-score at 12 months (MD -0.15, 95% CI -0.34 to 0.04; 1 study, 337 participants; low-certainty evidence). Two studies (with 564 participants) reported a range of outcome measures related to infant and child feeding practices at 12 months, showing little or no difference between the groups (very low-certainty evidence). No studies reported health service usage at 12 or 24 months, feeding practices at 24 months, or selected anthropometric indicators at 24 months. AUTHORS' CONCLUSIONS There is limited uncertain evidence on the effectiveness of GMP for identifying and addressing faltering growth, improving infant and child feeding practices, and promoting contact with and use of health services in children aged under five years in LMICs. Future studies should explore the reasons for the apparent limited impact of GMP on key child health indicators. Reporting of GMP interventions and important outcomes must be transparent and consistent.
Collapse
Affiliation(s)
- Melissa Taylor
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Israa Ali
- Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Qin Liu
- Affiliate of the Cochrane China Network, School of Public Health, Chongqing Medical University, Chongqing, China
| | - Qian Long
- Global Health Research Center, Duke Kunshan University, Kunshan, China
| | - Helen Nabwera
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| |
Collapse
|
2
|
Birth Weight and Body Composition as Determined by Isotopic Dilution with Deuterium Oxide in 6- to 8-Year-Old South African Children. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9101597. [PMID: 36291533 PMCID: PMC9600216 DOI: 10.3390/children9101597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 10/11/2022] [Accepted: 10/19/2022] [Indexed: 11/18/2022]
Abstract
Low and high birth weight (BW) are associated with obesity later in life; however, this association has not been extensively studied in African countries. This study determines the association between BW and body composition derived from deuterium oxide (D2O) dilution in 6- to 8-year-old South African children (n = 91; 40 boys, 51 girls). BW was recorded retrospectively from the children’s Road-to-Health cards. Weight and height were measured using standard procedures, and D2O dilution was used to determine total body water and, subsequently, to determine body fat. Fatness was classified using the McCarthy centiles, set at 2nd, 85th, and 95th (underfat, overfat and obese). BW correlated with body composition measures, such as body weight (r = 0.23, p = 0.03), height (r = 0.33, p < 0.001), and fat free mass (FFM; r = 0.27, p = 0.01). When multiple regression analysis was employed, BW significantly and positively associated with FFM (β = 0.24, p = 0.013; 95% CI: 0.032; 0.441) and fat mass (β = 0.21, p = 0.02, 95%CI: 0.001; 0.412) in girls and boys combined. A total of 13% of the children had a low BW, with 21% being overweight and 17% obese. More girls than boys were overweight and obese. Intervention strategies that promote healthy uterine growth for optimal BW are needed in order to curb the global obesity pandemic.
Collapse
|
3
|
Joseph L, Lavis A, Greenfield S, Boban D, Jose P, Jeemon P, Manaseki-Holland S. A systematic review of home-based records in maternal and child health for improving informational continuity, health outcomes, and perceived usefulness in low and middle-income countries. PLoS One 2022; 17:e0267192. [PMID: 35925923 PMCID: PMC9352021 DOI: 10.1371/journal.pone.0267192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 04/04/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Evidence shows that a gap in the documentation of patients' past medical history leads to errors in, or duplication of, treatment and is a threat to patient safety. Home-based or patient-held records (HBR) are widely used in low and middle-income countries (LMIC) in maternal and childcare. The aim is to systematically review the evidence on HBRs in LMICs for (1) improving informational continuity for providers and women/families across health care visits and facilities, (2) to describe the perceived usefulness by women/families and healthcare providers, and (3) maternal and child health outcomes of using HBRs for maternal and child health care. METHODS The protocol was registered in PROSPERO (CRD42019139365). We searched MEDLINE, EMBASE, CINAHL, and Global Index Medicus databases for studies with home-based records from LMICs. Search terms pertained to women or parent-held records and LMICs. Two reviewers assessed studies for inclusion using a priori study selection criteria- studies explaining the use of HBRs in LMIC for maternal and child health care. The included study quality was appraised using the Mixed Methods Appraisal Tool (MMAT). Results from all study designs were summarised narratively. RESULTS In total, 41 papers were included in the review from 4514 potential studies. Included studies represented various study designs and 16 countries. The least evaluated function of HBR was information continuity across health care facilities (n = 6). Overall, there were limited data on the usefulness of HBRs to providers and mothers/families. Home-based records were mostly available for providers during health care visits. However, the documentation in HBRs varied. The use of HBRs is likely to lead to improved antenatal visits and immunisation uptake, and skilled birth delivery in some settings. Mothers' knowledge of breastfeeding practices and danger signs in pregnancy improved with the use of HBRs. One randomised trial found the use of HBRs reduced the risk of cognitive development delay in children and another reported on trial lessened the risk of underweight and stunted growth in children. CONCLUSION There is limited literature from LMICs on the usefulness of HBRs and for improving information transfer across healthcare facilities, or their use by women at home. Current HBRs from LMICs are sub-optimally documented leading to poor informational availability that defeats the point of them as a source of information for future providers.
