54. Summerson JS, Konen JC, Dignan MB. Race related differences in metabolic control among 66. Robinson CH, Lawler MR, Chenoweth WL, et al. Normal and Therapeutic Nutrition. 7th ed New adults with diabetes. S Afr Med J 1992; 85: 953-956.
York: Macmillan, 1986: 759.
55. Rasmussen OW, Gregersen S, Dorup J, et al. Day to day variation of blood glucose and 67. Thornburn AW, Brand JC, Truswell AS. The glycaemic index of foods. Med J Aust 1986; 144:
insulin responses in type 2 diabetic subjects after starch-rich meal. Diabetes Care 1992; 15: 522-
68. Jackson RA, Blick PM, Matthews JA, et al. Comparison of peripheral glucose uptake after oral 56. Castillo MJ, Scheen AJ, Jandrian B, et al. Relationship between metabolic clearance rate of glucose loading and a mixed meal. Metabolism 1983; 32: 706-710.
insulin and body mass index in a female population ranging from anorexia nervosa to severe 69. Porte D, Sherwin RS. Ekkenberg and Rifkin's Diabetes Mellitus: Theory and Practice. 5th ed. USA: obesity. Int J Obes Relat Metab Disord 1994; 18: 47-53.
Appleton and Lange, 1997: 366.
57. Marion JF. Nutritional care in diabetes mellitus and reactive hypoglycemia. In: Krause MV, 70. Wolever TMS, Jenkins DJA, Jenkins AL. The glycemic index: methodology and clinical Mahan LK, eds. Krause's Food, Nutrition and Diet Therapy. 8th ed. Philadelphia: WB Saunders, implications. Am J Clin Nutr 1991; 54: 846-854.
1984: 479-509.
71. Bantle JP, Laine DC, Castle GW, et al. Postprandial glucose and insulin responses to meals 58. Weyman-Daum M, Fort P, Recker B, et al. Glycemic response in children with insulin- containing different carbohydrates in normal and diabetic subjects. N Engl J Med 1983; 309: 7-
dependent diabetes mellitus after high- or low-glycemic-index breakfast. Am J Clin Nutr 1987; 46: 798-803.
72. Nuttal FQ, Moorandian AD, DeMarais R, et al. The glycemic effect of different meals 59. Jenkins DJA, Wolever TMS, Jenkins AL, et al. The glycaemic index of foods tested in diabetic approximately isocaloric and similar in protein, carbohydrate and fat content as calculated patients; a new basis for carbohydrate exchange favouring the use of legumes. Diabetologia using the ADA exchange lists. Diabetes Care 1983; 6: 432-435.
1983; 24: 257-264.
73. Gannon MC, Nuttal FQ, Krezowski PA, et al. The serum insulin and plasma glucose response 60. Inoescu-Tîrgoviste C, Popa E, Sîntu E, et al. Blood glucose and plasma insulin responses to to milk and fruit products in type 2 (non-insulin dependant) diabetic patients. Diabetologia various carbohydrates in type 2 (non-insulin dependant) diabetes. Diabetologia 1983; 14: 80-84.
1986; 29: 784-791.
61. Venter CS, Vorster HH, Van Rooyen A, et al. Comparison of the effects of maize porridge 74. Laine DC, Thomas W, Levitt MD, et al. Comparison of predictive capabilities of diabetic consumed at different temperatures on blood glucose, insulin and acetate levels in healthy exchange lists and glycemic index of foods. Diabetes Care 1987; 10: 387-394.
volunteers. South African Journal of Food Science and Nutrition 1990; 2: 2-5.
75. Reaven GM, Chen Y-DI, Golay A, et al. Documentation and hyperglucagonemia throughout 62. Truswell AS. Glycaemic index of foods. Eur J Clin Nutr 1992; 46S: S91 - S101.
the day in nonobese and obese patients with non-insulin dependant diabetes mellitus. J Clin 63. Thompson DG, Wingate DL, Thomas M, et al. Gastric emptying as a determinant of the oral Endocrinol Metab 1987; 64: 106-110.
glucose tolerance test. Gastroenterology 1982; 82: 51-55.
