An evaluation of growth monitoring in Zaire

Growth monitoring has become a major component of most child health programmes in developing countries over the past two decades. The rationale for this activity is discussed and examined critically in the light of the evidence from previous studies and from a detailed evaluation of three child health care programmes in rural Zaire which included growth monitoring. The monthly sessions to which mothers brought their children were observed, the health workers were interviewed, and information was obtained on programme costs, supervision, and health records in all three programmes. A survey of the knowledge and practices of 547 mothers of children under five years of age was carried out in one programme's catchment population. A total of 497 consultations were observed in the three programmes as part of the evaluation. The consultations lasted between 30 seconds and five minutes each, with a mean of two minutes. Mothers and children spent three to eight hours at the clinic in order to receive these brief consultations, ten minutes of group health education, and if necessary, immunizations. Whilst staff measured and recorded weights accurately, they failed to take any specific actions in one-third of children who had growth faltering. Similarly, no counselling was given to one-third of mothers whose children were ill and/or had growth faltering, called "at-risk" children. Generally, the quality of advice and referral for illness was more satisfactory than the nutritional advice given mothers, which consisted of brief, standard directives. The at-risk children did not always receive special consultations by better-qualified staff. A household interview survey of 547 mothers of children under five assessed their understanding of the growth charts and their knowledge and reported practices with regard to child feeding and diarrhoea. Results showed that knowledge and practices improved with increased attendance at growth monitoring sessions, after controlling for the mother's educational level, tribe, socio-economic level and parity. Since nearly two-thirds of children attending the sessions were classified as at-risk, the value of individual screening by weighing is questionable. Not all at-risk children received interventions; of those who did, the quality of the interventions was frequently inadequate. Policy and programme recommendations for growth monitoring in child health programmes are described, and research needs identified.