Strategies to improve maternal and child health

Improving the growth and development of young children

To find a solution to inadequate nutrition of young children, strategies must focus on long term solutions and also address immediate needs. It is essential to work with community members to determine the best strategies for their situation. For example, intensive health education with family members about infant feeding is one strategy. Having a feeding program is another.

Discuss a range of options with the community and with family members

Growth Assessment and Action

The health status of children in the NT continues to be of concern.

See 'Chronic diseases' in Section 1 of the chapter

Growth is one of the best ways of assessing the general health of a child... Loss of weight, or slowing of growth is a sign that something is wrong... Regular growth assessment provides an early opportunity to identify growth faltering and initiate action immediately. THS 1998:1

The aim of growth monitoring is:

• to ensure that every child has the opportunity to have his or her growth assessed
• to ensure that mothers and carers are given appropriate feedback about the child's growth

It is the responsibility of staff to familiarise themselves with the 'Growth Assessment and Action Guidelines' and to treat growth monitoring as an essential core activity of the health centre.

Growth Action Plans

Every child who is not growing well should have an individual Growth Action Plan developed through consultation between the health and the child's extended family or carer.

		Contact the Nutrition team for more information and a copy of the Growth Assessment and Action Guidelines 1998
		See the CARPA Standard Treatment Manual
		See 'Maternal and Child Health' in Section 1 of this chapter

The Road to Health Chart

Every baby and small child should have a Road to Health (RTH) chart on their file. When babies are weighed and measured their results are plotted on the chart. Over time health teams and carers can see if the baby is growing properly. Illnesses can also be recorded on the chart.

The RTH chart gives a standard for weight-for-age and height-for-age. Haemoglobin levels are also measured at specific times.

The growth monitoring regime is more than just a regular weight check. It also involves length/height and head circumference at designated intervals, and constant reassessment of the child's health status.

The RTH chart is probably one of the most useful tools for health staff working with individuals, families and communities on infant and child health. It shows what is 'normal' growth for healthy kids. It is a very good education and assessment tool.

		Use the chart when talking with parents and carers about how a baby is growing and any problems. The chart provides an opportunity to offer support and explore solutions to problems together
		See the booklet and video "The New Road To Health Chart". Contact the Nutrition team for copies

Consider teaching the mums and other carers in the community to weigh their own babies and check their growth on the RTH chart

Tips for improving growth assessment and follow-up

• "They [health staff] need to take direction from Aboriginal people (health workers, grandmothers, parents and others) about what they think are the problems and solutions (CARPA 1997:113)"
• Children are raised differently. "Health staff must understand that the people they work with may have different beliefs and practices from their own (CARPA 1997:113)."
• People may be threatened by the request for frequent growth monitoring. Explain to carers and families that all babies in Australia get weighed and checked regularly
• If a child is not growing properly any intervention or follow up action should involve the extended family. (This will help strengthen the role of the family and share the responsibility for the raising of the child)
• Child health has, in many instances, been improved through community action. Communities can often help in situations where family problems make it difficult for individual carers to improve the situation of the child. Focusing on more than one child in an intervention means that there is less chance of carers and families feeling ashamed about the condition of their child

Tips for feeding back information to the community

Contact the Nutrition team for help in compiling community information for your area and providing training and support for doing growth assessments and follow-up activities

Enhancing antenatal care

The Strong Women, Strong Babies, Strong Culture Program

The Strong Women, Strong Babies, Strong Culture Program (SWSBSC) and how it started are discussed in Section 1 of this chapter. It is a good example of a comprehensive program covering clinical management, health promotion, social support and cultural revival. Community elders have a crucial role to play in passing on information.

Some of the things we have learned from the program:

• timing of antenatal care clinics is important, especially in a small community. For example, if antenatal care clinics are held at a set time each week then it will be obvious to everyone that women who attend the clinic are pregnant. This can violate a woman's privacy. It is a woman's right to let people know that she is pregnant, at a time which she considers appropriate
• early antenatal care needs to be available on request
• it is important to involve older women to help with the implementation of change. Young, pregnant women are likely to be those with the least decision making power in the family. They are often not in a position to ask for special or extra foods, or care. This can restrict a woman's ability to act on the advice given by AHWs, nurses or doctors. Older women can advocate for younger women
• it is important to involve older, related women in antenatal care consultations. Their presence and support can help to ensure that someone in the family understands the younger woman's needs

Throughout the NT maternal malnutrition is common. Weight gain within the normal range during pregnancy is directly related to better birth outcomes. Prevention of low birth weight is also an important primary prevention strategy for adult diseases such as diabetes, cardiovascular and renal disease.

Remember, the most underweight women need to gain the most weight during their pregnancies.

		Make sure you always weigh pregnant women when they come for antenatal care
		Monitor pre-pregnant weight for women of child-bearing age in the community