Health  Vol.5 No.12 , December 2013
Mothers’ and health workers’ perceptions of participation in a child-friendly health initiative in rural South Africa

Background: Primary health care clinics promote health in addition to treating illness, but are often perceived as unfriendly and frightening places for children. This research aimed to improve child-friendliness in primary health care settings in a rural, high HIV prevalence area in South Africa. Methods: As part of a larger intervention (“Amagugu” Intervention) health staff in nine primary health care clinics were trained in a child-friendliness approach. 281 enrolled mothers were invited to attend clinic with their primary school-aged children and assessed childfriendliness via structured questionnaires administered by independent assessors; a sub-group also participated in in-depth interviews. Post intervention, focus groups were conducted with 87 primary health staff to determine their experiences of providing child-friendly services. Results: Mothers rated 65% of clerks and 70% of nurses as “very friendly”. Qualitative data showed that heavy clinical loads, limited human resources and inadequate infrastructure were perceived as barriers to child-friendliness, while good clinic leadership and appropriate resources facilitated child-friendliness. Post intervention most health workers reported that child-friendly health promotion activities were rewarding. Conclusions: Providing child-friendliness training and support to primary health care facilities in low-resource settings is feasible, acceptable and yielded encouraging results.


Cite this paper: Mkwanazi, N. , Rochat, T. , Coetzee, B. and Bland, R. (2013) Mothers’ and health workers’ perceptions of participation in a child-friendly health initiative in rural South Africa. Health, 5, 2137-2145. doi: 10.4236/health.2013.512291.

[1]   Barnighausen, T., et al. (2012) HIV status and participation in HIV surveillance in the era of antiretroviral treatment: A study of linked population-based and clinical data in rural South Africa. Tropical Medicine & International Health, 17, e103-e110.

[2]   Edwards, L.V., et al. (2012) Am I my mother’s keeper? Children as unexpected sources of social support among African American women living with HIV-AIDS. Journal of Black Studies, 43, 571-595.

[3]   Mkwanazi, N.B., et al. (2012) Disclosure of maternal HIV status to children: Considerations for research and practice in sub-Saharan Africa. Future Virology, 7, 1159-1182.

[4]   Madiba, S. and Matlala, C. (2012) Disclosure of parental HIV positive status: What, why, when, and how parents tell their children in the era of HAART in South Africa. World Journal of AIDS, 2, 194-202.

[5]   Visser, M., et al. (2012) Development and piloting of a mother and child intervention to promote resilience in young children of HIV-infected mothers in South Africa. Evaluation and Program Planning, 35, 491-500.

[6]   Clarke, A. and Nicholson, M.S. (2007) The child friendly healthcare initiative—An update. Paediatric Nursing, 19, 36-37.

[7]   Emeghebo, L. (2012) The image of nursing as perceived by nurses. Nurse Education Today, 32, e49-e53.

[8]   Nabirye, R.C., et al. (2011) Occupational stress, job satisfaction and job performance among hospital nurses in Kampala, Uganda. Journal of Nursing Management, 19, 760-768.

[9]   Jewkes, R., Abrahams, N. and Mvo, Z. (1998) Why do nurses abuse patients? Reflections from South African obstetric services. Social Science & Medicine, 47, 1781-1795.

[10]   Bishop, K.G. (2008) From their perspectives: Children and young people’s experience of a paediatric hospital environment and its relationship to their feeling of wellbeing.

[11]   Kennedy, I. (2010) Getting it right for children and young people: Overcoming cultural barriers in the NHS so as to meet their needs.

[12]   Govender, L., et al. (2006) Pediatric nursing in the context of the HIV/AIDS epidemic in resource-poor settings-balancing the “Art and the Science”. Holistic Nursing Practice, 20, 247-254.

[13]   Janssen, N., et al. (2010) Successful paediatric HIV treatment in rural primary care in Africa. Archives of Disease in Childhood, 95, 414-421.

[14]   Rujumba, J., Mbasaalaki-Mwaka, C.L. and Ndeezi, G. (2010) Challenges faced by health workers in providing counselling services to HIV-positive children in Uganda: A descriptive study. Journal of the International AIDS Society, 13, 9.

[15]   Whiting, L.S. (2001) Health promotion: The views of children’s nurses. Paediatric Nursing, 13, 27-31.

[16]   Rochat, T.J. and Mitchell, C. (2011) Young children and HIV in Sub-Saharan Africa: Implications for practice and intervention, in international perspective on children and mental health.