76. Coulston AM, Hollenbeck CB, Swiskocki ALM, et al. Effect of source of dietary carbohydrate 64. Krezowski PA, Nuttal FQ, Gannon MC, et al. Insulin and glucose responses to various starch- on plasma glucose and insulin responses to mixed meals in subjects with NIDDM. Diabetes containing foods in type 2 diabetic subjects. Diabetes Care 1987; 10: 205-212.
Care 1987; 10: 395-400.
65. Hunt SM, Groff JL. Advanced Nutrition and Human Metabolism. New York: West, 1990.
77. Hollenbeck CB, Coulston AM, Reaven GM. Glycemic effects of carbohydrates: a different perspective. Diabetes Care 1986; 9: 641-647.
A community-based growth monitoring model to
complement facility-based nutrition and health practices in
a semi-urban community in South Africa

Serina E Schoeman, Muhammad A Dhansay, John E Fincham, Ernesta Kunneke, A J Spinnler Benadé
Objective. To assess the feasibility of a community-based monitoring system. The community-based growth growth monitoring model in alleviating the shortcomings in monitoring system increased growth monitoring coverage of health and nutrition surveillance of preschool-aged children preschool children by more than 60%. Attendance of as practised by the health services.
preschool children aged 12 months and older varied between Method. Baseline community and health facility practice 10% and 14% at the health facility practice compared with 80 surveys and interactive workshops with the community were - 100% in the community-based growth monitoring system.
conducted before the study. Eleven women were trained to This made the system more conducive for monitoring and drive the community-based growth monitoring project.
targeting of malnourished children for health and nutrition Health facility practice information was collected before and after establishment of the community-based growth Conclusion. The community-based growth monitoring model monitoring system.
demonstrated that community participation and mobilisation Results. The health facility practice reached 12 - 26% of the can increase preschool child growth monitoring coverage preschool population per month compared with 70 - 100% extensively and contribute to improved health and nutrition per 3-week session in the community-based growth Nutritional Intervention Research Unit, Medical Research Council, Parow, W Cape Parasitology Group, Medical Research Council, Parow, W Cape Serina E Schoeman, BA Cur
John E Fincham, BVSc
Muhammad A Dhansay, FCP
Department of Dietetics, University of the Western Cape, Bellville, W Cape A J Spinnler Benadé, DSc
Ernesta Kunneke, MSc
Nov./Dec. 2003, Vol. 16, No. 4 SAJCN

Inadequacies in preschool child growth monitoring (GM) perceptions of nutrition, while the CBGM model was the action coverage at health facility practices (HFPs) have been described component that developed after analysis of the baseline survey in several studies.1,2 Maternal perceptions of HFPs, and service data presented at a ZOPP (Ziel Orientierte Projekt Planung or providers emphasising a curative approach are key factors objective oriented project planning) workshop.10 The baseline influencing health care coverage of the preschool child. In the survey and the CBGM model will be discussed simultaneously absence of disease or clinical symptoms, mothers regard the to illustrate the impact of the model.
childhood immunisation schedule as the main reason forvisiting the HFP. The curative approach emphasised by the HFP fosters the perception among people that health care The study population consisted of ± 250 children aged 0 - 72 equals curative care, which is a fallacy.3 Health care is often months and their mothers, living in Langebaan, a small urban associated with ‘the provision of doctors, drugs, ambulances town on the west coast of the Western Cape, 136 km from Cape and hospitals', while preventive measures are less appreciated.3 Town. It has a population of approximately 4 000 people, and a After primary completion of the childhood immunisation preschool population of ± 350 children. Children were schedule at 9 months, GM and preschool attendance decline identified for the project using registrations from the HFP, the drastically at HFPs. HFPs are biased in favour of children community survey and birth records. The annual birth rate is between 0 and 24 months of age, and do not assess height-for- approximately 45 - 50 births and the prevalence of low birth weight (less than 2 500 g) remains at between 17% and 22%.
