Growth monitoring service utilization and its associated factors among mothers of children less than 2 years in Muhir Aklil district,Gurage zone,Southern Ethiopia,2020

Abstract

Introduction:

United Nations International Children’s Emergency Fund recommends a 100% growth monitoring and promotion coverage, but the prevalence of growth monitoring and promotion service utilization rate in Ethiopia is only 16.9%. Even though Ethiopia is attempting different strategies to cope up with this low rate, the problem is still unresolved.

Objective:

The aim of this study is to assess the prevalence of growth monitoring service utilization and its associated factors among mothers of children less than 2 years in Muhir Aklil district.

Methods:

A community-based cross-sectional study was conducted on 443 study participants from 10 February to 8 March 2020. The study participants in the study were selected using simple random sampling technique. The collected data were entered in to EpiData3.1 and exported to SPSS version 23. Bivariate and multi-variable logistic regression analysis was used to identify factors associated with growth monitoring service utilization. Statistically significance was declared at p value < 0.05% and 95% confidence interval.

Results:

In this study, the overall growth monitoring and service utilization was 32.9%. Fully empowered mothers adjusted odds ratio: 2.7, 95% confidence interval: 1.5–4.3), receiving counseling (adjusted odds ratio: 2.8; 95% confidence interval: 2.0–4.7) and regularly participating on community conversation (adjusted odds ratio: 2.8, 95% confidence interval: 1.8–7.6) were significantly associated with growth monitoring service utilization.

Conclusion:

Growth monitoring services utilization was 32.9%. Maternal empowerment on decision-making, engaging women on financial control, knowledge of mothers receiving counseling and regularly participating on community conversation were the independent factors for growth monitoring service utilization. The health extension workers should strengthen maternal empowerment and community conversation through increasing maternal awareness.

Keywords

Associated factors growth monitoring service under 2 year children mothers

Introduction

Growth monitoring and promotion (GMP) is a preventive activity that uses measuring and controlling growth status, to facilitate communication and interaction with caregiver and to generate adequate action to promote child growth.¹ Growth monitoring (GM) concept lays much emphasis on child growth and development in the age range of 0–59 months.² It has effect on individuals and societies like diminished cognitive and physical development, reduced productive capacity and poor health, and increased risk of degenerative diseases.³ It has also effect on achieving sustainable development goal (SDG) by supporting child nutrition and growth.⁴

An estimated 19 million under-5 children suffered from Severe Acute Malnutrition (SAM), and it is estimated to account for approximately 400,000 child deaths each year.⁵ Ethiopia is placed at the second place in high burden of malnutrition among sub-Saharan countries.⁶ According to Ethiopia Demographic and Health Survey (EDHS) report 2019, stunting, underweight, and wasted among children under 5 years of age is 37%, 21%, and 7%, respectively.⁷

Currently about 154 countries, including Ethiopia use GM as an essential component of primary health care. GM utilization is used to improve nutritional status, reduce the risk of mortality, counsel caregivers, and lead to early referral for conditions diagnosed as growth disorder of children.⁸ Even though United Nations International Children’s Emergency Fund (UNICEF) recommends a 100% GM coverage,¹ GMP utilization rate in Ethiopia was only 16.9%.⁹

Currently, Ethiopian government has been implementing community-based nutrition (CBN) program, as a key component of the national nutrition program. It facilitates to increase the GM utilization for all children under 2 years of age together with counseling for caregivers.¹⁰ There is paucy of research conducted on the prevalence and factors influencing GM service utilization in Ethiopia. The aim of this study was to assess the prevalence of GM service utilization and its associated factors among mothers of children less than 2 years in Muhir Aklil district.

Methods

This study was conducted at Mihur Akilel district, Gurage Zone, Southern Ethiopia, 210 km south from Addis Ababa and 52 km from Wolkite, the capital city of Gurage Zone of the Southern Nations, Nationalities and Peoples’ Region. The district has an estimated total population of 123,665 (male = 57,809, female = 65,856). The total under 2 year’s children was 5476. The town has 1 general hospital, 1 private hospital, 1 health center, 10 private clinic, and 5 health posts.

