Evaluation of a Health Care System for Children under Five Years of Age in Africa

The system of health care known as the Under Fives Clinic has been in existence in some African countries for the past ten years. The present study endeavours to evaluate this system of health care. An epidemiological study was undertaken in four areas of Africa each with an established Under Fives Clinic. These areas were Ilesha and Esa Oke in Western Nigeria, Namitambo in the Southern Province of Malawi and Mansa in the Luapula Province of Zambia. The method used was a point prevalence study that involved a stratified sample of approximately 200 dwellings in which lived children under the age of five years, for each area. In Ilesha there were 434 children, in Esa Oke 405, in Namitambo 261, and in Mansa 314 children who were taken into the survey. Data were collected from the families of these children using a questionnaire administered by an interviewer, that sought information on family and domestic circumstances and the health of the child. From this approach children who attended the clinic and those who did not were identified. A comparison between clinic attenders and non attenders has been made to discover whether there are any differences in the health of the two groups; and also what factors might influence health in these two groups. In general there were no major differences in health. Differences were found between the Under Fives Clinics in their activities, and this was reflected for example in the immunisation status of the children attending. The present study was the first of its kind to undertake a comparative evaluation of Under Fives Clinics in Africa. The methodology used in this study, with some modifications could be used in further evaluation studies where instead of doctors, medical auxiliaries, lay workers and even secondary school children could, perform the field work.