Designed for African Americans at risk for type 2 diabetes, the Road to Health Toolkit provides materials to start a community outreach program to help people. Use the NDEP Fat and Calorie Counter to demonstrate how to determine the grams of fat and calories eaten. • Use the poster Step by Step—The Road to Health. To recognize the signs and symptoms of malnourished and nutritionally deficient children. (Step 1). • To use and interpret the Road to Health Chart. (Steps 4, 5).
to Health A Road Step the on
The strata were then created by combining the determined size with known maternal HIV prevalence categorised into either high or low relative to the national average. Sample size at provincial and facility levels were then determined using probability proportionate to size with a target of providing reasonable provincial and national level estimates.
Details of the primary studies have been published elsewhere [ 11 , 12 ]. Face-to-face interviews were conducted after the routine visit activity was completed and data were captured electronically using mobile phones and then stored in an access-restricted database.
Data collected through interviews included maternal socio-demographic backgrounds, antenatal care histories and early postnatal health care uptake. All enrolled participants were asked to present the RtHB during the study interview. During the survey interviews, data were extracted from the RtHB, including infant birth weight, BCG immunization, infant HIV exposure status and maternal syphilis testing results.
We created a composite outcome variable using extracted data for four variables that should have been completed at birth, namely; infant birth weight, BCG immunization, maternal HIV status and indication of whether maternal syphilis testing was done.
Therefore, the outcome variable is ordinal with counts from 0 through to 4. These indicators were simply chosen because they were of common interest to both survey aims and are also important to assess PMTCT and maternal and child health service uptake.
Maternal characteristics potentially associated with uptake of health care services were assessed for association with completeness of the RtHB. SES, grouped into quartiles, was calculated for each year using principal component analyses from household characteristics which included type of housing, sanitation, water and fuel , household possessions such as TV, stove, radio , any food shortage and source of income [ 13 ]. Differences between provinces and survey years were also evaluated in relation to the primary outcome.
Variables which indirectly reflect competence of health service provision before 6 weeks postpartum were also included to give an indication of whether incompleteness of the booklet is related to the service provider. We hypothesize that performance of health care providers in providing basic services recommended during pregnancy, would reflect their diligence is recording patient-held records, including the RtHB when it is issued.
An ordered logistic regression analyses was used for the outcome variables. This was done to minimise deviation from the correct estimates when applying the survey sampling weights which were calculated based on the actual attained sample size. Factors associated with completeness of the RtHB were identified using a partial proportional odds PPO logistic regression analyses in three steps [ 14 , 15 ].
The assumption of proportionality of odds across sub-group pairs of the outcome variable, made by the proportional odds logistic regression model, was first tested for all predictor variables using the Brant test.
The rest of the predictor variables violated the proportional odds model assumption and thus were not constrained under this assumption.
Self-reported antenatal maternal HIV-positive status increased between the two surveys Socio-demographic profile of population and other independent factors enrolled in the and surveys, South Africa. On the other hand, most women had received infant feeding counselling during pregnancy, with a significant increase from Approximately two thirds of deliveries were attended by nurses, midwives or community health workers.
Significant differences in the distribution of variables between years were evident for maternal age, knowledge of MTCT modes, infant feeding counselling, place of delivery and birth attendant. Recording of each of the four health indicators in the RtHB were compared between the survey years Table 2. With the exception of infant BCG immunisation, there was a significant increase in the recording of the remaining three indicators on the RtHB with the most notable increase in the recording of infant birth weight Completeness of the RtHB improved over time.
Recording of only one or two of the four indicators decreased by 5. Having a RtHB with expected completeness ie, all 4 indicators in and , vs incomplete including no recording of all four indicators , was then stratified by each independent variable for each survey year Table 3 Overall, expected RtHB completeness increased from Overall during this survey period, between just under a fifth and a quarter of participants across age-groups, highest education achieved, marital status, parity, knowledge of MTCT, SES, infant feeding counselling, place of delivery and type of birth attendant had expected RtHB completeness.
Maternal and health provider risk factors by complete RtHB status and year in and surveys, South Africa. Therefore, the final model was controlled for all other remaining variables. Summary of the association between maternal and health provider risk factors and completeness of the RtHB in and surveys, South Africa; using a partial proportional odds logistic regression model.
Maternal education and parity were not significantly associated with completeness of the RtHB. All four factors TB screening during pregnancy, infant feeding counselling during pregnancy, place of delivery and birth attendant directly related to the health care provider were significantly associated with completeness of the RtHB. Having a nurse, midwife or community health worker handling a child birth as opposed to a doctor significantly increased the odds of having more indicators completed in the RtHB adjusted odds ratio AOR 1.
