Implementing an Integrated Nutrition Programme - Health Systems ...

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Supplementation Children with kwashiorkor are routinely given pottasium and magnesium supplementation, as well as a multivitamin mixture and iron and folate. High dose Vitamin A is not routinely administered. Treatment of complications Children are not routinely given antibiotics unless indicated. Amoxycillin or Penicillin are used as first line drugs. Stimulation Once a child’s condition improves, stimulation is regarded as being very important. The occupational therapist has been involved in trying to make the environment more stimulating. Nutrition education Accommodation is provided only for mothers who are breastfeeding. Nursing staff provide nutrition education to mothers on a informal basis – the mothers are encouraged to visit the children as often as possible, particularly during the day, when nursing staff are available. Follow-up On discharge, the child is referred to the local clinic for follow-up and ongoing supplementation when required. The relevant nutrition advisor is informed. PEM Committee Recently, a PEM committee has been formed at Gordonia Hospital. This is made up of the paediatric doctor, the nutritionist, and the nutrition advisors as well as representatives of the Welfare Department and the Child Protection Unit. 1.8 Micronutrient supplementation Micronutrient supplementation is not routinely given. Discussions concerning the introduction of routine supplementation with Vitamin A have taken place between the MCH directorate, Nutrition sub-directorate and pharmaceutical services at provincial level. However no definite policy has been decided on. Recent evaluation of EPI services in the Kalahari district of the Northern Cape revealed a good quality service with good coverage. A Vitamin A supplementation linked to EPI could therefore be expected to achieve a high coverage. 32
1.9 Parasite control There are no programmes for parasite control in the district. Treatment for worms is available at all PHC clinics, but is not administered on a routine basis. 2 Community-based nutrition programmes or projects Few non-governmental or Community-based organisations are active in the district. As a result government departments have been encouraged to play a direct role in communitybased projects. This situation is not ideal as nutrition workers do not necessarily have the time nor skills to act as development officers. In addition, projects have been poorly coordinated between the various departments. For instance there has been no contact between the Department of Agriculture, which is involved in supporting small-scale farming in Riemvasmaak (part of the Kakamas sub-district) and the Department of Health, which has been supporting the establishment of a community garden in the town itself. It is hoped that consolidation of all community-based projects under the Alleviation of Poverty Fund will lead to better co-ordination. The Fund falls under the Department of Welfare (which is now a separate department). In the future, the Nutrition Programme views its role as providing nutritional input to projects rather than being responsible for initiating community-based projects. The projects which will be funded during the 1999/2000 financial year in the district are shown in Appendix E. The Nutrition Programme has however been directly involved in two community-based nutrition programmes over the past few years. It is encouraging to note that both projects have now been taken up by community members and that the nutrition staff are able to downscale their involvement in the projects. 2.1 Kakamas community vegetable garden History The project began late in 1996 when the SANTA branch in Kakamas approached the provincial Department of Welfare with a request for assistance in establishing a community garden for TB patients in Kakamas. As a food production project it was referred to Nutrition sub-directorate of the Department of Health which agreed to fund the project. In1997, R39 000 was allocated to the project which was seen as part of an overall strategy to reduce the TB incidence in Kakamas. Organisational Structure The Project committee is responsible for running the project including control of finances. The committee consists of a project leader, a treasurer and a secretary. The sister-in-charge of the local clinic, the nutrition advisor and the local social worker are also members. 33
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 and 28: nurses) attended an eighty hour cou
Page 29 and 30: In theory every preschool child who
Page 31: • The mothers of children on the
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

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