Facilitators and barriers of community health workers screening for early childhood malnutrition in a socially disadvantaged community
1
Department of Global Health, Stellenbosch university, Cape Town, South Africa
Popul. Med. 2026;8(Supplement Supplement 1):A3255
ABSTRACT
INTRODUCTION:
Childhood malnutrition, including undernutrition and overnutrition, remains a major public health concern in south africa, particularly among children under five years.¹ Community health workers (CHWs) play a central role in early detection and referral through community-based screening,² yet their effectiveness is often limited by systemic challenges.³˒⁴ Identifying the facilitators and barriers influencing CHWs’ screening practices is essential to improving child nutrition outcomes in socioeconomically disadvantaged communities.
METHODS:
A descriptive cross-sectional study with an analytical component was conducted among 56 CHWs employed by the caring network in bishop lavis. Data were collected using a structured self-administered electronic questionnaire assessing sociodemographic characteristics, knowledge of malnutrition, screening practices, and perceived barriers and facilitators. Descriptive statistics were applied, and a one-sample t-test was used to compare CHWs’ knowledge scores with integrated community case management (iCCM) standards.⁵
RESULTS:
CHWs demonstrated average knowledge of malnutrition screening (mean score 7 ± 1.66), with no significant difference from the iCCM benchmark. Most reported monthly screenings, primarily among children under two, with limited screening of those aged four to five years. Mid-upper arm circumference was the most commonly used tool, while height and weight measurements were less frequent due to equipment shortages. Fewer than half provided caregiver counselling, and screening and referral practices were inconsistent. Key barriers included inadequate training, limited anthropometric tools, unreliable transport, and caregiver-related challenges, while facilitators included refresher training, clear referral pathways, and supportive supervision.
CONCLUSIONS:
CHWs are well positioned to support early detection of childhood malnutrition,⁶ but their impact is limited by gaps in training, equipment, and referral systems. Addressing these systemic challenges could enhance CHW effectiveness, and expanding screening beyond children under two and addressing both undernutrition and overnutrition are essential to tackling the dual burden of malnutrition.¹˒⁷
Childhood malnutrition, including undernutrition and overnutrition, remains a major public health concern in south africa, particularly among children under five years.¹ Community health workers (CHWs) play a central role in early detection and referral through community-based screening,² yet their effectiveness is often limited by systemic challenges.³˒⁴ Identifying the facilitators and barriers influencing CHWs’ screening practices is essential to improving child nutrition outcomes in socioeconomically disadvantaged communities.
METHODS:
A descriptive cross-sectional study with an analytical component was conducted among 56 CHWs employed by the caring network in bishop lavis. Data were collected using a structured self-administered electronic questionnaire assessing sociodemographic characteristics, knowledge of malnutrition, screening practices, and perceived barriers and facilitators. Descriptive statistics were applied, and a one-sample t-test was used to compare CHWs’ knowledge scores with integrated community case management (iCCM) standards.⁵
RESULTS:
CHWs demonstrated average knowledge of malnutrition screening (mean score 7 ± 1.66), with no significant difference from the iCCM benchmark. Most reported monthly screenings, primarily among children under two, with limited screening of those aged four to five years. Mid-upper arm circumference was the most commonly used tool, while height and weight measurements were less frequent due to equipment shortages. Fewer than half provided caregiver counselling, and screening and referral practices were inconsistent. Key barriers included inadequate training, limited anthropometric tools, unreliable transport, and caregiver-related challenges, while facilitators included refresher training, clear referral pathways, and supportive supervision.
CONCLUSIONS:
CHWs are well positioned to support early detection of childhood malnutrition,⁶ but their impact is limited by gaps in training, equipment, and referral systems. Addressing these systemic challenges could enhance CHW effectiveness, and expanding screening beyond children under two and addressing both undernutrition and overnutrition are essential to tackling the dual burden of malnutrition.¹˒⁷
| eISSN: | 2654-1459 |
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