|Year : 2005 | Volume
| Issue : 2 | Page : 61-62
Under fives clinic
Emeritus Professor of Tropical Child Health University of London, United Kingdom
|Date of Web Publication||30-Jun-2012|
Emeritus Professor of Tropical Child Health University of London
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Morley D. Under fives clinic. J Fam Community Med 2005;12:61-2
It is now over 30 years since the book "Paediatric Priorities in the Developing World" was written. This book was largely responsible for the award of the first prestigious King Faisal Prize for International Health, to the author of this editorial. The request to write a chapter for an African Public Health book offered the opportunity to think through the unusual ideas put forward in this book of which was perhaps the most innovative and significant concept of the Under Fives Clinic. It was initiated to meet a situation where there was high mortality and almost no preventive care in an area of Africa with a large population of children. The most significant features of these clinics are still relevant.
Local Personnel provided Preventive and Curative care
The locally trained nurses and clerks were all mothers or fathers. They knew the nuances of the language and the local beliefs. They were responsible for the immunisation, the nutrition of the children through monitoring of the weight curve, advising the mothers on the means to achieve an adequate birth interval, and the treatment of common conditions. For only 10% of the children did they consider it needful to see the doctor or bring the child to be seen and continue with the care on his advice.
Records were kept by the mother
The records consisted of a growth chart with the weight for age chart, information on the family, immunisation, and any reason for special care set out clearly in an easily recognizable form. These were protected by a polythene envelope and carefully kept by the mothers. A study showed that these fewer records were lost than occurred in hospitals which had proper records and filing systems. These records reduced the waiting time considerably and were taken to whichever other health unit the mother attended.
A building designed to meet the needs of the mothers, the children and the staff
Patients did not like a waiting room that was far from the physician's office, but crowding near the door of the consulting room had to be avoided. A low wall separated the nurses' station and the waiting area for the mothers. They were called in groups. While waiting, the children were weighed by staff with no medical training. Low benches provide the mothers comfortable seating with their children on their laps. There was drinking water and clean toilets for both mothers and children.
Staff discussions were held every week
Discussions on important issues relating to the health of their children took place while the busy mothers waited in the line of flow. After discussion, medications were made available to the nurses for distribution to the mothers to avoid further waiting and delays at the pharmacy.
The level of satisfaction among the mothers was high. They were seen quickly, usually by local nurses and clerks whom with their regular visits, they came to know well. For the staff, there was the satisfaction of playing a major role in the care for people from their own communities. For the doctor, it was the satisfaction that a good level of preventive and curative care was offered to an average of 400 children a day. His/her time was largely taken up by the care of the more severe or unusual and often more interesting conditions.
* Professor David Morley, a world renowned professor of tropical pediatrics and child health and a member of our journal Advisory Board, kindly accepted to write an editorial for the current issue of the journal at short notice. Professor Morley is the author of 'Paediatric Priorities in the Developing World' ; a book that was once described in a British Paediatric Association meeting as 'the most important book ever written in medicine in the twentieth century'. He won the first prestigious International King Faisal prize in medicine for this book and his other great scientific contributions and dedication and service to children in developing countries. I was honored to have had my postgraduate training under him at the Institute of Child Health, University of London and was honored to co-author the Arabic version of his outstanding book.
In this editorial, Professor Morley addresses a historic topic with much relevance to today's practice. He is the innovator of the concept of under five clinics and was the founder of these clinics in West Africa more than forty years ago. They are now widespread as a concept and practiced all over the world. The under five clinics are clinics that provide comprehensive care for the well as well as ill children. Why did Professor Morley call them under fives clinics? Children under the age of five are singled out for special care because the first five years of life are crucial for brain growth, and until the age of five, the child is completely dependent on his mother.
In the editorial, Professor Morley emphasizes the concept of home based mobile health record of the child which has proved a success. He also stresses the importance of the under- five clinic design to meet the needs of all parties. In referring to weekly clinic staff discussions, he is pointing to an important managerial component often neglected in everyday practice of children clinics.
Professor Hassan Bella