Samenvatting

The aim of this rapport is to assure that the best care possible is provided for the children at the NRH, a home that treats children with malnourishment in Kathmandu, Nepal. In order to do so, the NRH asked me to evaluate the working methods preformed by the nursing staff and to what extent they deviate from the WHO child growth standards. In addition, a review of relevant literature has been done to investigate what the implications of these standards are since their introduction in 2006. The main method of the conducted research was through observation. The weighing times in the mornings were observed. The 4 regular nurses were observed on 8 occasions, leading to a total of 73 observation periods. The behavioural variables observed were decided beforehand based on the WHO child growth standards and were adjusted accordingly after a pilot observation. Besides the observations, an interview with the program manager, a discussion session with the nursing staff and a review of relevant literature were conducted. Based on the results of the observations, several discrepancies were found in the working methods. A maximum margin of error was set to 5% by the program manager. This was not always met. The main cause of discrepancies was the use of the hanging (saltar) scale. Some discrepancies were caused by human faults. Discrepancies can have enormous consequences for both people's health as for an entire society. Children might get sent home while still suffering from malnourishment. Not only can malnourishment cause reduced growth but it can also cause negative implications for cognitive and mental development. It increases the risk of infectious disease and can lead to death. The literature review shows some contrasting results. Some research prove that the WHO child growth standards have a positive effect on identifying malnourishment in children below the age of 6 months, resulting in more children receiving treatment. However, the prevalence in children above 6 months is lower. This results in children being deprived from necessary treatment. The results on costs are also contrasting. Some studies argues that as more children at a younger age are being detected with malnourishment, quicker and shorter treatment can be given leading to less costs involved. Other studies show the opposite result saying that more malnourished children lead to higher medical and operational costs. The conclusion drawn is that the working methods need to be improved. This will be done through the implantation of simple, easy to use work instructions. They explain step-by-step how to weigh a child with a minimum chance of error. Furthermore, is it recommended to have a meeting once a month, and once every 6 months execute a recapitulation of the WHO child growth standards. This is aimed at developing and maintaining better future work instructions for other tasks within the NRH. As well, the conclusion drawn is that since the introduction of the WHO child growth standards, more children are being admitted for treatment at the NRH. This leads to more costs involved.