Collapse
Affiliation(s)
- Linju Joseph
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Anna Lavis
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Sheila Greenfield
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Dona Boban
- Amrita Institute of Medical Sciences and Research Centre, Cochin, India
| | - Prinu Jose
- Public Health Foundation of India, New Delhi, India
| | - Panniyammakal Jeemon
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Semira Manaseki-Holland
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
- * E-mail:
| |
Collapse
|
4
|
Liu Q, Taylor M, Nabwera H, Long Q. The impact of growth monitoring and promotion on health indicators in children under five years of age in low- and middle-income countries. Hippokratia 2021. [DOI: 10.1002/14651858.cd014785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Qin Liu
- Affiliate of the Cochrane China Network; School of Public Health and Management, Chongqing Medical University; Chongqing China
| | - Melissa Taylor
- Department of Clinical Sciences; Liverpool School of Tropical Medicine; Liverpool UK
| | - Helen Nabwera
- Department of Clinical Sciences; Liverpool School of Tropical Medicine; Liverpool UK
| | - Qian Long
- Global Health Research Center; Duke Kunshan University; Kunshan China
| |
Collapse
|
5
|
Kalangu KKN, Esene IN, Dzowa M, Musara A, Ntalaja J, Badra AK. Towards zero infection for ventriculoperitoneal shunt insertion in resource-limited settings: a multicenter prospective cohort study. Childs Nerv Syst 2020; 36:401-409. [PMID: 31455997 DOI: 10.1007/s00381-019-04357-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 08/15/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Shunting for hydrocephalus can lead to improvement in the quality of life although the latter has been subdued by complications like shunt infection. Established protocols have contributed to the reduction of ventriculoperitoneal shunt (VPS) infections. Previously, we retrospectively demonstrated a low infection rate despite some of the protocol recommendations not being implemented. The aim of this study was to prospectively establish the incidence of shunt infection in the early post-shunt period following our protocol and elucidate on associated risk factors. PATIENTS AND METHODS A multicenter prospective descriptive cohort study of consecutive 209 under-5 children requiring VPS for hydrocephalus was conducted between January 2013 and November 2018. An innovative protocol insisting on intermittent application of povidone-iodine on the skin during the operation was implemented. The patients were followed-up for 3 months post-surgery. RESULTS Included were 211 VPS procedures performed on 209 children. The median age was 9 months and 84 were males. Hydrocephalus was non-communicative in 72.0% and aqueductal stenosis was its most frequent cause (84.9%). Most surgeries were performed in the morning (90.5%), electively (95.3%), and for the first time (91%). The median duration of surgery was 65 min. Shunt infection rate was 1.9% (n = 4) (95% CI 0.7 to 5.0%) per procedure. CONCLUSION The observed infection rate was low. This suggests that the protocol followed captured the most critical components necessary to ensure low infection rates and that simple measures implemented in economically challenged environments may achieve internationally acceptable infection rates.