Underweight, which peaks after 18 months, and stunting are Most inhabitants earn their living through fishing and have a often not detected because of sporadic attendance and poor low income. The town is also a big tourist attraction. A small, GM at HFPs.1,2,4,5 Strategies such as GM and growth promotion, richer group in the town generates income mainly through oral rehydration therapy, breast-feeding, food supplementation accommodating tourists in holiday homes or guesthouses.
and education of women to promote and strengthen the healthfacility-based nutrition component, are therefore seriously Community baseline survey
The survey was conducted over 7 months. A community-based growth monitoring (CBGM) system in rural areas with inadequate health services appears to be a viable cost-effective option for monitoring growth, nutritional Eleven women from the local community were trained by staff status and health of children.9 To determine whether such a of the Nutritional Intervention Research Unit (NIRU) of the model could also be implemented in an urban setting with Medical Research Council (MRC) to administer questionnaires established health systems, required further investigation. An to determine caregivers' perceptions on disease, nutrition and opportunity to pursue this issue arose when the Child Welfare health practices. The information was obtained from parents or Society requested assistance from the Nutritional Intervention guardians of preschool children during house-to-house visits.
Research Unit (NIRU) of the Medical Research Council (MRC), Breast-feeding information was obtained in a separate study. because of perceived problems of malnutrition amongpreschool children in towns on the west coast, South Africa.
Langebaan was selected as a suitable community that could beresearched to identify possible causal factors for the suspected The women's training also involved anthropometry and GM.
nutritional situation. The purpose of this study was to Children were weighed with minimal clothing on an electronic determine whether a CBGM model could be established in an load cell scale to the nearest 0.05 kg, and height and length urban setting to alleviate shortcomings of the local HFP in were measured to the nearest 0.1 cm using wooden measuring terms of health and nutrition surveillance of preschool boards. Recumbent length for children under 2 years old, and measurements in the standing position for children 2 years andolder were obtained.11,12 A calibrated 10 kg weight was used to assess the accuracy of Materials and methods
the scales before GM sessions.
Study design
A member of the research team randomly selected children To develop the CBGM model a cross-sectional baseline survey for cross-checking. Anthropometric information was used to was done and the results were used in conjunction with the calculate z-scores using Epi-Info version 6.04.
community's perceptions of priority needs. The baseline surveycomprising community-based and health facility-based Health facility practices survey
components, was conducted to assess preschool children's The survey comprising preschool children attending the HFP nutritional status, nutrition and health practices and maternal was conducted over 12 months. The HFP survey ran Nov./Dec. 2003, Vol. 16, No. 4 SAJCN
concurrently with the CBGM model for the last 5 months of the immunisation schedule identified from the RTHC, complaints year. Information on preschool child attendance, disease from mothers of a child being sick or chronically ill, and prevalence and health and nutrition practices was obtained suspected problems of child neglect or abuse. The from the professional nurse as part of the information routinely infrastructure of the CBGM system allowed for additional collected at the HFP. activities such as nutrition and health education, biochemical The information was recorded on structured sheets specially and parasitological analysis, management of iron deficiency drawn up by the researcher. Mother's reason for visiting the and worm infection, and blanket deworming of preschool HFP, procedures performed, group or individual health children, which will be reported separately. education topics and outcomes of visit were recorded for eachchild. Client status such as visitor, first or follow-up visit, was also indicated. Food supplementation data were obtained froma register held at the HFP and growth plotting practices were Community baseline survey
observed from children's road-to-health cards (RTHCs).
Maternal reasons for visiting the HFP
Information was calculated monthly by listing items according Sixty-three per cent of mothers indicated that visiting the HFP to a coding system. after completion of the immunisation schedule was onlynecessary if the child was sick, while 17% said they would ZOPP workshop and the establishment of the
attend for general assessments, information, or weighing CBGM model
children, and 20% did not deem it necessary at all.
The ZOPP workshop was facilitated by the NIRU as the process allows maximum involvement, and an equal Seventy-nine per cent of the mothers initiated breast-feeding, opportunity for all participants to determine priority needs and but none of the infants was exclusively breast-fed. Formula to participate in the planning and implementation of an feeding was introduced soon after birth and solids from 0.5 -1.3 intervention project. The workshop participants comprised months of age.
stakeholders from the Departments of Health and Education,the local municipality, non-governmental organisations, health committees, women's committees, reconstruction and Maternal perceptions on food supplementation were not development programme committees, and NIRU staff.
Information collected during the baseline survey was used as astarting point and combined with the participant's information GM practices and anthropometry
to construct a problem tree, and to develop a causal and Z-scores below –2 standard deviations (SD) of the National objective model. This process pre-empted the establishment of Centre for Health Statistics reference median indicated stunting the CBGM model.
prevalence rates of 13%, underweight 7% and wasting 2.2%.
