Assessment of knowledge, attitude and practices of trained community resource persons. the case study of the Mbooni community based nutrition programme
The purpose of this study was to assess the knowledge, attitude and practices of the Community - Based Nutrition Programme's trained community resource persons (CRPs) in Mbooni and Kisau Divisions of Makueni District. The study was to assess particularly, the Community Health and Nutrition Workers' (CHNWs) current level of knowledge and also determine their attitude and practices towards health and nutrition issues. In addition, it also assessed the community's attitude towards the community health and nutrition workers and the other groups of community resource persons and their work within the community. The study was carried out in two divisions of Makueni district namely; Mbooni and Kisau which were purposively selected and a total of 72 health and nutrition workers who were trained between 1996-1999, by the Community - Based Nutrition Programme (CBNP) comprised the study population. A questionnaire divided into four main sections namely, demographic, knowledge, attitude and practices based on the curricula used for training were administered to all the CHNWs. Six Focus Group Discussions were conducted to provide information on the attitude and practices of the community health arid nutrition workers and also verify the information collected by the use of a questionnaire. The Focus Group Discussions were conducted with three groups, mothers with children under five years old, Participatory Approach to Nutrition Security (PANS) teams from both divisions, and community members who hold public responsibilities. Direct observation was done to collect information on the conditions of some of the tools used for growth monitoring, record keeping and existing records were used to check on new growth monitoring centres that have come up through the community health and nutrition workers and community" initiative. It was also to check on whether any nutrition education was given at the growth monitoring centres and whether those who brought the children were involved in weighing the children. A grading system was established and from the scores, percentages were derived and a cut off point set. All those who scored, half and above the expected points were classified as having adequate knowledge, while those who scored below half of the expected score had inadequate knowledge. The findings indicate that half of the interviewed community health and nutrition workers do not have adequate knowledge, while the other, half had adequate knowledge. This meant that half of them have forgotten what they were taught, even though it was noted that these were people with fairly good formal education. In attitude and practices majority of them were positive and affirmed, that the training received from the programme was adequate and had helped them in their service delivery. It was good and had helped them as individuals as well their families and community, since a majority willingly shared it. They were happy with their work and acknowledged that the community held them in high esteem. However, data implied that Kisau division performed better with a statistically significant difference in the total practice score than Mbooni (p < 0.001). There was also a significant difference in the total knowledge score between those who had received refresher training compared to those who had not received any other a part from that given by the Community - Based Nutrition Programme. Those who had refresher training scored better than, their counterparts (p =0.006). Also those above 35 years of age scored higher as opposed to those less or equal to 35 years (p =< 0.03). The findings also indicate that, the community health and nutrition workers faced some challenges especially with respect to the work being tedious, irregular growth monitoring attendance and some people not taking advice and behaving like they 'know it all'. The study therefore, recommends that the programme should conduct regular refresher training for those already trained, train more new community health resource persons to ease the workload. Special emphasis to be put on the importance of nutrition education, active involvement of mothers and guardians in weighing the children and proper record keeping. The programme should also carry out regular supervision to motivate the community resource persons as well as giving timely feed back to reports sent to the district staff. The programme should also work more closely with the two Participatory Approach to Nutrition Security (PANS) teams who are the technical resource teams at the ground. They supervise the implementation of community activities as well being the link between the community and service providers. This will improve the health and nutrition status of the community and enhance collaboration with the relevant ministries whom these teams represent. There is need to motivate the Cbmmunity Resource Persons (CRPS) by the community and the programme. The community should be continually sensitized on the work of these people and since they appreciate the work and services offered they need to look for ways of sustaining them. The programme should incorporate exchange tours to enable them to exchange ideas and learn from the other project areas. They could be also provided with information, education and communication materials (posters, brochures, books), this will make them feel that their work is not inferior, but important to them and the community.