NSU Development of The Newborn to 2 Year Old Wellness Clinic Paper
NSU Development of The Newborn to 2 Year Old Wellness Clinic Paper
Maternal and child health (MCH) clinics represent an integrated approach for providing healthcare to pregnant women and children 0-59 months of age. Although MCH clinics are also charged with monitoring child development, which involves tracking developmental milestones, it is unclear how these services are provided or perceived within the clinic. This study aimed to describe self-reported knowledge, perceptions, and practice of developmental monitoring in selected MCH clinics in western Kenya.
Methods:
This cross-sectional descriptive study was conducted within six clinics. We administered a descriptive survey to measure caregiver and healthcare staff attitudes towards and awareness of developmental monitoring; we also reviewed MCH booklets to identify services received at the clinic. Data collection occurred over a period of one day at each of the six clinic sites. The data were analyzed using descriptive statistics.
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Results:
During the study period, 78 caregiver-child pairs presented to the clinics and had their MCH booklets reviewed. The median child age was three months (interquartile range [IQR]: 1-8 months). Most caregivers were aware of weight monitoring and immunization services; however, when asked specifically about developmental monitoring, only 2.6% of caregivers were aware this service was available at the clinics. Nearly 80% of caregivers reported that they would be very interested in developmental monitoring services. Thirty-three MCH healthcare staff were interviewed about services provided and goals of clinical care. Fewer healthcare staff (60.6%) identified their roles in developmental monitoring compared to their roles in growth (90.9%) and nutritional monitoring (84.8%). Developmental milestones had not been recorded in any of the 78 MCH booklets. However, 78.1% of healthcare staff indicated support for developmental screening.
Conclusion and Global Health Implications:
While developmental monitoring was valued by healthcare providers, it was not consistently performed at the six clinics in our study. We recommend further work to raise awareness about developmental monitoring and to measure the implications of increased caregiver knowledge and perceptions on developmental monitoring practice.
Keywords: Child development, Development monitoring, Child health, Growth monitoring and promotion, Kenya, Screening
Go to:
1. Introduction
Well-baby clinics offer caregivers direct contact with healthcare staff during the early growth and development of their children.1, 2 During these visits, medical professionals recognize and treat illnesses, screen for growth and developmental delays, and provide health education to the child’s caregiver. Although there is limited data to evaluate the quality of care received by babies who visit the well-baby clinics generally, there is evidence that early childhood development and the monitoring of developmental milestones are evaluated less consistently than linear and ponderal growth. A 2018 study in South Africa found that immunization and weight monitoring were performed for almost all babies, but developmental milestones were assessed in only 34% of babies.3 Another study showed that only 26% of children were assessed for developmental milestones.4 Even in high-resource settings, developmental monitoring may be inconsistent—one study in the United States found that only 57% of mothers reported that their babies had ever received developmental screening in a pediatric office.5 Paired with nutrition, early childhood development interventions have shown promise for improving developmental outcomes.6, 7 However, children cannot be directed towards these interventions without early recognition of developmental delay.
In Kenya, well-baby services are offered through integrated clinics called maternal and child health (MCH) clinics. Growth charts are a central tool in these clinics and are included in the Kenya Ministry of Health-sponsored Mother and Child Health Booklet (MCH booklet).8, 9 In addition to age- and sex-specific growth charts, the MCH booklet includes birth history, the immunization schedule, illness records, and a checklist of developmental milestones. The MCH booklet were introduced in Kenya to ensure continuity of care between the prenatal period and postnatal life,8 and a recent systematic review suggests that the use of such booklets improves vaccination adherence and breastfeeding practices.10 During each visit, an MCH staff member—often a trained nurse—takes a history from the mother, examines the baby, and records findings in the booklet. The healthcare staff then implements interventions or connects the family to services and offers health education as needed.
MCH clinics are established in most public health facilities in Kenya and represent an opportunity for the early identification of children who have growth faltering and developmental delays.1 The extent to which MCH clinics deliver their mandate, however, is not known. The objective of this study was to describe the knowledge, perceptions, and practice of caregivers and healthcare staff around services offered at well-baby clinics, with a particular emphasis on developmental monitoring.