Women who were originally trained to do anthropometry Although 60% of the mothers could recognise a downward and GM for the baseline community survey, volunteered to growth curve and associated it with a problem or the child manage the CBGM system. Five health stations to serve as a being sick, 81% of the mothers were not familiar with the facility for preschool CBGM were volunteered by concept of GM.
representatives of a church, school, crèches, the municipality HFP survey
and individual families in the community. Mothers' reasons for visiting the HFP
An appointment system was used to accommodate mothers in geographical areas nearest to the CBGM points to ensure Weighing of children was the most important reason for effective functioning. Appointments were confirmed 1 week visiting the HFP (41%) and peaked in the 0 - 23-month-old before the GM sessions. GM was performed 4-monthly, while group. Ill health was the second most important reason (31%), nutritionally at-risk children detected during the GM sessions and peaked in the 12 - 23-month-old group. Childhood were monitored more than once a month and referred to the immunisation was the third most important reason (23%), and HFP for further management. Information was collected and exceeded ill health only during the first 12 months. Only 5% of 128 entered into a separate folder for each child. A simplified
the parents mentioned health assessments, screenings for growth chart was used for documentation, plotting and tuberculosis, or general health information as primary reasons interpretation of weight to avoid interfering with the RTHC for visiting the HFP. From 48 months, 6 out of 8 children visit used at the HFP. Nutritional risk criteria at the CBGM included the HFP mainly due to ill health. These findings are biased in weight and height below the 3rd percentile (scale of reference favour of mothers whose infants were in the 0 - 12-month-age at the HFP), low birth weight, growth faltering, incomplete Nov./Dec. 2003, Vol. 16, No. 4 SAJCN

Breast-feeding practices
HFP information regarding breast-feeding practices wasinconsistently recorded. Individual breast-feeding counsellingof mothers was indicated mainly if the mother experiencedproblems with her breasts or with breast-feeding. Exclusivebreast-feeding practices were not indicated.
Protein energy malnutrition scheme food supplement at the

Results indicated that only 21 out of 36 preschool children(58%) with weight below the 3rd percentile and growthfaltering were entered in the PEM scheme register before, and afurther 11 after, referral from the CBGM system. Of the 32children entered in the 1996 PEM scheme register, 37.5%received the food supplement more than once, while 62.5%received it only once. The results also indicated that only 12.5%received the food supplement at uninterrupted monthlyintervals for ± 3 consecutive months, while 87.5% received less Fig. 1. Coverage of preschool children at the health facility practice than four food supplements at intervals varying from 2 to 10 (January - December 1996 Langebaan). GM practices
The ZOPP workshop and the CBGM model
A growth chart study of 51 randomly selected RTHCs The establishment of the CBGM system that was pre-empted indicated an average of 5 weight plots between 0 and 6 months by the ZOPP workshop resulted in sustained GM and health (1 or no plot per month), 2 plots between 7 and 12 months, and nutrition surveillance of preschool children. The model 1 plot between 13 and 24 months and 1 or no plots per year complemented the existing HFP while primary health care was after the age of 24 months. Height was mainly measured at managed in the usual way by nursing staff under the birth and height plotting was not required on the RTHC.
governance of the local authority. Although the CBGM system Preschool child coverage at the HFP
approach was research-orientated, while the HFP was service-orientated, these findings could serve to enhance policy Age-specific attendance for preschool children after the age of 12 months varied between 0 and 10, 1 and 8, and 2 and 6 permonth over the respective months and attendance in the 0 - 12- Coverage of preschool children in the CBGM system
month age group tended to decline over the 4-monthly Preschool coverage in the CBGM system varied between 71% intervals as the year proceeded (Table I). The preschool and 100%, sustaining a high average coverage of 80 - 85% over attendance of 12 - 26% per month was constant throughout the a period of 3 years (Fig. 2). Age-specific attendance after the year. Average monthly attendance was ± 17% (Fig. 1).
age of 12 months varied between 17 and 37 children per sessionin the CBGM system compared with 1 - 8 children per monthat the HFP (Fig. 3).
