POST AND PHOTOS BY BAILEY ADAMS // PUBLISHED MAY 2017

Caregivers attend a growth monitoring campaign

Community growth monitoring campaigns are always an exciting and busy time for our team. Three times a year, before each new season, we join with community health workers (CHWs) at remote sites across the Musanze District of Northern Rwanda to weigh and measure children.

As part of the Ministry of Health’s First 1000 Days Community-Based Food and Nutrition Programs, the Government of Rwanda conducts routine growth monitoring of children across the country using community health workers to reach families in need. At GHI we utilize these campaigns to identify children with chronic and acute malnutrition across the communities where we work, and enroll the most severe cases in our Health Center Program.

In the past, we would use these campaigns to refer any children who fell below the “healthy” height-for-age or weight-for-height measurements - as defined by the WHO growth tables - to our enrollment days. During enrollment, all referred families came together at their nearest health center where GHI field staff, in collaboration with CHWs, would re-assess children to ensure accuracy and enter data into an electronic spreadsheet in real time.

Back in the office, our talented Monitoring and Evaluation Team would then rank those children according to a Z-score calculation of their weight-for-height (to detect acute malnutrition, or wasting) and height-for-age (to detect chronic malnutrition, or stunting) measurements with the following prioritization:

Severe acute malnutrition for children under 5
Moderate acute malnutrition for children under 5
Severe stunting (chronic malnutrition) for children under 2
Moderate stunting for children under 2
Severe stunting for children over 2
Moderate stunting for children over 2

The forty most severe cases of malnutrition at each health center were then invited to enroll in our program.

This season, we changed the structure of how we enroll families into our program by eliminating ‘enrollment days’ at health centers and instead using data directly from campaigns to prioritize families. This shift happened for a number of reasons:

Last season, only 38% of families that were referred from campaigns came to enrollment days, meaning that we could be missing some of the most vulnerable children by adding an extra step to the process.
We had previously thought enrollment days were important for ensuring accuracy of data; however, our field staff have been improving their techniques for taking measurements in the field, and last season only 4% of height or length measurements differed by more than 5 cm between campaigns and enrollment. In addition, to ensure that we still collect accurate data, our team weighs and measures children again at the first health center training to double-check nutritional status and record baseline data.
CHWs will also be changing how they conduct growth monitoring campaigns in the coming year, which made this a good time to make adjustments to our own enrollment strategy.
Our current seasonal schedule would have placed enrollment days at the same time as local market days in the communities, which would have meant particularly low turnout at enrollment.

Monitoring and Evaluation agent Donation helps weigh children.

One thing that hasn't changed, however, is that growth monitoring campaigns always call for “all hands on deck”. For each campaign, Ndera-based staff join with Musanze staff at sites across the district to help weigh and measure up to hundreds of children per site. Campaigns also offer an opportunity for our Ndera-based staff to interface directly with partner communities and vulnerable families.

Through joining community health workers in periodic growth monitoring campaigns, we are able to integrate with existing government policies and structures and avoid any overlap or competing interests. One of the hallmarks of GHI’s model has always been our productive working relationship with the Government of Rwanda. By partnering directly with government health centers, we are able to build capacity as well as reach the most vulnerable children at the point of care.

This season, our team - together with community health workers - weighed and measured over 18,000 children across Musanze District. Now that this season’s campaigns have come to a close, we will be able to jump right in with our next cohort of mothers as soon as the holidays are over. We look forward to working with our newest cohort and reporting on exciting new outcomes for 2017!

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Mugikorwa cyacu cyo gufasha abaturage kugenzura imikurire yabo, nigihe kiba gishimisheje ariko nanone nigihe itsinda ryacu riba rihuze cyane. Inshuro eshatu mumwaka, mbere yuko dutangira igihembwe gishya, twegera abajyanama b’ubuzima bacu bo mukarere ka Musanze ho mu ntara y’ amajyaruguru y’urwanda, kugirango dufate ibipimo by’ ibiro by abana.

Nkuko biri murigahunda ijyanye no kwita kumirire mu minsi igihumbi ya ministeri y’ urwanda ifite munshingano zayo kwita k’ ubuzima bw’ abaturage, buri gihe leta y’ urwanda ikurikirana imikurire y’ abana yifashishije abajyanama bubuzima bashobora kugera kumiryango itandukanye mugihe aringombwa. Mu murima wubuzima, dukoresha gahunda yo gupima abana tugamije gusuzuma abana bafite ikibazo cy’imirire mibi yababaye ho karande ndetse no kureba abafite ikibazo gikabije cy’imirire mibi ahantu hose dukorera ndetse twakira abantu muri porogarame yacu ishinzwe ubuzima ariko kubantu bafite ikibazo gikomeye cyane.

Mubihe bishize twajyaga dukora iyi gahunda tugamije kureba abana bafite ikibazo cyimikurire itajyanye nimyaka yabo cyangwa ibiro bitajyanye nuburebure bwabo nkuko byasobanuwe mu mbonerahamwe kubijyanye nimikurire yikigo cyisi gishinzwe kwita kubuzima bwabantu (WHO)- Twifashisha iyi mbonera hamwe twinjiza abantu bashya muri porogaramu yacu. Mugikorwa cyo kwakira abanyamuryango basha, imiryango yatoranyijwe yegera ibigo byubuzima aho umurima wubuzima ushobora kuba ukorera, tubifashijwe mo nabajyanama bubuzima bacu, twongera gusuzuma abana kugirango tubone amakuru afatika. Nyuma yaho, amakuru abikwa hifashishijwe ikoranabuhanga.

