THE KNOWLEDGE MOTHERS HAVE ABOUT CHILDREN ’ S GROWTH CHARTS

A study o f the amount o f knowledge mothers have regarding children‘s growth charts was carried out on mothers with children under the age o f five years in Bophuthatswana during June and July 1989. 218 Mothers who attended the Well Baby Clinic were interviewed to assess their understanding and interpretation of the growth chart. Results were disappointing and recommendations are made.

The grow th chart is essentially visual and provides the nurse with a useful instrument for e d u c a tin g th e m o th e r a n d th e fa m ily .F u r th e r m o r e , it p r o m o te s a c le a r e r understanding o f the nature of growth and d e v e lo p m e n t, an d p o r tr a y s c le a r ly th e consequences o f an inadequate diet and o f infectious diseases.In this way it contributes to a greater acceptance of responsibility for child care by the mother and to the concept of family self reliance in health matters, but only if the m other, herself, u n d erstan d s the m essage conveyed by the card.

Statement of the Problem
T he G o v ern m en t o f B o p h u th atsw an a has provided the basic infrastructure for the delivery of primary health care.One wonders whether such services are properly utilized or not.
However, records reveal that most sick children w ho are brought to the clinics and hospitals are diagnosed as suffering from malnutrition, upper respiratory infection and gastro-enteritis.These problem s directly in d icate p o o r health in children,and are likely to affect the growth o f the child.In this study, it was the researcher's in te n tio n to in v e s tig a te th e a m o u n t o f knowledge mothers have regarding the growth chart.

The Objective of the Study
The study w as designed to assess: * the m other's knowledge and understanding of the growth chart.
* the value of growth charts in primary health care.(1973)

M E T H O D O L O G Y
A descriptive study w as undertaken in the Ditsobotla, M olopo and Thaba'Nchu regions in Bophuthatswana.Fourteen research assistants w ho were BNSc students in their third year of study, trained initially by the researcher, were placed in these three regions in the respective clinics.
The population comprised all the mothers w ho attended the Well Baby Clinics in the months of showed a steady rate o f weight gain between 50th and 90th percentiles, Chart B showed a steady growth between the 10th and 50th percentiles and Chart C show ed steady growth above 90th percentile with sudden weight loss then recorded.

Findings
All results were analysed by hand.Table 1 shows the m others' levels of education and as W agstaff (1986) had found, mothers w ho had less than 4 years o f schooling (i.e., from nil to Standard 2) were not knowledgeable about the chart whatsoever, except for bringing it along to the clinic.
Points of interest and importance emerged.It w as surprising to find that 99% o f the mothers know that it w as necessary to bring the card to the cli nic, but only 30% of the mothers were able to give more than two reasons for attending the Under-Five clinic.The interpretation o f charts by the mothers w as rather disappointing.O f the A lthough the results show that nurses played a major role in persuading mothers to attend the Under-Five clinic, as well as instructing them to bring the card to the clinic or carry it along when visiting other regions, this appeared to be a passive role.T here is little evidence that mothers were expected or wanted to initiate independent responses consequent on their own understanding o f recorded growth and related factors.Generally mothers also accepted that their function w as to care and carry the card as required by others.

D ISC U S SIO N A N D R E C O M M E N D A T IO N S
T h e g r o w th c h a r t o f f e r s a s im p le and inexpensive m eans o f monitoring child health and nutritional status, and can be used by com m unity health w orkers w ith very little supervision.
Ideally, all the purposes the chart serves should be fully exploited, and such information be tra n sm itte d to the c lie n ts.M ost su b jects interviewed in this study pointed out that nurses assigned a passive role to the mother regarding other uses of the card.More emphasis was put on actual clinic attendance o f child with hiscard than on explaining the difficulty in assessing the child's progress and continuing care if the card did not accom pany the child.Advice and assistance should be given to the mother as necessary.
It is recom mended that during such visits to the c lin ic , c lie n ts are ed u c a ted abo ut sim ple measures o f treating diarrhoea at home and the understanding and interpretation o f the child's growth and weight gain as it is reflected on the card.This may be achieved through simple explanations to the mothers.
June and July 1989 at M ontshiw a C linic, Mmabatho, Itsoseng Polyclinic and Selosesina Clinic at Thaba'Nchu.A convenience sample of 218 mothers w as interviewed in their own language about the understanding o f the growth ch art.O nly m o th ers o f the b a b ies w ere interviewed although it w as found that many b ab ies w ere b ro u g h t to the c lin ic by the child-minders.Ev3ntually a total sample was a c h ie v e d m a d e up o f 85 m o th e rs fro m Ditsobotla, 73 mothers from M olopo and 60 mothers from Thaba'Nchu.Informed consent w as o b ta in e d from the m o th e rs p rio r to interviews being conducted.The Instruments a) A structured interview schedule reflected d e m o g ra p h ic d a ta su c h a s le v e ls o f e d u catio n o f the m o th ers, as w ell as informati on about thei r undcrstandi ng o f the nature and use of growth charts for their children.Information also w as asked for about the m others' understanding of the reasons for attendi ng Wei I Baby Cli ni cs and their familiarity with home management of diarrhoea with oral hydration solutions.b) Three fictitious growth charts plotted at m o n th ly in te rv a ls w ere sh o w n to the m others w ho were asked to com m ent and rank them in order of well-being.Chart A.
The findings o f this study are revealing and w ould appear to justi fy W ag staff s and De vries' suggestion that such local studies be carried out.C ontinuing health education on the functions of the growth chart is necessary and follow-up programmes should form part o f the process.S u c h p ro g r a m m e s s h o u ld a ls o in c lu d e documentation.F. AND BARLTROP D., 1978.C hildren in H ealth and Disease.London: B ailliereTindall.DONALD R. AND KIBEL M.A., 1984.The C h ild H ealth C ard -A C ornerstone of Preventive and Promotive Paediatrics.S A .Med.J. 65: 423-425.M O R LE Y D ., 1973.Paediatric Priorities in the Developing W orld. London: Butterworths.PH IL PO T T R .M .et al, 1986.Obstetrics, Fam ily P lanning and Paediatrics.3rd ed.Pietermaritzburg: U niversity o f Natal Press.WAGSTAFF L. A ND DE V RIES G., 1986.C hildren's Growth Charts in Theory and Practice.S A .Med.J. 70: 426-427.W ORLD HEALTH ORGANISATION, 1986.The Growth Chart: A Tool for Use in Infant and Child Health Care.Geneva.

FREQUEN CY DISTRIBUTION O F M OTHERS' LE V E L OF EDUCATION (n=218) 218
mothers, only 37% were able to give the correct ranking o f the three cards.
was the first person to promote the concept o f special health and weight charts in his book entitled Paediatric Priorities in the Developing W orld in which he showed that the growth charts can form the cornerstone of o f th is w o rk W .H .O in 1978 p u b lish e d guidelines for the international use of child growth charts in primary health care, giving re c o m m e n d a tio n s on gro w th stan d ard s, a prototype o f a growth chart, and suggestions on how to use the charts in the health services.W agstaff and De Vries, in their study conducted in Soweto in 1972, found that such charts serve as a valuable link between fragmented health services and were also regarded as a diagnostic tool to recognise poor nutrition and the effects o f ill health.An interesting bonus attached to the use o f the growth chart w as that mothers found, in the absence o f other documentation such as birth certificates, that the chart could provide entry for the child to crêches and schools.T A B L E 1