A community-based cross-sectional study was conducted from 10 February 2020 to 8 March 2020. The study populations were all mothers who had under 2 year child in Mihur Aklil district that fulfill the eligibility criteria.

Sample size and sampling procedure

The sample size was determined by using double population proportion formula by considering the following assumptions: 95% confidence interval (CI), proportion of exposed to non-exposed = 1, adjusted odds ratio (AOR) = 3.08, power = 80%, the value of “p” (prevalence in exposed (child age of 18–23 month) = 25.3) and prevalence in non-exposed (child age 6–11 month) which was found to be 7.5% (done in southern Ethiopia).⁹ Accordingly, the sample size with 10% non-response rate for this study was 295. The total sample size by multiplying by design effect of 1.5 is 443.

The district has 30 rural kebeles. Multi-stage cluster sampling technique was used to select the study participants’ from study population. Nine kebeles were selected from 30 kebeles using simple random sampling technique by lottery method. Samples were proportionally allocated to randomly selected kebeles. The study participants were selected from nine kebeles using simple random sampling technique from family folder of the health post. A total of 443 study participants were select using simple random sampling technique (computer-generated method) from a list found from CHIS family folder. All mothers with children under 2 years old who have been lived in Moher Akilel district for at least 6 months before the study in were included in the study. Mothers with children under 2 years of age suffering from chronic illnesses like mental disability and unable to communicate were excluded from the study.

Operational definition

GM services utilization (yes)

Attending GMP sessions once per month according to the child’s age.

GM services utilization (no)

Unable to attend GMP sessions once per month according to the child’s age.

Women’s empowerment

A women who decides alone or jointly with her partner in the following decision-making areas: (1) decision on health care for herself and her child, (2) decision on purchasing major household purchase, and (3) decision on asking families/relatives. If she had decided on all the three, she had considered as fully empowered, decided on 1–2 considered as partially empowered, and <1 conceded as disempowered.

Workload

Mothers/care givers who have not get support in homework either from husband, servant, or any other family member.

Knowledge on GM service

To measure knowledge of the mothers on growth, monitoring, and promotion, a scoring system was used. Each correct response was scored as 1 and incorrect response scored as 0 (zero). Variables in the questionnaire were given a total score range from 1 to 7 number of knowledge questions. Using a frequency distribution, poor knowledge was defined as a score of <75 % while a score of ⩾75 % was considered as good knowledge.

Attitude toward GM service

To measure attitude of the mothers on GMP, a scoring system was used. Each correct response was scored as 1 and incorrect response was scored as 0 (zero). Variables in the questionnaire were given a total score range from 1 to 4 (9 is the number of attitude questions, which were scored 36). Using a frequency distribution, unfavorable attitude was defined as a score of <75 % while a score of ⩾75 % was considered as favorable attitude.

Accessibility of health care

Presence of health care facility located within 5 km (60 min return journey), providing GM service, opening hours and appointment systems.

Data collection tools and procedure

The standardized data collection tool was developed through reviewing of related literatures^6,7,9,11 (Figure 1).

Figure 1.

Conceptual frame work of associated factors on growth monitoring service utilization, in Moher Akilel, district, southern Ethiopia, June 2020.^6,7,9,11

It contains information on socio-demographic, individual-related factors and health-related factors.

First the questionnaire was prepared in English, translated to Amharic and then back to English. A week before the beginning of actual data collection, a pre-test was done on 5% of the sample size in Ezha District. Training was given for data collectors and supervisors for how to manage the data collection process. The data were collected by face-to-face interview by using interviewer administered structured questionnaire. Proper information was given for each participant on the purpose of the study and after getting written consent interviewing of respondents was cascaded based on questionnaire.

Statistical analysis

Data were entered into Epidata version 3.1 and then exported to SPSS version 23 for further analysis. The descriptive analysis like percentage, frequency, and mean were calculated. Bivariate and multi-variable logistic regression analyses were used to identify presence of associations between dependent and independent variables. In bivariate analysis, variables with p ⩽ 0.25 were entered to multi-variable logistic regression analysis. The Hosmer–Lemeshow test was used to check the appropriateness of the model for analysis. The possible effects of confounders were controlled through multi-variable logistic regression analysis. The association between the explanatory and dependent variables were assessed at the p value of 0.05. The variables that show p value < 0.05 were declared as statistically significant variables in multi-variable logistic regression analysis. The degree of association between independent and dependent variables were assessed using crude odd ratio (COR) and AOR for bivariate and multi-variable logistic regression, respectively with 95% confidence interval.