However, there was no difference in RtHB completeness between deliveries assisted by doctors and those assisted by traditional birth attendants. Significant differences in the completeness of the RtHB at different levels were seen across provinces.
We set out to understand how well the RtHB was used to capture four key health indicators that we used to define completeness ie, birth weight, BCG immunisation, maternal HIV status and syphilis result and what were the key predictors of completion. This study shows that most infants were brought to the clinic by their mothers who were mostly between years, single, had achieved an education level of high school or more and were multiparous.
A study carried out at a primary, secondary and tertiary care centres in one province in South Africa showed that Similarly, Senanayake et al. High rates of possession of RtHB have been previously reported in studies conducted in Zimbabwe, Tanzania and India [ 19 - 21 ].
However, this has not been the case in earlier studies conducted in South Africa which included participants attending both well and sick child visits. Jacob and Coetzee reported a high but not satisfactory proportion of Failure to carry the RtHB may be attributed to the failure of health care workers to request for the booklet or caregivers not knowing that they have to carry the booklet to all consultations not only immunisation visits.
In particular, recording of maternal HIV outcome Although reasons for poor recording of health indicators were beyond the scope of this analysis, findings from other studies have provided possible challenges for poor monitoring of the RtHB resulting in missed opportunities for immunisation or growth monitoring.
Kitenge and Govender discuss several issues expressed by health care workers in monitoring the RtHB including staff shortages, lack of equipment, work overload and understaffing of nurses, stock-out of vaccines, absence of the RtHB and poor attendance of caregivers at immunisation scheduled visits [ 25 ]. Although these were not maternity-level staff, some of the challenges raised are likely to be common.
Mothers also expressed that information on the RtHB feeding, oral rehydration, play and stimulation and safety of the child was not discussed with them during consultations [ 26 ]. This study was a secondary analysis from the national PMTCT surveys; therefore data explaining why the RtHB was already incomplete as early as 6 weeks post-partum were not available.
This suggests the responsibility for the largely incomplete RtHBs observed here may lie primarily with provider-related factors.
Other studies conducted either in one sub-district or one province of South Africa have reported underutilization of the RtHB. These studies found that both health facility staff and mothers influence underutilization, for example, health facility staff often do not ask for the book, do not fill in the information adequately and accurately and have poor understanding and interpretation of the growth charts [ 16 , 27 ]. Subsequently, mothers are not made aware of the importance of taking the RtHB to the health facility at every visit, are not educated on whether their child has received all the required immunizations, unable to interpret deviations in weight and therefore cannot recognize and react quickly when the child falls ill or does not reach developmental milestones.
The outstanding very high adjusted odds ratios association between completeness of the RtHB and the KwaZulu-Natal and North West provinces is worth noting. The very low odds observed for North West are however difficult to explain with the available data. Although we could not infer causality due to the cross-sectional nature of this study, we observed that both maternal-related and health provider-related factors were associated with RtHB completeness.
An estimation of my daily activity - pedometer switched off in trains and buses - puts me at between 3, and 7, steps. More simply, I walk between 2. Hitting 10, steps means adding a 2km walk to my morning routine and opting to walk to MRT stations rather than taking the shuttle bus on a boiling hot afternoon. It is an achievable goal but tiring. Looking deeper into this 10,step thing, I find to my horror that it is not a scientifically determined target but an offshoot of Japanese marketing: Two years ago, journalist Rick Smolan tackled the world of "big data" - the vast amounts of information collected every day in the world by satellites, smartphones and other sensors.
In his book, The Human Face Of Big Data, he pointed out that the average human today processes more data a day than anyone in the 16th century did in an entire lifetime. The first day a baby is born, the resulting data in terms of the hospital monitoring vital signs or photos taken by adoring relatives is equivalent to that contained in America's Library of Congress.
So amid all this chatter, how do we pick out the information that is useful to us, which will help us move towards healthier, happier, more fulfilled and useful lives? The first step is clearly to not just accept information but also find out where it came from.
The oft-touted body mass index or BMI, for example, has been shown to incorrectly judge athletes as unhealthy and obese - these Olympian men and women have dense bones and muscle mass that throw the readings off. Of course that does not change the health benefits of walking more, it just means I need not beat myself up mercilessly when I hit only 7, steps or, on one terrible day last week, 9, Record one weight on the wall- sized chart under the lower reference line.
Record another weight for a child of the same age between the lines. Explain why we cannot say that one is healthy and the other "high risk" without more information. Draw growth curves for the six months prior to the weights given for each child as in the following example. He could be at "high risk.
Draw the arrows below on the flipchart and explain the significance of the directions of different growth curves. Directions of different growth curves. Looking for the Causes of Growth Failure: When growth failure occurs, the first thing to do is to find out what is causing it.
