A quality improvement initiative to improve growth monitoring of children attending immunization clinic in an urban primary health centre in Delhi.

Abstract

Background: Immunization clinics present an opportunity for passive screening for malnutrition among young children through plotting of growth charts. Passive screening for malnutrition can enable timely interventions and improve morbidity and mortality of under-five children. Therefore, we aimed to increase the plotting of growth charts (weight-for-age) to 90%, among under-five children attending immunization clinics in an Urban Health Centre (UHC) in south Delhi over three months.

Methodology: A Quality Improvement (QI) initiative was undertaken in the immunization clinic of an urban primary health centre in southern Delhi, from January to March 2024. A multi-faceted QI team was formed. The baseline coverage of weight-for-age growth chart plotting in the immunization clinic was 31%. The process flow was mapped, and critical gaps identified by root cause analysis (Fish Bone technique). Change ideas were discussed and prioritized using a prioritization matrix to implement these through sequential PDSA cycles. The main change ideas implemented were training of health workers, allotting regular supervisors for the session, and appending a stamp for quick identification of underweight children. Run chart was used to assess the changes over time. We considered the outcome achieved if the plotting coverage was more than 90% sustained for at least six consecutive immunization sessions.

Results: Multiple change ideas were implemented over a period of three months. The coverage of growth chart plotting increased to more than 90%. Lack of motivation among stakeholders was a challenge for some change ideas. Monitoring of immunization sessions for plotting of growth chart was continued post the implementation of all change ideas to assess sustainability which showed positive results. Post-implementation of the change ideas, a meeting was held with the members of the QI team to get feedback on this activity.

Conclusion: There is potential for improving growth monitoring at immunization clinics, which can be beneficial in strengthening passive screening for malnutrition in primary care settings.

Clinical trial number: Not applicable.