Results

Socio-demographic characteristics of study participants

A total of 443 study participants participated in this study giving the response rate of 96%. Majority (412 (94.9%)) of the respondents were married. The mean age of the children was 9.7 month with SD ± 5. More than half (50.4%) of the children were males. Three-hundred ninety-two (90.4%) of the children were delivered at health facility (see Table 1).

Table 1.

Socio-demographic characteristics of the study participants for study of GM service utilization and associated factors among mothers of less than 2 years children in Mihur Aklil district, Gurage zone, Southern Ethiopia, 2020.(n = 434).

Characteristic	Number	Percent (%)
Age of mothers
⩽29 years	177	40.8
30–39 years	145	33.4
⩾40 years	112	25.8
Marital status
Married	412	94.9
Not married	22	5.1
Educational status of husband
Diploma and degree	67	15.4
Secondary school	78	18.0
Primary school	118	27.2
No formal education	171	39.4
Educational status of mother
Diploma and degree	38	8.8
Secondary school	88	20.3
Primary school	119	27.4
No formal education	189	43.5
Religion
Orthodox	268	61.8
Muslim	120	27.6
Protestant	46	10.6
Ethnicity
Gurage	339	78.1
Amhara	43	9.9
Oromo	32	7.4
Other	20	4.6
Family size
⩽4	131	30.2
5–8	261	60.1
⩾9	42	9.7
Occupation of mothers
Formally employed	60	13.8
Trader	80	18.4
Farming	294	67.7
Age of child
<5 months	108	24.9
5–11 months	161	37.1
12–23 months	165	38,0
Sex of the child
Male 50.4	219	50.5
Female	215	49.5
Family income in ETB
⩾2000	212	48.8
1000–2000	150	34.5
<1000	72	16.7

ETB: Ethiopian Birr.

Individual-related factor for GMP

More than half (54.6%) of participants had good knowledge on GMP service utilization. Almost more than half (56.2%) of mothers had favorable attitude on GMP service utilization. One-hundred fifty-eight (36%) of the participants regularly participate on community conversation (see Table 2).

Table 2.

Individual-related factor for GM service utilization and associated factors among mothers of less than 2 years children in Mihur Aklil district, Gurage zone, Southern Ethiopia, 2020, (n = 434).

Variable	Category	Frequency	Percent (%)
Knowledge on GMP service	Good knowledge	237	54.6
Knowledge on GMP service	Poor knowledge	197	45.4
Attitude toward GMP	Favorable attitude	244	56.2
Attitude toward GMP	unfavorable attitude	190	43.8
Participation on community conversation	Regular	158	36.4
Participation on community conversation	Irregular	276	63.6
Maternal workload	Yes	215	49.5
Maternal workload	No	219	50.5
Maternal empowerment	Fully empowered	208	47.9
	Partially empowered	138	31.8
	Disempowered	88	20.3
Financial controlling autonomy	Alone or jointly	206	47.5
Financial controlling autonomy	Husband alone	228	52.5

GMP: growth monitoring and promotion.

Health-related factors for GMP

One-hundred fifty-seven (36.2%) of the respondents had accessible service for GMP Utilization. More than half (55.2%) of respondents wait a long time to get GMP service after reaching health post (see Table 3).

Table 3.

Health-related factors for GMP service utilization and associated factors among mothers of less than 2 years children in Mihur Aklil district, Gurage zone, Southern Ethiopia, 2020, (n = 434).

Variables	Category	Frequency	Percent
Accessibility of health facility	Accessible	157	36.2
Accessibility of health facility	Not accessible	277	63.8
Accessibility of transportation	Yes	88	20.3
Accessibility of transportation	No	346	79.7
Long waiting time	Yes	209	55.2
Long waiting time	No	225	44.8

Prevalence of GM utilization

The prevalence of GMP service utilization was 32.9% (95% CI: 28.3, 37.6) (see Figure 2).

