Sick child's weight checked against a growth chart
Percent of sick children aged 2-59 months who are weighed the day they are seen and whose weights are checked against a recommended growth chart.
Number of sick children aged 2-59 months who are weighed the day they are seen and whose weights are checked against a recommended growth chart.
Total number of sick children aged 2-59 months seen.
The data are gathered by direct observation of sick child consultation. The observer records whether the health worker weighed the child and plotted the child’s weight on a recommended growth chart (usually a standard WHO or national growth chart).
SPA (service provision assessment)
HFA (health facility assessment)
Supervision checklist
This indicator measures health worker compliance with Integrated Management of Childhood Illness (IMCI) guidelines for the routine assessment of the nutritional status of sick children by weighing the child and plotting the weight on a recommended growth chart.
There are two main reasons for this assessment. The first is to identify children with severe malnutrition who are at increased risk of mortality and need urgent referral. Second, an assessment of the nutritional status of sick children helps to identify children with low weight-for-age who may benefit from nutritional counseling. All sick children should be assessed for malnutrition.
Data for this indicator are easy to collect during sick child observation or routine supervisory visits. They give a good indication of health worker compliance with IMCI guidelines regarding the nutritional assessment of all sick children. The indicator can be applied at a specific interval post-training to those who attended IMCI training to evaluate the retention of this particular component of clinical assessment skills. This may help identify health workers who need refresher training or health centers in which weighing of sick children and recording the weight on a growth chart are not enforced.
Limitations to the use of observation for measuring quality of sick child assessment include “observation bias,” in that a health worker may abide to the guidelines more strictly when he or she is conscious of being monitored. Another limitation of the indicator pertains to variability between observers in measurement. This is hard to measure but can be assessed by having two independent observers rate a sick child consultation and then comparing the degree of agreement or disagreement in their ratings.
Note that the indicator does NOT reflect the correct measurement of the child’s weight, whether the child’s weight was accurately plotted on a growth chart, how effectively health workers interpret the information on the growth chart, or whether the health worker took an appropriate course of action based on insights from the growth chart. It is also difficult to tell from the indicator whether health workers are weighing/not weighing the children at all, or whether children are weighed but their weights are not plotted on a growth chart.
Pediatric care, Nutrition, Child health
Gage, Anastasia J., Disha Ali, and Chiho Suzuki. (2005). A Guide for Monitoring and Evaluating Child Health Programs. MEASURE Evaluation. Carolina Population Center, University of North Carolina at Chapel Hill. http://www.coregroup.org/storage/documents/Workingpapers/ms-05-15.pdf
