ChildCount.org

Part of the ChildCount+ implementation process involves the daunting task of registering all members of the community. Community Health Workers across all MVP sites are equipped with a standardized paper registration form. The form includes fields for Health ID numbers, First Name, Family Name, Gender, Age/DOB, Head of Household Health ID, etc. Community Health Workers fill out the fields either by referencing community member’s health booklets or by briefly interviewing them.

In Mbola, Tanzania, we have begun a registration form trial exercise in a village called Lolangulu. The trial began on Monday, 14 June, and we have already experienced two issues with the process.

• One of the Head of Households has two wives in two separate villages. This raises some interesting and challenging questions. Do we register the Head of Household in one village and not the other or in both villages? If we are to use one location, when we register the other household members from the other village, which Head of Household location should be used?
• With the focus of ChildCount+ on newborn, maternal and child health, only Children Under 5, Expectant Mothers and Heads of Households are registered. Many household members ask why this is the case. Maybe we should think about possibility of registering all household members seen during the visit.

Despite such challenges, the overall process is going well, and I am confident that some of the issues above and mistakes that may arise will be addressed during the retraining process.

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Now that we have the ability to record the key health interventions in a child’s health history, we’ve begun to think how we can convey this visually. Ideally, we want a method that will allow us to quickly evaluate the status of a child’s health taking in consideration health events in the past. We hope that this will also serve as a useful tool in discussing with with CHWs cases that go wrong or right.

Here is our first attempt. The line plot on the graph is based on the child’s mid-upper arm circumference (MUAC) which provides an indicator of the child’s nutritional status and is a good proxy for a child’s overall well being. The MUAC is plotted over periods of time (P) which is intersected by health events in the child’s life. We represent each intervention: nutrition screen, CMAM treatment or malaria/diarrhea diagnosis and treatment with a line. If the intervention is performed properly ie) a malaria diagnosis and treatment with 48 hour followup – the intervention line is solid. When a followup or screening is missed a dotted line is used.

For this example, we assume that for each period P a child should receive a routine nutrition screening where a MUAC is taken. In this example the child misses his screening at P2 but receives one at P3. Between P3 and P4 the child is diagnosed with diarrhea but for some reason does not receive the proper treatment (Zinc + ORS) or perhaps misses the required 48 hour checkup. At P5, the child has a MUAC of 108 which means he has secure acute malnutrition and needs to go on plumpynut therapy. In this case, the child receives treatment through period P8 until his health rebounds. He gets malaria somewhere between P8-P9 but is properly treated and child’s nutrition status returns to a normal level.

In this chart, the history is exactly the same for the child through P7. In this case, the child misses a key nutrition screening at P8 and is not properly treated for malnutrition at P9 when is MUAC is updated. Weakened after just having recovered from malaria, the child dies, unfortunately, before P10.

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