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Public Health. 1995 Mar;109(2):111-6.

Growth monitoring: the role of community health volunteers.

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Department of Social and Preventive Medicine, University of the West Indies, Kingston, Jamaica.


A community volunteer programme was initiated in rural Jamaica in May 1990. The main aim of the programme was to monitor the growth of children less than 36 months of age through community health volunteers (CHVs) and improve their nutritional status. At the end of the second year the programme was evaluated to determine its effectiveness. The results of the evaluation indicated that almost all (95.6%) of the children were covered by the CHVs. In addition the participation rate was high (78.5%). However, only 50% of the children were adequately covered. Nonetheless, 81% of them gained adequate weight. Indeed, malnutrition levels declined by 34.5%. The annual cost per child per year for the total programme was fairly moderate (US$14.5) with growth monitoring accounting for nearly half (42.7). The results suggest that CHVs can play an important role in primary health care programmes in developing countries.


In May 1990 in Jamaica, a nutrition program was established in the isolated and low economic level community of Freemans Hall (population, about 1400; altitude, 1000-1300 m; rainfall, 2000-2000 mm) in Southern Trelawny parish. Community health volunteers (CHVs) monitored the growth of children younger than 36 months. A committee of representatives from the local health team and parent- teachers' association selected four CHVs. One CHV covered about 22 children. Two public health nurses and two nutritionists conducted a one-week training course for the CHVs. Topics included malnutrition, young child feeding and weaning, nutrition during pregnancy, management of diarrhea, family planning, immunization, community weighing and growth monitoring, organization of a health district, and home visiting. The CHVs weighed and measured the height of all children under 36 months old monthly, provided nutritional advice to mothers, and referred malnourished children to a nutrition clinic. They received US$150 as an incentive, which they used to set up income-generating projects (e.g., goat rearing). An evaluation of the process and outcome of the CHV nutrition program during May 1990-April 1992 was conducted. None of the CHVs had stopped their duties. 95.6% of eligible children were registered in the program. 78.5% of the children participated. 50% of the children received adequate coverage. 85.7% of identified malnourished children were adequately covered. The CHVs referred all of the malnourished children to the nutrition clinic. The total cost of the program (nutrition clinics and food supplements) was US$2740. Overall cost/child was US$31.1. The cost for growth monitoring only was US$6.2. Growth monitoring accounted for 42.7% of annual costs. Malnutrition decreased from 17.1% to 11.2% (a 34.5% reduction). 81% of all children gained adequate weight. These findings show that CHVs can contribute significantly to primary health care programs in developing countries.

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