| 4. In which ways is the initiative creative and innovative?
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The Dietetics team wrote a motivational letter to the Hospital management requesting to initiate a crèche outreach in the Mapela area; approval was subsequently granted. Lists of all the crèches in the Mahwelereng/ Mapela area were requested from the Limpopo Department of Social Development. Other sections from within the hospital (Environmental Health Practitioners (EHP), Pharmacy (for procuring and issuing Vitamin A capsules and Worm-go tablets), Oral Health, Infection Prevention and Control Team (for administration of Vitamin A capsules and worm-go tablets to kids and total assessment of hygiene and safety) and Speech/hearing therapists) were formally requested to collaborate with our team for complete health assessment of the children. Nutritionists from the district were also involved for continued nutrition advocacy. Vitamin A tally sheets that were completed were taken to local clinics to be captured on DHIS.
Parent’s Consent forms were developed by Dietetics team and delivered to identified crèches before the visit and visit dates were given to the crèche principals in time. The Road-To–Health chart and a signed consent form were prerequisite for a child to be assessed. Prior arrangements were made with the hospital pharmacy to make available Vitamin A and de-worming medication during our crèche visits.
Following the assessment of each child, those found to be malnourished were referred for further management at their local clinic and hospital’s dietetics department. Follow –up is done on monthly basis until the patient is growing satisfactorily. Menus used at the crèches were reviewed and recommended provincial menus were provided considering the financial status of the crèche. Since the commencement of the project, most of Mapela Community Crèches are now empowered with up to date and correct nutritional information. The crèches have made use of this new found nutrition knowledge and has as a result observed that the children grow much better.
Since the commencement of the project, the coverage of administering Vitamin A supplementation has improved. This has been achieved through ensuring that at each visit, Vitamin A supplementation is given. In 2013 alone a 107 children received Vitamin A supplementation in 6 crèches.
Mapela area clinic staff and Maternity nurses have received regular in-service training on the correct and up to date infant and young child feeding practices. These health professionals are then encouraged to share this information with care givers to prevent malnutrition especially in children under 5 years.
The Dietetics team also gave nutrition education to mother lodgers and visitors in the hospital’s Paediatric ward during visiting hours to empower them with knowledge
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| 5. Who implemented the initiative and what is the size of the population affected by this initiative?
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Department of Social Development gave us the lists of all the crèches in the Mahwelereng/ Mapela area were requested from the Limpopo. Other sections from within the hospital (Environmental Health Practitioners (EHP), Pharmacy (for procuring and issuing Vitamin A capsules and Worm-go tablets), Oral Health, Infection Prevention and Control Team (for administration of Vitamin A capsules and worm-go tablets to kids and total assessment of hygiene and safety) and Speech/hearing therapists) were formally requested to collaborate with our team for complete health assessment of the children. The hospital transport was provided for the team going out for outreach when requested. Nutritionists from the district were also involved for continued nutrition advocacy. Completed Vitamin A tally sheets were taken to local clinics to be captured on DHIS.
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| 6. How was the strategy implemented and what resources were mobilized?
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All the resources which were utilised such as transport, stationary, height meters, scales, other medical equipments (ALLIED), Vitamin A capsules, Worm-go tablets, waste control equipments and human resource are all under Mokopane hospital budget. Transport requisitions are done the day before the outreach and supplements are requested by the infection control nurse from Pharmacy a week before; stakeholders are primarily responsible to bring along all medical equipments that will be needed for outreach. Nutritionists and the transportation utilised District Health budget.
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| 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
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Since commencement of the project; early identification of children at risk is done timely hence reduced number of children diagnosed with chronic malnutrition.
Mothers are more actively utilising primary health care services for follow ups and to also access other child health services such as immunisations.
Caregivers at crèches are now offering healthier meals for the children for better growth and development.
There is also an improved trans disciplinary team approach when doing crèche assessments.
There is a reduced incidence of gastroenteritis admissions in our hospital since the creche outreach started.
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| 8. What were the most successful outputs and why was the initiative effective?
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Monitoring : All Crèches were visited according to the agreed and approved program, all the kids in the targeted crèches were assessed and those who were eligible to receive Vitamin A supplements were given and whereby supplements were no available were referred to the local clinic for further help,. Up to date crèche visits are still done following the approved program still with other stakeholders involved. Dietetics make follow ups with district Nutritionists on continuing to do parents education and monitoring implementation of menus supplied
Evaluation:
Process : Raw statistics of all assessed targeted kids was kept and tally sheets were tallied for every administered vitamin A (308 received Vitamin A: 2012 May – 2013 April); monthly statistics were kept of all the referred kids brought to hospital for follow ups and they were given appropriate support (education and supplements) to ensure good growth and development ; Nutritionists give us reports on implementation of recommended menus monthly for better advocacy; the program for nurses in-service training at the clinics is still followed.
Outcome: There is 17 % reduction in malnutrition cases admitted in Mokopane hospital between May 2013- May 2014; There was reduction of referred undernourished children between 0-24 months in the year 2012- 2013 (n=06 – n=0); Vitamin A coverage in Waterberg district in 2013-2014 was 27,1 % and currently the coverage is 36 %.
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| 9. What were the main obstacles encountered and how were they overcome?
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Shortage of vitamin A supplementation capsules and de-worming medication at times. To order vitamin A supplementation and de-worming medication from pharmacy in advance.2. Poor logistics in arrangements of transport to crèche outreach. Collaborate with hospital transport services and book in advance 3. Lack of consistent commitment by some local clinics to the project Additional support was requested from hospital nurses in Infection control section to assist. 4. Some crèches are not funded, therefore menu planning problems and poor food security for such crèches. To have different menu’s that are balanced and cheap to afford. 5. Geographic location, some crèche are not accessible. To find directions in advance. 6. Poor capturing of Vitamin A statistics on DHIS – Nutritionists from the Districts to monitor the capturing of the Vitamin A tally sheets from clinic level so as to reflect on District data.
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