Why growth monitoring fails : an exploratory study of child malnutrition intervention in a rural African area
This study is an exploratory one of growth monitoring in a rural African village, Thornhill. Growth monitoring is a primary health care approach to prevent child malnutrition in under-developed areas promoted by a variety of development agencies, particularly UNICEF, as a part of the "child survival revolution." It involves weighing children regularly and plotting their weights on a growth chart retained by the child's mother. Growth charts provide a visual display of a child's growth to allow health workers and mothers to identify early signs of growth faltering in order to facilitate ameliorative action (usually food supplementation or nutrition education) to prevent malnutrition. It also aims to facilitate the active participation of mothers in ensuring their child's continual good growth. The history of growth monitoring and its use in the South African context is discussed. The underlying rationale and component processes needed to implement it effectively are identified in a review of process evaluation studies of growth monitoring. Thornhill is an impoverished African rural area in the Ciskei in which malnutrition is a serious health problem and growth monitoring has been systematically implemented. However, although the health service had a demonstrated capacity for successful health interventions it had been unable to improve nutritional status. Background information and previous research in the area is presented. The study aimed to explore why growth monitoring had failed to improve nutritional status in Thornhill by investigating the way in which the component objectives of growth monitoring in terms of making growth visible, facilitating nutrition intervention and facilitating mothers' participation in their children's care were perceived by mothers and health workers.
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