Collapse
Affiliation(s)
- Kazadi K N Kalangu
- Neurosurgery Division, Department of Surgery, University Of Zimbabwe, Harare, Zimbabwe.
| | - Ignatius N Esene
- Neurosurgery Division, Department of Surgery, University Of Bamenda, Bamenda, Cameroon
| | - Maximillian Dzowa
- Neurosurgery Division, Department of Surgery, University Of Zimbabwe, Harare, Zimbabwe
| | - Aaron Musara
- Neurosurgery Division, Department of Surgery, University Of Zimbabwe, Harare, Zimbabwe
| | - Jeff Ntalaja
- Department of Neurosurgery, University of Lubumbashi, Lubumbashi, Democratic Republic of Congo
| | - Aliou K Badra
- Neurosurgical Unit, Medipark/Oshakati Hospital, University of Namibia, Windhoek, Namibia
| |
Collapse
|
6
|
Sulley I, Abizari AR, Ali Z, Peprah W, Yakubu HG, Forfoe WW, Saaka M. Growth monitoring and promotion practices among health workers may be suboptimal despite high knowledge scores. BMC Health Serv Res 2019; 19:267. [PMID: 31035985 PMCID: PMC6489312 DOI: 10.1186/s12913-019-4103-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 04/16/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The child health record booklet (CHRB) is a powerful tool for screening children under five and for education of caregivers by health workers. The objective of the present study was to assess the knowledge and utilization of CHRB by mothers and health workers in child growth monitoring and promotion (GMP) in the East Mamprusi Municipal, Northern region, Ghana. METHODS A descriptive cross-sectional study was conducted among mothers attending child welfare clinics (CWC) and health workers providing GMP at CWC. Observational checklists were used to assess 73 CHRB on the completeness and correctness of growth charts. Mothers and health workers' knowledge on essential components of CHRB were assessed with a questionnaire. RESULTS Weight measurements were correctly recorded in all booklets analyzed. Even though a greater proportion (70.7%) of health workers exhibited high knowledge scores on the interpretation of the essential components of the CHRB,most of the charts analyzed were not completely filled (72.6%) but rather correctly filled (74.0%). Mean knowedge score (3.4 ± 1.3) on growth charting was low among mothers who attend GMP. Work overload (26.1%), inadequate supply of CHRB (26.1%) and vaccine shortages (18.7%) were concerns raised by health workers on the effective usage of the CHRB. CONCLUSION Knowledge scores on the child health record booklets among health workers and mothers in this part of northern Ghana were high but charting of growth of children was sub-optimal among health workers.
Collapse
Affiliation(s)
- Issahaku Sulley
- Department of Nutritional Sciences, School of Allied Health Sciences, University for Development Studies, P O Box 1883, Tamale, Ghana
| | - Abdul-Razak Abizari
- Department of Nutritional Sciences, School of Allied Health Sciences, University for Development Studies, P O Box 1883, Tamale, Ghana.
