ABSTRACT
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
Subject(s)
Caregivers , Child , Nutritional Status , Primary Health CareABSTRACT
Acting on a request form the community of Ndunakazi; a rural area bordering the Valley of a Thousand Hills; Kwa Zulu-Natal; South Africa; a comprehensive situation analysis was conducted. The results were used in an objective orientated programme planning approach; during a workshop attended by community representatives. One of the outcomes was the establishment of a model for a community-based growth and health monitoring system for pre-school children. As their contribution to the programme; families would make their homes available on a voluntary basis; once or twice a month to be used as community-based centers (called Isizinda). From a nutritional point of view; the programme has a hoslistic approach and is run by nutrition monitors. The programme was initially launched with one centre; but in response to requests received form the community; a further seven centres have been established. Approximately 500 pre-school children are currently being growth-monitored regularly; with an average monthly attendance of around 70 per cent. The nutrition monitors are responsible for conveying health and nutritional messages to the mothers and for collecting morbidity and mortality data. Children who are either not growing well or who are ill are referred to the nearest clinic. When available a community nurse attends to minor illnesses during these sessions. A soup kitchen is run during the winter; providing the mothers and pre-school children with soup and bread. Attitudes of mothers and nutrition monitors towards the programme are assessed regularly; the outcome of skills development that is an integral part of the model. This model falls within the scope of the policy objectives and principles on which the United Health System of South Africa will be based. The National Research Programme for nutritional Intervention (NRPNI) is in eh process of establishing a partnership with the department of Health of KwaZulu-Natal. Should the Department take long-term responsibility as an overall coordinator of these monitoring centers; the sustainability of the project will be increased and could then be extended to other areas