UNIVERSITY MONITORING AND PROMOTION IN PEDIATRIC WARD OF

UNIVERSITY
OF GONDAR

COLLEGE
OF MEDICINE AND HEALTH SCIENCES

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SCHOOL
OF NURSING

DEPARTMENT
OF PEDIATRIC NURSING

 

 

Clinical Audit
Report

STANDARD
OF GROWTH MONITORING AND PROMOTION IN PEDIATRIC WARD OF GURH

 

 

 

 

 

 

 

 

 

 

Background

Growth
Monitoring is a screening tool to diagnose nutritional status, chronic systemic
and endocrine disease at an early stage.(IAP). Growth monitoring (GM), a
process of regular weighing and measuring the height
and comparing the results with a standard.  
(Revisiting the concept of growth monitoring and its Possible role in
community-based nutrition programs).

Growth
Monitoring and Promotion (GMP) is a public health intervention through frequent
growth assessment of children under five years which enable health workers to
early detect growth failure and takes
corrective actions through improvements in feeding and care practices. (Accra).

 

So, growth monitoring consists of routine
measurements to detect abnormal growth, combined with some action when this is
detected. It is a standard component
of community pediatrics services throughout the world and is widely accepted
and strongly supported by health professionals. (GM IN Children).

 

The evaluation of anthropometric data on the height and weight
allows for the identification of subgroups of the child population that are at
increased risk of faltered growth, impaired mental development, and death.

 

Regular growth monitoring and promotion is one
of the basic activities of the under 5 clinics. Growth Monitoring must start at
an early age in the child’s life, right from birth. The suggested monitoring
intervals after birth are within one to two weeks of birth, at one, two, four,
six, nine, 12, 18 and 24 months, then once per year for children over 2 years
and for adolescents. Growth assessment should also occur at acute care visits,
keeping in mind that illnesses may affect weight.( A
Health Professional’s Guide for using the WHO GROWTH CHARTS FOR CANADA).

Children who are severely underweight, or who
have not gained weight for 2 months, or who are “at risk” of undernutrition, should be weighed frequently preferably
every month. The golden principle of New WHO Growth Standards suggests weighing
and plotting weight of children on the basis of completed weeks/months. It is
advisable to conduct four weighing sessions in a month at the AWC so that all
children are weighed every month.

According to guideline for assessing and
managing children at primary health-care facilities to prevent overweight and
obesity in the context of the double burden of malnutrition, all infants and children aged
less than 5 years should have both weight and length/height measured, in order
to determine weight-for-length/height and to classify nutritional status
according to WHO child growth standards. The guideline also suggests that caregivers
and families of infants and children aged less than 5 years presenting to
primary health-care facilities should receive general nutrition counsellin.

 

According to 2017 WHO report on African Region
undernutrition is still persistent in the Africa and along with this, the
prevalence of overweight among children under 5 years of age (as well as the
overall number of children affected) is also rising, whereas the target is to
halt its increase.( nutrition in WHO African region. This can be achieved
through frequent and regular growth monitoring of the children including
community based growth monitoring and promotion services.

 

 

Government of Ethiopia developed the National
Nutrition Strategy (FDRE 2008) and the National Nutrition Programmes (NNP) in
an effort to accelerate the reduction Of undernutrition. The Seqota Declaration
(2015-2030) aims to eliminate all forms of malnutrition among children under
age 2 by 2030 (FDRE 2015b). Growth monitoring and promotion is the potential
contributor towards the achievement of this goal.

There is low
utilization of growth monitoring and promotion services in Ethiopia. According
to research done in Southern Nations and Nationalities of Ethiopia, the overall utilization of GMP
services is 16.9%. The study found that the health professionals focus on
weighing and identifying children’s nutritional status instead of discussing with
mothers and communities.

 

 

 

 

 

 

 

 

 

 

 

 

Justification

Appropriate and regular growth monitoring
and promotion has the potential for significant impact on mortality even in the
absence of nutrition supplementation or education. It enables the care provider
in early identification of children with growth deviation i.e.,
undernutrition and over nutrition and to identify diseases and conditions that
manifest through abnormal growth. So this audit is aimed at identifying whether
the growth monitoring and promotion services given in the Gondar University
Hospital is being delivered as per the standardized and updated guideline.

