Breastfeeding and growth monitoring.

One of the main reasons women stop breastfeeding is they lack confidence in their ability to produce enough milk. Growth monitoring gives them the confidence by showing their baby's satisfactory growth. There are ten pitfalls to growth monitoring programs however: (1) the emphasis on a curative rather than a preventive approach; (2) monitoring starts too late; (3) programs emphasize nutritional status rather than growth status; (4) the chart is not used to prompt a dialogue with the mother on meaning; (5) health workers do not listen to find out why some babies are succeeding and others are not; (6) insufficient attention is paid to training and supervision, and programs should address the child's total environment; (7) growth monitoring is seen as isolated from other aspects of health care; (8) the community should become involved in addressing growth problems; (9) additional food is often seen as the only activity rather than separating the preventive strategy of growth monitoring from the curative activity; and (10) growth monitoring itself achieves little unless it leads to growth promotion.

Breastfeeding and growth monitoring.

One of the main reasons women stop breastfeeding is they lack confidence in their ability to produce enough milk. Growth monitoring gives them the confidence by showing their baby's satisfactory growth. There are ten pitfalls to growth monitoring programs however: (1) the emphasis on a curative rather than a preventive approach; (2) monitoring starts too late; (3) programs emphasize nutritional status rather than growth status; (4) the chart is not used to prompt a dialogue with the mother on meaning; (5) health workers do not listen to find out why some babies are succeeding and others are not; (6) insufficient attention is paid to training and supervision, and programs should address the child's total environment; (7) growth monitoring is seen as isolated from other aspects of health care; (8) the community should become involved in addressing growth problems; (9) additional food is often seen as the only activity rather than separating the preventive strategy of growth monitoring from the curative activity; and (10) growth monitoring itself achieves little unless it leads to growth promotion.

Ten pitfalls of growth monitoring and promotion.

PIP: Growth monitoring programs are often considered failures. These failures often stem from a lack of understanding of program implementation. The 10 most common pitfalls of the system are listed as follows: 1) Health workers tend to desire a diagnostic curative approach to malnutrition where Growth Monitoring and Prevention (GM/P) is a preventative measure. 2) Most current nutrition and GM/P programs start with children who are already undernourished. GM/P's should start with infants. 3) Nutritional status is currently emphasized rather than growth. 4) Mothers need to participate in monitoring more than they are currently expected to. 5) Standard GM/P's are normally not conducted on an individual basis. GM/P's must focus on communication between mother and worker. 6) GMP is simple in concept, but certainly not easy to implement. 7) GM/P is usually conducted as an isolated nutritional activity instead of an all-encompassing primary health care service. 8) GM/P is carried out by health workers with minimal community participation. 9) Most GM/P's provide free supplemental foods as incentive for mothers to attend monthly meetings, but the food becomes a preoccupation instead of an incentive. 10) People have too many false expectations of the program that are not grounded in reality. If workers concentrated on the overall goals and objectives of GM/P, these programs would have a greater impact on the health care of children.^ieng

Promoting growth: foundation for child health.

PIP: Growth monitoring and promotion (GM/P) is a concept that expands regular weighing of children to include appropriate activities by families, health practitioners and communities. Growth monitoring by itself has no direct benefit unless it is coupled with related strategies. 10 pitfalls of growth monitoring programs are discussed, highlighting the strategies. 1) Maintain good nutrition, rather than focus on curative interventions. 2) Begin growth monitoring at birth, rather than focus on 3-4-year olds. 3) Mothers, communities, and national programs should emphasize nutritional status rather than growth. 4) Mothers should be given feedback on their child's growth. 5) Individualized techniques, such as active listening, are key elements of success. 6) GM/P is simple, but not necessarily easy. 7) GM/P should be the framework for an entire range of primary health care and educational activities. 8) Growth monitoring should be community-based, not too far away, and involve the participants. 9) Food distribution programs linked with growth monitoring should not become the focus of the activity. 10) People should not expect monitoring alone to reverse nutritional disorders without a major, coordinated effort involving all aspects of primary health.^ieng

A case for integrated food, nutrition and family planning programmes.

PIP: Factors in support of integration of family planning with food and nutrition porgrams include effectiveness and efficiency, family rapport, public acceptability, community response, increased interest of workers, and survival of children. Integration begins at the policy and planning level, and each concerned department needs to make its programs multidisciplinary in character at the planning level. Integration at the policy level is most important as the 1st step. Other steps are coordination at the ministerial level; joint planning and evaluation process; integration of peripheral workers and community workers; and coordination of supervisory patterns, logistical support and training. In designing a motivational message for integrated food/nutrition/family planning programs, simplicity is the key element. There are ongoing integrated food/nutrition/family planning programs in operation in the Philippines and in Indonesia.^ieng

Karet KB and jamu: an integrated approach to condom marketing.

PIP: The development of an out-of-clinic method for marketing condoms in Indonesia is described. A jamu company (jamu referes to any herbal medicant, many of which are related to sexual activity, whose use is firmly integrated into the Indonesian way of life) was contracted by the private, non-profit Prosperous Indonesia Foundation (YIS) to distribute condoms as a jamu item. The condoms are donated to YIS by the U.S. Agency for International Development, and are retailed at 20 rupees for a package of 3, with a profit of 4 rupees for the retailer. Mobile promotional/sales units are the most effective means for selling the devices. The approach appeals to the cultural and sexual character of the people. The media is used extensively to promote condoms and family planning. Although it is too early to assess the impact of the program, it is anticipated that this novel approach will spread the use of condoms to all areas of Indonesia.^ieng