Use and records of child health handbook focused on growth and
                    development

Palombo, Claudia Nery Teixeira; Duarte, Luciane Simões; Fujimori, Elizabeth; Toriyama, Áurea Tamami Minagawa

doi:10.1590/S0080-623420140000600009

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Sumário

Artigo Original • Rev. esc. enferm. USP 48 (spe) • Aug 2014 • https://doi.org/10.1590/S0080-623420140000600009 copy

Use and records of child health handbook focused on growth and development

Uso y llenado de la libreta de salud infantil con el foco en el crecimiento y el desarrollo

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective

To evaluate the use and records of the Child Health Handbook (CHH), especially growth and development.

Method

Cross-sectional study with 358 mother-child pairs registered in 12 Primary Health Centers (PHCs) of a small municipality. Mothers were interviewed at the PHC from February to April 2013 using a questionnaire. Data analysis was done using WHO Anthro software, Epi InfoTM and Stata.

Results

Fifty-three percent of the mothers were carrying the CHH at the time of the interview, similar to the proportion of mothers who were instructed to bring the CHH to health appointments. Annotations in the CHH during the visits were reported by 49%. The vaccination schedule was completed in 97% of the CHH, but only 9% and 8% of the CHH, respectively, contained growth charts and properly completed developmental milestones.

Conclusion

Low rates of use and unsatisfactory record-keeping in the CHH reinforce the need for investment in professional training and community awareness for the CHH to become an effective instrument of promotion of child health.

Child health; Growth and development; Health Promotion; Primary Health Care

Variables^a a There were no data for the total sample a There was no information for the whole sample a There is no information for the whole sample a There was no information for the whole sample a Não se obtiveram informações para o total da amostra a Não há informações para a totalidade da amostra a Não há informações para a totalidade da amostra a Não há informações para a totalidade da amostra	N	%
Maternal characteristics
Age (years)
≤ 19	43	12.5
> 19	302	87.5
Education level (years in school)
≤ 8	124	35.1
> 8	229	64.9
Parity
Primiparous	153	42.7
Multiparous	205	57.3
Works outside of the household
Yes	137	38.7
No	217	61.3
Children's characteristics
Age (months)
< 6	129	36.2
6├ 12	81	22.8
12├ 18	51	14.3
18├ 24	40	11.2
24├ 30	26	7.3
≥ 30	29	8.2
Gender
Male	196	54.7
Female	162	45.3
Birth weight (grams)
< 2,500	42	11.7
≥ 2,500	315	88.3
Birth length (centimeters)
< 47	69	21.4
≥ 47	253	78.6
Attends day care center (full time or part time)
Yes	46	12.9
No	311	87.1
Main caregiver (except for children who attend full-time day care centers)
Mother	279	88.3
Others	37	11.7
Nutritional status
Underweight	25	7.2
Normal weight	213	61.2
Excess weight	110	31.6
Child Development
Normal	165	49.4
Alert	169	50.6

Variables	N	%
Use of the CHH
The mother had the CHH at the time of the interview	185	53.2
The mother reported having been instructed to take the CHH to health appointments	183	52.0
The mother reported taking the CHH to health appointments	271	76.6
The mother observed the health professional making annotations in the CHH	173	49.0
Complete records of the CHH items
Child identification	85	48.0
Information about birth	84	47.5
Anthropometric measurements record sheet	53	33.8
Height chart	14	8.9
Weight chart	14	8.9
Development chart	13	8.3
Vaccination scheme	169	96.6

Characteristics^a c Inadeq = inadequate (low weight and overweight) c Inadeq = inadequado (Baixo peso e excesso de peso)	Mother with CHH^a c Inadeq = inadequate (low weight and overweight) c Inadeq = inadequado (Baixo peso e excesso de peso)				p^b d Fisher’s exact test d Teste exato de Fisher
	Yes		No
	n	%	n	%
Mother instructed to take the CHH to the appointments
Yes	112	61.9	67	41.9	0.000
No	69	38.1	93	58.1
Mother observed that the professional made annotations
Yes	125	68.7	85	52.8	0.012
No	57	31.3	76	47.2
Mother was informed of the weight gain and height of the child
Yes	161	88.0	126	78.8	0.029
No	22	12.0	34	21.2
Nutritional status
Underweight	12	6.5	13	8.4	0.788
Normal weight	112	60.9	93	60.4
Excess weight	60	32.6	48	31.2
Adequate development
Normal	84	51.2	87	54.0	0.611
Alert	80	48.8	74	46.0
Age Group
≤1 year of age	122	66.0	75	50.7	0.005
>1 year of age	63	34.0	73	49.3

CHH item annotation^a	Nutritional statusa			Development^a			Age Group
	Adeq^b	Inadeq^c	p^d	Normal	Alert	p^d	≤1 year	>1 year	p^d
	n	n		n	n		n	n
	(%)	(%)		(%)	(%)		(%)	(%)
Registration sheet
Complete	29	24	0.300	27	22	0.160	36	17	0.384
	(30.5)	(39.3)		(40.3)	(28.6)		(36.7)	(28.8)
Incomplete	66	37		40	55		62	42
	(69.5)	(60.7)		(59.7)	(71.4)		(63.3)	(71.1)
Weight Chart
Complete	8	6	0.576	6	7	1.000	11	3	0.255
	(8.0)	(10.5)		(9.1)	(8.7)		(11.1)	(5.0)
Incomplete	92	51		60	73		88	56
	(92.0)	(89.5)		(90.9)	(91.3)		(88.8)	(94.9)
Height chart
Complete	9	5	1.000	6	7	1.000	10	4	0.576
	(8.9)	(8.9)		(9.0)	(8.7)		(10.0)	(6.9)
Incomplete	92	51 (91.1)		61	73		90	54
	(91.1)			(91.0)	(91.3)		(90.0)	(93.1)
Development chart
Complete	7	6	0.550	5	6	1.000	9	4	0.768
	(53.9)	(10.5)		(7.7)	(7.5)		(9.1)	(6.7)
Incomplete	92	51		60	74		89	55
	(64.3)	(89.5)		(92.3)	(92.5)		(90.8)	(93.2)

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Correspondence: Claudia Nery Teixeira Palombo.  Rua Osvaldo Guimarães Lanza, 197 – Vila Maria de Maggi,  CEP 08680-070 – Suzano, SP, Brasil.  E-mail: claudiapalombo@usp.br