Performance of the community based growth monitoring programme in Matuga Division of Kwale District, Kenya
A community based growth monitoring programme is implemented by trained and motivated community health workers at the village or household level. The programme is supported and supervised by skilled personnel from relevant ministries and organisations. All equipment and supplies including portable weighing scales, pants, growth monitoring cards, a shelter, recording books, pens, tables and chairs are supposed to be in place for the success of the programme. In Kwale District, community based growth monitoring had been in operation for 3 years and no assessment of the performance had been done to guide the stakeholders on the areas that they were doing well and those that might have been needing improvement. A household survey was conducted in Mazumalume and Mwachipanga communities of Kwale District Matuga Division. The objective of this study was to assess performance of the community based growth monitoring programme in Matuga Division of Kwale district. The subjects of the study included 154 mothers of children under 5 years old, 15 community health workers and programme committee members. Using semi structured questionnaires data were collected on the nutritional knowledge attitude and practices of the mothers, and community health workers. Anthropometric measurements were taken on all children aged 0–59 months old (N= 181) in the sampled households in the programme area. Observations were made on the activities in the centres to determine the competence of community health workers in weighing and positive communication with the mothers of children. Key informant interviews with the Participatory Approach to Nutrition Security team members were conducted; four focus group discussions were done with members of the Village Health Committees and representatives of the communities along with questionnaires administered to determine the attitude of the recipient xii community towards the Growth Monitoring Program activities. The study took place in September to November 2002. Data was analysed using SPSS and EPI INFO. Equipment and supplies were not sufficient as per UNICEF guidelines, as only one weighing scale was available for circulation in all the six weighing centres visited. The weighing pants were torn and old. Only two centers had chairs and benches and only two centres had a shelter where they weighed the children. There was no statistically significant difference (p-value=0.463) in the nutritional knowledge between mothers with children in the program (40.9%) and those with eligible children not in the program (43.1%). Only 40.9% of the mothers utilizing the program reported having given complementary feeds to their children earlier than 4 months (n=109) compared to 46.6% of the mothers not in the program and whose children were eligible (n=72). All the community health workers reported having been trained on growth monitoring .They were well skilled in weighing children; they read the scales at eye level and zeroed the scale with the weighing pants Most (60.1%) of the households (n = 93) were registered in the Growth Monitoring Program while 39.9% (n= 61) had not registered in the programme mainly because they did not know that the programme existed (37.9%) or that the health facility was nearer (48.3%) among other reasons given (13.7%). A Global acute malnutrition of 3.6% (n=109) among program utilizers compared to 7.2% (n=72) children not in the program was statistically significant (p= 0.034), hence nutritional status of children in the program was better than that of eligible children not in the program. Follow-up at all levels was not adequate with none of the centres reporting ever having been supervised by a Government of Kenya staff in the last one year preceding the asssessment especially during growth monitoring sessions. xiii In conclusion, the Community-Based Growth Monitoring programme in Matuga was being implemented as per the international standards with few areas needing improvement namely, social mobilization, support supervision, availing more weighing scales for each weighing centre and stationery and feedback to the communities as well as Community Health Workers. Therefore, the government and relevant bodies should support such community based growth monitoring programmes.