Figure 2.

Prevalence of GM service utilization among mothers of less than 2 years children in Mihur Aklil district, Gurage zone, Southern Ethiopia, (n = 434).

Factors associated with GM service utilization

In multi-variable logistic regression analysis variables, such as; mothers who have fully empowered and partially empowered on decision-making, financial controlling autonomy, knowledge on GM service utilization, participation on community conversation and counseling on GM service utilization were significantly associated with GM service utilization. Knowledge was statistically associated with GM service utilization. Mothers who have knowledge on GMP were 3.45 times more likely to have GMP utilization (AOR: 3.45, 95% CI: 2.13–5.92) than those mothers who had poor knowledge. Mothers who are regularly participating on community conversation were 2.76 times more likely to have GM service utilization (AOR: 2.76, 95% CI: 1.81–7.65) than those who did not participate regularly. Mothers who have counseled on GM service utilization were 2.82 times more likely to have GM utilization (AOR: 2.82, 95% CI: 2.16–4.67) than those mothers who did not receive counseling service (see Table 4).

Table 4.

Bi-variable and multi-variable logistic regression analysis of factors associated with GM service utilization among mothers of less than 2 years children in Mihur Aklil district, Gurage zone, Southern Ethiopia, 2020, (n = 434).

Variables	Categories	GMP utilization		95% CI		p value
Variables	Categories	Yes	No	COR	AOR
Maternal empowerment	Fully	93	115	11.0 (4.052–26.78)	2.74 (1.53–4.31)*	0.02
	Partially	44	94	6.39 (2.59–15.78)	1.46 (1.34–3.23)*	0.03
	Disempowered	6	82	1	1
Maternal financial autonomy	Alone /jointly	90	116	2.56 (1.696–3.87)	1.983 (1.5–6.87)*	0.01
Maternal financial autonomy	Husband alone	53	175	1	1
Knowledge on GMP service	Good	117	120	6.41 (3.949–10.41)	3.45 (2.13–5.92)*	0.03
Knowledge on GMP service	Poor	26	171	1	1
Counseling on GMP	Yes	81	83	3.27 (2.157–4.97)	2.8 (2.16–4.67)*	0.001
Counseling on GMP	No	62	208	1	1
Participation on conversation	Regular	80	78	3.47 (2.28–5.28)	2.76 (1.83–4.65)*	0.001
Participation on conversation	Irregular	63	213	1	1
Attitude toward GMP	Favorable	94	150	1.80 (1.19–2.73)	1.22 (0.97–1.89)*	0.07
Attitude toward GMP	unfavorable	49	141	1	1
Facility waiting time	Short waiting	123	102	2.99 (1.82–6.95)	1.43 (0.94–4.23)	0.12
Facility waiting time	Long waiting	60	149	1	1
Home workload	No	104	115	1.69 (1.57–7.41)	1.25 (0.63–5.31)	0.231
Home workload	Yes	75	140	1	1
Occupation of mothers	formally	33	27	3.85 (2.17–6.85)	2.35 (0.73–4.25)	0.31
	Trader	39	40	3.07 (1.84–5.15)	2.12 (0.93–3.67)	.26
	Farming	71	224	1	1	0.18
Estimated household monthly income	⩾2000	96	116	8.96 (3.723–21.59)	7.02 (0.87–11.41)	0.43
	1000–2000	41	109	4.075 (1.64–10.12)	3.47 (0.85–5.76)	0.24
	⩽1000	6	65	1	1
Educational status of mother	Dip & deg	38	29	5.176 (2.85–9.38)	2.31 (0.92–4.12)	0.25
	Secondary	34	38	3.53 (1.98–6.30)	1.76 (0.68–2.89)	0.41
	Primary	31	66	1.85 (1.07–3.22)	1.46 (0.88–2.67)	0.23
	No formal	40	158	1	1

GMP: growth monitoring and promotion; CI: confidence interval; COR: crude odds ratio; AOR: adjusted odds ratio.

variables which have p-value < 0.05.

