Monitoring well-baby visits in primary healthcare facilities in a middle-income country

Abstract

Background. Globally, child health services are a priority, but are most acutely felt in underdeveloped and developing countries. Most of the children who live in such countries die from a disease or combination of diseases that could easily have been prevented through immunisations, or treated at a primary healthcare level. Undernutrition contributes to over a third of these deaths. Preventive measures are important to proactively prevent such disease and mortality burdens. Well-baby visits are for babies who come to the clinic for preventive and promotive health, and who are not sick. One of the goals in the National Core Standards is to reduce waiting time in health establishments. However, it is imperative that all necessary assessments are conducted during a well-baby visit. The Road to Health booklet (RtHB) contains the baby’s health record, and is issued to all caregivers, usually on discharge post-delivery. It also contains lists of appropriate assessments that should be performed during each well-baby visit according to age, including immunisations and health promotion messages for caregivers. In South Africa, infant morbidity and mortality rates are decreasing very slowly, requiring effective use of the RtHB to address important applied and research problems. 

Objective. To investigate how ‘well babies’ were monitored in primary healthcare facilities. 

Methods. A descriptive quantitative cross-sectional survey design was used for retrospective review of 300 babies’ RtHBs, using a checklist developed directly from the assessment page of this booklet. The clinical microsystem model was used to guide the study. Data were analysed using SPSS version 22.0. 

Results. Babies were shown to have been immunised in 100% of records, while discussion of side-effects and the management thereof were only recorded in 9.7% (n=20) charts. Records indicated that 98.7% (n=296) of babies were weighed, but only 71% (n=213) of weights were ‘plotted’ and 56.3% (n=169) classified according to the integrated management of childhood illnesses norms. 

Conclusion. Based on the findings, this research was able to make a contribution to the body of knowledge about baby monitoring practices in primary healthcare settings.