Held 21-22 August 2000
Papers Presented at
the 2nd National NADEOSA Conference
Held 21-22 August 2000
Author:
Mailane Mofana-Semoko (Lesotho)
Title:
Research and Materials Development: How Adequate
is the Lesotho Distance Teaching Centre’s Booklet on Child Care?
Background
The Lesotho Distance teaching Centre (LDTC) was established in 1974, as a literacy programme to provide alternative educational opportunities for people who do not have access to formal education, namely mine workers, herdboys, out-of-school children, rural women and schools’ drop-outs.
The centre provides correspondence courses through distance education leading to Junior Certificate (J.C) and Cambridge Overseas School Certificate (C.O.S.C.). It also acts as a service agency for other organisations involved in non-formal education, for services such as producing radio Programmes, running communication support courses for field workers, conducting research and evaluation studies. It provides literacy and numeracy programme to youth and adults, with the main target group being herdboys and also basic practical skills to rural people, to offer opportunities for learning literacy and numeracy, through the then Basic Rural Education Section, now called Basic Education Section.
It was through the Basic Rural Education Section that the booklet on ‘Child Care’ was produced in 1979. The purpose of the booklet was to support campaign for health education to help mothers care for their babies and children with some guidance. It also gives LDTC’s neo-literates chance to practice their newly acquired reading and writing skills, and to provide them with practical knowledge which help them to increase their quality of life.
The paper discusses circumstances surrounding nutritional status of the country, the rate of malnutrition, morbidity and mortality rate, growth monitoring, which includes immunisation and management of diarrhoeal diseases.
The nutritional status of the country as a whole was very poor at the time the study was carried out and it is still the case, and this results in malnutrition among the under-five-year-olds. Malnutrition seemed to be the main cause of a larger number of deaths among babies in Lesotho. Children’s diseases were still a problem in Lesotho at the time. Many children suffered different diseases, which mothers did not know or understand what their causes were and what to do about them. It had been realised that mothers did not know how to read growth charts and so did not use them as they should, they lacked knowledge of the importance of growth monitoring and how to read and interprete growth chart. The mothers are not keen to take their babies to the clinic for immunisation programme. Many of them do not finish the immunisation process for their babies not knowing the danger of not completing immunisation programme. The most common problem that needs action is that mothers do not really know how to manage diarrhoeal diseases, how to make the right measurements for sugar and salt solution.
The booklet was originally produced by the LDTC as a result of the needs expressed by mothers during the pre-testing of a recipe booklet in 1975. The problem of ill-health -among the under-fives was still prevalent due to illiteracy rate or insufficient knowledge among parents especially mothers or anybody who looks after children, in regards child care.
Lesotho is enclosed on all sides by the Republic of South Africa, and this has greatly influenced some of our feeding patterns.
Children’s problems seem to be seasonal. The prevalence rate of malnutrition tend to be higher in the first quarter of the year compared to the rest of the year, this period corresponds to the pre-harvest, ‘hungry season’ and the period of summer diarrhoeal diseases. Lesotho experienced severe periodic droughts and shortage of rainfall at the time to sustain crop production. The food shortages have resulted in malnutrition which is more prevalent among the under-fives and among individuals and households in the more remote areas.
Objectives of the Study
The research project was carried out in order to find out what information could be included in the booklet and what could be omitted. So the study was aiming to find out what mothers wanted and needed to learn concerning child care and to assess the adequacy of the booklet in meeting the identified needs of the mothers.
At the end of the study the researcher would be able to say which information was missing from the booklet and should be added and which information was outdated or irrelevant and should be omitted.
Methodology
The study used three methods, the modified nominal group technique, the question guide with mothers at Scott Hospital, Morija and at Mazenod Health Centre, the questionnaire with professional people from different government departments and Non-Governmental Organisations and the interview method with some professional people who filled in the questionnaire, with the addition of other officers not necessarily technical people.
The nominal group discussions were led for 11groups of mothers. At Scott Hospital there were 6 groups, 2 of 7, another 2 of 8 and the last 2 of 9 mothers. At Mazenod Health Centre, there were 5 groups, 2 of 5, 2 of 7 and 1 of 6 mothers.