| | - Zakari Ali
- Department of Nutritional Sciences, School of Allied Health Sciences, University for Development Studies, P O Box 1883, Tamale, Ghana
| | - Wisdom Peprah
- Department of Nutritional Sciences, School of Allied Health Sciences, University for Development Studies, P O Box 1883, Tamale, Ghana
| | - Hamshawu Gombilla Yakubu
- Department of Nutritional Sciences, School of Allied Health Sciences, University for Development Studies, P O Box 1883, Tamale, Ghana
| | - Wilfred W Forfoe
- Impact Malaria Project, 14 Ollenu Street, East Legon, PMB 18, Accra, Ghana
| | - Mahama Saaka
- Department of Nutritional Sciences, School of Allied Health Sciences, University for Development Studies, P O Box 1883, Tamale, Ghana
| |
Collapse
|
7
|
Ramraj T, Goga AE, Larsen A, Ramokolo V, Bhardwaj S, Chirinda W, Jackson D, Nsibande D, Ayalew K, Pillay Y, Lombard CJ, Ngandu NK. Completeness of patient-held records: observations of the Road-to-Health Booklet from two national facility-based surveys at 6 weeks postpartum, South Africa. J Glob Health 2018; 8:020901. [PMID: 30356823 PMCID: PMC6189547 DOI: 10.7189/jogh.08.020901] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Continuity of care is important for child well-being in all settings where postnatal retention of mother-infant pairs in care remains a challenge. This analysis reports on completeness of patient-held infant Road to Health Booklets (RtHBs), amongst HIV exposed and unexposed infants during the first two years after the RtHB was launched country-wide in South Africa. Methods Secondary data were analysed from two nationally representative, cross-sectional surveys, conducted in 2011-12 and 2012-13. These surveys aimed to measure early effectiveness of the national programme for preventing vertical HIV transmission. Participants were eligible for this analysis if they were 4-8 weeks old, receiving their six-week immunisation, not needing emergency care and had their RtHBs reviewed. Caregivers were interviewed and data abstracted from RtHBs. RtHB completeness across both surveys was defined as the proportion of RtHBs with any of the following indicators recorded: infant birth weight, BCG immunisation, maternal syphilis results and maternal HIV status. A partial proportional odds logistic regression model was used to identify factors associated with completeness. Survey sampling weights were included in all analyses. Results Data from 10 415 (99.6%) participants in 2011-12 and 9529 (99.2%) in 2012-13 were analysed. Overall, recording of all four indicators increased from 23.1% (95% confidence interval (CI) = 22.2-24.0) in 2011-12 to 43.3% (95% CI = 42.3-44.4) in 2012-13. In multivariable models, expected RtHB completeness (ie, recording all four indicators vs recording of <4 indicators), was significantly (P<0.05) associated with survey year, marital status, socio-economic status, maternal antenatal TB screening, antenatal infant feeding counselling, delivery at a clinic or hospital and type of birth attendant. Conclusions Routine patient-held infant health RtHB, a critical tool for continuity of care in high HIV/TB prevalence settings, was poorly completed, with less than 50% of the RtHB showing expected completeness. However, government efforts for improved usage of the booklet were evidenced by the near doubling of completeness from 2011 to 2013. Education about its importance and interventions aiming at optimising its use without violating user privacy should be continued.
Collapse
Affiliation(s)
- Trisha Ramraj
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Ameena E Goga
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa.,Department of Paediatrics and Child Health, Kalafong Hospital, University of Pretoria, South Africa
| | - Anna Larsen
- US Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and Tuberculosis, Pretoria, South Africa
| | - Vundli Ramokolo
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | | | - Witness Chirinda
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Debra Jackson
- School of Public Health, University of the Western Cape, Cape Town, South Africa.,UNICEF, New York, New York, USA
| | - Duduzile Nsibande
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Kassahun Ayalew
- US Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and Tuberculosis, Pretoria, South Africa
| | - Yogan Pillay
- National Department of Health, Pretoria, South Africa
| | - Carl J Lombard
- Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa.,School of Public Health and Family Medicine, University of Cape Town, South Africa
| | - Nobubelo K Ngandu
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | | |
Collapse
|
8
|
Malan MF, Rabie T, Muller CE. Evaluating the Integrated Management of Childhood Illness counselling skills of professional nurses in the North West Province of South Africa. Health SA 2018; 23:1074. [PMID: 31934374 PMCID: PMC6917376 DOI: 10.4102/hsag.v23i0.1074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 06/05/2018] [Indexed: 11/15/2022] Open
Abstract
Background The Integrated Management of Childhood Illness (IMCI) strategy provides guidelines for supporting and improving the health system to reduce under-5 children’s mortality rates. This strategy specifically assists professional nurses with the case management of children aged birth–5 years. Aim The purpose of this study was to investigate how professional nurses provided counselling to caregivers of under-5 children based on the IMCI strategy in Primary Health Care facilities of one district in the North West Province of South Africa. Setting Primary Health Care (PHC) facilities of one district in the North West Province. Method A quantitative, descriptive and observational design was used. Counselling provided by the professional nurses was observed and a checklist was completed. This IMCI counselling checklist was based on aspects in the counselling section of the Health Facility Survey, formulated according to the IMCI strategy’s requirements. Results Counselling that focused on feeding, administration of medication and counselling skills used during the consultation were good. However, counselling of caregivers of children aged 13 months to 5 years could be improved and the caregivers’ health status should also be addressed. Conclusion Counselling provided to caregivers of under-5 children regarding feeding, administering of medication and caregivers’ health status used effective communication skills. However, technicalities of feeding such as lactation and nutritional guidance posed challenges.
