The evaluation of a nutritional surveillance. Growth monitoring and promotion programme: an overview of the coverage and quality of the services provided in Vihiga division of Kakamega district.

Abstract

Through a five year plan of Action Agre­ ement signed between the Ministry of Health of the Government of Kenya and UNICEF, major changes have been introduced into child growth monitoring which has been operating for many years in health facilities around the country. Nine pilot districts are actively involved in the new programme. The major inputs have been: a re-designed child health card; introduction of additional data forms for the newly initia­ ted clinic based nutritional surveillance system and training and supervision of the health facility personnel. Between January and April 1987, research work was conducted in Vihiga Division of Kaka­ mega District. The purpose of the study was to determine adequacy of Health Centre infrastructure, extent to which the intended growth monitoring services were being delivered as planned and the coverage attained by the Nutritional Surveillannce, Growth Monitoring and Promotion programme. Health Centre programme records were used and a set ( X X') In addition a Community Survey was car­ ried out in order to identify the socio-cultu­ ral factors which are potentially associated with the pre-school child's utilization of the growth monitoring services. The research design utilized the WHO recommended cluster sampling methodologies which have already been successfully employed in a number of countries. Data was collected on a total of 300 households with children aged 3-36 months from 30 randomly selected clusters within the division. The results show that not all the health centres within the division had satisfactory infrastructure. There is need to provide adequate and appropriate supplies of weighing scales, child health cards, and data recording forms. The training of health personnel needs to emphasise the use of growth monitoring as a tool for promoting adequate child growth. Growth velocity is not being emp~asised, the approach is still the categorization of normal and underweight children. The estimated coverage attained for growth monitoring was 32 per cent. This can be increased if all the children making cont­ act with the health centre are weighed, and efforts are made to motivate the community into taking on active part in the programme. Twenty five per cent of the children surveyed had no record of having been growth monitored. (xxi) The average age at first weight record was 3 months while the average number of health facility visits was 4. The Household/family characteristics associated with the preschool child's participation in the Nutritional Surveillance and Growth Monitoring and Promotion programme in Vihiga Division inncluded: high child's age at first visit to the health facility, lack of a clinic card and long distance to the health centre. The results show and support the view that care must be taken when general object­ ives for growth monitoring, set at national level, are adopted locally. A situation anal­ ysis should be made based on information coll­ ected on programme implementation and socio­ cultural determinants of utilization. Prog­ ramme objectives and priorities tailored to meet the needs of the local situation can then be made based on this information. It is hoped that the results of the study will significantly contribute to future evaluations of the Nutritional Surveillance and Growth Monitoring and Promotion Programme in the nine pilot districts.