ABSTRACT
This study assessed the knowledge, perception and
techniques adopted by mothers assessing and monitoring the growth and
development of under-five aged children in Osisioma L.G.A, The study was cross-
sectional and descriptive in design. A multi - stage sampling technique was
used to select 175 mothers in assessing and monitoring the growth and
development of under- five aged children residing in the study area. A well-
structured and validated questionnaire was used to collect information on
socio- economic characteristics, perception on growth monitoring,
anthropometric status, knowledge on growth monitoring, techniques used, and
relationship between mothers knowledge and the practice of growth monitoring
and development among mothers with children under -5 years of age. Using a
sample size of 175, data was collected using semi-structured questioners and
the obtained data was analysed using SPSS v.24.0 statistical software.
Statistical significance was declared at P- value and also analysed
frequencies, percentages and Pearson correlation. This study revealed that
50.9% of the mothers were within the age range of 31 to 35years, while 0.6%
mothers were less than 18years old. Only 0.6% of the mothers were separated,
58.0% mothers went to secondary school, while 43.4% mothers had tertiary
education. The result revealed that less than half of 34.3% of the mothers were
traders and business women and only 3.4% of the mothers were unemployed. The
result further showed that 44.0% of the mothers have average monthly income
less than ₦18,500, while 3.4% of the mothers have average monthly income
ranging from ₦75,000 to ₦94,000. It was observed that majority (99.4%) of the
mothers attended post natal clinic with their youngest child, while 0.6% did
not attend post natal clinic with their youngest child. 6.9% had knowledge of
measuring the weight of their child, while 4.0% did not know how to measure the
height of a child. 100.0% knew how to use the growth monitoring facilities and
group of children that should be monitored monthly, while 45.7% knew personnel
that should carryout growth monitoring evaluation. The result further showed
that 83.4% had knowledge of when a child should sit without support, and the
average age a child should walk alone, while 3.4% knew how to monitor a child’s
development using key motor milestone. 99.4% of the mothers knew the meaning of
key motor milestone while 98.9% identify what is key motor milestone. 6.3% of
the mothers, used observation as a technique for checking the child's growth,
while 0.6% of the mothers used height, weight and also growth chart for
checking the child's growth. 97.1% of the mothers do not check their child’s
weight while 1.7% used weighing scale as a technique in checking the child's
weight. 98.3% of the mothers do not check their child’s height while 1.7% of
the mothers used tape in checking the height and length. Using traditional
techniques, 37.1% of the mothers used cloth size as an indicator for growth in
relation to age while 13.7% of the mothers uses waist beads and bangles to
monitor the size of their child in relation to the Childs age. The result on
Weight - Height/length revealed that 73.7% were normal (>=2), 0.6% were
obese. 1.1% of the mothers were found to be ignorant of the need for growth
monitoring and 10.9% of the mothers had poor perception. This study also showed
that educational status of the mothers, economic status, and counselling by
health professionals are indicators of knowledge on growth monitoring and were
significantly associated with attitude towards growth monitoring. Level of
education notwithstanding, the mothers showed inherent passion for monitoring
the growth of their children. Formal education, counselling and education from
health professionals and economic status had a positive impact on knowledge and
attitude of the mothers towards growth monitoring. The knowledge status of the
mothers was found to be low.
TABLE OF CONTENTS
TITLE PAGE
i
CERTIFICATION ii
DEDICATION iii
ACKNOWLEDGEMENT
iv
TABLE OF CONTENT
v
LISTS OF TABLES viii
ABSTRACT x
CHAPTER
1
INTRODUCTION
a.
Statement of the Problem
3
b.
