WHO and UNICEF, based on available evidence, have identified 12 key family and community practices on child care. If properly promoted and adopted by the targeted communities, these practices would potentially contribute to improving child survival, growth and development.

Rationale

12 key practices and a review of the evidence

Rationale

Effective interventions to promote these practices have an impact on child health. They 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.

The 12 key family practices on child care

12 key practices and a review of the evidence

A technical review of the evidence of the 12 key family and community practices on child care promoted by WHO and UNICEF and feasibility of interventions to improve them—here referred to as “The Review”—was conducted by WHO in collaboration with the London School of Hygiene and Tropical Medicine in 2004. This followed The Lancet series on child survival (2003). More recently (2011), the World Health Organization (WHO), the Aga Khan University, the Partnership for Maternal, Newborn & Child Health (PMNCH) and 14 partners have carried out a review to identify key interventions to reduce maternal, newborn and child deaths. The review has confirmed the importance of the interventions identified earlier to promote those practices and has updated them.

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.

The original list of the 12 family and community practices is shown below, together with some information on each of them.

Family and community practices that promote child survival, growth and development – A review of the evidence

Essential Interventions, Commodities and Guidelines for Reproductive, Maternal, Newborn and Child Health (RMNCH)

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