An assessment of the 'road-to-health-booklet' based on knowledge/perceptions of the clinic nurses and conduct a record review of the completion of the booklets

Win, Thein
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INTRODUCTION Poor growth monitoring of children continues to be a major source of early death for children under five worldwide. The RTHB is an indispensable aid for under-five child development and health. AIM: To explore the knowledge and perceptions of the RTHB by clinic nurses, and to assess the completion of the RTHB booklets in the West Rand rural clinics. METHODS This study applied a quantitative and qualitative mixed method design. The first component is a retrospective records review of the 75 RTHBs of the children under-five. The second component is a qualitative study assessing the knowledge / perceptions of the new RTHBs by the nine nurses who provided child health services in the two rural clinics. Quantitative data was analysed using SPSS version 23 to conduct simple descriptive analysis for categorical variables. A thematic analysis was conducted on data collected through interviews with the clinic nurses. RESULTS The study found that only immunisation section was fully completed (100 percent). The weight-for-Age growth chart completion was excellent (81 percent). Most of the sections were less than 70 percent fully completed. The two growth charts (Lt/Ht X Age and Wt X Lt/Ht) were only around 30 percent fully completed. The Oral Health section was only seven percent fully completed. The qualitative interviews reveal six themes reflecting nurses perceptions of RTHB:: value of RTHB, barriers affecting effectiveness of RTHB, functions of RTHB, health system improvement, communication improvement and skills improvement. The value of the RTHB was based on the following: easy navigation; a comprehensive tool for child health information and child growth monitoring; clear scope; comprehensive infant feeding guidelines, and child referral tool. The barriers included poor completion, language, confidentiality, supply and demand, and limited note-making space. Suggested areas of improvement included: equipment availability for child growth monitoring; modifying sections of RTHB; providing mobile oral health services; completion of relevant sections by hospitals and cover change. CONCLUSION The study revealed that clinics from the West Rand District experienced problems in using the new RTHB, except for the Weight X Age Chart and Immunisation sections. The major problems were in the completion of child PMTCT/HIV section, the other two growth charts (Weight for Height and Height for Age growth charts) and referral for oral health examination. It is therefore essential to improve the RTHB utilisation in the West Rand District, since it is the cornerstone of the under-five child health care, which is closely related to mortality and morbidity of children. The District Clinical Specialist Team (DCST) should organise training, re-training, fire drills for the usage of RTHB.
A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master in Public Health in the field of Rural Health. Johannesburg July 2016