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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 <2 y old (n = 698) were purposively sampled from three health facilities (n = 459) and four community posts (n = 77) where health workers had undergone training in GMP and three health facilities where staff had not received training (n = 162). Qualitative data on knowledge, attitudes, and practices of GMP were collected from health facility managers (n = 6), health workers (n = 35), and mothers whose children attended all follow-up visits (n = 27).
Results: Anthropometric status of children in all groups deteriorated, with children at community posts having the worst outcomes (change in weight-for-age Z-score −0.8 ± 0.7), followed by trained (−0.5 ± 0.6) and untrained (–0.3 ± 0.47; P < 0.05) 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.