The research was done at Scott Hospital, Morija, 41 km from Maseru and Mazenod Health Centre, 15 km from Maseru. It had to be done with the nearest clinics outside Maseru town, so that the views of mothers in Lesotho would be represented. The original
Plan was to carry out the study with lactating mothers, on the day they had taken their babies to the clinics for growth monitoring, but instead it was done with expectant mothers, the reason being that with lactating mothers their babies cry and do not give their mothers chance to listen or do anything. This problem was experienced during the pre-testing of the tool.
The questionnaire method was used with the professional people from the following offices: Nutrition Office of the Ministry of Agriculture; Private Health Association of Lesotho; Food and Nutrition Coordinating Office and Control of Diarrhoeal Diseases Programme, Public Health Programme, Respiratory Infections Programme and the Expanded Programme for Immunisation, all of the Ministry of Heath. 10 questionnaires were given to ten selected professionals and 7 responded to it.
The interview method used an interview schedule with open-ended questions. 6 of the above group of professionals with the addition of one person were interviewed, asking for their opinions on the educational needs expressed by mothers concerning child care. The interviews were based on the information given by mothers. One of the questions asked was, "The mothers would like the messages on child care to be taught to fathers, grandmothers, baby sitters and youth. Would you comment on that?". In responding to the questions, the professionals would in most cases commend the mothers for their answers with an expression, "This is interesting", and then would give their opinions.
Review of Relevant Literature
In Lesotho, it has always been the task of a mother to take care of children. Studies show that mothers are the backbone of families. They are directly responsible for the welfare of their children. Child care messages are designed for parents, especially mothers who look after babies or children. This is the case because mothers are the providers of food and health for their families. So there is a need for them to be provided with primary health care skills. Many people believe the parents, especially mothers, must possess the qualities and the knowledge necessary to bring up children properly.
There is a lot that has to be learned for one to be able to care for children better from the stage when the baby is born and throughout all the developmental stages that a baby goes through, until the baby is ready for pre-school. It has been established that mothers need to know something about child nutrition, growth monitoring, morbidity and mortality, management of diarrhoeal diseases and immunisation.
The need for nutrition education has been advocated for by different people in an attempt to reduce under-five morbidity and mortality due to malnutrition. It is important that mothers know about child nutrition, without which the children are susceptible to different diseases and cannot develop or grow well. Particularly they should learn the importance of breast feeding and how to wean babies gradually. They should also learn how to prepare food and feed their babies and children. Proper nutrition prevents deficiency diseases.
The best way for mothers to know about the growth of their babies and children is through the use of a growth chart. There is a need for mother to be taught the importance of monitoring the growth of their babies, how to read and understand the growth lines on the chart and what they mean. It has been proved that mothers are trainable in this aspect. If a parent does not know that a child is growing poorly s/he will not be able to do anything about it.
One other aspect that mothers ought to learn about is common and communicable children’s diseases, so that when need arises, they will be able to know what to do or how to handle a patient. The mothers need to know about the prevention and control of such diseases. This has been a concern among health educators that mothers should know about the causes of illnesses and how they are passed on.
The literature reviewed showed the importance of mothers knowing the relationship between the common children’s diseases and immunisation. That immunisation of women and children against major infectious diseases is another crucial element in primary health care. This needs mother’s participation and she should know that it is important for her children and for herself. The mothers also have to learn about prevention and treatment of diarrhoeal diseases.
The idea of mothers learning about child care is supported by UNICEF (1986) that , mothers, for example, need to know the importance of and ways of implementing the key elements for child survival and development, namely antenatal care, maternity care, monitoring child growth, prevention and treatment of dehydration diseases, child feeding and immunisation.
Findings of the Study
The findings of the study are based on the views of the professionals or technical people or experts on primary health care, those of the mothers and some government officials.
The findings of the study showed that both the professionals and mothers understood the purpose of the booklet on child care for what it was intended for. According to them the booklet is very important, as it helps guide mothers in bringing up their babies and the most important reason being that it gives mothers necessary information about development of a child. Most of the information is still valid but needs changes here and there by including some new information suggested for inclusion in the booklet and omitting the old ones.
