Abstract
BackgroundAccurate record-keeping is important for continuity and quality of care. Completing a child’s Road-to-Health Booklet (RTHB), or the older, less detailed, Road-to-Health Card/Chart (RTHC), immediate interpretation thereof and appropriate action facilitates comprehensive care, which could contribute to a decline in child morbidity and mortality.ObjectiveThis study aimed to assess the extent to which healthcare personnel working in catchment clinics of Kalafong Provincial Tertiary Hospital (KPTH), Tshwane district, South Africa, complete HIV-related, sociodemographic, neonatal, growth and immunisation information in the RTHC and/or RTHB.MethodsA cross-sectional, quantitative record review was conducted. Data were extracted from 318 RTHCs and/or RTHBs of children attending KPTH for paediatric care. Data extraction focused on six main areas, namely documentation of HIV-related, neonatal, sociodemographic, anthropometric, immunisation and vitamin A-related information. During data analysis, age-appropriate completeness scores were generated for each area and completeness of documentation in the RTHB and RTHC was assessed.ResultsData demonstrate significantly less unrecorded HIV-related information (maternal HIV status, timing of maternal HIV testing, timing of maternal antiretroviral therapy [ART] initiation, current maternal ART use and infant feeding decisions) in RTHBs compared with RTHCs (p < 001). Despite this, 24% of all RTHBs had no record of maternal HIV status and 67% of RTHBs from documented HIV-exposed infants had no record of maternal ART duration. Neonatal information completeness was similar between RTHBs and RTHCs, but socio-demographic completeness was significantly better in RTHBs compared with RTHCs (p = 0.006). Growth (especially weight), immunisation and vitamin A completeness was > 80% and similar between RTHBs and RTHCs. Length-for-age, weight-for-length and head circumference were plotted in < 5% of RTHBs and none of the RTHCs.ConclusionAlthough completeness of key HIV-related information was better in RTHBs compared with RTHCs, RTHB completeness was suboptimal. Healthcare personnel need reminders to utilise the RTHB optimally to improve continuity and quality of child healthcare.
Highlights
Accurate record-keeping is important for continuity and quality of care.[1]
Of the 318 children included in the study, 153 (48.1%) were inpatients and 165 (52.1%) were outpatients; 56 (17.6%) were HIV-exposed; 39.3% had Road-to-Health Card/Chart (RTHC); and 60.7% had Road-to-Health Booklet (RTHB) (Figure 1)
Data demonstrated significantly less unrecorded information on mother’s latest HIV test result, timing of maternal HIV testing, timing of ART initiation, current ART use and infant feeding decision in RTHBs compared with RTHCs
Summary
Accurate record-keeping is important for continuity and quality of care.[1] Globally, patient-held maternal and/or child health records for literate and illiterate patients and healthcare personnel (including traditional birth attendants) have been used since the 1970s to track health status and document immunisation status.[2,3,4] These records, though designed to track patient health histories and facilitate continuity of care amongst healthcare personnel, empower patients to track their own health. The Road-to-Health Card/Chart (RTHC) is a useful patient-held child medical record as it summarises a child’s health in the first five years of life. Accurate record-keeping is important for continuity and quality of care. Completing a child’s Road-to-Health Booklet (RTHB), or the older, less detailed, Road-toHealth Card/Chart (RTHC), immediate interpretation thereof and appropriate action facilitates comprehensive care, which could contribute to a decline in child morbidity and mortality
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