Implementing an Integrated Nutrition Programme - Health Systems ...

More documents

Recommendations

Info

The above interventions have also been introduced at Kakamas Hospital. In September 1998, an Interim Hospital Assessment was undertaken by a nutritionist from the Child Health Policy Institute and a professional nurse from St Monica’s Hospital, the first hospital in South Africa to officially be declared Baby Friendly. Their assessment showed that the hospital had made significant progress in implementing all ten steps. Until now the hospital has not been able to officially be accredited as being Baby-Friendly due to the lack of recognised assessors in South Africa. It is hoped that during the second half of 1999, two assessors from each province will be trained as accreditors. The district nutritionist and the dietician from the hospital have been chosen as the two representatives for the Northern Cape. After the training, a pool of recognised accreditors will be readily available and it is hoped that Gordonia will rapidly be able to achieve official recognition for their efforts at becoming baby-friendly. 1.3 Nutrition education. Nutrition education is done by the nutrition advisors and by nursing personnel. Key messages include: • Growth monitoring • The Growth chart • Interpretation of the growth chart • Nutritional deficiencies • Management of diarrhoea • The use of Oral Rehydration Solution • How to make Sugar/Salt solution • Weaning practices • Breastfeeding recommendations • Micronutrients • PEM scheme • PEM intervention strategy • PEM protocols • Referral organogram • Nutrition during pregnancy and lactation • General problems • Management of overweight patients • Management of diabetic patients • Management of TB and HIV-positive patients 1.4 Growth monitoring Growth monitoring is done by all PHC facilities in the district. All facilities are equipped with baby scales although the quality of the monitoring has not been assessed. 28
In theory every preschool child who attends the clinic is weighed once a month. The child’s weight is plotted on the Road to Health Card. 1.5 Management and referral of children with growth faltering Nurses have been trained in identification of children with severe malnutrition and growth faltering. • Children who have clinical signs of severe PEM are referred to hospital. • Children with growth faltering are managed according to the referral protocol which is available in all clinics. • Food supplements are provided when the entry criteria for the PEM Scheme are met. • Children on the PEM scheme who are not gaining weight adequately are screened for conditions such as TB, anaemia and parasites. 1.6 PEM scheme Most PHC facilities in the district participate in the PEM scheme. During 1997, an evaluation of the scheme in the Northern Cape was undertaken by the Child Health Unit of the University of Cape Town in collaboration with the Provincial Nutrition Sub-directorate. The main findings of the evaluation 7 are shown below: Operational activities • During the 1996 - 1997 financial year, 67% of the allocated provincial budget for the PEM scheme was utilised. • During the same period the PEM scheme was estimated to have reached 30 - 40% of malnourished preschool children in the province and 35% - 60% of pregnant and lactating women. • Eighty-five percent of the health facilities in the province participated in the scheme. • Nursing staff who implemented the Scheme had not received training. • No management information system existed at district or provincial level. Implementation at local level • Clinic nurses regarded infants 0 - 6 months, children 6 - 24 months and the chronically ill as the main target groups. • Some clinics enrolled children over six years, siblings and unemployed people on the scheme despite the fact that they did not meet the inclusion criteria. • Inclusion and exclusion criteria were poorly applied to pregnant and lactating women. • Many participants received incorrect quantities of milk powder and PVM. • Conditions such as foetal alcohol syndrome, anaemia and chronic disease were not routinely excluded. 29
Page 1 and 2: Implementing an Integrated Nutritio
Page 3 and 4: Framework for District INP Situatio
Page 5 and 6: List of Tables Table 1: Admissions
Page 7 and 8: Table 1: Admissions to Gordonia Hos
Page 9 and 10: Department of Health survey The Nat
Page 11 and 12: serum ferritin levels below 12ug/l
Page 13 and 14: 15% 1% 11% 1% Tap in house Tapwater
Page 15 and 16: On average socio-economic condition
Page 17 and 18: Breastfeeding and weaning practices
Page 19 and 20: Chapter Two: Management of the INP
Page 21 and 22: Step 3: Orientation on programme pl
Page 23 and 24: Five key performance areas were ide
Page 25 and 26: Transport The district has a pool o
Page 27: nurses) attended an eighty hour cou
Page 31 and 32: • The mothers of children on the
Page 33 and 34: 1.9 Parasite control There are no p
Page 35 and 36: Development Forum (LDF) and the UNI
Page 37 and 38: Other concerns raised included that
Page 39 and 40: Chapter Five: Factors which facilit
Page 41 and 42: Integrating Nutritional Surveillanc
Page 43 and 44: APPENDIX A: RESULTS OF DEPARTMENT O
Page 45 and 46: 1. Implementation of the policy 2.
Page 47 and 48: APPENDIX C: DISTRICT NUTRTION PLAN
Page 49 and 50: 3. Monitoring and Evaluation Implem
Page 51 and 52: 5. Community Development + Intersec
Page 53 and 54: APPENDIX D: SCHOOLS PARTICIPATING I
Page 55 and 56: APPENDIX E: PROJECTS FUNDED BY ALLE

Implementing an Integrated Nutrition Programme - Health Systems ...

Create successful ePaper yourself

Delete template?

Save as template?