Collapse
Affiliation(s)
| | - Tinda Rabie
- School of Nursing Science NuMIQ Focus Area, North-West University, South Africa
| | - Catherina E Muller
- School of Nursing Science NuMIQ Focus Area, North-West University, South Africa
| |
Collapse
|
9
|
TB Presenting as Recurrent Pneumonia in a HIV-Infected Infant in Central Viet Nam. REPORTS 2018. [DOI: 10.3390/reports1020012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We report on a six-month-old infant admitted to our intensive care unit (ICU) with recurrent severe pneumonia. The mother was infected with human immunodeficiency virus (HIV)-infected, but initially failed to disclose this to doctors. Neither did she report the grandmother of the child’s chronic coughing, likely due to tuberculosis (TB). The infant was diagnosed with X-pert MTB/RIF® confirmed TB and tested positive for HIV infection. Once a correct diagnosis was established, the child demonstrated good recovery with appropriate TB and antiretroviral treatment (ART). The case demonstrates the importance of including TB in the differential diagnosis for young children not responding to first-line pneumonia treatment, especially in TB endemic areas. Taking a meticulous TB and HIV exposure history, with careful consideration of potential social stigma, is essential. It also demonstrates how the inaccessibility of HIV results and the absence of a continuous patient record may jeopardize patient care.
Collapse
|
10
|
Naidoo H, Avenant T, Goga A. Completeness of the Road-to-Health Booklet and Road-to-Health Card: Results of cross-sectional surveillance at a provincial tertiary hospital. South Afr J HIV Med 2018; 19:765. [PMID: 29707387 PMCID: PMC5913769 DOI: 10.4102/sajhivmed.v19i1.765] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 10/30/2017] [Indexed: 11/07/2022] Open
Abstract
Background Accurate record-keeping is important for continuity and quality of care. Completing a child’s Road-to-Health Booklet (RTHB), or the older, less detailed, Road-to-Health Card/Chart (RTHC), immediate interpretation thereof and appropriate action facilitates comprehensive care, which could contribute to a decline in child morbidity and mortality. Objective This study aimed to assess the extent to which healthcare personnel working in catchment clinics of Kalafong Provincial Tertiary Hospital (KPTH), Tshwane district, South Africa, complete HIV-related, sociodemographic, neonatal, growth and immunisation information in the RTHC and/or RTHB. Methods A cross-sectional, quantitative record review was conducted. Data were extracted from 318 RTHCs and/or RTHBs of children attending KPTH for paediatric care. Data extraction focused on six main areas, namely documentation of HIV-related, neonatal, sociodemographic, anthropometric, immunisation and vitamin A-related information. During data analysis, age-appropriate completeness scores were generated for each area and completeness of documentation in the RTHB and RTHC was assessed. Results Data demonstrate significantly less unrecorded HIV-related information (maternal HIV status, timing of maternal HIV testing, timing of maternal antiretroviral therapy [ART] initiation, current maternal ART use and infant feeding decisions) in RTHBs compared with RTHCs (p < 001). Despite this, 24% of all RTHBs had no record of maternal HIV status and 67% of RTHBs from documented HIV-exposed infants had no record of maternal ART duration. Neonatal information completeness was similar between RTHBs and RTHCs, but socio-demographic completeness was significantly better in RTHBs compared with RTHCs (p = 0.006). Growth (especially weight), immunisation and vitamin A completeness was > 80% and similar between RTHBs and RTHCs. Length-for-age, weight-for-length and head circumference were plotted in < 5% of RTHBs and none of the RTHCs. Conclusion Although completeness of key HIV-related information was better in RTHBs compared with RTHCs, RTHB completeness was suboptimal. Healthcare personnel need reminders to utilise the RTHB optimally to improve continuity and quality of child healthcare.