 

 

 

AIM AND OBJECTIVES

 

 

AIM:

 

To improve nutritional assessment of under-five children by proper application of WHO
growth monitoring and promotion charts in Gondar University Referral Hospital,
2018.

 

 

 

 

 

OBJECTIVES

 

1.    To assess the current growth monitoring
and promotion standards in Gondar University referral Hospital, 2018

2.    To compare the the current growth
monitoring and promotion practices of GURH with the standards.

3.    To inform the findings of the audit with
the relevant clinicians in the hospital.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Standards of practices for growth
monitoring  and promotion

 

SN

            List of standards
 

Target

Exceptions

Source
of evidence

Source
of data

1

The child’s age – in months – is
correctly calculated and recorded in the correct place.

100%

No

JSI Research & Training Institute
2008

Observation during care delivery

2

The weight of the child is correctly
measured and recorded;

100%

No

 

 

3

The child’s length is correctly
measured and recorded to the nearest 1cm.

100%

No

 

4.

Weight and/or height measurements are
plotted on the growth monitoring chart.

100%

No

 

5

The health provider visually screens
the child for malnutrition and assesses the anthropometric readings on the
growth monitoring charts.

100%

No

 

6

Signs of anemia are checked (pallor)
and laboratory tests are requested when needed.

100%

No

 

7

The health provider provided the
caregiver with the needed supplementations (iron, vitamin A)

50%

Iron is given for child dxed with  anemia.

 

8

The health provider explains procedures
and feeds back to the care giver how the child is growing.

100%

No

 

9

The health provider responds to the
caregiver questions and provides information about the proper feeding
practices.

100%

No

 

10

The health provider tells the caregiver
when to come for the next visit.

100%

No

 

11

The appointment is recorded on the
card.

100%

No

 

 

 

 

Audit Methodology

 

5.1.       
Audit
population

The number
of growth monitoring sessions given for all under five children in GURH

5.2.     
Audit sample

The number of growth assessment sessions given for under
five children who were at pediatric OPD and malnutrition ward at the time of
data collection.

5.3.       
Audit
sample size and sampling technique

Thirty
care providers have been observed while giving care for children
under five-years. Simple random sampling technique will
be employed.

5.4.      
Data
collection

Standardized
checklist adopted from JSI Research and Training Institute 2008 has been used
as standard to assess the care delivery of the health care providers in the
Hospital. The data has been collected by the direct observation during each
care delivery sessions and review of the charts has been done to check
appropriate recording of the the datas.

 

Starting date:-  
16/01/2018 GC

Completion date:- 26/01/2018 GC

Presentation date:- 08/02/2018 GC

 

 

 

 

 

 

 

 

 

 

 

 

 

 

AUDIT PERFORMA

 

SN

Standard practices for growth
monitoring

 Observation

 

1

The child’s age – in months – is correctly
calculated and recorded in the correct place.

 

 

 Recording age: The child’s
age – in months – is correctly calculated and recorded in the correct
place.

 

Yes

       No             NA      

2

The weight of the child is correctly measured
and recorded; to the nearest 100 grams.

 
Yes

       No 

       NA

      

3

The child’s length is correctly measured and
recorded to the nearest 1cm.

 
Yes

       No 

       NA

      

4

Weight and/or height measurements are plotted
on the growth monitoring chart.

 
Yes

       No 

       NA

      

5

The health provider visually screens the
child for malnutrition and assesses the anthropometric readings on the growth
monitoring charts.

 
Yes

       No 

       NA

      

6

Signs of anemia are checked (pallor) and
laboratory tests are requested when needed. Hemoglobin is routinely performed
at 9-12 months and/or according to the protocol

 
Yes

       No 

       NA

      

7

The health provider provided the caregiver
with the needed supplementations (iron, vitamin A&D)

 
Yes

       No 

       NA

      

8

The health provider explains procedures and
feeds back to the care giver how the child is growing.

 
Yes

       No 

       NA

      

9

The health provider responds to the caregiver
questions and provides information about the proper feeding practices.

`
Yes

       No 

       NA

      

10

The health provider tells the caregiver when
to come for the next visit.  

