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.