Collapse
Affiliation(s)
- Harishia Naidoo
- Department of Paediatrics and Child Health, Tembisa Provincial Tertiary Hospital, University of Pretoria, South Africa
| | - Theunis Avenant
- Department of Paediatrics, Kalafong Provincial Tertiary Hospital, University of Pretoria, South Africa
| | - Ameena Goga
- Department of Paediatrics, Kalafong Provincial Tertiary Hospital, University of Pretoria, South Africa.,Health Systems Research Unit, South African Medical Research Council, South Africa
| |
Collapse
|
11
|
Kazungu JS, Adetifa IM. Crude childhood vaccination coverage in West Africa: Trends and predictors of completeness. Wellcome Open Res 2017; 2:12. [PMID: 28459105 PMCID: PMC5407439 DOI: 10.12688/wellcomeopenres.10690.1] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2017] [Indexed: 12/21/2022] Open
Abstract
Background: Africa has the lowest childhood vaccination coverage worldwide. If the full benefits of childhood vaccination programmes are to be enjoyed in sub-Saharan Africa, all countries need to improve on vaccine delivery to achieve and sustain high coverage. In this paper, we review trends in vaccination coverage, dropouts between vaccine doses and explored the country-specific predictors of complete vaccination in West Africa. Methods: We utilized datasets from the Demographic and Health Surveys Program, available for Benin, Burkina Faso, The Gambia, Ghana, Guinea, Cote d'Ivoire, Liberia, Mali, Niger, Nigeria, Senegal, Sierra Leone and Togo, to obtain coverage for Bacillus Calmette-Guerin, polio, measles, and diphtheria, pertussis and tetanus (DPT) vaccines in children aged 12 - 23 months. We also calculated the DPT1-to-DPT3 and DPT1-to-measles dropouts, and proportions of the fully immunised child (FIC). Factors predictive of FIC were explored using Chi-squared tests and multivariable logistic regression. Results: Overall, there was a trend of increasing vaccination coverage. The proportion of FIC varied significantly by country (range 24.1-81.4%, mean 49%). DPT1-to-DPT3 dropout was high (range 5.1% -33.9%, mean 16.3%). Similarly, DPT1-measles dropout exceeded 10% in all but four countries. Although no single risk factor was consistently associated with FIC across these countries, maternal education, delivery in a health facility, possessing a vaccine card and a recent post delivery visit to a health facility were the key predictors of complete vaccination. Conclusions: The low numbers of fully immunised children and high dropout between vaccine doses highlights weaknesses and the need to strengthen the healthcare and routine immunization delivery systems in this region. Country-specific correlates of complete vaccination should be explored further to identify interventions required to increase vaccination coverage. Despite the promise of an increasing trend in vaccination coverage in West African countries, more effort is required to attain and maintain global vaccination coverage targets.
Collapse
Affiliation(s)
- Jacob S. Kazungu
- Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
- Department of Public Health, Pwani University, Kilifi, Kenya
| | - Ifedayo M.O. Adetifa
- Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- College of Medicine, University of Lagos, Lagos, Nigeria
| |
Collapse
|
12
|
Liu Q, Long Q, Garner P. Growth monitoring and promotion (GMP) for children in low and middle income countries. Cochrane Database Syst Rev 2017; 2017:CD010102. [PMCID: PMC6464995 DOI: 10.1002/14651858.cd010102.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To evaluate the effect of routine child growth monitoring, combined with health and nutrition promotion, on: substantive health outcomes (anthropometric indicators of nutrition, mortality); intermediate outcomes, including health service use, improved health, nutritional behaviour and knowledge; mothers' views of the value of the process; resource use by mothers and service providers.
