Barriers and facilitators to head circumference and neurodevelopmental surveillance in wellchild clinics in Jamaica
Neurodevelopmental risks from Zika virus infection during pregnancy are becoming increasingly understood, and comprehensive physical exams, including growth parameters, and developmental monitoring and assessment at each well-child visit for all infants with possible congenital Zika virus exposure during pregnancy are recommended by the U.S. Centers for Disease Control and Prevention. Barriers to neurodevelopmental assessments have been identified in a number of settings in the United States and other high-income countries, but in the context of Zika infection risk, it is imperative to identify the locally-relevant barriers to implementing neurodevelopmental surveillance. In early 2018, the USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project has partnered with the Ministry of Health and Wellness (MOHW) in Jamaica to identify and address needs for strengthening Zika-related care and support services for infants and young children affected by Zika and their families. ASSIST activities include support to neurodevelopmental surveillance of infants and young children in well-child clinics and, as needed, their referrals to care and support services in accordance with MOHW guidelines.
The purpose of this study was to identify facility-level barriers and facilitators to the assessment and interpretation of head circumference measurements and neurodevelopmental surveillance in Jamaican well-child clinics to inform MOHW-led and partner-supported strategies for strengthening services in the context of Zika in Jamaica. A qualitative exploratory design was applied to explore these issues. Two qualitative methods were used: (1) in-depth interviews with health workers, facility leaders/managers, and parents/caregivers attending well-child visits; and (2) direct observations of service delivery (well-child visits) processes. Observations and interviews were conducted in eight primary health care centers with well-child clinics in which ASSIST was working. Interviews were conducted with the head of each primary health care center, the head of the well-child clinic, health care providers who regularly staff the well-child clinics, and parents/caregivers attending the well-child clinic. Data collection occurred in March- April 2019.