Explain that illness, a change in feeding habits, separation of mother and child, etc. This can be done in small work groups or individually. When they finish, discuss each of the five growth curves mentioning the common causes of growth failure for each age group. Adapted and excerpted from World Health Organization. Trainers should select growth charts available in their regions.
These growth charts should be substituted for the growth charts used in figures and exercises in this workbook. If charts with more than two reference lines are used, the description and instructions for recording and interpreting weight will also require modification. A Growth Chart is basically a graph on which a child' weight is shown at different ages.
There are many types of growth charts, but most of them have the same basic features. It should be printed on card or paper sufficiently strong to be used to some years. The horizontal lines in this chart represent weight in kilograms. The vertical lines represent age in months. The weights are marked against each horizontal fin' on the left-hand side of the chart. The vertical lines for 12 columns for each year, corresponding to the months of the year.
The month names can be written in the 12 boxes below the columns. The first box on the left-hand side of the chart is for the month of birth. This box has thick line around it. The first column for each year also has a box with thick lines around it. This is to identify the beginning of each year of age. The year of birth is marked by the side of the box for the month of birth i.
Across the graph are printed two growth reference lines These lines give the general direction of growth in health children. They are not the target for the growth of all children. If a child's weight is much below these grows!
There is a space for recording the different dates of immunizations. This also serves as a reminder of when the next immunizations are due. It is convenient to write the illness suffered by the child on the side of the chart that shows the weight graph. The name of the disease can be written vertically in the month in which it occurs. This makes it easy to see ho, a disease such as measles seriously affect.
The same chart can also be used for recording additional information. For example, if a nutritional supplement programme is being carried out and vitamin A is given every 6 months, a large A can be written at the bottom of the column of the month in which it was given. If food supplements or antimalarial drugs are given monthly a tick can be marked in the column for the appropriate month. Parents are advised to space their children as this permits each child to have a maximum of care and nourishment; if they have been advised, or have accepted some form of contraception, it is good to record this on the chart as well.
Certain social, economic and health factors are associated with a high risk of malnutrition. The chart has a space to record these factors; it is headed "Reasons for special care. If parents are made to understand the significance of the information on the chart, and then allowed to keep the chart themselves, they will feel more involved and responsible for the child's health care. This encourages community participation.
It saves the time and space needed for storing charts in a health centre. Also the charts can be taken with a child during visits outside the community e. The charts should be put in plastic polyethylene covers to help parents keep them clean and dry. Another advantage of keeping cards with the parents is that the community health worker does not have to carry them when making home visits.
In the case of children who are at a special risk. Accurate weighing is important. A community health worker can learn how to weigh a child quite easily by following the instructions given below. Hang the scale up securely, keeping the dial at eye-level so that the weight can be read easily. Adjust the pointer to zero before placing the child in the sling or basket. Most scales have a knob or screw to make this adjustment. Undress the child with the help of the mother.
It is better to weigh the child naked if it is not too cold and if local customs permit. Place the child in the sling or basket with the help of the mother.
Ask the mother to stand nearby and talk to the child. The mother should not hold the child and the child's feet should not touch the ground when the weight is being read. Read the weight on the scale. If the child is struggling, try to calm him with the help of the mother and when he stops moving read the weight quickly.
The most common spring scale often called a Salter scale, although many other brand names exist has a face which looks like a clock. The weights are marked in kilograms around the dial. Some dials also show gram divisions between kilograms, but the simplest scales only have kilograms marked by bold lines and grams marked by thin lines. Such scales are convenient for workers with limited education because these lines are similar to those which are drawn on the most widely used growth charts Fig.
Marking on the spring scale. There are two important factors in measuring growth weight and age. It is very important, therefore, to know the correct age of a child. Often mothers do not remember the dates of births of their children. In such cases the community health worker can estimate the age of a child by Asking the mother certain questions and by using a local events calendar. The first simplest way to find out the age of a child is to look up the local official register of births, baptismal certificate book, or similar record.
Often mothers forget or are not aware of the existence of such records. If the child is not registered or if no such records exist, the community health worker should first try to find out the year of birth of the child. This can be done by asking the mother if the child wee born a few months before or after another child in the neighborhood. The community health worker should then find out if the date of birth of that child is known.
If the mother of the second child knows the date of birth of her child, the year of birth of the first child can be easily estimated.
10,000 steps on the road to health
I threw out my old bathroom scale on Friday. I like to think I would have done so even if it hadn't consistently shown me as 2kg heavier than the. PDF | Background The Road to Health Card (RTHC) provides a simple, cheap, practical and convenient method of tive steps can be taken to ensure normal. Data have to date been summarized as daily step counts and daily durations of Substantial associations have been noted between the overall health of.