Collapse
Affiliation(s)
- Qin Liu
- School of Public Health & Management, Chongqing Medical UniversityChina Effective Health Care NetworkNo.1 YixueYuan RoadChongqingChina400016
| | - Qian Long
- World Health OrganizationUNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research20 Avenue AppiaGenevaSwitzerland1211
| | - Paul Garner
- Liverpool School of Tropical MedicineDepartment of Clinical SciencesPembroke PlaceLiverpoolUKL3 5QA
| |
Collapse
|
13
|
Ezeofor IO, Garcia AL, Ibeziako SN, Mutoro AN, Wright CM. Health staff understanding, application, and interpretation of growth charts in Nigeria. MATERNAL AND CHILD NUTRITION 2016; 13. [PMID: 28025865 DOI: 10.1111/mcn.12402] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 10/18/2016] [Accepted: 10/25/2016] [Indexed: 11/27/2022]
Abstract
We aimed to compare plotting accuracy and interpretation of weight gain patterns in average and small infants on road-to-health (RTH) and the new World Health Organization (WHO) growth charts in Enugu, Nigeria. Child health staff plotted standard weights on both formats. Twelve plotted charts were created, permutating three different weight trajectories (fast, steady, and slow) ending at two attained weights (average and small), with each plotted on both chart formats. Respondents were shown four of these charts and asked to describe the weight gain pattern shown and what action this pattern would prompt. There were 222 respondents, of whom 78% were hospital based; 54% were nurses, 32% medical doctors, and 13% nutritionists. Plotting accuracy was good on both the WHO and RTH charts, but rating of weight gain was generally poor. On the RTH chart, slow weight gain was correctly recognized in only 19% average and 35% small infants, and responses were not significantly associated with the pattern shown. On the WHO charts, slow weight gain was correctly recognized in 40% average and 65% small infants (p = .002 and <.001), but they were also more likely to rate small children with normal growth as slow weight gain. In a logistic regression model, final weight predicted a slow weight gain rating more strongly (OR = 2.4; 1.8-3.2) than an actual slow weight gain pattern (OR 1.8; 1.1-1.6). Health staff seemed unable to recognize slow weight gain and were influenced more by current weight than actual weight gain pattern, though the new WHO format improved recognition.
Collapse
Affiliation(s)
- Ifeyinwa O Ezeofor
- Child Health, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Ada L Garcia
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
| | - Stella N Ibeziako
- College of Medicine, University of Nigeria Teaching Hospital (UNTH), Ituku-Ozalla, Enugu State, Nigeria
| | - Antonina N Mutoro
- Child Health, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Charlotte M Wright
- Child Health, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| |
Collapse
|
14
|
Cloete I, Daniels L, Jordaan J, Derbyshire C, Volmink L, Schubl C. Knowledge and perceptions of nursing staff on the new Road to Health Booklet growth charts in primary healthcare clinics in the Tygerberg subdistrict of the Cape Town metropole district. SOUTH AFRICAN JOURNAL OF CLINICAL NUTRITION 2016. [DOI: 10.1080/16070658.2013.11734458] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
15
|
Smith S, Reji E. Doctors’ attitudes to and knowledge and usage of growth charts. S Afr Fam Pract (2004) 2015. [DOI: 10.1080/20786190.2014.976978] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
16
|
Kitenge G, Govender I. Nurses' monitoring of the Road to Health Chart at primary healthcare level in Makhado, Limpopo province. S Afr Fam Pract (2004) 2014. [DOI: 10.1080/20786204.2013.10874350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- G Kitenge
- Louis Trichardt Memorial Hospital, Louis Trichardt
| | - I Govender
- Department of Family Medicine, University of Limpopo (Medunsa Campus)
| |
Collapse
|
17
|
Validating child vaccination status in a demographic surveillance system using data from a clinical cohort study: evidence from rural South Africa. BMC Public Health 2011; 11:372. [PMID: 21605408 PMCID: PMC3118246 DOI: 10.1186/1471-2458-11-372] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Accepted: 05/23/2011] [Indexed: 11/30/2022] Open
Abstract
