Primary Health Care Facility Infrastructure and Services and The Nutritional Status of Children 0 to 71 Months Old and Their Caregivers Attending These Facilities in Four Rural Districts in The Eastern Cape and Kwazulu-Natal Provinces; South Africa

Objective: To assess primary health care (PHC) facility infrastructure and services; and the nutritional status of 0 to 71-month-old children and their caregivers attending PHC facilities in the Eastern Cape (EC) and KwaZulu-Natal (KZN) provinces in South Africa. Design: Cross-sectional survey. Setting: Rural districts in the EC (OR Tambo and Alfred Nzo) and KZN (Umkhanyakude and Zululand). Subjects: PHC facilities and nurses (EC: n = 20; KZN: n = 20); and 0 to 71-month-old children and their caregivers (EC: n = 994; KZN: n = 992). Methods: Structured interviewer-administered questionnaires and anthropometric survey. Results: Of the 40 PHC facilities; 14 had been built or renovated after 1994. The PHC facilities had access to the following: safe drinking water (EC: 20; KZN: 25); electricity (EC: 45; KZN: 85); flush toilets (EC: 40; KZN: 75); and operational telephones (EC: 20; KZN: 5). According to more than 80of the nurses; problems with basic resources and existing cultural practices influenced the quality of services. Home births were common (EC: 41; KZN: 25). Social grants were reported as a main source of income (EC: 33; KZN: 28). Few households reported that they had enough food at all times (EC: 15; KZN: 7). The reported prevalence of diarrhoea was high (EC: 34; KZN: 38). Undernutrition in 0 to younger than 6 month-olds was low; thereafter; however; stunting in children aged 6 to 59 months (EC: 22; KZN: 24) and 60 to 71 months (EC: 26; KZN: 31) was medium to high. Overweight and obese adults (EC: 49; KZN: 42) coexisted. Conclusion: Problems regarding infrastructure; basic resources and services adversely affected PHC service delivery and the well-being of rural people; and therefore need urgent attention

Adverse Social; Nutrition and Health Conditions in Rural Districts of Kwazulu-Natal and the Eastern Cape Provinces; South Africa

Objective: This study determined the socio-demographic; nutritional and health status of children and their caregivers in two rural districts in KwaZulu-Natal (KZN) and one rural district in the Eastern Cape (EC); South Africa. Design: A cross-sectional survey was conducted. Setting: The study population resided in Umkhanyakude (sub-district Jozini) and Zululand (sub-district Pongola) in KZN; and in OR Tambo (sub-district Nyandeni) in the EC province. Subjects: Children 0 to 59 months old (Umkhanyakude n = 398; Zululand n = 303; OR Tambo n = 364) and their caregivers were included.Methods: Structured interviewer-administered questionnaires were conducted and height and weight were measured.Results: Households in OR Tambo had less access to services (tap water 3; toilets 33); compared to Umkhanyakude (tap water 50;toilets 82) and Zululand (tap water 74; toilets 98). Wood was the main energy source used to cook food in all three districts ( 75).Grants were a main source of income (Umkhanyakude and Zululand 61; OR Tambo 55). Many households obtained vegetables from their own garden (Umkhanyakude and Zululand 30; OR Tambo 70). The households that reportedly had enough food available at all times (Umkhanyakude and Zululand 25; OR Tambo 17); were in the minority. The diarrhoea prevalence reported by the caregivers was high (Umkhanyakude 35; Zululand 24; OR Tambo 24). The prevalence of stunting was higher for children older than 12 months and varied between 22 and 26. The prevalence of overweight among children 0 to 23 months exceeded the prevalence of underweight. The prevalence of overweight and obesity among caregivers was high (Umkhanyakude 42; Zululand 60; OR Tambo 56).Conclusion: Concerted efforts are needed to address the adverse social; nutrition and health conditions in these districts

The targeting of nutritionally at-risk children attending a primary health care facility in the Western Cape Province of South Africa.

AIM: The aim of this study was to determine the practices of primary health care (PHC) nurses in targeting nutritionally at-risk infants and children for intervention at a PHC facility in a peri-urban area of the Western Cape Province of South Africa. METHODOLOGY: Nutritional risk status of infants and children <6 years of age was based on criteria specified in standardised nutrition case management guidelines developed for PHC facilities in the province. Children were identified as being nutritionally at-risk if their weight was below the 3rd centile, their birth weight was less than 2500 g, and their growth curve showed flattening or dropping off for at least two consecutive monthly visits. The study assessed the practices of nurses in identifying children who were nutritionally at-risk and the entry of these children into the food supplementation programme (formerly the Protein-Energy Malnutrition Scheme) of the health facility. Structured interviews were conducted with nurses to determine their knowledge of the case management guidelines; interviews were also conducted with caregivers to determine their sociodemographic status. RESULTS: One hundred and thirty-four children were enrolled in the study. The mean age of their caregivers was 29.5 (standard deviation 7.5) years and only 47 (38%) were married. Of the caregivers, 77% were unemployed, 46% had poor household food security and 40% were financially dependent on non-family members. Significantly more children were nutritionally at-risk if the caregiver was unemployed (54%) compared with employed (32%) (P=0.04) and when there was household food insecurity (63%) compared with household food security (37%) (P<0.004). Significantly more children were found not to be nutritionally at-risk if the caregiver was financially self-supporting or supported by their partners (61%) compared with those who were financially dependent on non-family members (35%) (P=0.003). The weight results of the nurses and the researcher differed significantly (P<0.001), which was largely due to the different scales used and weighing methods. The researcher's weight measurements were consistently higher than the nurses' (P<0.00). The researcher identified 67 (50%) infants and children as being nutritionally at-risk compared with 14 (10%) by the nurses. The nurses' poor detection and targeting of nutritionally at-risk children were largely a result of failure to plot weights on the weight-for-age chart (55%) and poor utilisation of the Road to Health Chart. CONCLUSIONS: Problems identified in the practices of PHC nurses must be addressed in targeting children at nutritional risk so that appropriate intervention and support can be provided. More attention must be given to socio-economic criteria in identifying children who are nutritionally at-risk to ensure their access to adequate social security networks.