Implementing an Integrated Nutrition Programme - Health Systems ...

• Nutrition education was given regularly at most, but not all clinics. The main focus of
nutrition education was on the preparation of supplements, promotion of breastfeeding
and dietary advice.
• 63% of clinic nurses who implemented the Scheme felt that children participating in the
scheme achieve good catch-up growth. Perceived problems with the scheme included:
products not reaching the target groups, dependency on the supplements, irregular clinic
attendance by participants and unacceptability of the supplements.
• Suggestions for improving the scheme included: increasing supplies and resources,
supervised feeding of the target groups at a central point, increasing the regularity of
supplies and increasing personnel to assist in running the scheme.
Impact of the Scheme
This was assessed in two ways:
Retrospective analysis:
Records of 386 participants obtained from 34 clinics were analysed.
• Birthweights were recorded for 222 children. Ninety-two (41%) had low birth weights.
• Only 9.6% of children moved into the normal Z score range after a mean follow-up of
7.5 months.
• Fifty-eight children in the sample were diagnosed as having tuberculosis and one had
HIV.
Prospective study:
A monitoring tool was devised and tested in the Diamond Fields District for three months.
• The target groups who were enrolled were children 0 - 6 years (88%), lactating women
(3%), pregnant women (1%) and the chronically ill (8%).
• The main reasons for enrolment were underweight for age and growth faltering.
• The correct amounts of milk given to children were as follows:
0 - 6 months 26%
6 - 12 months 18%
12 - 72 months 43%
• The correct amounts of PVM were given in the following cases:
6 - 12 months 25%
12 - 72 months 35%
• Thirty-one percent of infants 0 - 6 months were inappropriately given PVM.
• An analysis of the weight-for-age Z scores at the first and third visits showed that 11%
of children had moved from below to above - 2 Z scores.
• 66% of children had dropped out of the Scheme by the third visit.
Acceptability of the products
30