Discussion

This study had assessed the prevalence of GM service utilization and its associated factors among mothers of children less than 2 years in Muhir Aklil district, Gurage zone, southern Ethiopia. In this study, the overall GM service utilization was (32.9%). It is consistent with study conducted in Gondar Ethiopia which is 38.9%.¹²

This finding is lower than study conducted in Uganda (59%).¹¹ The possible difference might be due to differences in economic and health delivery system. Those countries which are better in economic had better access in providing health professional, infrastructure, and transportation for their communities. This made mothers to utilize GM service.

In this study, having good knowledge on GM service utilization is associated with GM service utilization. It is consistent with study conducted in Southern Ethiopia⁹ and Ghana.¹³ The justification might be because of those mothers who had good knowledge will have awareness on poor outcome of non-utilizing GM service which leads to utilization of GM service. Presence of maternal knowledge on GMP improves children’s nutritional status, subsequently growth¹³ and improves infant and young child feeding practices.¹⁴

This study showed that receiving counseling significantly affect GM service utilization. It is consistent with study conducted in Ethiopia.¹⁵ The justification might be because of those who received counseling service had awareness on GM service utilization which will enforce them to utilize GM service.

This study showed that regularly participating in community conversation was significantly associated with GM service utilization. It is consistent with study conducted in Ethiopia.^9,16 The justification might participating in community conversation had effect in attitude, practice, and knowledge on GM utilization.

This study showed that empowering mothers on financial control is associated with GM service utilization. It is consistent with study conducted in India.¹⁷ The justification might be because of mothers who had power on financial control had the ability of deciding performing what is important for their child and for themselves.

This study showed that mothers who had a power on decision-making were more likely to utilize GM service than their counter parts. It is consistent with study conducted in Nepal.¹⁸ The justification might be mothers’ who can decide on what they want without the influence of any other make them confident enough on their action to their children service utilization.¹¹

Limitation

The cross-sectional study design has weakness in the establishing temporal relationship. It was better if supported by qualitative method. Barriers for non-utilization of GM could be better assessed using if it is supported by qualitative study.

Conclusion

GM services utilization was 32.9%. Maternal empowerment on decision-making, engaging women on financial control, knowledge of mothers receiving counseling and regularly participating on community conversation were the independent factors for GM service utilization. The health extension workers should strengthen maternal empowerment and community conversation through increasing maternal awareness.

Supplemental Material

sj-docx-1-smo-10.1177_20503121221133936 – Supplemental material for Growth monitoring service utilization and its associated factors among mothers of children less than 2 years in Muhir Aklil district, Gurage zone, Southern Ethiopia, 2020

Supplemental material, sj-docx-1-smo-10.1177_20503121221133936 for Growth monitoring service utilization and its associated factors among mothers of children less than 2 years in Muhir Aklil district, Gurage zone, Southern Ethiopia, 2020 by Getu Endale, Tamirat Melis, Andamlak Dendir, Kifle Lentiro and Tadesse Sahle in SAGE Open Medicine

Footnotes

Acknowledgements

The authors would like to express their heartfelt appreciation to data collectors and all mother and care givers of children less than 2 years who were involved as study participant in this study. They are also grateful to all their colleagues and health professionals who supported the study process.

Authors contribution

T.M., G.E., A.D., K.L., and T.S. made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; took part in drafting the article or revising it critically for important intellectual content; agreed to submit to the current journal; gave final approval of the version to be published; and agree to be accountable for all aspects of the work.

Availability of data and materials

The data sets used/or analyzed during the current study available at all authors on reasonable request.

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Ethical approval

Ethical approval was obtained from Institutional Review Board of Wolkite University, Collage of Medicine and Health Science with the ethical approval number of wku/059/13. Formal letter of cooperation was written to Mother Akilel district Administration and district health office. It was approved by Institutional Review Board of Wolkite University, Collage of Medicine and Health Science.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Informed consent

Written informed consent was obtained from all subjects before the study to assure the voluntariness of the participants. This is because study participant should be autonomous during conducting the research process. It is also ethical principle to get informed written consent to conduct study. For those study participants who could not able to read and write, the data collectors read the consent to study participants which is approved by Institutional Review Board of Wolkite University.