Objectives 4
1.3 Significance of the Study 5
CHAPTER 2
LITERATURE REVIEW
2.1 Overview
of Growth Monitoring 6
2.1.1 History and
development of growth monitoring programmes 9
2.1.2 Expected
benefits of growth monitoring and growth promotion 14
2.2 The Coverage of Growth Monitoring 14
2.3 Factors Associated
with the Practice of Continued Growth Monitoring 16
2.3.1 Socio-demographic and
economic characteristics of the mothers and growth
Monitoring 16
2.3.2 Maternal knowledge and
practice of growth monitoring 16
2.4 Availability
and Accessibility of Health Services
and Growth Monitoring
Services 18
2.5 Factors Affecting the
Growth of Under 5 Years Aged Children 19
2.5.1 Illness and diseases 19
2.5.2 Eating habits and poor
food consumption 20
2.5.3 Physical activity
levels 20
2.5.4 Lack of Nutrition
education and knowledge of caregivers 21
2.6 Anthropometry 21
2.6.1 Weight 22
2.6.2 Height 22
2.6.3 Body Mass Index 23
2.6.4 Height-for-age 24
2.6.5 Weight-for-height 24
2.6.6 Body Mass
Index-for-age 25
2.6.7 Waist circumference
(WC) 25
2.6.8 Mid-Upper-Arm
circumference (MUAC) 26
2.6.9 Head circumference 26
CHAPTER 3
MATERIALS AND METHODS
3.1 Study Design 27
3.2 Area of study 27
3.3 Population of the
Study 28
3.4 Sampling and Sampling
Techniques 28
3.4.1 Sample Size 28
3.4.2 Sampling Procedure 29
3.5 Preliminary
Activities 29
3.5.1 Preliminary Visit 29
3.5.2 Training of research
assistants 29
3.5.3 Ethical Approval 29
3.6 Data Collection 30
3.6.1 Questionnaire Design 30
3.6.2 Questionnaire
Administration 30
3.6.3 Anthropometric
measurement 30
3.6.4 Weight measurement 30
3.6.5 Height measurement 30
3.7 Data Analysis 31
3.8 Statistical Analysis 31
CHAPTER 4
RESULTS AND DISCUSSION
4.1 Demographic/
socioeconomic characteristics of the mothers 33
4.2 Characteristics of
youngest and index child
35
4.3 Knowledge of mothers
on growth monitoring of under – five aged children 36
4.4 Knowledge of mothers
on development of under – five aged children 37
4.5 perception of
mother's in growth monitoring and development of under – five
aged children
39
4.6 Techniques used by
mothers
40
4.7 Growth and
development of the children
43
4.8 Anthropometric
characteristics of the children
43
4.9 Relationship between
the mothers' knowledge, perception and the
growth and development status of their under 5
children 45
CHAPTER 5
CONCLUSION AND
RECOMMENDATION
5.1 Conclusion
47
5.2 Recommendation 47
REFERENCE
48
APPENDIX 51
CHAPTER
ONE
INTRODUCTION
1.1 Background to the Study
Growth is an essential feature of life of a child that
distinguishes him or her from an adult. Growth refers to an increase in the
physical size of the whole or any of its parts. It results because of cell
division and the synthesis of proteins. It causes a quantitative change in the
child’s body. Development refers to a progressive increase in skills and
capacity to function. It causes a qualitative change in child’s functioning
(Dorothy, 2010). Growth monitoring and promotion is an important aspect in childcare.
Childcare in a right perspective is very important, as children are our future
generation. Care implies not only providing children with proper food and
shelter but also their growth, psychological, emotional and social development.
Growth monitoring (GM) is the process of following the growth rate
of a child (0-60 months) in comparison to a standard by periodic anthropometric
measurements in order to assess growth adequacy and identify faltering at early
stages (UNICEF, 2008). Growth monitoring Promotion (growth monitoring) is a
preventive activity that uses GM that is measuring and interpreting growth, to
facilitate communication and interaction with caregiver and to generate
adequate action to promote child growth (UNICEF, 2008).
Growth
monitoring has
a long history. Regular weighing of infants was advocated by Guillot in the
1850s for assessing the adequacy of lactation in neonates, and in the 1870s
Cnopf in Nuremberg was the first to weigh infants systematically beyond the
perinatal period, while Russow in St Petersburg was the pioneer of growth
standards and of the idea that growth reflects an infant’s well-being (Tanner,
2011). In 1899 in St Helens, England, regular child weighing and practical
advice were provided by volunteers of the Infant Welfare Movement (Williams,
2016) and by the mid-1920s there was a nationwide network of welfare centres
that were organized around child weighing. The first growth reference was
introduced in England in 1906 (Tanner, 2011). Dr Cicely Williams reported that
as early as 1910 mothers in Jamaica were weighing their babies (Rohde 2018).
