9. Growth monitoring
Fagbule, D.O., Olaosebikan, A. and Parakoyi, D.B. (1990) Community awareness and utilization of growth chart in a semi-urban Nigerian community. East. Afr. Med. J. 67, 69-74. Ref ID : 8397 (Borderline for inclusion in database)
Target Group/Country Mothers resident in Adeta, Sawmill and Baboko Communities of Ilorin Local Government Area of Kwara State, Nigeria
Intervention Methodology Mothers had attended a health facility in the previous six months either for preventive or curative child health purposes. The service provided had included use of growth monitoring and there was no special programme effort over and above that of routine growth monitoring service.
Evaluation Method 518 mothers were interviewed to assess their knowledge, utilization, and understanding of the growth chart. Five health facilities in the communities studied were visited to assess the availability, utilization and understanding of growth. There were no controls.
Impact Achieved Over half (53.7%) of the mothers interviewed had heard about growth charts. The level of awareness was significantly influenced by maternal age, educational status and parity (p<0.05) Of those who have heard about growth chart, only 155 (55.8%) had it, and 150 of these (96.8%) used it regularly. One hundred and seventy four (33.6%) of all mothers, but 62.6% of those who have heard about the chart demonstrated an understanding of the markings on it. One hundred and sixteen mothers found the growth chart useful for immunization record, nutrition advice, clinic appointment dates, and assessment of developmental milestones. This study provides a useful evaluation of the educational impact of routine child health services. A limitation is that the study did not record the reasons for attendance of health facilities by mothers with children and the degree of exposure to health education. Also the study did not collect data that might help to explain whether the reasons for the non-understanding of the growth charts could be attributed to the deficiencies in the health education content of the growth monitoring process or other factors. There were no controls.
Forsyth, S.J. (1984) Nutrition education: lack of success in teaching Papua New Guinea mothers to distinguish "good" from "not good" weight development charts. Food and Nutrition Bulletin 6, 22-26. Ref ID : 6665
Target Group/Country Mothers attending child health clinics in Papua New Guinea
Intervention Methodology Some of these mothers received individual training to identify examples of weight charts.
Evaluation Method A survey of 142 women, attending maternal and child health clinics A follow-up was done 4 months later to measure the effects of nutrition Autumn Rugby Hospitality education in mothers' accuracy in identifying test charts and the children's nutritional development.
Impact Achieved Results indicate that weight charts achieve little in the way of motivating urban Papua New Guinea mothers to provide nourishment for their children. Despite the wide popularity of weight charts in nutrition education, their role in involving mothers in assisting child development was not demonstrated
George, S.M., Latham, M.C., Abel, R., Ethirajan, N., and Frongillo, E.A.,Jr. Evaluation of effectiveness of good growth monitoring in south Indian villages . Lancet 342(8867):348-352, 1993. Ref ID : 207
Target Group/Country Mothers of under fives in rural Tamil Nadu, India.
Intervention Methodology A functioning primary health care system was in place in all 12 villages implemented a set of interventions including health and nutritional education. The interventions were identical in the two sets of villages except for the use of growth charts in education in the 6 Growth Monitoring Programme (GMP) villages The nutrition worker in the non-Growth Monitoring Programme (NGM) villages had the same contact time as in the GMP villages but advised mothers without the benefit of growth charts
Evaluation Method A community intervention trial in 12 villages. The villages were divided into 6 "growth-monitoring package" of intervention villages (GMP) and 6 "non-growth-monitoring package" of intervention villages (NGM). About 550 children under the age of 60 months were studied over 4 years in GMP villages and a similar number of children in NGM villages. The research team, independently of the nutrition worker, did anthropometric studies on children in all villages every 4 to 5 months. Comparisons were done by calculating monthly gains in stature, and weight, and the significance of differences observed was adjusted for age and sex.
Impact Achieved After 30 months of interventions, similar improvements in growth were seen in GMP and NGM children. The interventions seemed to have improved the nutritional status of young children in both groups of villages. In view of the lack of additional benefit from growth monitoring over other educational interventions, the authors question its use as part of child survival programmes in India.
Martinez,H., Chavez,M.M., Guarneros,A.R.,
Rios,A. and Chavez,A. (1996) Mothers' knowledge, understanding, and use of
the bubble chart in a rural area of central Mexico. Food and Nutrition Bulletin
17, 241-247.Ref ID: 6653
Target Group/Country Mothers living in a rural area of central Mexico
Intervention Methodology The bubble chart is a growth chart that has a vertical layout rather than the more common horizontal one, and bubbles instead of criss-crossing lines. All mothers of children<2yrs were visited and invited to participate. Mothers who accepted were visited by field auxiliaries at home once a month when the child was weighed, the weight plotted and the mother was instructed on how to interpret the chart. When growth faltered the mothers were instructed on appropriate actions.