Tugarutse aho dukorera (mu biro), itsinda ryacu ryabizobereye mo rinononsora ayo makuru yose, rikanashira kurutonde abana, bifashishije igipimo bita Z-scores. Bapima kubijyanye nuburebure ni biro ( kurigango bashobore kubona ikibazo cyimirire mibi cyangwase gutakaza ibiro). Banapima nanone ibijyanye nuburebure nimyaka ( kugirango babone abana bafite ikibazo cyimirire mibi yababaye ho akarande, ndetse no gusuzuma ikibazo cyo kugwingira). Iri tsinda rikaba rifata ibyo bipimo muri ibi byiciro byingenzi:

Ikibazo cyimirire mibi gikabije kubana bari munsi yimyaka 5
Ikibazo cyimirire mibi kidakabije kubana bari munsi yimyaka 5
Ikibazo cyo kugwingira ( imirire mibi) kubana bari munsi yimyaka 2
Ikibazo cyo kugwingira kidakabije kubana bari munsi yimyaka 2
Ikibazo cyo kugwingira gikabije kubana bari hejuru yimyaka 2
Ikibazo cyo kugwingira kidakabije kubana bari hejuru yimyaka 2

Nyuma yaho, abana mirongi ine bagaragawe ho ikibazo gikabije cyimirire mibi kuri buri kigo ndera buzima binjizwa muri porogaramu yacu.

Muri iki gihembwe, twahinduye uburyo twakira imiryango muri porogaramu yacu; dukuraho iminsi yarisanzweho yo kwakira imiryango kubigo nderabuzima, ahubwo twakira imiryango mishya tugendeye kumakuru twakusanyirije ako kanya mugikorwa cyacu cyo gupima abana. Iyi mpinduka yabayeho kubera izi mpamvu zikurikira:

Mugihembwe gishize, mirongo itatu numunani kwijana (38%) yabantu batangajwe muminsi yo kwakira imiryongo misha muri porogamu yacu nibo bitabira gusa, bityo bigatuma tudashobora kubona amakuru ahagije kumiryango ibabaye cyane.
Tugitangira, twatekerejeko iminsi ihamye yo kwakira imiryango mishya muri porogaramu yacu izadufasha kubona amakuru afatika kandi meza, ariko abakozi bacu bo kuri tere bagerageje guhindura uburyo bafata ibipimo. Mugihembwe gishize kane kwijana (4%) yagaragazaga ikinyuranyo cya santimetero eshanu (5 cm) hagati yagahunda zacu ndetse no kwakira imiryango mishya muri porogaramu. Na none, kugirango tubone amakuru afatika kandi yizewe, itsinda ryacu ryongera gusuzuma abana mumahugurwa yabana kubigo ndera buzima kugirango hasuzumwe kuburyo bwimbitse imiterere yimirire myiza ndetse bagire amakuru yingenzi.
Abjyanama bubuzima nabo bazahindura uburyo bafata ibipimo bijyane no gusuzuma imikurire muri gahuda zabo mumwaka utaha. Ari nacyo gihe cyacu cyiza cyo kuba twahindura uburyo tugenderaho twakira imiryango mishya muri porogaramu yacu.
Ubu, muri iki gihembwe, gahunda yari yarateguwe kuburyo iminsi yagahunda zacu ihuzwa niminsi yisoko, byajyaga bituma umubare wabo twinjiza muri porogaramu zacu ugabanyuka.

Ikintu kimwe kitahindutse, nuko ibikorwa byacu bishinzwe gusuzuma imikurire bizahora byitwa “Duhurize ibiganza kumeza amwe.” Kuri buri gikorwa (kampanye), abakozi bo muri Ndera bazajya bahura nabo muri Musanze ahantu site yegereye akarere kugirango hafatwe ibipimo birenze ijana byabana kuri buri site. Nanone, gahunda zacu (kampanye) zihereza amahirwe abakozi bacu ba Ndera kugirango bahure nabafatanyabikorwa bacu ndetse nimiryango ibabaye cyane.

Tugerageza kwegera abajyanama bubuzima bacu mubikorwa byo gupima abana kubijyanye nimikurire. Dukorera hamwe na guverinema yurwanda tukanagendera no kungamba zayo twirinda ibintu bijya gusa no guhangana. Ikiranga imikorere y’ umurima w’ ubuzima nukuba dukorana neza cyane na leta yurwanda. Mu kwifatanya nibigo bya leta bishinzwe ubuzima, dushobora kuba twakubaka ubushobozi bwacu ndetse tunagera no kuri babana bababaye cyane murwego rwo kubitaho.

Muri iki gihembwe, itsinda ryacu hamwe nabajyanama bubuzima bafashe ibipimo kubana barenga ibihumbi cumi numunani (18,000) bo mukarere ka Musanze. Aha ninaho ibikorwa byagahunda zacu muri iki gihembwe bigarukiye, turategura kwakira irindi tsinda rya badamu mugihe kitarambiranye mugihe ibiruhuko bizaba birangiye. Twishimiye kuzakorana nitsinda rishya ndetse no kubagaragariza umusaruro mwiza wu mwaka wa 2017.

Supporting Community Growth Monitoring Campaigns