Table I. Age-specific coverage of preschool children at the HFP
(April, August, December 1996, Langebaan)

Number of chidren attending the HFP * Best attendance pattern.
† Worst attendance pattern.
Fig. 2. Coverage of preschool children in the CBGM system (August1996 - November 1998). Nov./Dec. 2003, Vol. 16, No. 4 SAJCN

preschool visits, which impact negatively on childhoodnutrition and health as well as health care practices. Thisresults in the HFPs missing the majority of mothers shortlyafter weaning is initiated, and the child's risk of malnutritionand infectious diseases increasing. HFP and GM practices
Irregular and inaccurate measuring of weight and height andpoor plotting and interpretation of children's weight at theHFPs is a reality.1,2,5,15,16 This results in under-detection ofretarded growth and underweight. Weighing a child withoutplotting is often regarded as synonymous with GM, whilefailing to plot weight deprives nursing staff of the opportunityto promote child growth and development.17,18 Lack of heightassessments deprives stunted children from being targeted for Fig. 3. Comparison of age-specific attendance at the HFP and in the appropriate interventions. Discontinuous GM of preschool CBGM system (August 1996). children hampers detection and targeting of nutritionally at- GM practices and anthropometry (November 1996,
risk children, and therefore control of malnutrition and November 1997 and November 1998)
infectious diseases. The CBGM system was successful in nutrition surveillance of Food and iron supplementation and breast-feeding
preschool children as reflected by the results. Average z-scores at the HFP
of children aged 0 - 12 months for November 1996, 1997 and1998, revealed height-for-age of –1.2 SD, –0.8 SD, and –1.1 SD The PEM scheme register revealed that the HFP could not and weight-for-age of –0.4 SD, –0.3 SD, and –0.1 SD. Weight- successfully detect, target and monitor nutritionally at-risk for-age z-scores deteriorated further after 18 months, while preschool children. More than 40% of preschool children with height-for-age z-scores for preschool children older than 12 growth faltering were not detected and targeted for food months remained the same. Average height- and weight-for- supplementation before referral from the CBGM system. The age z-scores remained consistently below the reference median.
number of children who received less than four food Annual low birth weight prevalence rates varied between 17% supplements in 12 months at intervals varying from 2 to 10 and 22%. Stunting prevalence rates among the preschool months, reflected a failure rate of 87.5%. Failure of 62.5% of the population varied between 14% and 15%, underweight 5 - 7%, mothers to return for follow up reflect the low priority of the and wasting 0.5 - 1%.
PEM scheme programme at the HFP.
Despite well-planned nutrition strategies, the prevalence of low birth weight remains high (20%), and exclusive breast-feeding practices and iron deficiency among preschool children Impact of the HFP on nutrition and health care
in Langebaan remain a problem.7,8,13,19,20 Iron requirements for The prevailing low preschool attendance and low priority low-birth-weight infants (less than 2.5 kg) or infants born given to preventive health care should not be allowed as they before 37 weeks are increased, and iron supplementation from influence health practices negatively. The CBGM system using the age of 6 weeks is therefore recommended.21 Guidelines to women from the community has strengthened preventive support these recommendations and criteria that are effective health practices and should therefore not be seen as an in targeting high-risk pregnant mothers for food and/or iron obstacle, but rather as a mechanism to improve comprehensive supplementation need to be communicated clearly for effective health care delivery. The increased prevalence of tuberculosis implementation of nutrition programmes at the HFPs.7,8,13,20,22 and HIV infection limits the capacity of nursing staff at the Nutrition programmes at the HFPs which include the PEM HFP, which signals a need for such models to enhance social scheme, have functioned poorly during the past decade and are 130 development, improve nutrition and health care delivery and
largely attributed to poor GM and promotion and sporadic reduce disease recurrence.3, 8,13,14 preschool coverage for GM.6,7,8,13,20 The HFPs can potentiallyreach all preschool parents during their infants' first 9 months Sporadic preschool attendance at the HFP
of life to promote nutrition and health through accurate GM as Nursing staff emphasising curative care and the mothers' this is part of routine health practice. Despite this, GM and wrong perceptions of the HFPs contribute largely to sporadic nutrition practices remain unsatisfactory.23,24 Berg's questioningof operational nutritionists and academics for golden Nov./Dec. 2003, Vol. 16, No. 4 SAJCN

opportunities lost, misdirected efforts, and ignoring local needs Briend and Bari25 believe that mothers who recognise and preferences, is therefore justified.24 abnormal growth might be prompted to take action to preventtheir child's death. The positive effect of the CBGM system in The ZOPP workshop and impact of the CBGM
growth promotion, as measured by the increased number of model on nutrition and health care
mothers who reported for GM, is encouraging.
