Community growth monitoring campaigns are always an exciting and busy time for our team. Three times a year, before each new season, we join with community health workers (CHWs) at remote sites across the Musanze District of Northern Rwanda to weigh and measure children.
As part of the Ministry of Health’s First 1000 Days Community-Based Food and Nutrition Programs, the Government of Rwanda conducts routine growth monitoring of children across the country using community health workers to reach families in need. At GHI we utilize these campaigns to identify children with chronic and acute malnutrition across the communities where we work, and enroll the most severe cases in our Health Center Program.
In the past, we would use these campaigns to refer any children who fell below the “healthy” height-for-age or weight-for-height measurements – as defined by the WHO growth tables – to our enrollment days. During enrollment, all referred families came together at their nearest health center where GHI field staff, in collaboration with CHWs, would re-assess children to ensure accuracy and enter data into an electronic spreadsheet in real time.
Back in the office, our talented Monitoring and Evaluation Team would then rank those children according to a Z-score calculation of their weight-for-height (to detect acute malnutrition, or wasting) and height-for-age (to detect chronic malnutrition, or stunting) measurements with the following prioritization:
- Severe acute malnutrition for children under 5
- Moderate acute malnutrition for children under 5
- Severe stunting (chronic malnutrition) for children under 2
- Moderate stunting for children under 2
- Severe stunting for children over 2
- Moderate stunting for children over 2
The forty most severe cases of malnutrition at each health center were then invited to enroll in our program.
This season, we changed the structure of how we enroll families into our program by eliminating ‘enrollment days’ at health centers and instead using data directly from campaigns to prioritize families. This shift happened for a number of reasons:
- Last season, only 38% of families that were referred from campaigns came to enrollment days, meaning that we could be missing some of the most vulnerable children by adding an extra step to the process.
- We had previously thought enrollment days were important for ensuring accuracy of data; however, our field staff have been improving their techniques for taking measurements in the field, and last season only 4% of height or length measurements differed by more than 5 cm between campaigns and enrollment. In addition, to ensure that we still collect accurate data, our team weighs and measures children again at the first health center training to double-check nutritional status and record baseline data.
- CHWs will also be changing how they conduct growth monitoring campaigns in the coming year, which made this a good time to make adjustments to our own enrollment strategy.
- Our current seasonal schedule would have placed enrollment days at the same time as local market days in the communities, which would have meant particularly low turnout at enrollment.
One thing that hasn’t changed, however, is that growth monitoring campaigns always call for “all hands on deck”. For each campaign, Ndera-based staff join with Musanze staff at sites across the district to help weigh and measure up to hundreds of children per site. Campaigns also offer an opportunity for our Ndera-based staff to interface directly with partner communities and vulnerable families.
Through joining community health workers in periodic growth monitoring campaigns, we are able to integrate with existing government policies and structures and avoid any overlap or competing interests. One of the hallmarks of GHI’s model has always been our productive working relationship with the Government of Rwanda. By partnering directly with government health centers, we are able to build capacity as well as reach the most vulnerable children at the point of care.
This season, our team – together with community health workers – weighed and measured over 18,000 children across Musanze District. Now that this season’s campaigns have come to a close, we will be able to jump right in with our next cohort of mothers as soon as the holidays are over. We look forward to working with our newest cohort and reporting on exciting new outcomes for 2017!