An assessment of the effectiveness of growth monitoring and promotion practices in the Lusaka district of Zambia
Objective: We evaluated the effectiveness of the growth monitoring and promotion (GMP) program in Zambia.
Methods: A 3-mo prospective study of growth outcomes was undertaken at randomly selected health facilities and community posts within the Lusaka district. Children(n equals 698) were purposively sampled from three health facilities (n equals 459) and four community posts (n equals 77) where health workers had undergone training inGMP and three health facilities where staff had not received training (n equals 162). Qualitative data on knowledge, attitudes, and practices of GMP were collected from health facility managers (n equals 6), health workers (n equals 35), and mothers whose children attended all follow-up visits (n equals 27).
Results: Anthropometric status of children in all groups deteriorated, with children at community posts having the worst outcomes, followed by trained and untrained health facilities. A similar trend was seen for weight for length. The overall dropout rate was 74.1%. Weight-for-age Z-scores were higher at 1- and 2-mo follow-up visits for children who did not complete the study at trained health facilities and community posts compared with those who remained in the study. Mothers/caregivers identified GMP as important in attending the under-five clinic, associated their child's weight with overall health status, and expressed a willingness to comply with health workers' advice. However, health care providers were poorly motivated, inadequately supervised, and demonstrated poor practices.
Conclusions: The GMP program in Lusaka is functioning suboptimally, even in facilities with trained staff.