The ZOPP workshop demonstrated that attitudes such as Advantages of the CBGM model
health professionals claiming the monopoly on healthknowledge and management could be eliminated through The CBGM model is not a blueprint, but can be recommended acknowledgement, involvement and joint commitment by for alleviating shortcomings of HFPs in urban areas. It has the health professionals, the community and stakeholders in capacity for large-scale implementation, monitoring, follow-up programme planning from the initial stage.14 Alternative and evaluation of programmes on a sustained basis, viz.
solutions for priority needs identified could be debated and nutrition surveillance, and vitamin A, iron and food accepted collectively. The NIRU staff of the MRC facilitated the supplementation. It provides accurate and representative data establishment of the CBGM system, while the community on nutritional status and ensures comprehensive detection and committed itself to addressing priority needs and providing targeting of high-risk groups for intervention. The cost of venues to serve as additional health stations for GM and appointing three women on a part-time basis three times a year important interventions. Training of women to drive the varied from R8 000 to R10 000 (10 days), while exposure to process facilitated transfer of knowledge and skills to the medico-legal risks or impingement on physical resources was community; this allowed inadequacies related to GM, health and nutrition surveillance to be addressed, and facilitated 4- Although proposals for iron supplementation, screening, and monthly deworming of children 2 years and older. This free deworming at HFPs have not yet been implemented either complemented the HFP in preventive care delivery.
regionally or nationally, the model has successfully facilitated Although three women could comfortably operate the screening and management of iron deficiency and mass CBGM system, training an additional eight ensured continuity deworming.20,26,27 Mass deworming was found to be of and future benefits to the community. The sustained CBGM immediate benefit in high-risk populations for the effective contributed to the achievement of national health objectives as prevention of worm infections and the harmful effects of it encompasses the principle of community participation, an Trichuris-dysentery syndrome on growth in children.27-30 essential element for the transformation of health services in Overcrowding, poverty and malnutrition that precipitate South Africa.8 In this way, the model demonstrated that the disease are often obscured in well-serviced urban areas with perceptions of passive recipients of health care could be the requisite health facilities. Enlisting complementary systems such as the CBGM model could potentially reduce theepidemic proportions of tuberculosis and HIV infections and The CBGM model and GM practices
the high prevalence of low birth weight in disadvantaged The HFP survey ran concurrently with the CBGM model for urban communities.
the last 5 months of the year and demonstrated differences inGM practices and preschool child coverage for GM between the two systems before and after establishment of the model.
The 4-monthly GM improved the average coverage of Considering the results of studies done in Alexandra, the preschool children by more than 60%. It also improved the Eastern Cape, Eersterust and KwaZulu-Natal, one would detection and targeting of nutritionally at-risk and assume that the situation in Langebaan is not unique, but could malnourished preschool children by more than 40%.
be indicative of a countrywide situation. The 3-year evaluationof the CBGM model in Langebaan has demonstrated that This system improved health and nutrition surveillance of shortcomings in terms of health and nutrition surveillance the preschool population and indicated that infants were could be eliminated and the HFP could be complemented with nutritionally compromised before their birth as reflected by the guidance and minimal supervision. This is necessary for high prevalence rate of low birth weight, and mean height-for- improving the quality of health care of South Africans in age z-scores below the reference median from birth. It is believed that stunting reflects serious problems associated withpoor environmental and socioeconomic factors, repeated The authors acknowledge co-workers Ms Vera Arendse, Mrs exposure to adverse conditions and chronic malnutrition in Deirdré Sickle, Mrs Karen Koegelenberg and Miss Lesleen Adonis; populations. Height assessment, which is neglected, should statisticians Mrs J A Laubscher and Dr C Lombard; technical therefore receive more priority. 2,11 support Mr De Wet Marais, Mrs Martelle Marais, Ms Johanna VanWyk, Mr Eldrich Harmse, Ms E Strydom and Mrs A Potgieter; and Nov./Dec. 2003, Vol. 16, No. 4 SAJCN
Langebaan nutrition monitors Mrs Joan Blake, Mrs Jeremien 12. Jeliffe DB, Jeliffe EFP. Community Assessment with Special Reference to Less Technically Developed Countries. Oxford University Press,1989.