Information to be included in the booklet
There was a lot of information that the professionals and mothers suggested should be included such as weaning process, child nutrition, children’s diseases, new immunisation schedule, information on the problems of breast feeding, growth monitoring, information on management of diarrhoea and other topics related to child care.
The results showed that there was a need for knowledge on child nutrition which includes the weaning process, the types of foods to feed a baby or a child and how to prepare it and the frequency of feeding. The professionals suggested that the importance of colestrum should be stressed in educational endeavours. The results also showed that mothers did not know that breast milk was as important as food even after four months of age. So, they should be taught what to do if babies like breast milk more that any other food.
The results also showed that there were a number of children’s diseases mothers would like to learn about such as typhoid, meningitis, polio, colic. Tetanus taxoid, acute respiratory diseases, intestinal worms, pneumonia, kwashiorkor, malnutrition-related diseases, diarrhoeal diseases, constipation, sores, measles, flu, pertusis and scabies. There was a need to include them in the child care booklet in details. This would give them answers to many of the diseases-related problems they experience when bringing up their babies. The professionals suggested that all immunisable diseases and the new immunisation schedule be included in the booklet.
Other topics the study revealed as important for inclusion in the booklet are breast feeding and the complications or problems of breast feeding. The other ones are growth monitoring, the importance of mother knowing how to interprete growth curve and mothers’ concern about the direction of the growth curve. It was also found out that mothers did not know the new method of preparing salt and sugar solution for the management of diarrhoea. So it is important that they know about it.
The study came up with a number of topics under ‘Family Life Education’ that were related to child care such as family planning; relationship between parents and children; how to help a child develop physically, mentally and spiritually and how poor families should manage to bring up their children. It was also found out that it was widely believed that parents who took alcohol did not care for their children and they needed to be counselled.
The study revealed what mothers would like to know about the kinds of clothes suitable for babies and how take care of them. The professionals suggested that mothers be taught about the kinds of materials suitable for babies.
Information to be omitted
There was not much information to be eliminated from the booklet. However, the study indicated some information that was outdated and needed to be eliminated as follows:- old information on child nutrition, old immunisation schedule and the old method of management of diarrhoea, which includes the old method of preparing oral rehydration solution or salt and sugar solution.
The respondents also pointed out some sentences in the booklet to be cut out on page 16 and the last paragraph and page 36, point number 3, the first sentence.
There is a need to change pictures and get new ones. Generally, the results showed that the pictures were not satisfactory and needed to be replaced. Also that pictures should portray what they are supposed to represent, the age of children in pictures should correspond with messages and if it is supposed to show a healthy baby, that baby should look healthy and that pictures should have captions.
Acceptance of the booklet
Generally, the booklet was accepted on the basis of it being readable, because of its size, simple and understandable language, content and its presentation. A reader could read it up to the end because of its simple language and the writing that is large enough, even for semi-literate people.
The professionals found the pictures in the booklet to be faint and that several of them needed to be changed.
Distribution of the booklet
The professionals found the booklet very useful in that it helps mothers in caring for their babies. According to the professionals, there is a need for a wide distribution of the booklet. They would like it to be distributed through health facilities, clinics in both urban and rural communities, in schools, villages and to be used by extension workers, village health workers and teachers as well. Also there was a need for a wider spread of child care messages through the mass media, radio Programmes; printed materials, perhaps newspapers; television Programmes and posters.
According to both the mothers and the professionals, child care was supposed to be taught to the community as a whole. It is not only mothers’ responsibility to bring up babies, that other target groups like fathers, baby sitters, youth and grand parents should be addressed on child care aspects.
Conclusions
The study did meet its aims and objectives and has definitely proved the inadequacy of the Lesotho Distance Teaching Centre’s (LDTC) booklet on child care. It has come up with the suggestions of what mothers should learn about child care, that is the topics to be included in the booklet during its review. The results showed that mothers would like to learn more than what the booklet gave them. The study also revealed the information that should be eliminated from the booklet.
