Nutrition News for Africa

Abstract - February 28, 2007

An article entitled “The targeting of nutritionally at-risk children attending a primary health care facility in the Western Cape Province of South Africa” was published by Schoeman et al, in Public Health Nutrition, 2006: 9(8), 1007–1012.

Introduction: Undernutrition is emerging as a silent emergency affecting families and communities that contributes to half of the 10.8 million annual deaths in under fives in developing countries. South Africa has tried to tackle this problem through its national Integrated Nutrition Program (INP). Success has been limited with underweight and stunting rates of South African children remaining unchanged over a 5-year period. The aim of this study was to assess the knowledge and practices of primary health care (PHC) nurses in targeting nutritionally at-risk children for intervention at a PHC facility.

Methodology: A cross-sectional, descriptive study was conducted at a PHC facility in a low socio-economic peri-urban area of the Western Cape in South Africa, between November 2001 and January 2002. Participants consisted of infants and children aged 0–72 months (n=134), their caregivers (n=124) and PHC nurses. The caregivers’ and children’s data were collected on a daily basis, and data relating to nurses was obtained towards the end of the study. Nurses’ knowledge and practices regarding nutrition protocols were assessed by means of structured interviews and observation of nurses’ weighing methods and practices.

Results: The researcher’s weight measurements were consistently higher than the nurses’ with the exception of one case where the opposite was true. The differences were primarily due to differences in weighing practices where the infant or child is weighed with or without clothing and shoes, and to differences in calibrating the scale. The Road to Health Chart (RTHC) was available for 123 (92%) children. When assessing completion of the weight-for-age chart, it was found that dates of birth were entered on 50%, calendars were completed on 8%, weights were plotted on 46%, while only 4% had information on infant and or child feeding. Four recent weights for each underweight and growth faltering child were obtained from the health facility records and plotted on a growth chart similar to the weight-for-age chart of the RTHC and as a result, a total of 67 (50%) children were assessed as being underweight or faltering in growth.

Discussion: Fifty per cent of children were found to be nutritionally at-risk and factors such as unemployment, food insecurity and dependency on non-family members for financial support significantly increased the risk of undernutrition. A major limitation in growth monitoring and promotion (GMP) practices of nurses was under-utilization of the RTHC with concomitant poor plotting and no entry of important nutrition-related information on the RTHC. As a result, the nurses missed 84–95% of nutritionally at-risk children eligible for nutrition interventions recommended by the INP. Other shortcomings in GMP related to poor maintenance, calibration and standardization of scales as well as inaccuracies in weighing.

Conclusion: The authors conclude that there are numerous shortcomings relating to implementation of the INP at the primary level of care in South Africa. The poor targeting and intervention of nutritionally at-risk children by those given the task of implementing the INP was due to lack of training of PHC nurses, lack of supervision and nutrition monitoring, inconsistent GMP practices, and the absence of community- based nutrition programs to address underweight and poor food security in the long term. The authors recommend that policy-makers urgently address these issues to ensure appropriate intervention for nutritionally at-risk children in similar communities.