Blaauw, Mrs Donitha Cupido, Ms Gertrude Engelbrecht, Ms 13. South African Health Review. Durban: Health Systems Trust and Henry J Kaizer Foundation, Denelda Ocks, Mrs Eileen Ocks, Mrs Rhona Ocks, Mrs Wilna 1996: 141-150.
Pholman, Mrs Doreen Tango and Mrs Daphne Van Der 14. De Villiers MR, De Villiers PJT. Lessons from an academic comprehensive primary health care centre. S Afr Med J 1996; 86: 1385-1386.
15. Gerein NM, Ross DA. Is growth monitoring worthwhile? An evaluation of its use in three child health programmes in Zaire. Soc Sci Med 1991; 32: 667-675.
Financial support was received from Sanlam Insurance 16. Kuhn L, Zwarenstein M. Weight information on the ‘Road to Health' card inadequate for Company and the South African Sugar Association. Special growth monitoring. S Afr Med J 1990; 78: 495-496.
acknowledgements go to Mr Andy Evans for his sacrifice, 17. World Health Organisation. Guidelines for Training Community Health Workers in Nutrition. 2nd ed. Geneva: WHO, 1986.
enthusiasm and dedication to the project and the people of 18. Thaver IH, Midhet F, Hussain R. The value of intermittent growth monitoring in Primary Langebaan and to Dr Henk Tichelaar as independent reviewer.
Health Care Programmes. Journal of the Pakistan Medical Association 1993; 43: 129-133.
Dietary Practices and Iron Status of Preschool Children in Langebaan (Report to Sugar Association). Parrowvallei: Medical Research Council, 1998; 1-28.
20. South African Vitamin A Consultative Group (SAVACG). Anthropometric, vitamin A, iron and immunisation coverage status in children 6 - 71 months in South Africa 1994. S Afr Med 1. Chopra M, Sanders D. Growth monitoring — is it a task worth doing in South Africa? S Afr J 1996; 86: 354-356.
Med J 1997; 87: 875-877.
21. Ireland JD, Power DJ, Woods DL. Primary Care for Paediatric Clinical Nurses. Cape Town: 2. Coetzee DJ, Ferrinho P. Nutritional status of children in Alexandra Township. S Afr Med J University of Cape Town Press, 1981: 63-67.
1994; 84: 413-415.
22. Dhansay MA, Schoeman SE, Dixon M, Kunneke E, Laubscher JA, Benadé AJS. Risk markers 3. Tarin EU, Thunhurst C. Community participation with provider collaboration. World Health for low birth weight in women attending an antenatal clinic in Bishop Lavis, a low socio- Forum 1998; economic area (abstract). S Afr J Food Sci Nutr 1996; 8: Suppl, 14.
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4. Yach D, Martin G, Jacobs M, eds Towards a National GOBI-FFF Programme for South Africa 23. Fry J, Hassler J, eds. Primary Health Care 2000. Edinburgh: Churchill Livingstone, 1986: (Proceedings of the Health Seminar, Cape Town). Parowvallei: Medical Research Council, Chapters 6, 10.
24. Berg A. Sliding toward nutrition malpractice: time to reconsider and redeploy. Am J Clin Nutr 5. Harrison D, Heese de V, Harker H, Mann MD. An assessment of the ‘Road to Health Card' 1992; 57: 3-7.
based on perceptions of clinic staff and mothers. S Afr Med J 1998; 88: 1424-1428.
25. Briend A, Bari A. Critical assessment of the use of growth monitoring for identifying high 6. Kuhn L, Zwarenstein MF, Katzenelenbogen J. Village health-workers and GOBI-FFF: risk children in PHC programmes. BMJ 1989; 298: 1607-1611.
evaluation of a rural programme. S Afr Med J 1990; 77: 471-475.