Informed consent

Informed written Consent was obtained from study participants before conducting the study to assure the voluntariness of the participants. The data collectors read the consent for study participants who could not read and write which is approved by Institutional Review Board of Wolkite University. Respondents were informed about the purpose and procedure of the study, the importance of their participation, and the right to withdraw at any time if they want and about privacy and confidentiality of the information given by each respondent kept properly and name was not be recorded.

ORCID iDs

Tamirat Melis

Tadesse Sahle

Supplemental material

Supplemental material for this article is available online.

References

UNICEF. Experts’ consultation on growth monitoring and promotion strategies: program guidance for a way forward recommendations from a technical consultation. New York: UNICEF, 2008, pp. 10–12.

Daniel

Tesfaye

Mekonin

, et al. Knowledge and attitude on growth monitoring and its associated factors among mothers/ guardians of children less than two years in Areka town, southern Ethiopia. J Nutr Disord Ther 2017; 7(3):216.

Black

Allen

Bhutta

, et al. Maternal and child undernutrition: global and regional exposures and health consequences. Lancet 2008; 371: 243–260.

Central Statistical Agency (CSA) [Ethiopia] and ICF. Ethiopia demographic and health survey, 2016, https://dhsprogram.com/pubs/pdf/FR328/FR328.pdf

World Health Organization. Pocket book of hospital care for children: guidelines for the management of common childhood illnesses, 2013, https://www.who.int/publications/i/item/978-92-4-154837-3

Demissie

Worku

Magnitude and factors associated with malnutrition in children 6–59 months of age in pastoral community of Dollo Ado district, Somali region, Ethiopia. Sci J Public Health 2013; 1(4): 175–183.

Ethiopian Public Health Institute (EPHI) [Ethiopia] and ICF. Ethiopia mini demographic and health survey 2019: key indicators, 2019, https://www.unicef.org/ethiopia/media/1721/file

Ashworth

Shrimpton

Jamil

Growth monitoring and promotion: review of evidence of impact. Matern Child Nutr 2008; 4(Suppl. 1): 86–117.

Feleke

Adole

Bezabih

AM.

Utilization of growth monitoring and promotion services and associated factors among under two years of age children in southern Ethiopia. PLoS ONE 2017; 12(5): e0177502.

10.

Federal democratic republic of Ethiopia. National nutrition program 2016–2020, https://extranet.who.int/nutrition/gina/sites/default/filesstore/ETH%202016%20National%20Nutrition%20Programme%20II.pdf

11.

Nankinga

Kwagala

Walakira

EJ.

Maternal employment and child nutritional status in Uganda. PLoS ONE 2019; 14(12): e0226720.

12.

Yeshaneh

Fentahun

Belachew

, et al. Utilization of growth monitoring and promotion services and associated factors among children aged 0–23 months in Banja district, northwest Ethiopia 2020: a crosssectional study. PLoS ONE 2021; 16: e0259968.

13.

Debuo

Appiah

Kweku

, et al. Caregivers knowledge, attitude and practices on child growth monitoring and promotion activities in Lawra district, upper west region of Ghana. Sci J Public Health 2017; 5: 20–30.

14.

Hendrickson

Dearden

Pachón

, et al. Empowerment in rural Viet Nam: exploring changes in mothers and health volunteers in the context of an integrated nutrition project. Food Nutr Bull 2002; 23(4 Suppl.): 86–94.

15.

Daniel

Tesfaye

Mekonin

, et al. Knowledge and attitude on growth monitoring and its associated factors among mothers/guardians of children less than two years in Areka town, southern Ethiopia. J Nutr Disord Ther 2017; 7: 216.

16.

Tekle

Tariku

Alagaw

, et al. Exploring reasons for low attendance of mothers to growth monitoring and promotion program at Loka Abaya district, southern Ethiopia: exploratory qualitative study. J Nutr Metab 2019; 2019: 3510649.

17.

Shroff

Griffiths

Suchindran

, et al. Does maternal autonomy influence feeding practices and infant growth in rural India? Soc Sci Med 2011; 73(3): 447–455.

18.

Zhang

Cunningham

Adhikari

, et al. Maternal decision‑making input and health‑seeking behaviors between pregnancy and the child’s second birthday: a cross‑sectional study in Nepal, Matern Child Health J 2020; 24: 1121–1129.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.06 MB