Notes from the field: a day at the assessment centre

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Globally, 149.2 million under-five children suffer from stunting (UNICEF-WHO-World Bank Group Joint Malnutrition). Stunting affects a child’s capacity to think clearly, do well in school and work well as an adult. To tackle this problem, as researchers, we must understand the factors leading to the vicious cycle of stunting and malnourishment. And to my pleasure, I have the chance to work with Action Against Stunting Hub (AASH). AASH is a research consortium funded by the UKRI GCRF that works towards rethinking strategies for stunting prevention. AASH operates in 3 countries, namely, Indonesia, Senegal and India, under the leadership of local research organisations and institutes.

How does the day begin?

 As a PhD student, I work at the National Institute of Nutrition (NIN), Hyderabad, one of the two Indian partners of AASH. NIN is a pioneer institute working on food, health, nutrition, malnourishment, and lifestyle-related disorders such as obesity, diabetes and hypertension. 

My day usually starts at 10 a.m., as I reach NIN’s field office, energised to work with my colleagues. Srinivas, our phlebotomist, briefs me about the status of the participants soon to arrive at the assessment centre with their babies. Most of the participants belong to two urban slums, namely Addagutta and Warasiguda of Hyderabad city, coming from humble middle-class and lower-middle-class backgrounds and mostly staying in rented houses.

Why call participants at the assessment centre?

Soon the mothers and their babies arrive at our office in rickshaws hired by the hub. Bringing the mother and infant to the field office allows the four different assessments, like anthropometry, blood sampling, diet, psychological well-being and child development, to happen well-coordinatedly. It also helps the four teams, as travelling with the tools and instruments to the participant’s homes can be daunting. Finally, and most importantly, when the mother comes to the office, she feels confident to talk about her physical and psychological well-being in a neutral environment.

Once the participants arrive at our office, I explain to the mothers why we are conducting the tests, what kind of tests we are conducting, what we will be doing, and the baby will be safe during the tests. Upon hearing answers to all their queries, the mothers feel relieved and confident in allowing the team to handle their babies.

Four stages of assessment

The first activity involves the anthropometric measurement of mother and child. Malnourishment manifested as stunting leads to less height for the age of the affected child, so measuring the length and weight of infants is one of the primary tasks.

Next, the psychology team, handled by me, assess the child’s neurodevelopment. As a research fellow, I collect information related to stress and depression from the mothers. In addition to that, for my PhD, I am conducting a neurodevelopmental test called DASII (Developmental Assessment for Indian Infants).

DASII: First cognitive and neurodevelopmental test for infants

DASII is the first cognitive and neurodevelopmental test done for infants in the 6th month of their life. It reveals a lot of information regarding the current developmental milestones, such as neck control, turning side to back, sitting with and without support, crawling etc.

Also, until the 6th month, it is recommended to breastfeed the baby exclusively. So, one of my study objectives involves understanding the determinants of prevention of breastfeeding and the comparison between exclusively breastfed and non-exclusively breastfed infant. It can help understand if and how maternal nutrition, iron status, stress, and depression affect the baby’s cognitive skills.

When the parents see their child responding and passing all these tests, they feel a sense of joy and accomplishment that their child is intelligent and sharp. Also, the parents trust us more, knowing that their baby is in safe hands and that all the tests and assessments are for the good of their baby. 

I start by lighting a toy torch to check the visual reflexes of the baby, then click a small switch near their ears, similarly with a bell and rattle. It helps verify the baby’s hearing skills. I then test their fine motor skills using small cubes and toy cups. Following this, the gross motor skills are put to the test by making them sit without support, letting them turn sides, or letting them crawl.

Seeing their child respond and do various tasks on the tests brings the parents a sense of joy and accomplishment. This way, the parents trust us more, knowing that their baby is in safe hands and that all the tests and assessments are for the benefit of their baby. 

Caring about the mother’s mental health

Later, I finish my review by asking the mother about her current state of mental health. Before asking the questions, I tell her they relate to their mental state during the last month. There are a few questions that the mother might feel embarrassed or uncomfortable to answer. Here I make them more comfortable by asking some follow-up questions, easing them into a conversation style of query. These kinds of follow-up questions and detailed explained questions help the mother in sharing their experiences. 

Pediatric and diet assessment

The next station in their visit is the paediatric desk, handled by Dr Monica. She checks the baby and the mother, enquiring about their health concerns. To proceed with the sensitive task of blood collection, she reassures the parents explaining the crucial importance of monitoring the child’s health as they transition from breastfeeding to complementary food at 6th month. Parents then understand the relevance of keeping track of information such as iron levels, haemoglobin levels, blood group, etc., and to see whether the baby has any infections. The report is later sent to the parents in soft copy through Whatsapp messages.

The last station in the assessment is the diet room, where our enumerator, Mrs Vijaya Pushpalatha, inquires in detail about every aspect of the food consumed by the baby. She uses a kitchen balance to note the exact amount of food the baby consumes. She also inquires about the family history of the baby’s parents to know details such as the height of members, past hardships faced by the family, and any emergency hospitalisation for any reason. These questions about the parent’s past are asked to know if any past event like this affects the baby genetically.

Caring for the participants

Once all the assessments are finished, our phlebotomist, Mr Srinivas, gives a small monetary token as compensation to the mother for her cooperation and assistance. The mothers are also given essential medicines Dr Monica prescribes if the baby needs them.

All the staff at the field office are very helpful to the mothers and children. They make their brief stay at the office as comfortable as possible. We provide them refreshments to the mother and any accompanying elder child. Sometimes, when any older toddler accompanies the mother, our staff ensures the elder child is entertained. It helps us continue the assessments uninterrupted. Our team also ensures the safety of the mother and infant during pickups and drops by accompanying them during the journey in the rickshaws.

In this way, the assessments are conducted in a pleasant, caring, and hospitable manner to ensure that the participants remain satisfied and happy with the practice of conducting assessments. This ensures that the participants will cooperate with us until the end of the study.

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1 Comment

  1. Soosamma Thomas on 13th June 2023 at 3:59 pm

    Good explanation keep forward

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