Charlton Karen E, Kawana Beatrice M, Hendricks Michael K
School of Health Sciences, Faculty of Health and Behavioural Sciences, University of Wollongong, Wollongong, New South Wales, Australia.
Nutrition. 2009 Oct;25(10):1035-46. doi: 10.1016/j.nut.2009.03.008. Epub 2009 Aug 5.
We evaluated the effectiveness of the growth monitoring and promotion (GMP) program in Zambia.
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).
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.
The GMP program in Lusaka is functioning suboptimally, even in facilities with trained staff.
我们评估了赞比亚生长监测与促进（GMP）项目的有效性。
在卢萨卡区随机选择的卫生设施和社区站点进行了一项为期3个月的生长结局前瞻性研究。从3个卫生设施（n = 459）和4个社区站点（n = 77）中有意抽取了<2岁的儿童（n = 698），这些卫生设施和社区站点的卫生工作者接受了GMP培训，另外还从3个未接受培训的卫生设施中抽取了儿童（n = 162）。从卫生设施管理人员（n = 6）、卫生工作者（n = 35）以及其孩子参加了所有随访的母亲（n = 27）那里收集了关于GMP知识、态度和实践的定性数据。
所有组儿童的人体测量状况均恶化，社区站点的儿童结局最差（年龄别体重Z评分变化为-0.8±0.7），其次是接受培训的卫生设施（-0.5±0.6）和未接受培训的卫生设施（-0.3±0.47；P<0.05）。身长别体重也呈现类似趋势。总体失访率为74.1%。与留在研究中的儿童相比，在接受培训的卫生设施和社区站点未完成研究的儿童在1个月和2个月随访时的年龄别体重Z评分更高。母亲/照顾者认为GMP对于参加五岁以下儿童诊所很重要，将孩子的体重与整体健康状况联系起来，并表示愿意遵守卫生工作者的建议。然而，医疗保健提供者积极性不高，监督不足，且实践不佳。
卢萨卡的GMP项目运作未达最佳状态，即使在有经过培训的工作人员的设施中也是如此。