Background Childhood vaccination coverage can be estimated from a range of sources. This study aims to validate vaccination data from a longitudinal population-based demographic surveillance system (DSS) against data from a clinical cohort study. Methods The sample includes 821 children in the Vertical Transmission cohort Study (VTS), who were born between December 2001 and April 2005, and were matched to the Africa Centre DSS, in northern KwaZulu-Natal. Vaccination information in the surveillance was collected retrospectively, using standardized questionnaires during bi-annual household visits, when the child was 12 to 23 months of age. DSS vaccination information was based on extraction from a vaccination card or, if the card was not available, on maternal recall. In the VTS, vaccination data was collected at scheduled maternal and child clinic visits when a study nurse administered child vaccinations. We estimated the sensitivity of the surveillance in detecting vaccinations conducted as part of the VTS during these clinic visits. Results Vaccination data in matched children in the DSS was based on the vaccination card in about two-thirds of the cases and on maternal recall in about one-third. The sensitivity of the vaccination variables in the surveillance was high for all vaccines based on either information from a South African Road-to-Health (RTH) card (0.94-0.97) or maternal recall (0.94-0.98). Addition of maternal recall to the RTH card information had little effect on the sensitivity of the surveillance variable (0.95-0.97). The estimates of sensitivity did not vary significantly, when we stratified the analyses by maternal antenatal HIV status. Addition of maternal recall of vaccination status of the child to the RTH card information significantly increased the proportion of children known to be vaccinated across all vaccines in the DSS. Conclusion Maternal recall performs well in identifying vaccinated children aged 12-23 months (both in HIV-infected and HIV-uninfected mothers), with sensitivity similar to information extracted from vaccination cards. Information based on both maternal recall and vaccination cards should be used if the aim is to use surveillance data to identify children who received a vaccination.
Collapse
|
18
|
Ndirangu J, Bärnighausen T, Tanser F, Tint K, Newell ML. Levels of childhood vaccination coverage and the impact of maternal HIV status on child vaccination status in rural KwaZulu-Natal, South Africa*. Trop Med Int Health 2009; 14:1383-93. [PMID: 19737375 PMCID: PMC2788050 DOI: 10.1111/j.1365-3156.2009.02382.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To analyse coverage of childhood vaccinations in a rural South African population and investigate whether maternal HIV status is associated with children's vaccination status. METHODS 2 431 children with complete information, 12-23 months of age at some point during the period January 2005 through December 2006 and resident in the Africa Centre Demographic Surveillance Area at the time of their birth were investigated. We examined the relationship between maternal HIV status and child vaccination status for five vaccinations [Bacillus Calmette-Guérin (BCG), diphtheria-tetanus-pertussis (DTP3), poliomyelitis (polio3), hepatitis B (HepB3), and measles] in multiple logistic regressions, controlling for household wealth, maternal age, maternal education and distances to roads, fixed and mobile clinics. RESULTS Coverage of the five vaccinations ranged from 89.3% (95% CI 81.7-93.9) for BCG to 77.3% (67.1-83.6) for measles. Multivariably, maternal HIV-positive status was significantly associated with lower adjusted odds ratios (AOR) of child vaccination for all vaccines [(AOR) 0.60-0.74, all P < or = 0.036] except measles (0.75, P = 0.073), distance to mobile clinic was negatively associated with vaccination status (all P < or = 0.029), household wealth was positively (all P < or = 0.013) and distance to nearest road negatively (all P < or = 0.004) associated with vaccination status. CONCLUSION Positive maternal HIV status independently reduces children's probability to receive child vaccinations, which likely contributes to the morbidity and mortality differential between children of HIV-positive and HIV-negative mothers. As a means of increasing vaccination coverage, policy makers should consider increasing the number of mobile clinics in this and similar communities in rural Africa.
Collapse
Affiliation(s)
- James Ndirangu
- Africa Centre for Health and Population Studies, University of KwaZulu Natal, South Africa.
| | | | | | | | | |
Collapse
|