Use of a child health surveillance instrument focusing on growth. A cross-sectional study

ABSTRACT BACKGROUND: Proper use of a child health handbook is an important indicator of the quality of care provided to children at healthcare services. This study aimed to evaluate the use of child health surveillance tool (by health professionals?), especially focusing on growth. DESIGN AND SETTING: Cross-sectional study carried out in the context of the Family Health Strategy in two municipalities in Paraíba, Brazil. METHODS: Three hundred and twenty-one children under five years of age from areas covered by health workers were included in the study. Mothers answered a questionnaire asking for information on sociodemographic characteristics. Growth charts, records of iron and vitamin A supplementation and notes on immunization schedules registered in the instrument were analyzed. In the case of children for whom the third version of the child health handbook was used, the association between completion of this handbook and sociodemographic characteristics was analyzed. RESULTS: All the parameters studied showed high frequencies of inadequate data entry, ranging from 41.1% for the weight-versus- age chart to 95.3% for the body mass index-versus-age chart. Higher frequency of inadequate data entry was found among children aged 25 months and over and among those living in areas of these municipalities with minimal numbers of professionals in the healthcare teams. CONCLUSIONS: The use of a child health handbook to monitor children’s growth in the municipalities studied appeared to be faulty. Data entry to this instrument was better at locations with larger healthcare teams.

摘要
**研究背景**：正确使用儿童健康手册（child health handbook）是评估医疗服务机构儿童照护质量的重要指标。本研究旨在评估卫生专业人员对儿童健康监测工具（child health surveillance tool）的使用情况，重点聚焦儿童生长发育监测相关内容。
**研究设计与实施现场**：本研究为横断面研究（cross-sectional study），在巴西家庭健康战略框架下，于帕拉伊巴州的两个自治市开展。
**研究方法**：本研究纳入了基层医疗工作者服务覆盖区域内的321名5岁以下儿童。由儿童母亲填写问卷，收集社会人口学特征相关信息。对该手册中记录的生长发育曲线图（growth charts）、铁剂与维生素A补充登记情况以及免疫接种程序记录进行分析。针对使用第三版儿童健康手册的儿童，进一步分析了手册完成情况与社会人口学特征之间的关联。
**研究结果**：本次研究涉及的所有参数均存在较高比例的数据录入不规范情况，其中体重-年龄曲线图的不规范录入率为41.1%，体质指数-年龄曲线图的不规范录入率高达95.3%。在25月龄及以上儿童，以及所在自治市医疗团队专业人员数量较少区域的儿童中，数据录入不规范的比例更高。
**研究结论**：在所研究的自治市内，使用儿童健康手册监测儿童生长发育的工作存在明显疏漏。医疗团队规模更大的区域，手册的数据录入质量更高。