Evaluation of community-based growth monitoring in rural districts of the Eastern Cape and KwaZulu-Natal provinces of South Africa
Smuts, Marius Cornelius
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Background: The Health Systems Trust implemented a community-based growth-monitoring intervention project that fits into the Integrated Nutrition Programme focus areas and commissioned an evaluation of this project. Objective: To assess project volunteers' knowledge on infant and young child nutrition and growth monitoring, and evaluate community-based growth-monitoring activities. Design: Five randomly selected growth-monitoring sites per sub-district were evaluated. Project volunteers (n=45) and caregivers (n=186) attending the growth-monitoring sites were interviewed by means of a questionnaire. Growth-monitoring and nutrition education activities were observed at the growth-monitoring sites. Setting: Two rural districts in KwaZulu-Natal (Umkhanyakude: sub-district Jozini; and Zululand: sub-district Phongola), and one rural district in the Eastern Cape (OR Tambo), South Africa. Results: Project volunteers were mostly women (87%), 38±10 years old, and 27% had matric/Grade 12. There was a high turnover of project volunteers. Their nutrition knowledge varied. Forty-six percent of the project volunteers and 39% of the caregivers could correctly identify the growth curve of a healthy growing child. Seven of the 13 sites that were visited were at a crèche. There was a referral system between the growth-monitoring site and the local clinic, and links with the Department of Agriculture and, to a lesser extent, the Department of Social Welfare. Weighing methods were inconsistent and the steps of growth monitoring were not followed through. Nutrition education to the caregivers was lacking at several of the sites. Conclusion: The study highlighted both strengths and limitations of the project. Areas that need improvement include the selection, training and supervision of project volunteers performing community-based growth monitoring.