[17]   Richter, L.M., et al. (2012) Evaluation of a brief intervention to improve the nursing care of young children in a high HIV and AIDS setting. Nursing Research and Practice, 2012, 15.

[18]   McNally, L.M., et al. (2006) HIV-exposed but uninfected children: Why are they vulnerable? Vulnerable Children and Youth Studies, 1, 139-148.

[19]   Darbyshire, P. (2013) A review of palliative care and support services in south tyrol for children and young people living with a life-threatening or life-limiting illness and their families.

[20]   Gibson, F., et al. (2010) Children and young people’s experiences of cancer care: A qualitative research study using participatory methods. International Journal of Nursing Studies, 47, 1397-1407.

[21]   Kikuta, A., et al. (2011) Practices and perceptions regarding pain and pain management during routine childhood immunizations: Findings from a focus-group study with nurses working at Toronto Public Health, Ontario. Canadian Journal of Infectious Diseases & Medical Microbiology, 22, 43-48.

[22]   Norton-Westwood, D. (2012) The health-care environment through the eyes of a child—Does it soothe or provoke anxiety? International Journal of Nursing Practice, 18, 7-11.

[23]   Cox, E.D., Smith, M.A. and Brown, R.L. (2007) Evaluating deliberation in pediatric primary care. Pediatrics, 120, e68-e77.

[24]   Coyne, I. (2006) Consultation with children in hospital: Children, parents’ and nurses’ perspectives. Journal of Clinical Nursing, 15, 61-71.

[25]   Rochat, T., Mkwanazi, N. and Bland, R. (2013) Maternal HIV disclosure to HIV-uninfected children in rural South Africa: A pilot study of a family-based intervention. BMC Public Health, 13, 147.

[26]   Tanser, F., et al. (2013) High coverage of ART associated with decline in risk of HIV acquisition in rural KwaZulu-Natal, South Africa. Science, 339, 966-971.

[27]   Hontelez, J., et al. (2012) The impact of antiretroviral treatment on the age composition of the HIV epidemic in sub-Saharan Africa. AIDS, 26, S19-S30.

[28]   Houlihan, C.F., et al. (2010) Cohort profile: Hlabisa HIV treatment and care programme. International Journal of Epidemiology, 40, 318-328.

[29]   Leech, N.L. and Onwuegbuzie, A.J. (2009) A typology of mixed methods research designs. Quality & Quantity, 43, 265-275.

[30]   Onwuegbuzie, A.J., et al. (2009) Toward more rigor in focus group research: A new framework for collecting and analyzing focus group data. International Journal of Qualitative Methods, 8, 1-21.

[31]   Coyne, I. and Kirwan, L. (2012) Ascertaining children’s wishes and feelings about hospital life. Journal of Child Health Care, 16, 293-304.

[32]   Gaskell, S., et al. (2005) Taking the sting out of needles: Education for staff in primary care. Paediatric Nursing, 17, 24-28.

[33]   Moore, L. and Kirk, S. (2010) A literature review of children’s and young people’s participation in decisions relating to health care. Journal of Clinical Nursing, 19, 2215-2225.

[34]   Friese, S., (2012) Qualitative data analysis with ATLAS. SAGE Publications Limited.

[35]   Muhr, T. and Friese, S. (2004) User’s manual for ATLAS. Scientific Software Development, Berlin.

[36]   Rowe, A.K., et al. (2005) How can we achieve and maintain high-quality performance of health workers in lowresource settings? The Lancet, 366, 1026-1035.

[37]   Scott, T., et al. (2003) Implementing culture change in health care: Theory and practice. International Journal for Quality in Health Care, 15, 111-118.

[38]   Reed, P., et al. (2003) Promoting the dignity of the child in hospital. Nursing Ethics, 10, 67-76.

[39]   Roohafza, H., et al. (2009) Impact of nurses clothing on anxiety of hospitalised children. Journal of Clinical Nursing, 18, 1953-1959.

[40]   Salmela, M., Aronen, E. and Salantera, S. (2011) The experience of hospital-related fears of 4-to 6-year-old children. Child: Care, Health and Development, 37, 719-726.

[41]   Richter, L., Chandan, U. and Rochat, T. (2009) Improving hospital care for young children in the context of HIV/ AIDS and poverty. Journal of Child Health Care, 13, 198-211.

[42]   Richter, L.M., et al. (2012) Evaluation of a brief intervention to improve the nursing care of young children in a high HIV and AIDS setting. Nursing Research and Practice, 2012, Article ID: 647182.

[43]   Parker, G., et al. (2011) Evaluating models of care closer to home for children and young people who are ill.