Effect of knowledge, attitude and practice of service providers and users on growth monitoring and vitamin A supplementation in Dar-es-salaam- Tanzania
A cross-sectional study was carried out between April and September 2001 in Dar-es- Salaam, Tanzania. The purpose of the study was to assess the effect of knowledge, attitude and practice of health service providers and users on growth monitoring and vitamin A capsules supplementation services. Multi-stage sampling was used. Sixty health service providers (actively involved in growth monitoring) in thirty health facilities and 240 health service users (mothers/guardians of children aged less than two years) were selected from the three municipalities of Dar-es-Salaam (Temeke, Kinondoni and I1ala). Information 011 knowledge, attitude and practices of both health service providers and users were collected through structured questionnaire interviews, observations, focus group discussions and key-informant interviews. The results of the study showed that the factor level means for knowledge, attitude and practices among service providers and users were significantly different among districts (p<0.05) at 5% level of significance. The service users The results of regression analysis using stepwise model showed that the age of the service users and their ability to real and write are the major predictors of their knowledge on vitamin A capsules supplementation and growth monitoring. However this influence varies from one district to another. I1ala district had a significantly (X,2=49df=Z p<O.OOO) higher proportion of service users that had good knowledge (61%) than Temeke (36.3%) and Kinondoni (8.4%). It had also a higher proportion of attendance for growth monitoring Cl=7.484 p=0.024) and for vitamin A capsules supplementation (98.7% and 94.8%; l=9.107 p=O.Oll) than had Kinondoni (92.8 % and 92.8%) and Temeke (87.5% and 81.3%). This means that knowledge has effect on services. The district with higher knowledge had also better services. Service providers The grading criteria developed for this study showed that about half of the service providers had fair level of total performance for knowledge and practices and categorised less than ten percent (6.7%) as having good performance. Slightly more than a quarter (26.7%) had poor level of performance while 16.7% had very poor level of performance. The knowledge of health service providers was positively correlated with weighing technique performance (p<O.OI). Service facilities Based on standard deviations from the mean, categories were established and used to classify the 30 health facilities. Out of the 30 surveyed health facilities seventeen (46.7%) were classified as good performers and only two (3.4%) facilities were classified as very good performers; thirteen (43.4%) facilities were below the standard deviation and were classified as poor performers and four (6.7%) facilities were classified as very poor performers.