26. Dhansay MA, Sickle DM, Van Stuijvenberg ME, Fincham JE, Schoeman SE, Benadé AJS. Iron 7. Department of Health. Protein Energy Malnutrition Scheme. Western Cape Provincial Update, deficiency and iron deficiency anaemia in infants, toddlers, school children in the Western Circular No. 68 of 1996. Provincial Administration, Western Cape.
Cape and KwaZulu-Natal. XVth Meeting of the International Society of Haematology —Africa and European division, Durban, 18-23 Sep 1999: 64.
8. White Paper for the transformation of the health system in South Africa. Government Gazette 382 (17910); 1997: 26-46.
27. Fincham JE, Evans AC, Dhansay MA, Yach D, Schoeman SE. The Case for Mass Deworming.
Durban: Health Systems Trust Update, 1996: 20.
9. Faber M, Oelofse A, Benade AJS. A model for a community-based growth monitoring system. Afr J Health Sci 1998; 28. Callender JE, Walker SP, Grantham-McGregor SM, Cooper ES. Growth and development four 5: 72-78.
years after treatment for the trichuris dysentery syndrome. Acta Paediatr 1998; 87: 1247-1249.
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11. Gorstein J, Sullivan K, Yip R, et al. Issues in the assessment of nutritional status using 30. Winstanley P. Albendazole for mass treatment of asymptomatic trichuris infections. Lancet anthropometry. Bull World Health Organ 1994; 1998; 352: 1080-1081.
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Nov./Dec. 2003, Vol. 16, No. 4 SAJCN
SAJCN CPD activity No 23 – December 2003
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not be processed.
(There is only ONE correct answer per question.)
1. The community-based growth monitoring (CBGM) system After completion of the immunising schedule, most mothers visit reached 70-100% of preschool children for growth monitoring the health facility: for weighing of the child because the child is sick Mothers associated a downward growth curve with a problem or Preschool children's clinic attendance increase after the age of a child being sick.
Most mothers understand the concept of growth monitoring.
The community-based growth monitoring (CBGM) system increased preschool coverage by more than 60%.
10. What percentage of children received food supplements for 3 consecutive months? Underweight tends to peak: 11. The community-based growth monitoring (CBGM) system The recumbent position is used to measure: replaced existing growth monitoring (GM) practices: children under 2-years-old children up to 6-months-old children over 2-years-old 12. What activity was successfully facilitated through the Which of the following was used as risk criteria in the community-based growth monitoring (CBGM) system? community-based system? treatment of tuberculosis weight-for-age < 97th percentile weight-for-age > 3rd percentile weight-for-age < 3rd percentile ✁ Cut along the dotted lines and send to: SASPEN Secretariat, SAJCN CPD activity No 23, c/o Department of Human Nutrition,
PO Box 19063, Tygerberg, 7505 to reach the office not later than 5 March 2004
HPCSA number: DT Surname as registered with HPCSA: Initials: Postal address: _ Full member of ADSA: yes no If yes, which branch do you belong to? 134 Full member of SASPEN: yes no Full member of NSSA: yes no
"A community-based growth monitoring model to complement facility-based nutrition and health practices in a semi-urban
community in South Africa"
SE Schoeman, MA Dhansay, JE Fincham, E Kunneke, AJS Benadé
Please color the appropriate block for each question (e.g. if the answer to question 1 is a: 1) a b)



Antiviral Research 71 (2006) 154–163 Antiviral drugs for cytomegalovirus diseases Department of Clinical Virology, Division of Virology, GlaxoSmithKline Inc., RTP, NC, United States Received 15 March 2006; accepted 4 May 2006 Dedicated to Prof. Erik De Clercq on the occasion of reaching the status of Emeritus-Professor at the Katholieke Universiteit Leuven in September 2006

Design of the hiv prevention trials network (hptn) protocol 054: a cluster randomized crossover trial to evaluate combined access to nevirapine in developing countries

Design of the HIV Prevention Trials Network (HPTN) Protocol 054: A cluster randomized crossover trial to evaluate combined access to Nevirapine in developing countriesJim HughesUniversity of Washington, Robert L. GoldenbergUniversity of Alabama, Catherine M. WilfertElizabeth Glaser Pediatric AIDS Foundation/Duke University,