Child and Adolescent Health and Development

• Introduction

• 12 key practices and a review of the evidence

WHO and UNICEF, based on available evidence, have identified 12 key family and community practices that, if properly promoted and adopted by the targeted communities, would potentially contribute to improving child survival, growth and development. Effective interventions to promote these practices require systematic planning, well coordinated use of a combination of channels of communication, close follow-up, monitoring and supervision. The interventions need to go beyond knowledge acquisition to facilitate changes in behaviour. Behavioural changes take time to occur and, once initiated, need to be sustained over a relatively long period of time. Adequate resources must therefore be identified within and outside the community to support the intervention in the long term. The more actively the community is involved and participates in the intervention, the higher is the possibility that the intervention will be sustainable and result in the desired outcome. The health system plays an important role in supporting families in their child care responsibility.

See the section on evaluation for information on indicators and surveys.    Top
 

A technical review of the evidence of the 12 practices and feasibility of interventions to improve them —here referred to as “The Review”— has recently been conducted in collaboration with the London School of Hygiene and Tropical Medicine and published (Family and community practices that promote child survival, growth and development – A review of the evidence, World Health Organization, Geneva, 2004 – ISBN 92 4 159150 1).

The list of the 12 family and community practices is shown below, together with some information on each of them, using The Review as a main reference. The Review has an extensive reference section that can be consulted to refer to the original studies. Common lessons identified include the need for an in-depth situation analysis, for the use of a variety of approaches when promoting these practices, and to sustain coverage once the practice has been adopted in the community.

1. EXCLUSIVE BREASTFEEDING. Breastfeed infants exclusively for up to 6 months. (Mothers found to be HIV positive require counselling about possible alternatives to breastfeeding). More

2. COMPLEMENTARY FEEDING. Starting at about 6 months of age, feed children freshly prepared energy and nutrient rich complementary foods, while continuing to breastfeed up to two years or longer. More

3. MICRONUTRIENTS. Ensure that children receive adequate amounts of micronutrients (vitamin A, iron and zinc, in particular), either in their diet or through supplementation.  More

4. HYGIENE. Dispose of faeces, including children’s faeces, safely, and wash hands after defecation before preparing meals and before feeding children. More

5. IMMUNIZATION. Take children as scheduled to complete a full course of immunizations (BCG, DPT, OPV and measles) before their first birthday. More

6. MALARIA: USE OF BEDNETS. Protect children in malaria-endemic areas, by ensuring that they sleep under insecticide-treated bednets. More

7. PSYCHOSOCIAL DEVELOPMENT. Promote mental and social development by responding to a child’s needs for care and through talking, playing and providing a stimulating environment. More

8. HOME CARE FOR ILLNESS. Continue to feed and offer more fluids, including breastmilk, to children when they are sick. More
   ► Home care for sick children includes several “practices” which are enumerated individually in this list of 12 key family practices, such as: continuing feeding and offering more fluids (practice no. 8), oral rehydration treatment and treatment of fever (practice no. 9), prompt care-seeking (practice no. 10), and compliance with health provider’s advice (practice no. 11)].

9. HOME TREATMENT FOR INFECTIONS. Give sick children appropriate home treatment for infections. More
   (see also practices 8, 10 and 11 related to home care)

10. CARE-SEEKING. Recognize when sick children need treatment outside the home and seek care from appropriate providers. More

11. COMPLIANCE WITH ADVICE. Follow the health worker’s advice about treatment, follow-up and referral. More

12. ANTENATAL CARE. Ensure that every pregnant woman has adequate antenatal care. (This includes having at least four antenatal visits with an appropriate health care provider and receiving the recommended doses of the tetanus toxoid vaccination. The mother also needs support from her family and community in seeking care at the time of delivery and during the postpartum and lactation period). More
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