The proposed changes for the review of the LDTC’s booklet on child care, are the same way a concern for health educators world wide as the literature reviewed has shown. Child care has been a component of health education and health educators world wide want to educate parents in better child care, as shown in the review of relevant literature. There is a need to equip them with all the key aspects for child survival and development, such as the importance of breast feeding; how to wean babies gradually with proper supplementary foods or child nutrition in general; growth monitoring, with the use of growth chart; morbidity and mortality.
There is too much information the study came up with, that should be incorporated into ‘Child Care’ Booklet. To put it all in one booklet will result in one unacceptable, volumenous material. However, the possible way to present it is in a package, consisting of one booklet and a series of leaflets or pamphlets concentrating on certain topics, for example, children’s diseases, growth monitoring or family life education in details.
The review of the booklet will be an interesting activity because there will not be any problem in eliminating the old information from the booklet and adding the new one. Again, it will not be difficult to get new photographs for the LDTC because of the availability of equipment and personnel.
Recommendations
The recommendations are organised into categories concerning content, presentation, distribution of the booklet and recommendations for further research.
This means the whole campaign will involve journalists. They could spare a column for child care messages. also radio and television programmes could do the work.
The research could be done by the office of the National Curriculum Development Centre (NCDC). It could be done with teachers’ and curriculum developers’ suggestions. The office might use interviews and questionnaires to collect information.
The study could either be done by the Ministry of Health, through its Health Education Division or by the Lesotho Distance Teaching Centre. Interviews and questionnaires could be used to get information.
This seems to be interministerial concern. The Ministry of Agriculture, Education, Health and Employment could be involved in doing a research to find out for example the attitudes of men towards sharing the work done by women. Also to find out what skills they need to learn to be able to help women with family chores.
This research could be done using Nominal Group Technique, Focus Group Discussions and interview methods.
The Lesotho Distance Teaching Centre could do this study. The Nominal GroupTechnique could be used with all these categories of people, using a discussion guide.
References
Almroth, S. (May 1988). Development of Revised Bukana Growth Chart of Lesotho. Progress Report V: UNICEF (unpublished).
Byrne, M. and Bennett F. J. (1986). Community Nursing in Developing Countries. A Manual for the Community Nurse, 2nd Ed. Oxford Medical Publication: Oxford Press.
Carr, W. and Kemmis, S. (1986). Becoming Critical: London. The Farmer Press.
Division of Family Health (1986). How to use the Child Health Card. A Guide for Health Workers in Kenya: Nutrition Section, Ministry of Health. Nairobi, Kenya.
FNCO (Jan.-June 1991). Food and Nutrition Information Bulletin, Vol.1 No.13: Ministry of Agriculture, Lesotho.
Gay, J. (1985). Social and Economic Aspects of the Catholic Relief Services. Food and Nutrition Programme in Lesotho.
Jabre, B. (1986). Education and Primary Health Care. Health Education and Women’s Activities, Digest No. 17: UNESCO-UNICEF Co-operative Programme, Paris.
Kingdom of Lesotho FHI (April 1988). International Evaluation: Family Health Programme. Ministry of Health.
Makhetha, L. and Bastian, M. J. (1980). Basic Needs of Women and Children in Lesotho. Report of the National Survey: LDTC. Maseru.
Malibo, R., Mpeta, M. and Matete, P. (1987). Food and Nutrition Situation in Lesotho. A paper presented at the Nutrition course in Mauritius, 14th Sept.-23rd Oct., 1987.
O’neil, Michael (1981). Nominal Group Technique: An evaluation data collecting process. Evaluation Newsletter, 5(2), pp44-60.
School Feeding Management Committee (1983). The Management of the Primary School Feeding Programme: Ministry of Education, Lesotho
UNESCO-UNICEF (1986). Education for Child Survival Development in Africa, Digest No.20: UNESCO-UNICEF Co-perative Programme, Paris.
Winikoff, B., Castle, M. N. and Laukaran, V.H. (1988). Feeding infants in Four Societies: Causes and Consequences of Mothers' Choices. Greenwood Press, New York.
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