Academic journal article Journal of Health Population and Nutrition

Practices and Challenges of Growth Monitoring and Promotion in Ethiopia: A Qualitative Study

Academic journal article Journal of Health Population and Nutrition

Practices and Challenges of Growth Monitoring and Promotion in Ethiopia: A Qualitative Study

Article excerpt


The overall health status of children in Ethiopia is poor (1). According to the 2011 Ethiopian Demographic and Health Survey (EDHS) report, the prevalence of stunting was 44%, underweight 29%, and wasting 10% (2). These numbers are still one of the highest in sub-Saharan Africa and very far from ideal (3). Currently, the Government of Ethiopia and a range of non-governmental organizations are working on prevention and promotion activities to fight malnutrition in children. One of these activities is growth monitoring and promotion (GMP). The World Health Organization (WHO) defines GMP as a nutritional intervention that measures and charts the weight of children and uses this in formation to counsel parents so that they can take actions to improve child growth (4-6).

Since the 1990s, the use of GMP has become widespread (7, 8); it is one of the most clearly-visible child health activities, which is aimed at reducing malnutrition and has the potential to contribute towards reaching the Millennium Development Goals of halving hunger and reducing child mortality by two-thirds within 2015 (9, 10). Ideally, in GMP, every child's weight is measured periodically, giving primary focus to children below the age of two years (under-two children). The measurement starts at birth and should be performed on a monthly basis, accurately recorded on a growth chart, and interpreted. Additionally, the health workers provide services, such as giving information through counselling, facilitating communication, and interacting with mothers in a way that aims to generate adequate maternal action to promote child growth. Furthermore, adequate supervision and supplies are provided for the health workers while strong links between GMP and therapeutic feeding units are established to address moderate and acute malnutrition problems (5, 6). In Ethiopia, GMP is implemented through the use of growth charts, which are seen as monitoring and educational tools that help both health workers and mothers to visualize child growth and to take further action (11).

Even though GMP would appear to be a prerequisite for good child health, several studies have shown that there is a discrepancy between the purpose and the practice of GMP. The high prevalence of malnutrition in many developing countries seems to confirm this fact (3). A recent systematic review questions the effectiveness and relevance of GMP programmes in general (12).

A few studies have explored the issues behind this apparent lack of effectiveness. One qualitative study, conducted among an international panel of district medical officers, showed that the suboptimal function of GMP was mainly due to the lack of participation of caregivers and a poor understanding of the concept of growth monitoring (13). Another institution-based prospective study conducted in Zambia mentioned poor community involvement, lack of support from health workers, poor referral systems and monitoring, and suboptimal supervision practices. Together with inadequate logistics and overruling poverty, these issues seemingly continue to challenge the effectiveness of GMP (14).

However, little research has been done to assess the real-world practice of GMP at the grassroots level, among those who actually perform GMP. It is also important that the problem be investigated in different contexts since the practice of GMP and underlying causes can differ hugely between countries, and researchers from different countries may be able to learn from the successes and failures in other countries. In that respect, Ethiopia is an interesting setting in which to study this issue. Malnutrition is widespread in Ethiopia, and there have been several reforms in the healthcare system, with increased attention towards GMP but with little success; further research could usefully shed light on the factors that influence successful implementation of GMP in Ethiopia.

We undertook a qualitative study with the following research questions: How do mothers and health workers practise GMP? …

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