Evaluation Method Of 100 eligible mothers, 85 agreed to participate. The evaluation was done with a pre-intervention-post intervention design - the first test took place after the field auxiliaries had been visiting the mothers for four months. The second took place 12 months after the monthly visits had begun. At each evaluation a field psychologist carried out a home interview with the mother using a questionnaire containing 14 questions based on Bloom's taxonomy of the learning process, which defines a sequence that goes from knowledge to understanding (comprising translation, interpretation and extrapolation) and finally to application. There were no controls.
Impact Achieved All areas evaluated showed an increase between pre-intervention and post-intervention, with a statistically significant (p<0.5) increase in knowledge, interpretation, and application; the mothers ranked highest in knowledge. The children's nutritional status increased significantly (p<.0001) between pre-intervention and post-intervention. Except for one child, they had at least one period of weight loss during the study period. However, 81% of them gained weight most of the time (i.e. at least two-thirds of weight records showed neither gain nor loss), and 12% lost weight most of the time (at least two-thirds of records showed weight loss). Mothers of children who mostly gained weight had higher knowledge, understanding, and application scores (p<.01). Similarly, these mothers were most likely to perform all the activities promoted as part of the growth programme (p<001). Whilst demonstrating an impact, this study is limited by lack of controls and the intensive nature of the intervention which raises issues of sustainability. Whilst not having a control, the demonstration of the effect of improved knowledge on nutritional status does at least provide some supporting evidence for the impact of the programme.
Ruel, M.T., Habicht, J.P., and Olson, C. Impact of a clinic-based growth monitoring programme on maternal nutrition knowledge in Lesotho. International Journal of Epidemiology 21(1):59-65, 1992. Ref ID : 2516 (Borderline for inclusion in database)
Target Group/Country Mothers with children < 2 years attending health clinics in Lesotho
Intervention Methodology At the clinics, the mothers did not undergo individual counseling or receive training in growth charts. Group nutrition education efforts did take place however, but separately from the growth monitoring program. Details of this nutrition education are not provided but according to the authors it was "of variable duration and quality depending on the skills, interest and enthusiasm of the clinic nurse in charge".
Evaluation Method Data from 907 mothers of <2-year-old children in 8 clinics were analyzed to determine if attendance at a typical nationwide clinic-based growth monitoring program improved maternal knowledge of weaning practices and diarrhhoea management. All mothers with a child younger than 2 years and who had attended the clinic for less than 2 years were included in the study. There were no controls and no baseline.
Impact Achieved Mothers who attended a clinic had a significantly higher increased knowledge of the appropriate timing for introducing animal protein rich foods and about the use of oral rehydration salts than those who did not attend (p<.05). This association was especially significant for mothers with only primary education and those with infants <6 months old. The mothers reported breast feeding a mean of 2 years. 85% knew to introduce cereals and liquids between 4-6 months old. Yet few mothers knew how to appropriately stop breast feeding. For example, 50% believed it should stop in 1 day. A problem with this report is that clinic attendance is not defined and data is not presented of the distribution of clinic attendance among the sample, especially since the sample members were recruited from the clinic itself.
Sohal, H., Wilkinson, D., and Morley, D. The 'growth monitoring teaching aid' rapidly improves mothers' understanding of growth curves. Trop.Doct. 28(3):160-162, 1998. Ref ID : 7898
Target Group/Country Mothers attending various clinics at hospital in rural Hlabisa District, Kwa Zulu
Intervention Methodology The 'Growth Monitoring Teaching Aid' (GMTA) is an educational game which attempts to expedite the process of understanding growth curves by simulating the growth curve of a child using water added to a bucket suspended below the direct recording scales
Evaluation Method Thirty mothers were divided into an experimental group who used the GMTA for 2-4 h and a control group who did not use it. Six questions were used to test each subject's understanding of growth curves.
Impact Achieved Paired t tests revealed that the experimental group significantly increased their understanding of growth, whereas the control group did not. The mean score for the experimental group prior to playing the game was 1.43; this increased to 5.27 after playing the game (P < 0.0001). The GMTA by rapidly improving the present poor level of understanding of growth curves, may allow greater maternal participation in growth monitoring. Note that this is an evaluation of a methodology under ideal conditions and that a field test might produce different results according to the skill and motivation of health workers using it as an educational tool.
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