Growth monitoring targets early detection of growth
retardation in children, high risk of malnutrition/mortality, and provides
health or nutrition education with the aim to improve nutrition status of the
children. Though acute signs of malnutrition are easily noted by health
workers, it is often too late, and always more expensive, to help the severely
malnourished child (Ashworth et al., 2008;
Ministry of Health (MOH)/UNICEF, 2004). Growth monitoring alerts both the
health care worker and the mother early enough that the child's health is
deteriorating and enables the family to correct the problem while the solution
is still within its means (MOH, 2007).
Growth monitoring is best initiated from birth rather
than when the child is already 2 to 3 years. Infancy is traditionally
designated as the period from birth to one year of age. Infants become children
and children become adolescents, passing through their parents’ lives and disappearing
into adulthood; full–fledge persons with lives and future of their own.
This year is known for its rapid growth and development
with tripling birth weight and increasing length of 50%. Without proper
stimulation and nurturing care by consistent caregivers, the infant may not
develop a healthy interest in life or a feeling of security essential for
future development. The mothers play an important role in the life of children.
Infants are usually seen at health care facilities for health maintenance at
least six times during the first year.
Recent empirical evidence has shown that growth
monitoring of children by mothers are done using the height for age (stunting)
from birth to 2 years because this is the fastest period of growth and
development in all aspects (Ministry of Health (MOH), 2010).
Another growth monitoring techniques lies in the use of diagnostic tool for identifying a child
with a nutritional or health problem, thus enabling action to be taken before
the child’s nutritional status is seriously jeopardized. Most growth monitoring programmes use weight charts to provide a graphic representation of a
child’s weight-for-age (UNICEF, 2008). An undernourished or sick
child will have a slower rate of weight gain than a well-nourished, healthy
child. Monitoring growth by plotting a child’s weight at regular intervals and
comparing the pattern of growth to reference curves of healthy children permits
early detection of growth faltering. It provides an early warning signal and a
trigger for early action (UNICEF, 2008).
1.2 Statement of the
Problem
Even though growth monitoring 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 growth monitoring. The high prevalence
of malnutrition in many developing countries seems to confirm this fact (Black,
et al., 2008). A recent systematic
review questions the effectiveness and relevance of growth monitoring
programmes in general (Roberfroid, et
al., 2005).
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 growth
monitoring was mainly due to the lack of participation of caregivers and a poor
understanding of the concept of growth monitoring (Roberfroid, et al., 2005). 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 growth monitoring (Charlton, et al., 2009).
However, little research has been done to assess the real-world
practice of growth monitoring at the grassroots level, among those who actually
perform growth monitoring. It is also important that the problem be
investigated in different contexts since the practice of growth monitoring 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, Nigeria is an interesting setting in which to
study this issue. Malnutrition is widespread in Nigeria, and there have been
several reforms in the healthcare system, with increased attention towards
growth monitoring but with little success; further research could usefully shed
light on the factors that influence successful implementation of growth
monitoring in Nigeria.
1.3 Purpose of the Study
The purpose of the study is to determine the knowledge, perception
and techniques by mothers in growth monitoring and development among children
under 5 years of age in selected rural and urban location in Abia state.
2.
Assess the demographic and
socio-economic characteristics of the mothers with children under 5 years of
age in selected rural and urban location in Abia state.
3.
Determine the dietary habits of
the private and public school aged children.
4.
Assess the anthropometric
status of the private and public school aged children.
5.
To assess the knowledge on
growth monitoring and development among mothers with children under 5 year of
age in the study area.
6.
To assess the techniques used
on growth monitoring and development among mothers with children under 5 year
of age in the study area.
7.
To
determine the relationship between mothers knowledge and the practice of growth monitoring and development among mothers with children under
5 years of age
1.4 Significance
of the Study
The study has generated information that
may be useful to the Ministry of Health and other organizations working in the
child survival programmes to design interventions to improve the activities of growth monitoring.
It is planned that the study findings will be communicated to the mothers and
community and may influence them to continue taking their children for growth monitoring
even after completing immunization schedules. The study will also contribute to
the body of knowledge on child growth monitoring and development.
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