Hossain Muttaquina, Haque Md Ahshanul, Faruque Abu Syed Golam, Ahmed Tahmeed, Ashorn Ulla, Ashorn Per
Nutrition Research Division, icddr, b, Dhaka, Bangladesh.
Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
PLoS One. 2025 Jun 5;20(6):e0324918. doi: 10.1371/journal.pone.0324918. eCollection 2025.
In Bangladesh, utilization of government health facility-based growth monitoring and promotion (GMP) services is notably low, prompting non-governmental organizations (NGOs) to collaborate with the government to enhance GMP service utilization through home-based delivery. Despite this, there is limited information available on home-based GMP service utilization. This study aimed to investigate the utilization of GMP services between home-based and facility-based programs and identifying key factors and barriers to caregiver engagement with GMP services in rural Bangladesh.
A descriptive mixed-method study was conducted across six sub-districts from August to December 2019. Three sub-districts with home-based GMP services provided by NGOs were compared with three neighboring sub-districts offering government facility-based GMP services. A total of 3038 randomly selected mothers and children under one year old were included in the quantitative part of the study. Quantitative surveys include information on household socio-demographic information, GMP service components, knowledge, utilization, barriers, and qualitative approaches were used for data collection on caregivers and service providers perspectives on GMP services. Descriptive statistics were conducted for sociodemographic characteristics, caregivers' knowledge, perception and barriers to utilization of GMP services. Student's t-tests and chi-square tests were used to compare quantitative and qualitative variables between both GMP arms. Risk ratios (RR) with 95% confidence intervals were calculated to compare GMP knowledge. Simple logistic regression identified GMP service use levels and related barriers. Multiple logistic regression was employed to determine statistically significant associations between GMP utilization and independent variables such as caregivers who heard about GMP or GMP cards, were members of an NGO, and lacked interest in GMP services at p-value <0.05 and adjusted risk ratio (ARR) values. Thematic analysis of qualitative data was performed. Results were triangulated across sources.
Children's average age was 9.8 months, with a 1:1 male-to-female ratio in both groups (home-based vs. facility-based: 51.9% vs. 50.0%). Home-based GMP services exhibited higher utilization rates, with more children receiving weight and length measurements and caregivers receiving counseling than facility-based services (40% vs. 0% utilization, respectively). Caregivers' utilization of GMP services in home-based areas was positively influenced by their knowledge of GMP or GMP cards (Adjusted risk ratio, ARR: 37.4) and their involvement with an NGO, association, or health program (ARR: 1.3). Caregivers in home-based GMP areas relied on NGO staff for service delivery, while those in facility-based areas reported no outreach from government health workers and lacked access to GMP cards due to supply issues. Across both areas, low awareness of GMP services and the absence of incentives contributed to limited utilization.
GMP service utilization remains low in rural Mymensingh district of Bangladesh. Home-based GMP service utilization was 40% but none of the caregivers utilized facility-based GMP services. Higher utilization in home-based areas was linked to caregiver awareness, access to GMP cards, and NGO involvement, while key barriers included lack of government outreach, supply gaps, and absence of incentives. To improve GMP coverage, government programs should enhance community level outreach, ensure consistent supply of growth cards, and consider integrating small incentives to motivate caregivers.
在孟加拉国，基于政府卫生设施的生长监测与促进（GMP）服务利用率极低，这促使非政府组织（NGO）与政府合作，通过居家服务来提高GMP服务利用率。尽管如此，关于居家GMP服务利用率的可用信息有限。本研究旨在调查居家和基于设施的项目中GMP服务的利用率，并确定孟加拉国农村地区照顾者参与GMP服务的关键因素和障碍。
2019年8月至12月在六个分区开展了一项描述性混合方法研究。将由非政府组织提供居家GMP服务的三个分区与提供政府设施型GMP服务的三个相邻分区进行比较。研究的定量部分共纳入了3038名随机选取的一岁以下母亲和儿童。定量调查包括家庭社会人口信息、GMP服务内容、知识、利用率、障碍等信息，定性方法用于收集照顾者和服务提供者对GMP服务的看法的数据。对社会人口特征、照顾者对GMP服务的知识、认知和利用障碍进行描述性统计。采用学生t检验和卡方检验比较两个GMP组之间的定量和定性变量。计算95%置信区间的风险比（RR）以比较GMP知识。简单逻辑回归确定GMP服务使用水平和相关障碍。采用多元逻辑回归确定GMP利用率与独立变量之间的统计学显著关联，这些独立变量包括听说过GMP或GMP卡的照顾者、是NGO成员以及对GMP服务缺乏兴趣，p值<0.05且调整风险比（ARR）值。对定性数据进行主题分析。结果通过不同来源进行三角验证。
儿童平均年龄为9.8个月，两组（居家组与设施组）的男女比例均为1:1（分别为51.9%和50.0%）。居家GMP服务利用率更高，接受体重和身长测量的儿童以及接受咨询的照顾者比基于设施的服务更多（利用率分别为40%和0%）。居家地区照顾者对GMP服务的利用受到他们对GMP或GMP卡的了解（调整风险比，ARR：37.4）以及他们参与非政府组织、协会或健康项目的积极影响（ARR：1.3）。居家GMP地区的照顾者依靠非政府组织工作人员提供服务，而设施地区的照顾者表示政府卫生工作者没有进行外展服务，并且由于供应问题无法获得GMP卡。在两个地区，对GMP服务的低认识和缺乏激励措施导致利用率有限。
孟加拉国迈门辛区农村地区的GMP服务利用率仍然很低。居家GMP服务利用率为40%，但没有照顾者利用基于设施的GMP服务。居家地区较高的利用率与照顾者意识、获得GMP卡以及非政府组织的参与有关，而关键障碍包括政府外展不足、供应缺口和缺乏激励措施。为了提高GMP覆盖率，政府项目应加强社区层面的外展服务，确保生长卡的持续供应，并考虑纳入小激励措施以激励照顾者。