Yes

       No 

       NA

 

11

The appointment is recorded on the card.

 Yes

       No 

      NA

     

 

 

Total score = ______ of _____ maximum indicated = _____%

NB: – YES
if they perform all necessary steps under each activity.

        NO If they couldn’t perform any steps
under each activity.

 

 

 

 

Data analysis

Data would be checked for its completeness &
reliability. The data was analyzed manually by tally & data are presented
by using tables, graph &pie chart.

 

 Result

 
SN

      
List
of standards
 

              Results per care delivery
sessions

Compliance %

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

 

1

The child’s age correctly recorded in
months.

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

×

?

?

?

×

×

?

?

?

?

?

?

?

?

?

90%

2

The weight of the child is correctly
measured and recorded; to the nearest 100 grams.

?

?

×

?

×

×

×

?

?

?

?

?

?

?

?

?

?

?

?

?

×

×

×

?

?

?

?

?

?

?

77%

3

The child’s length is correctly
measured and recorded to the nearest 1cm.

 
?

 
×

 
?

?

×

?

?

×

×

×

?

×

×

?

?

?

?

×

?

?

?

?

?

×

×

×

×

?

×

×

53%

4

Plot wt and/or ht on growth monitoring
chart

×

×

×

?

×

×

×

?

×

×

×

×

×

×

?

×

×

?

×

×

×

×

×

×

?

×

×

×

×

×

17%

5

Check for sign of malnutrition &
assesses the anthropometric readings on the GM charts.

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

×

?

×

?

?

?

×

?

?

×

×

?

87%

6

Signs of anemia are checked (pallor)
and laboratory tests are requested when needed.

?

?

?

?

?

?

?

×

×

×

×

×

×

?

?

?

?

?

×

?

×

?

?

?

?

?

?

?

?

?

73%

7

Supplementation of Iron, Vit A&D

×

?

?

×

?

?

?

×

×

?

?

×

?

?

?

?

?

?

?

?

×

?

×

?

×

×

×

×

×

?

60%

8

The health provider explains procedures
and feeds back to the care giver how the child is growing.

?

?

?

×

×

×

?

?

?

×

?

?

?

×

×

×

?

?

×

×

×

?

?

?

?

?

×

?

?

?

63%

9

The health provider discuss with
caregiver about feeding practices

?

?

×

?

?

?

?

?

?

×

?

?

?

?

?

?

?

?

?

?

×

?

×

?

?

?

×

×

×

?

77%

10

The health provider tells the caregiver
when to come for the next visit.

×

×

?

?

×

×

×

?

?

?

×

?

?

×

×

?

×

?

?

×

×

×

?

?

?

?

?

×

?

?

57%

11

The appointment  is recorded on the card.

×

×

?

?

×

×

×

?

×

×

×

?

?

×

×

?

×

?

?

×

×

×

?

?

?

×

×

×

?

?

43%

 

 

              
Overall Compliance Rate

63.3%

Total score = 209 of 330 maximum indicated = 63.3%

The total compliance rate of standards of growth
monitoring of under five children in pediatric OPD and malnutrition ward was

 

= 63.3% & the noncompliance rate
(gap) was 36.7%.

 

Table 1: Frequency distribution of standards of
practice of growth monitoring and promotion in GURH pediatric OPD and
Malnutrition ward.

 

Frequency

Percent

Cumulative

Yes

209

63.3 %

63.3 %

No

121

36.7 %

36.7 %

Total

330

100 %

100 %

 

This audit result find out that out 11
standards of growth monitoring and promotion services delivered to 30 under
five children in pediatric OPD and malnutrition ward of GURH, about 63.3% of
the services are delivered according to the standards of the practice.

 

 

Figure 1: The frequency showing the
number of growth pattern correctly plotted on the WHO growth chart in the
pediatric OPD and Malnutrition ward GURH.

 

 

 

 

DISCUSSION

 

The compliance rate of growth monitoring
and promotion service given at pediatric OPD and malnutrition ward of GURH with
the standards of the practice is found to be around 63.3%. This means the
health care provider’s compliance with standards during care delivery was 63.3%
and 36.7% care are delivered doesn’t comply with the standard of growth
monitoring and promotion.