Evaluation of a Nutrition Unit in Winterveld, South Africa. Record Analysis: Part 3

Abstract

We report on an evaluation of a Nutrition Rehabilitation Unit (NRU) ,u the request of Medecin du Monde (South Africa) on behalf of the St Peter's Health Centre (SPHC) in Winterveld. Winterveld is a sprawling squatter camp north of Pretoria, the capital of South Africa, with huge socio-economic and environmental problems. The prevalence of protein-energy malnutrition in the community was recently measured but the results are still not available, Nevertheless malnutrition is a common clinical problem at the SPHC. For this reason a NRU was initiated in 1989. The evaluation had two main components: an unstructured interview with health workers at SPHC and the NRU and an analysis of all the records ol' patients admitted to the unit since it opened. The results of the unstructured interview have been previously reported.-' Here we report on the analysis of all patient records admitted to the NRU between April 1989 and April 1991. The major conclusions are that the malnourished children admitted to the NRU come from a background of severe poverty, poor environmental conditions, high rate of infections and inadequate attendance of well baby care. Patient management at the NRU seems inappropriate with poor record keeping, high rates of failure to gain weight, of infections and of failing to complete treatment. The major recommendation is that the problem of malnutrition should not be addressed as the problem of the NRU. It is a community problem that needs to be addressed comprehensively by community structures and all levels of health workers. The NRU should be seen as a last resort.